Fatigue: the problem most people don’t understand

If you’ve never experienced extreme fatigue, then it’s difficult to appreciate. It’s all too easy to say that someone is “lazy” if they complain of no energy or go for a lie down at two in the afternoon. For a long time, many doctors haven’t understood it. For people who are constantly exhausted, us doctors would scrawled ‘TATT’ in the medical notes when someone said they were ‘tired all the time’. They are letters I had often scribbled, but until I felt real fatigue after brain tumour surgery nine years ago, I didn’t truly understand it.

In 2008, a strawberry-sized chunk was taken out of my brain in an attempt to extract a cancerous growth. This missing chunk now forces the rest of my brain to work harder to compensate. Like the London Underground on a day when the District Line is out of action, all the other routes get busier to ferry everyone to their destination. The trains shunt faster but the system soon gets strained. And when it’s your brain cells that are working overtime to do the same job, it soon runs out of steam. When the brain finally goes on strike, utter physical and mental exhaustion take over. Fatigue is very different to tiredness – which is resolved by sleep – and I have often likened it to being hit by an invisible freight train.

I am far from the only one who battles with bouts of crippling exhaustion. 1 in 10 of us experience prolonged fatigue at any given time; and it is the young and middle age adults who are most often struck down by an energy-sapping locomotive. Typically, there is no obvious physical explanation (like a hole in the brain) but it is always worthwhile getting a check-up. Fatigue can occasionally be the first warning of a serious condition and it is vital a doctor rules out curable causes, such as hormone imbalances, anaemia and vitamin deficiencies.

Even our best detective work may come to nought, however. On the internet, quacks are quick to offer us wonder cures to get us back to full health, but they offer us nothing but false hope and a lighter wallet. Don’t think that we fatigue-fighters are helpless though. Current UK medical guidelines say that your doctor should offer you a personalised treatment plan to help you to take control of your symptoms. Strategies include: lifestyle adjustments, supplements and diet changes, a type of counselling called CBT, exercise therapy and (sometimes) drugs. It definitely isn’t glamorous but most people get better.

Mysterious bouts of fatigue combined with aches and pains can sometimes start after an episode of glandular fever or other infection, when it can get labelled ME. This is not to be confused with MS (multiple sclerosis) and it sounds serious. Literally meaning ‘Myalgic Encephalomyelitis’, this is a silly, old-fashioned name that was born out if a false belief in the 1950s that the brain and spine were swollen. Doctors now prefer to use the name ‘chronic fatigue syndrome’ (CFS, or even CFS/ME) because, to be honest, no one quite knows what is going wrong.

Unfortunately, like all other medical conditions that have no simple solutions, chronic fatigue sufferers can feel ashamed and stigmatised. I have found that pacing myself and letting others know when fatigue strikes can be immeasurably helpful. Hiding our struggles almost always makes it worse. Even though no one else can see it, the strike of the ghost train is very real.

Thanks for reading. Feel free to add your thoughts in the comments below.



Image sources: ‘Dealing with Fatigue U.S. Air Force Illustration by Airman 1st Class Devin Boyer/Released,

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