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There she sat. Tired, exhausted, empty, with no home. her husband took her to my practise by car because she could not walk the 200 meters from the tram stop to me. Even that was too much. Marianne was an administrative employee in a multinational, until she suddenly ‘broke’ on her 37th. Then the long path of 10 years of invalidity started, because her body was exhausted and could not do anything anymore. That is what it seemed like. It could be seen in her empty, fatigued look. Her voice sounded tired and frail. Her muscles even protruded around her bones.
The list of doctors, physiotherapists, medical centers and caregivers which she had visited was impressive. Complicated treatment schedules each time which she tried to follow properly, but when I asked about results, nothing much came up. Often, the treatments in themselves were already very tiring, meaning there was not much life energy left during the days in between the sessions.
Had I not been properly trained as a ‘detective’ during my doctor’s training, specialized in detecting (invisible) hope and help sources in human beings, I would probably not have asked anything more. Luckily, my teacher told me never to give up, because every human being who goes to a doctor has some hope left inside of them, a hidden talent with which they can heal themselves. Most wounds are healed by our body itself, are they not? Both plants and animals have an inherent self-healing capability. Sometimes it is enough to just get this capability in action.
− What if, during our cooperation, a miracle happens and you suddenly get back all the energy of which you dream, I asked. What would you then do with your life? Who would you want to become?
− Actor! … ‘Stand-up comedian’ is what I want to become, she said while a spark transformed her dull stare into a sea of light.
I felt that she bared the depths of her soul and followed this impulsive, authentically human feeling with the question: – Show him to me! – Eh? – Yes, show him, your ‘stand-up comedian’

The miracle

I watched her with honest interest, to see the ‘actor inside of her’. She felt that this was sincere. With my hand I signaled her that she could stand up and that the space of my office was her stage. She hesitated. She looked at me and stood up. A little later I was the observer of an amazing private show. She bustled with energy and shone, like an artist in a ‘flow’.
− You see, scientifically there has now been given irrefutable proof that your mind and body can do this, I said. The hardware and the software are present and working, I joked.
She nodded, accepting this. Nobody could deny this.

The small steps

There was hope now. The next step is to realize the plan of action to make this dream come true, to activate it.
− Now, the art is found in building this up in small steps, because your problem right now is that you want more at this moment than your body can do, I continued. Your brain and muscles have indeed become fatigued because you wanted too much. When you could handle 100 percent, you gave 105 percent. You stole from your system until it gave out and left you on your own. It could then handle 90 percent, but you tried to give 95 percent… and in the start even still 105 percent. Your drive and perfectionism continued pushing you, to keep increasing your standards. At a certain point your body could only handle 80 percent, and instead of letting it rest and giving 75 percent, you gave 85 percent or even more.
− But now I cannot even give 5 percent anymore, Marianne pondered.
− Yes, I nodded. So now you should give 4 percent, so that your body can re-charge to slowly increase this limit to 6 percent, 7, and so on, until you can give 80 or 90 percent again.
− Yes but I cannot do anything anymore, she repeated. My life is over.
− I understand that you feel that way, I smiled understandingly. The problem is not how much you can do in the long-term. The issue is that you try to do a little more than you can do today.
I tried to explain to her that one can only be cured from CFS or ‘chronic fatigue syndrome’ by taking slightly smaller steps than the body can handle at that specific moment.
− You have just now proven that there is hope, I added to this. Your performance just now showed that you have got potential. Your brain, muscles, and body can do it. You need not give up your dream. I will guide you and support you so that you can realize your way to your dream, but I will need your help. You need to help by being willing to look at your dream while taking small steps in the here and now. I know that you want to take larger steps, but quick is slow for you, and slow is quick. That is difficult to accept. Do me a favor and think about this again until our next session and whether you are willing to take this road together with me. If you want to take this path, I want to support you.
− Okay, that I will think about sometime.

