There are people who want CFS/ME to be this or that, organic, psychological ... yet is it nothing but an artifical construct that is causing torture? Torture from psychiatrists (who inclidentally actually often refuse to diagnose the organically ill as having ME) and torture from "ME specialists" who diagnose everyone with it. Which is worse?
I agree that the 'CFS' definition is a problem.
Fukuda is an exceptionally loose definition, and defines little more than chronic fatigue.
(Or in the case of the Oxford CFS criteria, it diagnoses only chronic fatigue.)
Many different types of patients fit into the category of 'CFS'.
So, yes, it is the case the CFS is probably highly heterogeneous, and the loose way that doctors tend to use the diagnosis leads to further heterogeneity because of misdiagnosis.
But the biggest problem is not the diagnosis itself, but the vested interests.
If the psychiatrist lobby stopped claiming that CFS is a functional disorder, or a 'meme', then there would be very little conflict within the field of ME/CFS.
It's only the psychiatric lobby who are causing the problems, as part of a strategic power-grab.
And unfortunately they have unwitting, but very willing, accomplices, such as various governments (and in the UK: NICE and the NHS.)
All the evidence suggests that CFS does not fit the model of illness that the psychiatrists propagate.
e.g. The PACE trial demonstrated exceptionally clearly that physical disability in CFS does not respond to CBT.
Researchers should be working towards defining subsets of CFS.
This would be good science.
But have you noticed that the psychiatrists rarely attempt to narrow down cohorts?
There is no honest attempt by the psychiatric lobby in the UK to do proper science.
Instead, based on the lack of response to CBT in the PACE trial for objective measures, CBT is rolled out across the UK, and CFS is labelled as a functional illness.
No attempt was made in the PACE trial to look at any objective measures. They just aren't interested in finding out more about the disease/s and they aren't interested in accurate categorisation, and they aren't interested in defining subsets.
The psychiatric lobby will not have an honest conversation about the issues.
They are intent on continuing with their lucrative power-grab.
So it's not possible to have a conversation about the nature of ME, because the psychiatric lobby simply don't want one.
What we need is proper honest science that attempts to define subsets.
I think most patients would be happy if CFS was researched with honest intent, whatever the nature of the research (e.g. biomedical/psychiatric/functional).
The problem we have is that the psychiatric lobby have done an excellent power-grab, fitting all CFS patients into their hypothetical model/s of illness, despite a lack of evidence, thus harming wider ME/CFS patient community. And they don't intend to give up any of their power.
So, in a nutshell, the conflict within the field of ME/CFS is not about the nature of ME or CFS, but it's about honest vs dishonest propagation and implementation of science.
Researchers who are interested in biomedical models of illness don't purposely widen cohorts to muddle results. Instead, they do proper science which attempts to find out more about the disease/s, and they attempt to define subsets.