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The difference between mental fatigues.

The conflation of Chronic Fatigue and M.E is a problem.  Psychiatrists have missed a trick on this one, for the lack of differentiation hides an incredibly important diagnostic observation, one that could literally cost or save a life.

There are two distinct forms of mental fatigue.  It is easy enough to differentiate between them.

The first is psychological fatigue.  It is world-weariness: the idea that one is tired of life. It is perhaps best expressed by the phrase "What's the point?".  Psychological fatigue can express itself physically.  The body becomes leaden to match the mind and, over time, unfitness causes ill health "The great muscles of the body shall have their exercise, or they shall have their revenge."

Psychological fatigue as long been recognised.  In spiritual terms it has been known as Acedia and the traditional treatment is exactly in line with modern medicine: Jump back into life.  Force yourself, against your wretched will if necessary, to re-engage in social and work pursuits.  In this manner, slowly, but surely life will resupply reasons for you to get up in the morning, reasons to regain fitness and, in addition, the energy to fund all of these pursuits.

The second form of mental fatigue results not from experience, but from the mechanics of thinking.  This form of mental fatigue is the weariness you might experience after adding up a long column of figures.  One may be entirely engaged in a pursuit, be it work or recreation, and want to continue, but simply find that one is too tired.

The treatment for this form of fatigue is the exact opposite of the former.  It is to go and rest.  Through rest, physical recreation, and sleep our minds recharge ready to function at a high level all over again.

As the  two forms of fatigue have diametrically opposite treatments, diagnosis becomes extremely important.  Remember:

In a mirror context any effective treatment can cause harm.

It is easy to see how this maxim applies to mental fatigue.  If a patient is computationally tired and we instruct him to re-engage with life we will simply tire him further.  Likewise, if a patient is psychologically fatigued and we advise them to rest in a quiet room, the patient is likely to fall deeper into the isolation and despair of "What's the point?"

M.E patients have found themselves disbelieved for decades.  Medicine has found it very, very, hard to accept that exercise could be a cause of symptoms.  Thus M.E patients have been pushed gently towards a psychological explanation for the fatigue symptoms that dominate any discussion of M.E.

In fact M.E patients can suffer both forms of mental fatigue.

M.E is characterised by illness following exertion and fatigue may well result from mental effort.  Even where these appear limited and few, an M.E patient presenting to his doctor is highly likely to be tired out by the sheer physical effort of processing the sights, sounds and social experiences of their life.

The trouble is, M.E is an appalling disease.  It can be a true and long lasting misery.  The M.E patients I have met seem courageous, strong, and dedicated in their fight, however there is a constant mental pressure to think "Aw, what's the point?".  M.E symptoms can continue over decades.  When an M.E patient presents they are also likely to present with extreme psychological fatigue both from the effort of carrying extreme, unremitting, symptoms and from the heavy social burden and stigma of a diagnosis of M.E.

Correct assessment at this point is vital.  We have seen that physicians are likely to be biased towards treating both forms of mental fatigue as psychological in origin, however we have also seen that misdiagnosis and application of the wrong treatment can worsen the situation.  As always in M.E, bias must be resisted for the risks are real:

A patient advised to exert in response to physical weariness is likely to become more fatigued.

Likewise a patient advised to rest in response to psychological fatigue will likely experience an increase in psychological fatigue.

Further, patients whose reports of physical weariness are overruled by their physician are likely to experience increased world-weariness.  I mean, what is the point of going to the doctor if they're not going to listen to what you tell them?

There is one particularly interesting aspect to consider in M.E and this is the relationship between the two forms of fatigue.  Let's consider them as (physical) health and happiness and place them at right angles on a graph (below).  I have observed that there is give and take between the two axes.

For example, if an M.E patient has rested long-term they are likely to be PEM symptom-free.  They'll be unfit and there will be symptoms arising from this, but in terms of M.E, they will be healthy.
This will, however,  go hand in hand with a radical lowering of happiness.  Work and social lives will be non-existent.  Darkness, loneliness and social isolation: these are not conducive to happiness.  

However, with the health budget brimming over, something can be done.  As we said above, the remedy for psychological fatigue is to get back out there and interact with people, places and things.  The health budget can be spent on restoring happiness.  There is a cost, symptoms are likely to increase, but there is at least something that can be done to prevent mental energy levels from crashing through the floor.

It is always worth remembering that a human life needs both a healthy mind and body in order to continue.

Likewise, where happiness is riding high, it is not so difficult to dutifully accept the reality and the return of your illness and return to rest and recuperation.  There is a cost, of course, and it is with sadness that one retreats into one's rooms.  In this way happiness, mental health, is effectively transformed into physical restoration.

Obviously where health and happiness remain high, we have the best of both worlds.  Psychological fatigue is low, and computational fatigue is low.  But there is a flip side.  What happens when both of these drop to minima at the same time?

At this point there is no way for happiness to "borrow" from health and likewise, there is no way for health to borrow from happiness.

An M.E patient experiencing a breakdown of both mental outlook and physical computational ability at the same time is in danger.  They require huge support, for they will need to take tiny steps in order to reclaim the safety of their previous position.

As we see, conflating psychological fatigue with the physical fatigue resulting from computation and thought does an M.E patient a disservice.  It obscures our view of their true situation leaving us to misdiagnose, mistreat or entirely miss the seriousness of the situation presented or the situation that we find ourselves trapped within.

Nota Bene: