What is Chronic Fatigue Syndrome and What Causes It?

Chronic Fatigue Syndrome (CFS) affects up to 2.5 million people in America. The medical community still doesn't fully understand it. This article sheds a little light on the subject.

November 09, 2023

Chronic fatigue syndrome (CFS), more recently called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is a disorder dominated by fatigue. Chronic fatigue syndrome can be recognized by fatigue that increases after exertion, not feeling rested after sleep, lightheadedness after prolonged standing, and in some, “brain fog.”

By definition, the diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome is given after symptoms have persisted for at least 6 months. Many with CFS suffer under a cloud of fatigue for years.

What causes Chronic Fatigue Syndrome?

To this day, the cause of CFS has been widely suspected of being a chronic viral infection, or a consequence of a previous viral infection. However, a causative virus is rarely identified. Ask any infectious disease specialist; they will tell you they don’t think it is a virus, and they don’t know the cause.

In medicine and medical research, we aim to understand the cause of medical conditions and utilize treatments that can alleviate, or better yet, cure them. Unfortunately, the cause of CFS has eluded the medical community to the point that one of the diagnosing criteria is the absence of any abnormality among blood tests.

While some CFS patients have symptoms of depression, studies consider CFS to be a separate condition, dominated by physical symptoms, and not a mood disorder.

Most recently, the question has been raised concerning a link between COVID and chronic fatigue, or “long COVID.” The link remains to be clarified.


Treatments for Chronic Fatigue Syndrome

Concerning the treatment of CFS, there is, to date, no known treatment that can eliminate CFS or relieve its symptoms. Currently, the only steps offered are guidance about how one can live a little bit better with the symptoms by implementing lifestyle changes. 

In other words, after decades of research, we don’t know the cause of CFS, we have no diagnostic tests to confirm it, and we don’t know how to treat it!

All kinds of alternative treatments have been suggested, but there is no cure. 

So to sum up, the current state of our understanding and treatment of CFS is very poor. 

So the question becomes, are we stuck with the chronic and debilitating illness of CFS and the mystery of its origins?

My understanding of CFS and the Mind/Body Connection

I am not an infectious disease specialist, but my experience and research have led me to a new understanding that is rarely considered in the medical profession. This understanding offers hope and new directions in treatment.

My experience with several medical conditions whose cause remains at least partly a mystery suggests that there is an unsuspected underlying cause or trigger. 

 I discuss the relevance of this understanding as it relates to CFS, and to other common inadequately understood and treated chronic medical conditions, in my recent book Hidden Within Us; a Radical New Understanding of the Mind-Body Connection


To understand the relationship between mind and body, we have to first recognize the considerable power of emotions. Few realize that our most powerful emotions are often those that we are completely unaware of. Emotions that we would insist we don’t feel or harbor within us.

Without conscious effort, these are emotions that have been repressed from our awareness.

Repression of emotions is not a psychological disorder; it is a hugely important defense mechanism and a crucial component of our emotional resilience. It is a gift of evolution that keeps us going during times when powerful emotions could otherwise cripple us.

Even though the emotions we have repressed may be our most powerful emotions, their potential role in medical illnesses is rarely considered because we are not at all aware of them.

Evidence that emotional repression can cause Chronic Fatigue Syndrome

Concerning CFS, there are 3 types of evidence suggesting it is linked to powerful emotions that are hidden from our awareness by repression:

1 - Anecdotal experience: 

The CFS patients that I have seen generally do not describe any current severe stress other than the obvious challenges of dealing with CFS symptoms.  However, nearly all of them reported a history of severe or prolonged stress or trauma. They also insist that those events did not affect them psychologically.

They did not realize that those powerful emotions had silently been repressed, and kept from their awareness. They also were not aware that repressing them had  enabled them to avoid potentially lifelong emotional consequences, such as depression, and anxiety, but at the expense of their physical health.

Typical examples: a patient who grew up in a home dominated by relentless arguing and fighting among her parents. A patient who was bullied for years in high school, with no intervention whatsoever. A gay male patient who lived in a rural area and for whom school was torture, for years. None ever experienced depression!

2 - Studies of adverse childhood events: 

Studies report that those with CFS are much more likely to report a history of adverse childhood events than those who don’t have CFS.

3 - Studies demonstrating the increased activity of the sympathetic nervous system (SNS) in patients with CFS: 

Nearly every study has observed this increase. The SNS is the neural network that governs our fight-or-flight reflex in response to stress or danger. The main stimulus of the SNS is emotion. It makes sense that our most powerful emotions, even if we are not aware of them, are a likely cause of increased SNS activity. This is hardly ever considered.

This understanding of the role of repressed emotions is not mentioned or considered in the decades of studies that have left the origin and treatment of CFS a mystery. Also unmentioned, is its relevance to possible new directions in treatment. 

Treating CFS

A new approach to treating CFS would be to convey the role played by repressed emotions, and introducing the possibility of gaining awareness of the repressed emotions, which can lead to emotional and physical healing.

The process can happen quickly in some. However, in others, particularly survivors of severe trauma, gaining awareness might not be a possibility. 

Fortunately, even here, this understanding offers another, usually overlooked, treatment option.

A trial of an antidepressant is not often considered in patients with Chronic Fatigue Syndrome or other chronic illnesses because of the absence of overt psychological symptoms. However, studies suggest that an antidepressant can be helpful.

I offer this new understanding, and its unrecognized relevance, to CFS and many other chronic medical conditions. While their origins and treatments have remained inadequately understood and ineffectively treated for decades, understanding the role repressed emotions play in the human body will hopefully lead to a better understanding of these illnesses, and to much better treatment.

Physician. Professor. Researcher. Author. Speaker.

Hypertension specialist, New York Presbyterian Hospital - Weill Cornell Medical Center



Hidden Within Us: A Radical New Understanding of the Mind-Body Connection

This award-winning book by Dr. Mann dives deep into the relationship between repressed emotion and illness. Our ability to repress emotions is a vital gift of evolution, but, silently, the emotions we've repressed do persist and can affect our health years later. This recognition can lead to new pathways to understanding, treatment, and healing.