Solid epidemiological evidence links «chronic stress» to an increased risk of cardiovascular disease, lung and liver disease, obesity, cancer, inflammatory and autoimmune disorders, early menopause, osteoporosis, depression, anxiety, infections, chronic pain and chronic fatigue (1, 6 - 9, 11, 12, 17, 18, 20). Of all these conditions, the last two are the ones least understood from a biomedical point of view. Chronic fatigue, especially, represents a medical enigma (3).
In a recent review article of the condition known as CFS (chronic fatigue syndrome) (in Anglo-American literature, the authors write: «Numerous immunological parameters have been tested and many of them are abnormal but inconsistently so among the various studies.» They continue, «A disruption of the HPA axis has been implicated in the pathogenesis of CFS. Early studies have shown that cortisol levels in patients with CFS are reduced...» (21).
One of the most consistent findings has been that various infections can trigger a state of constant low energy or tiredness as well as other health problems, with chronic pain showing up most frequently, either in general or localized in different parts of the body (3, 21). When infections are a possible common denominator, it is reasonable to ask if there are certain conditions in the individual patient that cause many infections (including ones not normally seen as problematic) to have such devastating consequences. If CFS is a condition that includes a chronic sense of not coping, the implication is that the syndrome is a consequence of changes in several systems. This further signifies that the changes in each system may be too small to appear in biochemical and immunological tests. So, a conflict between systems caused by strain leads to the clinical syndrome, rather than an isolated dysfunction within one system.
Of all possible causes assessed, defined as either somatic or psychiatric, no convincing explanation has come up. Previous infections are a typical symptom of the condition, but even more consistent is the effect of what is persistently defined as emotional stress. In the aforementioned review (21) the authors write, «... emotional stress is known to influence immune responsiveness and virus pathogenesis, and has a profound importance to our understanding of the pathogenesis of infectious diseases and cancer, and may therefore be a key aspect in the pathogenesis of CFS» (our italics).
We wish to emphasize two aspects of this conclusion. Firstly, it has been shown, as we have mentioned, that it is not possible to separate «emotional» stress from other types of stress, both from a biological and an existential perspective. Secondly, the authors contradict their own conclusion in that they categorize «emotional stress» as belonging to the same analytical level as the three other frequent findings in the CFS patient, namely immunological, hormonal and central nervous system deviance. The various immunological and hormonal aspects of the lived body are neither autonomous, nor independent of the body they are a part of. Neither does the central nervous system live independently of its owner’s life, consciousness, perception and situation. These three aspects can neither ontologically nor epistemologically be considered «on the same level» as painful and difficult experiences. Consequently, the conditions categorized as «emotional stress» are a prerequisite for understanding the complex patterns of known dysfunctions and deviations in the cellular, humoral and central nervous system.
Furthermore, defining the category «emotional stress» is problematic. In epidemiological research the term usually comprises supposedly temporary stresses and strains. Frequently studied examples are exams, money problems, job loss, divorce, the death of a near relative or serious illness in the family, or among friends (8). But such problems may last a long time. A person forced into a divorce may continue to suffer long after the event. A child’s death may affect parents decades later. Moreover, there are stresses and strains that are constant and impossible to avoid because they are socioculturally legitimized or covered up and concealed. These concern discriminating social structures related to skin colour, ethnicity, gender, sexual preference etc. and humiliating relationships in the form of destructive enmity within the family. All this signifies that an abstract stress typology is not helpful when exploring dysfunctional relations between the immune, hormonal and nervous systems. An adequate epistemological and methodological starting point is rather the individual’s situation in life.