When Schaffner reaches the turn of the twentieth century, she introduces the biggest problem in her book: the gulf between theories about exhaustion and actual experiences of exhaustion.
This gulf is at its widest in her chapter on Chronic Fatigue Syndrome, a condition about which medical practitioners and patients often have extremely divergent opinions. Although most doctors and researchers agree that there is a microbiological trigger for the syndrome, they also see patients’ behavioral and psychological responses as perpetuating the condition.
At its extreme, this view holds that CFS is a psychological illness with physical symptoms. Most patients, meanwhile—often housebound, even bedbound, unable to do the simplest task without suffering debilitating exhaustion—vehemently reject this model, arguing that CFS is a physical, and only physical, disease.
In writing about CFS, Schaffner returns to an idea she first mentions in her introduction, borrowed from the medical historian Edward Shorter: that patients, absorbing the medical and cultural discourses of their time, unconsciously display the psychosomatic symptoms that doctors will take seriously.
Shorter is convinced that CFS is all in the mind, a twentieth-century version of hysteria with subjective symptoms (fatigue, muscle pain) both impossible to disprove and in line with what “doctors under the influence of the central-nervous paradigm [expect] to see”.
