ABSTRACT: Leading CFS researcher, Jay A. Goldstein, MD posits an
etiology for CFS in limbic encephalopathy in a dysregulated neuroimmune
network. Thus his allopathic treatment protocols include interventions
in the “bidirectional communication” between the immune and neuroendocrine
systems. This means that CFS can be considered among those syndromes
which respond to Psychoneuroimmunology (PNI), through intervention in the
“cross-talk” between the central nervous system and the immune system.
Viral disease can also cause neuropsychological deficits which are amplified
under physical or emotional stress. The limbic system plays a crucial
role in regulatory physiology. The Consciousness Restructuring Process
(CRP) can influence this psychophysical network, through cognitive, behavioral
and attitudinal changes that alter the state of limbic elements.
Nonrestorative, alpha-EEG sleep abnormalities are common in CFS patients.
Nevertheless, most report frequent, vivid dreams and nightmares which can
be used to initiate the therapeutic process.
Chronic Fatigue Syndrome (CFS) has been called one of the most treatment-resistant
disorders encountered in primary care. Though there are several views
of its underlying causes, this paper will approach it as a disorder of
regulatory physiology, and describe a process-oriented therapy which intervenes
to re-establish self-organizing order in the whole pyschophysical organism.
CFS is the result of an interplay of genetic, environmental, and infectious
factors. Only the limbic dysfunction theory can account for the diverse
symptomology, whether its source is a viral syndrome, post-viral syndrome,
immune dysfunction, neurologic disease, or metabolic/nutritional/toxic/hypersensitivity
disorder. As of today, the biopsychosocial model yields the best
treatment options, combining allopathic medication and psychotherapy.
Most patients who complain of fatigue have normal workups. However,
the symptom profile of CFS is fairly distinctive, with prolonged fatigue
after exercise, cognitive impairment, characteristic tender-points, and
recurrent flu-like illnesses with sore throat. Onset generally occurs
between ages 30-35. The finding of limbic/prefrontal abnormalities
in all CFS patients augments the distinction between CFS and depression,
and between “physical” and “mental,” and lends support to a certain type
of somatization as relevant to CFS physiology. The tendency to somatization
is amplified when childhood abuse is a factor. The amygdala, or alarm
signal in the brain, gets conditioned into hyperactivity. Traumatic
stress modifies synaptic connections to alter normal regulation of neuroimmune
function, and may be a factor in predisposition.
In CFS, the brain is involved with inappropriate, or chronic, immune activation
which leads to the production of auto-toxic chemicals in the body, which
in turn feedback to the brain producing mood disorders and cognitive dysfuctions.
The bidirectional communication of this psychosomatic network forms a feedback
loop between the immune system and CNS (Central Nervous System).
Thus, CFS appears to be a psychoneuroimmunolgic disease since neurologic
symptoms are prominent and the severity of the illness, including flu-like
symptoms, is so influenced by stress.
It becomes difficult when the disease is raging to know “what is me and
what is the disease process?” Emotional issues are involved such
as lowered self-esteem and sensitivity to rejection.
SYMPTOMS AND DIAGNOSIS OF CFS
The symptoms of CFS are numerous and easily mistaken for other disorders,
such as fibromyalgia (FM) or multiple sclerosis (MS). Both CFS/FM
syndromes can appear together and share characteristic tender-points and
hypersensitivity, and limbic disorders. Many neuropsychiatric, allergic,
neuroendocrine, psychosomatic, and functional disorders can be found in
the CFS population. Thus, it is a syndrome with various manifestations,
characterized by multi-system dysregulation.
Diagnosis includes distinguishing the range of symptoms from its mimics,
such as FM, and the chronic fatigue of Hepatitis C and mononucleosis.
