Combined approach

Dr Shyam Bhat Dr Shyam Bhat

There is that old story about the blind men who encounter an elephant for the very first time. Each describes the animal by touching one part of it. To one blind man, touching the leg, the elephant is like a mighty tree trunk. To the man touching the tusks, it is like the finest marble, and to a man at the tail, it is like a rope.

To really understand what the elephant looks like, all perspectives need to be synthesised. Understanding a disease is often similar. It needs a synthesis of different perspectives and specialities. Many conditions do not fit into our neat categories—a disease can and often does affect both mind and body.

Chronic Fatigue Syndrome (CFS) is one such condition that medical science doesn't yet understand. CFS, which affects about 80 to 100 per lakh people, is defined as the presence of debilitating fatigue that lasts at least six months, and the fatigue has no other diagnosable medical cause. Other symptoms can include headaches, lack of refreshing sleep, muscle pain and problems with memory.

Most of these symptoms are what doctors would call “non-specific”, meaning that they are common in many illnesses. So the doctor would first look for other medical conditions such as infections, thyroid disorders, heart disease and metabolic issues. However, when all of these are negative, and no other medical causes for the symptoms are found, then the person would be diagnosed with CFS.

Now, most people suffering from CFS have a coexisting psychiatric issue such as stress, anxiety or depression. However, the treatment of the depression alone does not result in remission of CFS.

Although researchers speculate that CFS occurs possibly because of immune system dysfunction, and others speculate that it is a neurobiological problem, it is probably a blind-men-and-the-elephant situation. As a psychiatrist and physician, I see the symptoms of fatigue and the emotional symptoms as aspects of the same condition—some symptoms are expressed through the body and others through the mind.

An integrated treatment approach works best for CFS. Firstly, the person is evaluated for other medical conditions that cause similar symptoms. If there are no other conditions, the doctor (or a lifestyle coach) would then help the patient improve their nutrition—research shows that processed food and sugars worsen CFS. The next step is to help the person begin a graded exercise programme and to help them stay motivated to follow it despite fatigue and pain. If there are any problems with mood, the person should consult a psychiatrist, and any anxiety, depression or other issues should be treated.

The psychiatrist or psychologist will then also use what is called CBT (cognitive behaviour therapy), a form of psychotherapy that helps a person change their negative thought patterns into more balanced thinking. This would help the CFS sufferer address fears and misgivings about the condition and about their own limitations. Therapeutic massage, yoga and meditation add a lot of benefit as well. A combination of these approaches in the right manner is the best approach to treating CFS.

Bhat is head of, a part of health and lifestyle startup