‘An irritating enigma’ is a description of chronic fatigue syndrome quoted by the author, but ‘irritating’ is the last adjective that could be applied to his book. Rather, it is engaging, entertaining, thoughtful, and moving, and it goes a long way to demystifying the enigma it explores.
Nick Duerden was, in 2009, a successful self-employed journalist, thriving on frenetic activity and, by his own admission, prone to ‘a little harmless competition’. His hectic lifestyle came to a sudden halt following a bout of severe flu-like illness contracted in the US, launching him into a new existence in which debilitating fatigue overshadowed everything else. His book, which in itself would prove to be part of his therapy, tells the story of his attempts to understand his condition and his search for a cure.
It comes as no surprise that the NHS was unable to offer much help, and neither his GP nor the specialist to whom he is first referred — whom he tellingly dubs Dr Dolittle — emerge with much credit. He is diagnosed as having post-viral fatigue but is advised to follow the guidance offered to those labelled as having full-blown ME/CFS, an arguable error of judgement of which, later in his narrative, he makes perhaps too much. In any case it transpires that he is not depressed enough to qualify for CBT on the NHS (and no one seems to have given him any detailed advice about graded exercise therapy, the other NICE-approved treatment), so, with the help of his long-suffering and admirably determined wife, he sets out to find his own solutions.
By nature something of a sceptic, he wisely avoids the wilder shores of alternative medicine, apart from some dubious nutritional supplements, focusing instead on therapies that aim to transcend the mind–body dualism of which mainstream medicine is so often accused. Over the years that follow he takes up various forms of yoga and meditation, spending a small fortune with various outfits — some wackier than others, and many founded and run by recovered sufferers of CFS with messianic zeal and an eye for commercial success. He passes up the offer of a day with a celebrated ‘motivational guru’ at the discounted price of £6000.
His investigations finally lead him, via explanations of the stress–adrenaline–cortisol axis, to the reluctant acceptance that there might be some psychological factors involved in his collapse into crippling fatigue, not only relating to his lifestyle but also to his childhood. At the same time he learns strategies for dealing with his day-to-day symptoms and the demands of parenting a young family as well as keeping up with his work, and he manages to convey the sensations of extreme fatigue with powerful imagery.
Duerden employs a light touch, and his gentle pokes at some of the more outrageous practitioners he meets is matched by his self-deprecation. But his purpose is serious, and he does not shy away from sharing painful insights and experiences. On the whole though he is generous in his opinions, and his open-mindedness extends to both the orthodox and the alternative. Towards the end of his explorations he spends an hour with Susie Orbach, of Fat is a Feminist Issue fame, and is clearly struck by her undogmatic wisdom, as she gently explains her psychoanalytical perspective on his story. What finally emerges is the uncertainty that we all feel when faced with the challenge of a chronic condition with psychosomatic components.
To disentangle the predisposing, precipitating, and perpetuating factors becomes almost impossible, but the attempt is surely worthwhile. This book will appeal to anyone with an interest in chronic fatigue — doctor, patient, or involved observer — whose opinions on this most puzzling of conditions are not already fixed.
- © British Journal of General Practice 2018