As well as a physical exam and tests, there are brain function tests (neuropsychological
testing), like that of the SPECT scanner, PET and MRI. Topographic
brain mapping with evoked responses is almost always abnormal in CFS patients
. The temporal lobes, left more than right, are most frequently abnormal
on visual and auditory evoked response measurement by BEAM (brain electrical
activity mapping). Functional capacity evaluation (FCE) is also useful.
Cognitive testing has shown that CFS patients are prone to overestimating
their cognitive abilities. A 90-item symptom checklist for CFS uses a 5-point
self-rating scale. It has nine dimensional scales: somatization,
obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility,
phobic anxiety, paranoid ideation, and psychoticism. [See Appendix
A for CFS Symptom Checklist]. Screening also includes depression,
anxiety and somatization inventories. CFS can occur simultaneously
with personality and mental health disorders, such as Bipolar, MPD, Borderline
Personality, and Anxiety Disorder.
CFS symptoms range from hypersensitivity and mood swings to sleep disturbances,
frequent nightmares, muscle and joint aches and weakness, to recurrent
flu-like symptoms, decreased libido, allergies and other immune disorders.
Other aspects include irritability, PMS, anxiety, panic disorder,
restless leg syndrome (RLS), sleep apnea, headache, bruxism, fibromyalgia,
tinnitus, vertigo, hyperventilation, carpal tunnel syndrome (CTS), arrhythmia
or tachycardia, and irritable bowel syndrome (IBS).
Symptoms can be mild or severe, and vary widely between patients in type
and degree of impact. A defect in natural killer (NK) cell activity
is frequently seen in the CFS population. Reactivation of CFS is
often accompanied by reactivation of other stress-related viruses, such
as Herpes. It has been conjectured that perhaps the gene products
of multiple infectious agents may need to synergize to produce the characteristic
Hugh Besedovsky, a preeminent researcher on immune function, views the
immune system as being a “receptor sensorial organ” and has demonstrated
that the hypothalamus and the limbic system respond to activation of the
immune system as they would to other types of “somatic” receptors.
In line with the immune system’s being a receptor sensorial organ that
responds to alterations in an internal self image, these researchers postulate
a “code based on combinations of soluble messengers which could inform
the central nervous system about the type of immune response in operation.”
The response of the organism will therefore be determined by the immune
and neuroendocrine systems acting in a network.
The immune system cannot be dealt with in an isolated manner. That
is why Psychoneuroimmunology takes a psychophysical approach. The
Consciousness Restructuring Process uses this philosophy of treatment as
the basis for a mind/body intervention which creates more harmony in that
interaction. It is especially useful in the so-called “treatment-resistant
depression,” which responds poorly to drug treatment.
THE LIMBIC SYSTEM
We can only understand CFS by grasping that the generation of symptoms
involves a part of the brain called the limbic system, master regulator
of the brain and body. Limbic dysfunction may produce the symptoms
of chronic fatigue syndrome. Thus, some symptoms of CFS are similar
to temporolimbic epilepsy and migraine auras. The limbic system is
the visceral brain which acts as a buffer between the internal and external
world. It is involved in memory storage and retrival.
CFS is not depression, per se, but features serotonin deficiency.
It can be more productively viewed as a limbic encephalopathy (limbic/prefrontal
abnormalities). It is aggravated by stress, exercise, infection,
and possibly nasal allergy. It is thought that the associated fatigue
is inappropriately generated by the central nervous system, unrelated to
physical exertion. Those with CFS can wake up fatigued from stress,
odors, trauma, circadian oscillations, or from no apparent cause.
The medial temporal lobe is the fatigue center. This is exacerbated
by slow-wave sleep deprivation and leads to cognitive dysfunction.
The limbic system comprises several brain structures associated with memory
and emotion, particularly the temporal lobe of the brain. The hypothalamus,
the limbic system, and the amygdala have all been proposed as the centers
of emotional expression.
