Customer Reviews

Fatigue as a Window to the Brain (Issues in Clinical and Cognitive Neuropsychology)

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Fatigue in all its many forms is one of the most pervasive and debilitating problems faced by millions of people around the globe.

This book provides one of the best overviews available, with research up to the end of 2003. The articles show how far, thankfully, we have progressed beyond the simple - and patently false - notions that people with chronic fatigue are just depressed or hypochondriacal. Though designed as a scholarly work for clinicians and researchers, all the chapters are so well written that It would also make a good resource for sufferers. With any chronic problem, knowledge is power.

There is not much in the way of practical advice for individuals, though there is a nice review of some of the conventional treatment options available.

For books that also get into less conventional approaches to managing fatigue, I have found the books by Jacob Teitelbaum and George Redmond to be some of the best ones.

This is an unusual book in the genre of fatigue and illnesses that cause it. I would never expect to see a book that included a section by simon wesseley and one on ME (aka cfs) as a psychiatric illness (!) alongside articles by Leonard Jason and Nancy Klimas. The latter two are incredible scientists who have done so much to advance knowledge, while Simon Wessely does all he can to muddy the waters with his own anti-scientific biases. Nancy Klimas is one of the world's foremost authorities and bench scientists on both ME and AIDS. She and her team write an article under the "Physical Diseases" section on "Neuro Endocrine Immune Disease" i.e. ME while the "Psychiatric Diseases" has an article on "CFS" (ME). Bizarre.
I laud the good science in this, but the bad science is so horrendous it is the bad apples that spoil the whole barrel.
For the real story of ME read the amazing Osler's Web: Inside the Labyrinth of the Chronic Fatigue Syndrome Epidemic You can thank me later!

Overview
When I first purchased this book for my introductory neuroscience class, I was hoping that the science behind fatigue would be explained through its affect on people's everyday lives. In contrast, the actual mechanisms behind the subject are rarely explained. This book is more a collection of experimental results than a learning adventure.

Separated into 19 different chapters within 6 main divisions of the book, approximately 30 different authors are given the opportunity to discuss how fatigue relates to different medical conditions. It would seem that such a wide variety of topics would leave the reader with a good understanding of the influences fatigue can have on a person. However, the main "take-home" point of the book seemed to be that no one really knows how to define fatigue. As a reader of the book, I finished it with no better understanding of what the condition actually is, or what exactly it affects.

I think that the first section of the book is the worst, and improves from there. In the first section, "The Nature of Fatigue" I expected to gain a basic understanding of what was known about fatigue. Instead, the authors spent the three sections telling the reader how much is still undefined with fatigue. Several quotes listed below point out just how little we actually know about this concept.

"Neurophysiological differences between fatigue subtypes, which would lend additional support to such distinctions, have not been well established."

"Fatigue remains a poorly understood symptom whose management strategies, whether behavioral or pharmacological, are only partially effective."

"There is no universally accepted definition of fatigue."

"Unfortunately, the lack of relationship between subjective and objective fatigue was observed more than 100 years ago, illustrating how little has been learned since that time."

Having said this, the book is not completely void of information. It is very good in quickly giving an overview of many subjects, with all of the results from associated studies. Each chapter is devoted to a particular relation, for example, "Fatigue after Stroke." Within this chapter of the book (which in my opinion is one of the best chapters), three authors explain methods by which to attempt to assess fatigue following a stroke. I liked this chapter better than earlier ones because they included which sections of the brain seemed to be associated with the fatigue associated with stroke. Although it cannot be ruled out that these areas are not also affected in other conditions as well, they at least acknowledged the physiology behind what their results were showing. Several of the chapters in this section of the book did this, and my initial hesitations about the book were lessened some by this fact.

One of the main points to note about this book is that it is NOT for people who are not scientifically inclined. Basic explanations of the conditions are not given in the different chapters; it is assumed that those reading the book already have an understanding of what multiple sclerosis, traumatic brain injury, heart disease, etc. are. Also, this is not a book for people who wish to learn more about the background of the conditions discussed. This book only points out studies that have been done to try and quantify fatigue and how it is associated with the given condition.

