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A historian traces the cultural contexts of chronic fatigue

Sick and Tired: An Intimate History of Fatigue

Emily K. Abel
University of North Carolina Press
206 pp.
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Anyone who has an invisible illness: Emily Abel sees you. Abel knows the dual anguish of suffering from an invisible illness and of responding to people who fail to fully recognize this suffering. For decades, she experienced persistent fatigue and intense shame about it. In Sick and Tired, Abel comes to terms with this shame through a personal history of “cultural values” in modern white America.

Abel was born in 1942 into the educated elite class of New York City. Her lawyer father moved the family to a rich suburb in Westchester County, where she and her four siblings lived in a big house, attended fine schools, and were raised by a stay-at-home mom. Also living in the home was an “African American woman,” who cooked, cleaned, and helped care for the children.

In this wealthy white bedroom community, Abel writes, poverty and racism “remained carefully hidden.” Whether an experience is hidden or visible, however, is not a statement of universal truth—it is a marker of a person’s position and a sign of what they are willing to perceive.

Abel explains that her mother was the source of a lacerating mindset that she internalized as a child, directed at the world as an adult, and rejected when she became immobilized by fatigue. That mindset captured a triumvirate of “cultural attitudes”: first, if an illness cannot be confirmed through externally verifiable evidence, then the patient is making it up; second, people have value to the extent that they are economically productive; and third, when people get sick, they can always recover. Sick and Tired is Abel’s disavowal of this cruel triumvirate and her repentance for the discriminatory thoughts and actions it produced in her. Above all, it is a raw processing of her relationship with her mother.

Abel recounts childhood headaches, stomachaches, skin rashes, pain sensitivity, a broken arm, and more, which her mother met with limited sympathy. Nesting her mother’s responses within the postwar context of psychosomatic theory and the medical model of disability, Abel laments, “My mother had little patience with sickness at home and believed that care could morph too easily into coddling.”

Abel attended elite universities, earned a doctorate in history, and became a faculty wife. When her husband accepted a professorship in Los Angeles, the family followed. Eventually, she found a teaching job and began writing about health and gender history. When Abel became debilitated by fatigue after undergoing chemotherapy, she stopped working; she could rely on her husband’s income to support them.

Abel pressed doctors to search for an “organic” cause, rather than a psychological source, of her fatigue. Eventually, she recognized the discriminatory logic of her assumption that mental illnesses are not real diseases. Likewise, when a friend urged her to file for disability accommodations, she admits, “I’ve never thought of disabled people as fully competent.” In processing her own upbringing, Abel comes to understand former truths as merely a set of values characteristic of white middle class America.

Substantial sections of this lean book give the history of overwork and the types of fatigue that Abel insists she is not experiencing (tiredness from stress or depression, for example) as well as the wishful cures of behavioral or biochemical change (naps, drugs). Just beyond the book’s pages is the crucial point that overwork has been medicalized because the alternative to “fixing” individuals’ tired bodies is to fix the system that is driving a growth economy amid a weak welfare state toward increasing economic inequality.

In portraying people’s misrecognition of fatigue as a matter of misplaced values, Abel prescribes individual value change at a mass scale. Absent from this approach is a structural account of the system that is invested in producing those values. A shift from a psychological to a structural account of fatigue would relocate Abel’s suffering from bad parenting to bad politics, bringing into alliance groups experiencing multiple, seemingly unrelated, forms of marginalization and precarious survival under capitalism, including but not limited to communities of health activism. The Black woman living as a domestic worker in her Westchester home, who flickered away in one line, would become essential to the story of Abel’s fatigue. With a structural account, relationships of mutual aid can emerge beyond the family and across lines of difference to build a more robust politics of care.

About the author

The reviewer is at the Department of History and the Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN 37235, USA.