The emotions are what link body and mind into bodymind. Neuropeptides
or cytokines and neurotransmitters are small informational substances which
both initiate and respond to environmental and emotional cues. Neuropeptides
and their receptors, the biochemicals of emotion, orchestrate many key
bodily processes, linking behavior and biology to effect a smooth functioning
of the organism. The immune system and endocrine system are intrinsic
parts of this bodymind circuit.
The limbic system plays a role in the emotional hijackings we experience,
sexual passion, worry, and PTSD (Post Traumatic Stress Disorder).
It is implicated when passions overwhelm reason, when we have instinctual
impulses to act. It regulates the psychophysiology of anger, fear,
fight-flight, happiness, love, surprise, disgust, and sadness. Our
biological propensities are shaped further by our life experiences and
our culture. Childhood trauma preconditions the limbic system for
We all know the higher centers don’t always govern emotional life, especially
in crucial matters of the heart, and in emotional emergencies. Control
defaults to the limbic system. Because so many of the brain’s higher
centers sprouted from or extended the scope of the limbic area, the emotional
brain plays a crucial role in neural architecture. It shares intertwined
circuits with all parts of the neocortex, enabling it to influence the
functioning of the rest of the brain--including its centers for thought.
The amygdala plays a crucial role in this circuit as a neural tripwire
or emergency alarm signal. It activates the emotional centers.
This visceral-mind is a source of “gut-feelings.” This emotional sentinel
can be programmed with out-of-date neural alarms which keep the body/mind
hypervigilant and overreactive. They may be residuals from very old
or more recent traumas, compounding with one another.
Emotions affect our health and toxic emotions influence it adversely, through
anger, suicidal ideas, panic and anxiety which is out of proportion and
out of place. A single trauma can program a severe dysfunction, but
the Consciousness Restructuring Process facilitates emotional relearning
which promotes psychophysical recovery or remission. Therapy targets
precisely the effects of PTSD on the amygdala and connected neurotransmitter
The hallmarks of the emotional mind are a quick but sloppy response, first
feelings and then thoughts, a symbolic childlike reality, the past imposed
on the present, selective memory, and a state-specific reality dictated
by the feeling or mood of the moment. Both drugs and mood states
have been shown to induce state-specific encoding operations and retrieval
strategies, and provide specific cues for accessing previous experience.
Information acquired in a given state remains available in memory, but
inaccessible when remembering takes place under different retrieval (state)
HEALING TRAUMATIC STRESS
Horrors frozen in memory can be “liquified” and transformed for the benefit
of the whole person. PTSD is a limbic disorder which may be compounding
some cases of CFS and FM, and manifest as Dependent Personality Disorder.
CFS patients with this feature may use their disease for secondary gains,
and thus try to avoid recovery as a means of maintaining a pseudo-control
or the status quo.
In PTSD, emotional re-learning fails to occur, and fear pathways are reinforced
and generalized by anything even vaguely reminiscent of the original trauma.
For CFS patients, making new memories is extremely fragile and disrupted
by proactive interference; they do not benefit from memory cues.
The making of new memories is easily disturbed by increasing the amount
of information presented.
How does this translate into body chemistry? Our labels filter and
influence how we experience emotions. How we chose to label an emotion
or thought, influences our internal, subjective experience. These
choices influence our stress level. A former decision about
an experience, a former belief about the world, prevents us from allowing
in new information.
In Chaos Theory, when information gets organized in the same way each time,
it is called infinite nesting, the natural phenomena by whereby structures
tend to replicate themselves. Belief structures acts as control parameters
for the outcome of behavior creating artificial boundaries. Patterns
repeat underlying beliefs, patterns within patterns, which is known in
Chaos Theory as self-similarity.
The self-organizing of our internal universe in order to maintain its equilibrium
causes major psycho-emotional limitations. We reject all disruptions
to this underlying state and self-organizing, and accept only those which
maintain our view of ourself and the world. If condensed energy or
a nucleus of energy shifts its attention around and becomes aware of itself
as undifferentiated energy, then the attraction to create the molecules
of anger, disease, fear, or pain is shifted.