The guidance

The next session she told me that she wanted to put her trust in me and walk this road together with me. My role was to regularly tell her to take even smaller steps, while ensuring her that she would not need to lose her final dream. After six months or so she had stopped her revalidating in the Belgian reference center for CFS, and did more on her own. Her husband did no longer need to take her by car, she came on her own. She started out with some non-profit activities, to test how much she could do without the pressure of an employer, before going into the professional circuit. We saw each other only every other month in the end, while she followed the odd month of the 15Minutes4Me self-help program to ensure that she had the support she needed while showing herself which direction she wanted to go. One day she told me that she wanted to try to go a few months without me. We only saw each other once every 6 months, until even that became unnecessary.
Recently, I met Marianne and her husband in a mall. She works 80% in the cultural sector and also has a part-time job in … you will never guess: animation, acting, and entertainment for those in need and people in the social sector. She told me that she still regularly needs to check that she is not crossing her limits, but she can now see her signals early on and steer away from the limits. Her husband nodded happily and said he had gotten back the woman with whom he once fell in love.

The underlying philosophy

Marianne is just one out of hundreds of fatigued people whom I have guided. Each time, the same ingredients come up: first, restoring the hope that it is still possible to be and become who you want to be. Secondly: encouraging people to take smaller steps. This last thing often takes a lot of effort because people find it difficult to believe that a lot can be done with small steps.
This is logical if you know that the personality profile of the standard chronic-fatigued person is one which includes perfectionism, perseverance, and willpower. Often these people have a lot of ambition and expect a lot of themselves and have demanding parents, or a father or mother who did very well in life, often with a large dose of perfectionism themselves.

The paradox

The paradox is that these specific ‘values’ – when administered in a too large dose – can become the cause of the pathology. The patient then does not want to give up these values.
These are namely the points which they find to be a part of themselves.
A paradox is an ‘apparent contradiction’, so luckily not a real one. Most people – especially when they are stressed or very fatigued – confuse a paradox with a contradiction and become defensive. They then refuse to take smaller steps as they are afraid that this means that they need to give up and neglect their fundamental values such as perseverance, willpower, or the will to deliver good work.
In the nineties I regularly had coffee with the Austrian philosopher Warzlawick considering the chronic fatigue syndrome in his office in the Mental Research Institute in Palo Alto. Watzlawick is the man who described the theory of this paradox in his books ‘Change’ and ‘Pragmatics of Human Communication’. From our philosophical afternoons and the deep discussions we then had, I learned how important it is to help people to distinguish when they are experiencing a paradox versus a contradiction.
As soon as people discover that they need not forego their fundamental deeper values in order to find a solution, it is easier to get them to go along on this difficult journey toward healing. This journey requires a lot of courage and effort from the client, which is why good guidance is necessary.
To some extent this is in accordance to that which we wrote in the earlier article about letting go. In short-term, we definitely need to let go of the need to give 105 percent when we can maybe only handle 20 percent. Long-term, this effort pays of, because a proper coach includes a second phase after this first healing phase, in which you learn how to have an increased output while using fewer resources or efforts. This is done by not blindly starting at ‘doing things right’ – which is efficiency -, but rather by focusing more and more on ‘doing the right things in order to more toward your goal’. This is called effectivity.
Medical science has not yet gotten far in research on fatigue, chronic fatigue, and fibromyalgia. This means that a medical magic pill comparable to antibiotics against bacterial infections does not yet exist.
While this perfect ‘solution’ does not yet exist, you can best treat this illness by first of all accepting the (temporarily) unsolvable. Then, you can start looking at how you can heal in small steps, until the body slowly heals itself. i often notice that many patients follow expensive and complicated treatments which often do not help. The golden rule is: if something helps, do more of it. But if something does not help, stop doing it and do something else. Do not hang on to a treatment which does not work, but make sure to discuss it with your doctor each time.
Marianne felt relieved after the first session, and she felt so, too, after the second and following sessions. That is an indication that this approach worked for her. The therapies which did not help for her, did not give her a feeling of relief. She always came out even more fatigued than she entered, which often is a sign of the bar still being set too high.
Unfortunately, not everyone recovers by 100 percent. Science has a long way left to go. Still, my personal experience as a doctor is that most people with cfs – even many of those who had already given up – can improve a lot and become much happier by following the plan which we showed you with the help of the story of Marianne.
Read and download the entire Dutch article: (pdf) Chronic fatigue
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Paul Koeck, MD

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