The Concept of ‘Illness Without Disease’ Impedes Understanding of Chronic Fatigue Syndrome: A Response to Sharpe and Greco

Article Summary by Steven Lubet and David Tuller

Today we present the very last of MH essays on CFS.

The medical condition known as “chronic fatigue syndrome” has often been presumed to be primarily caused by psychological and behavioural factors, and therefore “reversible” by cognitive behavior therapy (CBT) or graded exercise therapy (GET). In 2015, the U.S. Institute of Medicine (now the National Academy of Medicine) issued a definitive report classifying CFS (also known as myalgic encephalomyelitis or ME/CFS) as biomedical disease. Nonetheless, the medical establishment in the United Kingdom continues to promote what they describe as a biopsychosocial theory of ME/CFS. In a recent Medical Humanities article, Sharpe and Greco label the condition an “illness-without-disease” and assert that patients reject treatments like CBT and GET because of their own misconceptions of their condition. Our response observes that Sharpe and Greco are repeating a long-standing pattern of attributing serious ailments to psychological causes when medical understanding and diagnostic tests have not yet caught up with the disease. Moreover, Sharpe and Greco ignore the extensive literature that has demonstrated the inaccuracy of long-standing claims that CBT and GET provide benefits to ME/CFS patients.

Read the complete article on the Medical Humanities journal website:


Portrait of David TullerDavid Tuller, DrPH, is a senior fellow in public health and journalism at UC Berkeley’s Center for Global Public Health, which is part of the School of Public Health. He was a reporter and editor for ten years at The San Francisco Chronicle and served as health editor at He has written regularly about public health and medical issues for The New York Times, the policy journal Health Affairs, and many other publications. Since 2015, he has been investigating scientific, methodological and ethical problems with research on the illness, or cluster of illnesses, variously known as myalgic encephalomyelitis, chronic fatigue syndrome, ME/CFS or CFS/ME. His ongoing series on this issue, Trial By Error, can be found on Virology Blog, the science site hosted by Vincent Racaniello, a microbiology professor at Columbia University. The entire series can be found here:

Portrait of Steven LubetSteven Lubet is Williams Memorial Professor at the Northwestern University Pritzker School of Law, where he specializes in professional responsibility, ethics, and advocacy. He is the author of 14 books, on subjects ranging from abolitionist lawyers to the evidentiary bases for ethnography, and over 400 articles in both popular and academic journals. He was diagnosed with ME/CFS in 2006 and has been partially disabled since then. Unlike virtually every other ME/CFS patient, he has never been referred to a psychiatrist, which is probably because he is male, professionally established, and friends with the dean of the medical school. Patients without these advantages have frequently been treated poorly and dismissed by physicians, which is why Steven cares deeply about ME/CFS and writes about it often.

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