Through our label, we experience and condense an emotion into a particle.
This decision about undifferentiated energy, labeled fear, pain, or stress,
initates and kindles the production of neuropeptides, or chemical messengers.
This chemical reaction is the link wherein mind affects matter, which then
feedsback onto the physical organism in a vicious cycle. The more
this cycle is reinforced the more fixed it becomes in the mind/body.
The energy becomes solidified when we hold a set of fixed beliefs around
it. Different or new information cannot flow in or out; consciousness
then becomes less fluid.
Thus, the particle is essentially a belief. When we look at our own
experience, we can notice that when we believe something is true, we feel
it is true, and it becomes subjectively true for us. All the events
in the world that seemingly happen to us are funneled through that belief-system.
This reinforces the standard we have of the world and ourselves.
By judging our experience as good, bad, or neutral we begin to solidify
our own perceived realities. The more we continue to access these
realities and label them, we create more density and mass in our thoughts
and emotional patterns. We believe the reality we create is the true
one. As this energy continues to be labeled, the belief in our internal
reality and its perceived nature solidifies.
The latest research on the molecules of the mind bears out this notion
that beliefs manifest as physical particles. Information initiates
and controls the process. According to Candace Pert:
“In a network, there is a constant exchange and processing and storage
of information, which is exactly what happens, as we have seen, as neuropeptides
and their receptors bind across systems. . .So what we have been talking
about all along is information. In thinking about these matters,
then, it might make more sense to emphasize the perspective of psychology
rather than of neuroscience. . .[The mind] may be said to have a nonmaterial,
nonphysical substrate that has to do with the flow of that information.
The mind, then, is that which holds the network together, often acting
below our consciousness, linking and coordinating the major systems and
their organs and cells in an intelligently orchestrated symphony of all
life. Thus, we might refer to the whole system as a psychosomatic
information network, linking psyche, which comprises all that is of an
ostensibly nonmaterial nature, such as mind, emotion, and soul, to soma,
which is the material world of molecules, cells, and organs. Mind
and body, psyche and soma.”
Thus, the classically separated areas of neuroscience, endocrinology, and
immunology (with their various organs) are actually joined to one another
through a multidirectional network of communication, linked by information
carriers known as neuropeptides. Peptide-producing cells like those
in the brain also inhabit the bone marrow, where immune cells are “born.”
“When researchers found brain peptides in the immune system, they went
looking for neuropeptide receptors there. They discovered that every
receptor found in the brain is also on the surface of the monocyte. . .These
emotion-affecting peptides, then, actual appear to control the routing
and migration of monocytes, which are very pivotal to the overall health
of the organism. . .they help the immune system launch a well-coordinated
attack against disease. . .Immune cells also make, store, and secrete the
neuropeptides themselves. In other words, the immune cells themselves
are making the same chemicals that we conceive of as controlling mood in
the brain. So, immune cells not only control the tissue integrity
of the body, but they also manufacture information chemicals that can regulate
mood or emotion. This is yet another instance of the two-way comunication
between brain and body.” (Pert, 1997).
These chemical messengers even have a way of breaching the blood-brain
barrier. They bind on receptors on the surface of the brain in such
a way they affect the permeability of the brain’s surface membranes.
From there they propagate a signal that gets picked up by other peptides
and receptors deep within the brain. The questions is: What
is the purpose of such communications?
Information generated in the body at large is fed back directly to the
brain, which Pert has laughingly described as “a big hormone bag!” inundated
with peptide juices. This is a paradigm shift from the old synaptic
model to one of information exchange. The mind in the body is concerned
with filtering, storing, learning, remembering, and repressing. Neuropeptides
are the cues for our bodymind to retrive or repress emotions and behaviors.
