• About Fred Friedberg
• Book Excerpts
• Notes from lecture to NoVA CFS/FMS Support Group, April 5, 2007
• Thank You Letter to Fred Friedberg
• Web Links for Fred Friedberg, PhD
  

The Last Page   [skip ahead if you don't want to know how it ends]

    In the process of healing, you develop and value yourself, not only as an engine of work and sacrifice, but also as a human being with important personal needs. Curing symptoms without healing means that you are much more vulnerable to relapses. A cure without healing will probably be short-lived; your desperation to recapture your pre-illness lifestyle will just deplete your precious energies all over again.
     Healing begins when you listen to your body and respect the signals that come from it. For too long your history has been to ignore your body's signals and push onward regardless of the consequences. Respecting  signals of exhaustion, pain, and stress allows you to recognize your responsibility to yourself to preserve your health. Healing means that you permit yourself time to preserve your heath––and recover as much as possible. You cannot directly control the process of recovery, but you can guide yourself through a healing process that ultimately leads to improvement and perhaps near-recovery. There's a bridge between illness and recovery; its called "healing."

Chapter 3: Why Mind-Body Dualism Doesn't Help.
Page 17: The Downside of "Biology is Everything"

     If you view treatment of these illnesses as a search for purely biological causes, then you're ignoring what may be most helpful to your right now: the control you can exert over your own beliefs, personal stress levels, and activities.
     When I was in that biology-is-everything camp, I sustained myself with the belief that I would find a practitioner who could cure me––but after 18 years of slavish adherence to the biological model, I had little to show for it other than a depleted bank account. ...
     Why I left the Mind-Body Debate: ... First, finding a cure could occur well after my lifetime, and I'm not willing to just wait. Second, I can substantially improve my illness––through lifestyle adjustments and stress reduction techniques.


Chapter 18: Medical and Alternative Treatments, Page 150

Because fatigue and depression are often linked, physicians sometimes prescribe antidepressants for CFS patients. However, two controlled studies of Prozac in CFS patients have reported no beneficial effect on CFS or depression symptoms (Wearden et al. 1998; Vercoulen, Swanink, Zitman, et al 1996). This doesn't mean that anti-depressants aren't helpful for some people with CFS. In fact, a survey I did of 285 CFS patients (Friedberg 1995) revealed that roughly one in four respondents did indeed report significant benefits from antidepressant medications. On the other hand, 31 percent of respondents said that antidepressants made them feel worse.


Chapter 10: Identifying and Lessing Anger, Page 102

     What are realist expectations? First, I would suggest minimizing expectations altogether. Expectations are implicit demands that others behave in a certain way. Of course, everyone develops expectations for others––there is nothing criminal about them. But if others don't live up to your expectations, it's better to feel that this is only unfortunate or inconvenient, not devastating. For instance, a study of marriages found that partner satisfaction in long-lasting marriages increased after twenty years––not because husbands and wives became better husbands and wives, but because old expectations about how the other spouse should behave were dropped.
     Your expectations may extend to doctors who are "supposed to" try to help you. But as you have discovered, doctors aren't always helpful. .....


Chapter 11: Finding Relief from Worry, Discouragement, Guilt

[Grief]
Acknowledging the losses you experience when you're ill is a healthy and important process––a process that sets the stage for future healing. Writing down these losses and how you feel about them is one way to begin the process. ...

[Discouragement]
 ... Yes, you do have the illness and its limitations, but dwelling on these things requires thinking. This type of thinking can be changed. .... refocus on what you can do. Appreciate the rewards and good feelings from accomplishments, however small compared to you pre-illness activities. ...

[Worry]
 ... Worrying isn't equivalent to caring about yourself of anyone else––it's merely a repetive thought process without a constructive end. ...

[Guilt]
... To help lessen these harmful feelings of guilt, I suggest practicing some personalized variation on the following statements:

    • I will do what I can reasonably do, and I will value this achievement
      rather than condemning myself for what cannot be done.

    • Guilt neither makes me do more, nor changes my behavior–– it only sustains bad feelings.


Chapter 6: Can Good Coping and Stress Reduction Improve Illness? Page 43

     You may be unaware of the low-level stress that you experience. This is quite common in people with these illnesses––many have learned to ignore stress signals from their bodies, simply pushing on with their daily activities. Also, much of the stress resides just below consciousness, so you may fail to recognize it or dismiss it because it's not obvious. However, even persistent, low-level stress can keep symptom levels higher than they would otherwise be.
     Stress reduction techniques, another important tool in this improvement program, can reduce both stress flare-ups and the general stress that is always with you.


