The history of chronic fatigue syndrome (CFS) is cursed with its pliable and ever-changing nomenclature, leading to the prevailing assumption that its medical induction is quite new, despite its study for over a century. Through the course of this period, the understanding of CFS has been exasperatingly slow to mature, and the body of knowledge is still, with great patience, unveiling today.
As early as 1869, the state of illness manifested by CFS was recognized. Without digging past the crust of understanding, electrotherapist George Beard began referring to the vague symptomatic state (collectively) as neurasthenia (exhaustion of the nervous system). Eventually, this recurring group of symptoms became common enough to warrant publication in the 1920's, despite the still-minimal understanding of the cause or extent of the illness.
In 1938, CFS began to appear in medical literature under the name myalgic encephalomyelitis (ME) and was believed to be an immunological neurological disorder. ME implies that the sufferer experiences inflammation of the brain and spinal cord along with muscle pain.
Several years later, Hans Selye's notion of general adaptation syndrome (GAS) entered the arena of understanding and began to provide further insight into the condition (Selye, 1946). GAS illustrated the human body's biological reaction to stress. The adrenal gland, responsible for much of our endocrine function and a major player in the body’s stress response, instantly became the flagship biological marker for many CFS researchers at the time. Like all biological systems, GAS showed that the adrenal gland must ceaselessly respond to the stresses of life from birth to death. If it is functioning properly, normal bodily function results. If it reacts adversely, the body will be vexed with physical ailments. This offered a rational biological explanation to the symptoms manifested by neurasthenia/ME.
For many researchers, GAS was the breaking of the crust of understanding. Still, however, the understanding of CFS at this stage was little more than an improperly functioning GAS, which prompted another shift in terminology: hypoadrenalism.
At this point, the use of the term neurasthenia was waning while ME and hypoadrenalism both remained commonly used names for effectively the same symptomatic conditions. Despite extensive publication on ME (especially throughout the 50's, 60's, and 70's), research began to unveil that inflammation of the brain and spinal cord was not in fact a distinguishing characteristic of the sufferers of the CFS symtptoms. Although much of European research still uses the name ME, this solidified the ambiguity in the GAS explanation (as well as the name hypoadrenalism) in much of the American research, aided by the World Health Organization's classification of CFS as a disease of the central nervous system in 1969.
Up until quite recently, chronic fatigue syndrome, Epstein-Barr virus and fibromyalgia (three related conditions) were all unheard of (despite the obvious existence of the illness state described by each). It wasn't until 1988 (after enduring a series of other names) when researchers at the Centers for Disease Control appointed the name Chronic Fatigue Syndrome, and Holmes, et. al. (1988) provided the first accepted definition, with an attempt to objectify the diagnosis. Within this definition, it was asserted that CFS can not be diagnosed if the symptoms present are the product of an illness by another name. This led to CFS becoming known as a disease of exclusion. When the symptoms are not explicable by another condition, it is then chronic fatigue syndrome.
Despite the widespread use of this term, it did not mark an end-all to the whirling apparatus of nomenclature. In 1992, the term post viral fatigue syndrome was branded based on evidence that CFS frequently sets in after a viral infection, such as Epstein-Barr virus. Hence the term chronic Epstein-Barr virus (or chronic mononucleosis) was coined as well. The problem with the post viral definition, however, is the lack of necessity in a viral origin.
Further names (with varying amounts of staying power) also rose alongside the medical profession's growing inclination to study the condition. Low natural killer cell disease, Akureyri disease, atypical poliomyelitis, epidemic vasculitis, raphe nucleus encephalopathy and many more have made an appearance and are now rarely seen in modern research. Derisive slang (such as yuppie flu) have also caught on for periods of time, often motivated by the patterns of demographics, precipitating the need to constantly alter the name based on the perpetuation of negative public perception.
Since then, a more modern term, chronic fatigue immune dysfunction syndrome (CFIDS) has appeared in attempt to curb its stigma as a psychiatric illness as well as define it with immune description. The definition of CFS itself has also adapted alongside the terminology. The Centers for Disease Control reworked their 1988 definition by creating the Fukuda, et. al. (1994) model and the more modern Holmes, et. al. version (1998) in attempt to revise the diagnosing criteria to be very straightforward, objective, and concurrent with modern evidence.
Even with this new criteria with which to diagnose CFS, it is not doubtful that more names will come in an effort to remain one step ahead of public stigmas and perception while the research continues to unveil further insights into the syndrome.
[Differentiating CFS from Depression]
Fukuda, Straus, Hickie, Sharpe, Dobbins & Komaroff. (1994). The chronic fatigue syndrome: a comprehensive approach to its definition and study, Annals of Internal Medicine, 121(12): 953-959.
Holmes, et al. (1988). Chronic Fatigue Syndrome: A Working Case Definition. Annals of Internal Medicine, 108:387-389.
Selye. (1946). The general adaptation syndrome and the diseases of adaptation. Journal of Clinical Endocrinology, 6:117-230.