Field of medicine: Internal medicine, family practice, rheumatology, psychiatry, neurology, and rehabilitation medicine.

Format: Softcover book.

Audience: Physicians involved in disability determinations.

Purpose: The editors "... hope to open the door to debate on equitable assessment of disability in CFS [chronic fatigue syndrome] and equitable access to entitlement programs."

Content: The book includes editorials about disability issues and the chronic fatigue syndrome; sections on the neuropsychological testing of patients with this syndrome, the legal aspects of this syndrome, and disability determinations; and general information about the Social Security Disability program. It concludes with contributions from two patients with the chronic fatigue syndrome, who relate their experiences with the condition and with long-term disability insurers.

Highlights: The sections on the Social Security Disability determinations process are particularly informative and useful for a broad audience. The proposed guidelines for disability determinations for chronic fatigue syndrome claimants are also novel. The section by S. Sandhaus, an attorney who represents patients with chronic fatigue syndrome who are seeking long-term disability benefits, provides an interesting look at how a practicing lawyer conceptualizes a case and uses medical records.

Limitations: This text is limited by general confusion about chronic fatigue syndrome as a valid and legitimate diagnostic entity. This syndrome is an idiopathic condition that overlaps considerably with well-validated (and potentially quite disabling) diagnoses, such as somatization disorder and major depressive disorder. A text such as this, which promotes the chronic fatigue syndrome as a distinct disease and then recommends procedures whereby persons with this syndrome may obtain long-term disability benefits, further legitimizes what might be a superfluous diagnosis. Particularly poignant are the two contributions by patients who insist that their condition is not "psychiatric"-as if a medical condition that happens to fall under the aegis of psychiatry cannot be devastating and disabling.

Context: Readers who are interested in balancing their view of the chronic fatigue syndrome would be well served by referring to a general psychiatry textbook, such as Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 6th edition (Williams and Wilkins, 1995). Persons who are less comfortable with a general psychiatry textbook might benefit from the relevant chapters in Washington University's Adult Psychiatry (Mosby, 1997). This book, edited by Samuel Guze (who developed the criteria for the Briquet syndrome, now called somatization disorder), is targeted toward the generalist or primary care practitioner. Donna Greenberg's Currents in Affective Illness interview (March 1992) provides an additional perspective on the chronic fatigue syndrome.

Reviewer: Gregg Bassett, MD, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois.