Thank you, Cort, Sing, Sushi
... for your kind words and encouragement. The things you say are right on. I'm not very good at budgeting my energy. Part of that is medical training; physician culture does not permit admission of illness or weakness. License applications illustrate and reinforce this: they all ask if you have any medical problems, mental or physical that "might interfere with you ability...". Implies that all physicians are specimens of perfect health! One license application I encountered (every state has their own; you have to be licensed in each state separately to practice there) even asked if you now, or in recent years, had any condition that might be or have been a problem if it weren't treated! Forgive the venting...
Also, I liked what you said, Cort, about not being attached to pet theories. I think that's true for me. I try to keep an open mind. Some doctors out there who claim to have had CFS and to have "cured themselves" seem a bit attached to their theories... But, maybe because I haven't found an answer for myself I don't think I have the singular answer for anyone else. I certainly have my biases. For example, I am strongly of the opinion that ME/CFS has one etiology (cause). There is a pattern in medicine that diseases of unknown cause tend to be first thought to have multifactorial etiologies, or to be "final common pathways" of multiple insults. In the early days of AIDS, for example, some researchers believed it to be caused by the breakdown of the immune system due to repeated exposures to infectious or toxic agents through the "homosexual lifestyle" during the wild bath-house days of the '70s: multiple sexual partners, anal sex, use of "poppers" and other drugs. Now, all but the most stubborn recognize that the Human Immunodeficiency Virus is the cause of AIDS. The parallel to ME/CFS is striking: those theories of "burnout", stress, somatization will likely never die until a specific agent akin to HIV is definitively found to be the cause.
Having knowledge of the real cause of ME/CFS will fuel true progress in treatment. In the meantime, however, we have to use what we do know to relieve suffering as much as possible. That what helps one patient does not help another is terribly frustrating, and further underscores that we haven't yet pinpointed the underlying cause of the disease. So, the role of the treating physician is to help each CFS patient find the best ways to feel better, even if we don't understand why it helps. We need to keep open minds, so we don't miss answers because we refuse to believe in them. At the same time, critical thinking is necessary. One of my favorite quotes is the one that says, "Half of what we 'know' in medicine is wrong. But we don't know which half..."