Formatting
The overall format of the book makes it easy to jump through sections if the reader is only interested in a particular topic. However, because there are so many different conditions, I feel that none of them are fully explained. An author may bring attention to comparisons such as, "healthy control subjects showed cerebral activation primarily in the left hemisphere" versus "TBI subjects displayed bilateral activation that was more lateralized." However, the reasons behind why these patterns appear are not discussed. The six main sections of the book are:

1. The Nature of Fatigue
2. Fatigue in Neurological Conditions
3. Fatigue in Psychiatric Conditions
4. Fatigue in General Medical and Other Conditions
5. Treatment of Fatigue
6. Conclusions

This format of the book makes it difficult to get an overall flow to the reading. About the time I got into a subject and was starting to feel like I was getting something out of it, I would reach the conclusion paragraph of that chapter and it was time to move on. If the goal of the book was to simply state the results of other people's studies then this book deserves a higher rating. However, when given the title, "Fatigue as a Window to the Brain," I was expecting more insight into how these conditions overall actually affect the brain itself. For example, how physiologically does fatigue in a MS patient differ from fatigue in a cancer patient? Comparisons between the results of the studies in each chapter are never made. Perhaps the next multi-author book that is compiled could pick a couple of the conditions used in this book, talk about them much like this one did, but then devote the rest of the book to comparing what has been found in one condition to that of another.

It was made quite clear that fatigue does not have a clear-cut definition. There is mental fatigue and physical fatigue, and in each of these two groups there are many subsets of the type of fatigue people can experience. This book mainly described studies in which the scientists were trying to fatigue a patient in order to determine their sustainability. Observations were rarely made just on the patients themselves during normal daily activities. In this same manner, studies were not discussed that compared one patient's fatigue to another. Most comparisons were done between healthy control subjects and subjects with a particular condition. This simply looks at whether fatigue is more prevalent in people with these certain conditions, not how they are affected by it. It is never decided whether fatigue should be considered a symptom or a disease.

Potential Uses
The book could be used as a motivator for scientists who study fatigue to actually seek out more information. Several authors within the book state how very little the study of fatigue has progressed over the last 100 years, as stated in one of the above quotations. Perhaps the editor hoped to enlighten the scientific community on the disagreement on what exactly fatigue is. By incorporating the hundreds of references that are cited in this book, the authors sort of unknowingly dispute themselves in the text from section to section by "defining" fatigue in a different manner in almost every chapter.

The last chapter of the book, "Fatigue: Its Definition, Its Study and Its Future," does a good job of explaining exactly this goal to the readers who make it to the end. While acknowledging the disagreement among scientists, the editor of this multi-author work states that "it is hoped that this book will be the first step toward a new science of fatigue."

References in the Book
While mentioning the references in this book, it should be noted that the results of all of the studies discussed could be easily verified by searching for the original journal publication. All sources are explicitly cited within the text and a full bibliography is listed at the end of every chapter. Although this is a positive thing when crediting the original scientists with their work, I found the format of the citations to actually hinder the reading of the text. There was almost always more than one source for a single topic, and these would be listed midsentence with all of the contributing authors and the year of publication. Often times there were more words in the citations than words in the sentence. Since a fully formatted bibliography was presented at the end of each chapter instead of overall at the end of the book, it would have been beneficial to use a numbering system for the in-text citations of the chapters.

Potential Readers
I am not trying to discourage readers from purchasing this book. I just wish to give a little more background behind the book to anyone who may be unsure about its applicability. This is a great book for anyone who would like to have a one-stop resource to all of the most current updates on fatigue research. This is not a great book for people who do not already know something about fatigue.

Overall, my rating is not the full five stars because I did not get out of the book what I hoped to, and I felt that the organization could have been better so that the actual information was the focus of the book. This book reminds me of a time-limited acceptance speech for a prestigious award. The winner stands on stage and rattles off as many people as they can think of who contributed to their work. The book does something similar by listing as many possible sources within a single chapter. I understand that having good references to back up the author's words is important... but how much is too much? Just be prepared to sort through what is citation and what is informational text as you read.

Conclusion
The one "symptom" of almost every patient is a feeling of tiredness or general fatigue. Yet when asked, almost no two physicians describe this symptom in the same manner. The lack of advancement in the field and the ambiguity of the overall subject leads to disagreements between scientific scholars such as doctors and psychiatrists. Perhaps someone who picks up this book will know how to achieve that next breakthrough in the study of fatigue in order to unify the work being done to understand this medical mystery.