Emotions help us decide what to remember and what to forget. And
these memories are state-dependent on the various neuropeptides which created
the emotional states or mood. Feeling is also a mechanism for activating
a particular neuronal circuit--simultaneously throughout the brain and
body--which generates behavior involving the whole person, with all the
necessary physiological changes. Pert concedes that the sum of the
peptide secretions in our brains and bodies biases our memory and behavior
so we automatically get what we expect.
However, healing feelings and happiness can also result from natural hormones,
in a rapid feedback loop during therapy. Pert believes that, “happiness
is what we feel when our biochemicals of emotion, the neuropeptides and
their receptors, are open and flowing freely throughout our systems, organs,
and cells in a smooth and rhythmic movement. Health and happiness
are often mentioned in the same breath, and maybe this is why: Physiology
and emotions are inseparable. I believe that happiness is our natural
state, that bliss is hardwired. Only when our systems get blocked,
shut down, and disarrayed do we experience the mood disorders that add
up to unhappiness in the extreme.”
The question becomes, “How quickly do you let go of learned fear?”
That takes an intentional, conscious intervention on unhealed feelings.
It includes becoming conscious, accessing the psychosomatic network, tapping
into your dreams, getting in touch with your body, reducing stress, adopting
a healthier lifestyle, and spiritual healing.
The Consciousness Restructuring Process is highly effective for leading
clients passed their perceived fears and psychophysical pains, and in reeducating
the emotional brain. This emotional relearning leads to recovery
from trauma. It restores the sense that they need not be completely
at the mercy of the emotional hijacking and alarms that flood them with
anxiety, sleeplessness, and nightmares. Brutalized emotional circuitry
rediscovers that life is not a threat and helps restore a sense of security
The limbic system is involved not only in higher order regulatory structure
and the neuroendocrine immune network, it is implicated in consciousness
and the interface of mind and body. Therefore the therapeutic effect
of dream journeys can be immediate. Diffuse projection systems such
as exist for dopamine, norepinephrine, serotonin, and acetylcholine could
be rapidly modulated, taking only seconds to occur.
Most CFS sleep is non-restorative. Jet lag and shift work cause greater
difficulty for sufferers. However, CFS patients report very vivid
dreams, which can be used as therapeutic starting-points. The cause
of alpha-EEG sleep abnormalities in CFS and fibromyalgia (FM) is unknown.
They are also prone to “somatosensory amplification,” which can be utilized
in the therapeutic intervention.
Cognitive, behavioral, and attitudinal changes can alter the state of limbic
elements, producing biological changes in neurotransmitter production and
deployment. In the psychoneuroimmunological postulate, psychological
influences can do most things that viruses can do; the virus may simply
provide a bridge between the “psychological” and “organic.” CRP interrupts
this somatization disorder, modulating not only the biology, but the individual’s
CONVENTIONAL TREATMENT PROTOCOLS
In the mid-1980s, when doctors found that many people with CFS had high
levels of antibodies to the Epstein-Barr virus (EBV), which causes mononucleosis,
in their blood, they thought they had found the culprit. But it turned
out many healthy people also had high EBV counts. Scientists also
found high levels of other viral antibodies in the blood of those with
CFS. It is now conjectured that a combination of viruses may trigger
CFS. There is still no single known cause for CFS, and there is no
cure, but many treatments are available to help relieve the symptoms.
The role of psychological problems in CFS is very controversial.
Because many with the syndrome are diagnosed with depression, some conclude
that the symptoms are psychological. But without evidence of psychological
disorders prior to onset, we can conclude the depression is a result of
mood-altering neurohormones created in the disease process, as described
in extensive PNI research.
Treatment programs are individualized to each person’s particular symptoms
and needs. The first treatment is generally a combination of rest,
exercise, and a balanced diet. Prioritizing activities, avoiding
overexertion, and resting when needed are keys to maintaing existing energy
reserves. Moderate exercise helps conditioning, but too much can
worsen fatigue and other CFS symptoms. Counseling and stress reduction
techniques also help many.
