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Book Reviews   |    
Stricken: Voices From the Hidden Epidemic of Chronic Fatigue Syndrome
Reviewed by Burton C. Einspruch, M.D., F.A.C.P.
Psychiatric Services 2003; doi: 10.1176/appi.ps.54.4.582-a
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edited by Peggy Munson; New York, Haworth Press, 2000, 270 pages, $24.95 softcover

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Stricken: Voices From the Hidden Epidemic of Chronic Fatigue Syndrome is a collection of essays and some poetry built around an intriguing title. One must question why there would be a conspiracy to hide the existence of chronic fatigue syndrome. The word "epidemic" is defined by Webster's dictionary as "an outbreak of a contagious disease that spreads rapidly and widely." Is there really an epidemic of this illness according to this definition? The authors of Stricken frequently note that there are 800,000 cases of chronic fatigue syndrome in the United States, citing the Centers for Disease Control and Prevention as their source. The numerous contributors to this book address the question of why so many cases should be underobserved, undertreated, and neglected.

Chronic fatigue syndrome is a collection of subjective and nearly impossible-to-verify complaints. These complaints defy identification through customary objective tools such as the stethoscope or even complex laboratory studies. Modern diagnostic machinery or future laboratory tests may some day lend scientific clarity to this clinical puzzle, but at this time they do not, despite a persistent search for etiologies ranging from viruses to environmental toxins.

Linked by a common thread, the contributors to this collection have all been brushed by personal and difficult encounters with chronic fatigue syndrome. They all appear to be activists and in their zeal have lost the objective capacity to present a critical opinion. Lacking scientific credentials, they are simply zealots who are bolstered by their intuitions, sincere feelings, and wish to reach out and communicate with their fellow sufferers.

Stricken is essentially an unofficial "self-help by disclosure" pamphlet of the Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Society. With a strong bias toward alternative lifestyles, the book seems to give equal footing to physicians who treat the illness—none of whom contributed to this collection—and to hairstylists, herbalists, a lesbian who is an aspiring supermodel, poets, and others.

The book includes some interesting comments about the illness, especially how poorly its sufferers are perceived by the press, family members, employers, and physicians. Some of the authors lament how they have been misunderstood victims and have suffered, but many of the accounts are interesting, demonstrate fine writing style, and convey an element of desperate persuasion. However, the rage of some of the authors is unconcealed and no different from that of many patients—past, present, and future—who feel ignored by the current health system and who may get a measure of relief from ventilation and "unionization." Support groups are an essential part of the medical landscape for these patients and can provide a link between the neglected and sick whose suffering is unappreciated by well-intentioned and bewildered health care providers.

It is hard to know exactly to whom I could recommend this book, because it is limited in scientific worth. Personally, I rarely recommend this type of book, but I can recommend the essays written by Floyd Skloot, several of which are included in the book, and I plan to read some of his other works.

For those who would like to know more about chronic fatigue syndrome, the Internet is a very mixed resource but includes ample entries of material and references (nearly 500,000). Stricken deserves little space on a doctor's bookshelf.

Dr. Einspruch is clinical professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas and clinical associate professor of psychiatry at New York University Medical Center in New York City.

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