Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?

In 1977 George Engel wrote about the need for an ‘integrated approach’ in medicine that moves the focus beyond biological mechanisms of disease to include all pertinent aspects of illness presentation; setting out a ‘biopsychosocial model’.1 Around the same time, McEvedy and Beard asserted that the disease ‘benign myalgic encephalomyelitis’ described by Ramsay at the Royal Free Hospital London, was nothing more than a case of ‘mass hysteria’.2 In the 1980s, doctors combined theories of neuroasthenia, hysteria, and somatoform illness, to reconstitute ME as ‘chronic fatigue syndrome’: psychiatrists argued that CFS is best understood using a biopsychosocial (BPS) framework, being perhaps triggered by viral illness (biology), but maintained by certain personality traits (psychology) and social conditions (sociology).3 While the BPS model holds much utility in understanding ‘illness’ in a wider context, many CFS sufferers reject the notion that their illness is psychologically or socially derived and significant numbers report difficult interactions with doctors that leave them feeling dissatisfied, disbelieved and distressed. In this article, we question whether or not the BPS model generates ‘harms’ for CFS patients, and we ask if other alternative approaches might be more preferable to both patients and general practitioners.