Sociosomatics and illness in chronic fatigue syndrome.
OBJECTIVE
This study examines social processes that construct the course of chronic illness. Specifically, it identifies and describes mechanisms that constitute the process of role constriction in employment for individuals with chronic illness.


METHODS
Sixty-six persons meeting the Centers for Disease Control case definition of chronic fatigue syndrome (CFS) participated in a longitudinal study involving three waves of data collection over 3 years. Qualitative and quantitative methods were combined in the research, which included face-to-face semistructured interviews, telephone interviews, and self-report questionnaires. Materials presented in this study are drawn principally from the Year 1 face-to-face and telephone interviews.


RESULTS
When patterns of symptoms and of the illness course in CFS intersect with work requirements, they impede performance and place ill individuals at risk for job loss. Persons with CFS devise and implement specific strategies to resist role constriction and remain in the work force.


CONCLUSIONS
Role constriction is a social process of marginalization in chronic illness. Opposing forces of marginalization and resistance define the social course in chronic illness and suggest that chronicity can be thought of as a marginalized position in social space.
Department of Social Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA. nware@warren.med.harvard.edu
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D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D003674:Defense Mechanisms; D015673:Fatigue Syndrome, Chronic / Q000523:psychology* / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment; D011788:Quality of Life; D012050:Rehabilitation, Vocational / Q000523:psychology; D012380:Role; D012803:Sick Role; D012931:Social Environment; D013001:Somatoform Disorders / Q000523:psychology* / Q000534:rehabilitation