Many medications, nutritional supplements, and herbal preparations have
been used to treat CFS. Conventional drug treatment includes NSAIDS,
nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen, to
relieve pain and reduce fever. Flexeril is prescribed for pain and
Depressive symptoms are treated with antianxiety drugs. Florinef,
a synthetic steroid, helps the body retain salt, increase blood pressure
and stave off hypotension. Beta-blockers, gamma globulin, and Ampligen
are also employed, as needed.
Integrative treatments include vitamin and mineral suppliments, immune-boosting
herbs (astragalus, echinacea, garlic, ginseng, gingko, shiitake mushroom
extract, borage seed oil, and quercetin), and stress reduction techniques
(biofeedback, meditation, acupuncture, yoga).
The course of CFS varies widely. Some people get worse over time,
while others gradually improve. Some individuals have periods of
illness that alternate with periods of good health. While many never
fully regain their health, they find relief from symptoms and adapt to
the disorder by getting adequate rest, nuturtion, exercise, and other therapy.
CONSCIOUSNESS RESTRUCTURING PROCESS
The Institute for Applied Consciousness Science (IACS) has developed and
uses a Consciousness-Restructuring Process (CRP) to treat Chronic Fatigue
Syndrome. It utilizes REM-dream consciousness. A brief description
of the process follows:
Imagination-REM based, the process explores the sensory nature and roots
of a dream, feeling, or symptom. REM is attained through breathing
techniques. Using imagination in this state, the patient begins to
notice and identify images and/or sensations suggested by a dream symbol,
feeling or symptom itself. These sensory images of what the experience
is like are followed to their source, that is, to the consciousness structure
that shaped an formed them. This process is often described as a
“Dream Journey,” and we used to call this therapy Dreamhealing. But
not all journeys begin with dream material, however they all take place
People’ lives, behaviors and physiology are based on perceptions of self
and its relationship to the world. Past and present experiences create
consciousness structures that are stored as the neural patterns and shape
these perceptions. This body-mind phenomenon underlies our personal
and unique experience of self and reality.
CRP allows the experience of this structure as a primal self image.
It is a sensory, existential, (meaning self, the world and the relationship
between them), self-image; becoming aware of and accepting it as self presents
the means to restructure it. Studies at IACS demonstrate that fear-based
patterns of consciousness such as these seem to be the body-mind’s foundations
of illness of all types.
Dreams occur in REM sleep while the brain is in its most complex and chaotic
synaptic firing dynamics. In this extremely complex neural state,
it is generally thought that the brain is organizing the stimuli experienced
from daily activities, and developing new neurological firing patterns
in the nervous system to help assimlate, integrate or deal with them.
These dream state or chaos/complexity brain dynamics are needed to balance
and heal our complex organism.
Our dream experience is shaped by these inner, consciousness patterns (neural
firing patterns) that also shape our behavior and physiology. Every
dream, among other things, is a self-portrait, but an impressionistic one.
Each dream element represents different aspects of self, although since
dreams are holographic in nature, any part or symbol in a dream also contains
By imagining the sensory experience of becoming one of the dream symbols
and following this sense of being to its source, we directly experience
the consciousness dynamics and patterns underlying it. These dynamics
at this primal level incorporate the disease patterns. This “exploration”
is accomplished using imaginary sensory images that arise spontaneously
from the subconscious. Using CRP as the primary treatment modality,
one dreamhealing participant lowered her EBV count from 900 to 90, over
a period of time; “normal” count is 100.
APPENDIX A: CFS SYMPTOM CHECKLIST
Gale Encyclopedia of Medicine
Goldstein, Jay A., M.D. CHRONIC FATIGUE SYNDROMES: THE LIMBIC HYPOTHESIS,
Haworth Medical Press, New York; 1993.
Goleman, Daniel, EMOTIONAL INTELLIGENCE, Bantam Books, New York; 1995.