Chapter 9: How to Pace ALL of Your Activity––Its More Than You Think

... Fits and starts of activity when symptoms ease may cause you to run out the clock on your energy while ignoring pain and fatigue. The result: relapses, collapses, crashes, and setbacks. ... There are always certain things you must do regardless of their effect on your illness, but you probably have more flexibility than your realize to rearrange your schedule or do your activities in a more energy-conserving manner. ... Daily pacing, however, frees you from this frenetic pursuit of accomplishments, large and small.

Chapter 16: How to Make Yourself Miserable

[Oh did this make me laugh as I could recognize myself in each of them at different parts of my journey!! When I read it to others, its usually to a chorus of laughs where people have made progress, and groans to the points that are still sore. Its okay to laugh and groan simultaneously, too, or think these only apply to other people in the group!  Hey, that could be number 10! - Elly]


Nine Rules to CFS/FM Misery  [Page 133]

- Ask yourself "Why Me?" as often as possible. Whenever your feel any degree of peace, know that this is a false peace––you are still ill; you must endlessly question why this curse has been visited upon you.

- Focus on how sick you are, magnify every ache, pain, flu-like feeling, or discomfort that you have–– to he greatest degree possible. Only in this way will you realize the true impact you your illness.

- As an alternative, ignore––and deny––all of your symptoms. Consume as much caffeine as necessary to power through your day. After all, ignoring your illness is the only way to feel normal and healthy.

- View relapses and setbacks as your body betraying you; this illness obviously has nothing to do with you or your lifestyle. View it as a foreign invasion––as if aliens have taken over your body.

- Look to physicians, medical researchers, and other healers for your salvation. After all, only they can improve your life, and only they can possibly have a clue about how to lesson your symptoms. Reject any personal efforts to change your life as simply cosmetic. Remember: a complete cure is the only acceptable outcome.

- Be as mad at yourself as you can for not being able to make yourself well. Also be mad at anyone and everyone who doesn't understand your illness––what's there not to understand in an illness that's invisible, not recognized by doctors, and has no identified cause or effective treatment?

- Declare yourself inadequate because you cannot do things or help others in the way that you used to. After all, if you cannot meet your own high standards now that you're ill, you must be even more inadequate than when you were well and doing more.

- View relaxing thoughts as satanic––banish them immediately from your consciousness. Replace them with thoughts of all the things that you'd like to do but know that you can't do. Keep your mind focused firmly on the happy days of the past, when you were well. Remember, those days as blissful and carefree yet highly productive. Never question your old priorities–– they were indisputably the correct ones.

- View guilt, anxiety, and frustration as your dearest friends that prove how intolerable your life is with your illness.

[Fred goes on to discuss until a few years ago, he believed points 4 and 5, viewing setbacks with loathing and intolerance and looked to any number of medical and alternative treatments to cure him because anything less than that would have been unacceptable.]

Chapter 17 is called, "Physician Visits: Why They Go Wrong"

[The sub-headings tell some the story. One excerpt given.]

Physicians and the Psychiatric Model
   - What Doctors Recommend to Other Doctors about CFS/FM
   - Your Right to be Skeptical

The Role of Doctors in Discouraging Healing Possibilities

The Modern Medical Myth: Most Illnesses have Identified Causes
   - The Physician's View

Physician Skepticism: Does the Diagnosis Perpetuate the Condition?
   - Arguments For and Against Withholding Diagnosis

   - Do Symptoms and Impairments Change After a Diagnosis? Page 145

    "One recent Canadian study did explore how symptoms and disabilities change after a diagnosis of FM is made. In this study, Kevin White and his colleagues (2002) evaluated fifty-six patients newly diagnosed with FM. These same patients were then reevaluated eighteen to thirty-six months later. At these follow-up evaluations, no changes were found in physical function or health care utilization. In addition, these patients acutally reported fewer symptoms as well as a significant improvement in health satisfaction. So these individuals, after receiving the diagnosis of FM, not only did no worse, they actually seemed to be do somewhat better! This is the first study (at least, that I am aware of) that directly tested the hypothesis that a diagnosis of CFS or FM perpetuates these conditions; its findings decidedly do not support the anti-diagnosis argument. If this type of study is replicated––perhaps with a "no diagnosis" control condition––physicians may, at long last, take notice.
    Finally, I have found no study that shows that withholding a diagnosis and referring patients to mental health professionals actually helps people with these illnesses; although skeptical physicians may refuse to diagnose CFS and FM, many of them do not offer any alternatives for dealing with these illnesses."

How Doctors can Help
Combining Medical and Behavioral Approaches

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