Shirah Vollmer MD

The Musings of Dr. Vollmer

Debilitating Fatigue

Posted by Dr. Vollmer on March 19, 2014

Wyatt, fifty-three, comes in complaining of “debilitating fatigue.” He sleeps fine, and consistently, and yet, he never feels like he has enough energy. A medical work-up proved negative, meaning there was no obvious medical explanation for his, what he experiences, as a sudden free-fall into “no energy.” “Tell me about your life,” I say, trying to understand the complexity to his fatigue. Certainly, medical problems are still on my mind, but at the same time, I wonder about his fatigue as an unconscious manifestation of his psychological stress. “Well, I am getting a divorce. I am really unhappy that I won’t see my kids, as much, but that has gone on for six months now.” He says, as if six months is a long time. “Maybe now it is hitting you in a new way,” I say, suggesting that the journey of adjustment is a long process. “That is possible,” Wyatt says, in a way in which he feels open, but reluctant to accept a psychological explanation for his fatigue. Fatigue, like a fever, is the point of inquiry, both medical and psychological, in which the mystery begins. Like the Malaysian Airlines plane disappearing, so too, Wyatt’s fatigue presents more questions than answers. Moving away from binary thinking is the key. Many factors could be at play, creating a perfect storm of mental distress. As long as Wyatt and I can stay in a place of curiosity, we can begin to explore together, possibilities which might illuminate factors which go into his “sudden free-fall.” As with all kinds of disturbances, the fatigue then causes secondary issues of depression and hopelessness. The spiral goes down, giving us the challenge of making a 180. Exercise, diet, and meditation are all positive suggestions, but our focus is motivation. Wyatt needs to see there is light at the end of his fatigue. Working together helps give him the hope and discipline to keep focusing on his fatigue, until it goes away. I do not long how long it will take, but I do know that we are in it together until the spiral turns.

2 Responses to “Debilitating Fatigue”

  1. Shelly said

    There’s the chicken and egg problem here. Is Wyatt fatigued because he is depressed, or is he depressed because he is fatigued? Or does he not complain of depression at all, just unhappiness that he won’t get to see his kids enough because of the upcoming divorce? How is his job going? Financial situation? To the person who feels fatigued, sometimes exercise and a change of diet can be overwhelming. Is Wyatt open to your suggestions?

    • Yes, the chicken/egg problem is always present. His openness, like all of us, changes from moment to moment and from session to session. Seeing the fatigue like a fever, as a point of inquiry is the challenge. Yes, exploring these other aspects of his life is one way to explore the many factors of his fatigue. Wyatt serves as an example of how symptoms point to further inquiry. The goal is not so much to get rid of his fatigue, which would of course be helpful, but the goal is to understand the contributing factors to his fatigue so that he can then deal with the underlying issues which will then create a more long-lasting sense of wellness.

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