Autonomic Imbalance and CFS (Chronic Fatigue Syndrome) in Japan
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Editorial add: Please see our reader Tobias Tohill's post in the end of this page. His post further explained the CFS as well as Dysautonomia, a word I wasn't aware when I wrote this article. If you have further comment, please post them to the end of this page.
A Japanese friend of mine recently got disease which was categorized as Autonomic Imbalance. I was shocked and I was worried that something in her central nervous system had gone wrong, or perhaps something in her mid ear, you know that little gyroscope-kind of organ, I was worried she might keep falling over.
But she can walk just fine and her nervous system has nothing wrong. In other words, she is suffering from chronic fatigue syndrome. But women in Japan are very rarely diagnosed as CFS, in fact the entire diagnosis is missing from Japanese medical science.
In Japan there are thousands, if not hundreds of thousands women suffering from CFS, but the symptoms of chronic fatigue are often diagnosed as "phantom illnesses" or just generally "something between her ears". Word for this is "jiritsu shinkei shitchosho" the autonomic imbalance, which sounds convincing, serious and efficiently draws the attention away from the real cause of the problem which would be the hard environment.
However, not even the CFS is well known or studied. It is still not yet sure what might be the reason of it.
Let's see what the U.S Centers for Disease Control say about the CFS. They say that patient must have at least one of the two:
"1. Have severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis, and;
2. Concurrently have four or more of the following symptoms: substantial impairment in short-term memory or concentration, sore throat, tender lymph nodes, muscle pain, multi-joint pain without swelling or redness, headaches of a new type, pattern or severity, unrefreshing sleep, and post-exertional malaise lasting more than 24 hours."
Although I'm not 100% sure, it appears this word has roots in Japan. Either Oxford English nor Wikipedia recognizes this term.
In the old times in US, there was diagnosis called "hysteria" which Freud labeled later as the term "neurasthenia" .
Still, as one might expect, either autonomic imbalance nor CFS appear only with females. It is equally men's problem in any environment that causes excess and continuous stress. Then why there are so much more reports from women rather than men? It could be simply that men feel it as a sign of weakness to go to doctor for such psychosomatic thing, although in reality CFS is not necessarely psychosomatic. Or it could be that the men take care of their heavy condition by excess doses of alcohol. This thought will lead to dark path. Japan is so far the only country in the world that has own word for "dying from working too hard".
However. Little is known even from CFS. There would be some clear biomedical issue that really exists, and that could be corrected medically by some as yet unknown technique. Obviously there is more to it than "stress of being a housewife" or the emotional aspect of stress. Oxford English mentios the following:
"CFS: a medical condition of unknown cause, with fever, aching, and prolonged tiredness and depression, typically occurring after a viral infection. "
I want to appeal for the doctors and medical experts of Japan to research this topic more, and make another example of Japanese cutting edge skills of team work. Rather than labeling the attempt as another pursuit of feminism, this should be taken seriously a medical research no different from seeking cure to cancer.
See also: Century of Women
Jiritsu shiken, a medical condition Japanese doctors (and electronic dictionaries) often translate as Autonomic Imbalance, is called Dysautonomia in English.
Dysautonomia was once called
"neurasthenia," or a "weak nervous system" in the 19th century and was almost entirely diagnosed to women. These women would present symptoms of fatigue, weakness, dizziness and fainting, and the doctor's orders would simply be bed rest. Some of these women died, while many others recovered. No one understood where the problems came from.
With the advances in modern medicine, diagnostic criteria and treatment for various forms of dysautonomia have sharpened. Doctors and researchers are including males in their subject population for this disorder.
There is no cure for dysautonomia. There are medications to assist, often needed on a long-term basis. In many cases treatment of primary dysautonomia is symptomatic and supportive. Measures to combat orthostatic intolerance (fainting and dizziness) include elevation of the head of the bed, frequent small meals, a high-salt diet, fluid intake, and compression hose. Drugs can be used to treat symptoms.
Treating dysautonomia can be difficult. Treatment that helps one individual may actually worsen the symptoms of another. Often drugs and measures that are helpful are found through trial and error.
Other disorders, such as multiple system atrophy (Shy-Drager syndrome) and chronic fatigue syndrome, have dysautonomia as one of several system malfunctions caused by them.
I have Dysautonomia. I am male, and have lived in Japan for four years. Its onset was sudden and acute. I started fainting at work. It would seem overtiredness, environmental and work stress, too much static standing and a lack of salt in my diet may have all contributed to causing the condition. The main symptom of it for me is Orthostatic Intolerance (fainting and dizziness). Fatigue is a secondary symptom.
Dysautonomia is not that same thing as Chronic Fatigue Syndrome (CFS), it is just one symptom of it. CFS is not well understood and quite contentious in many respects. CFS is diagnosed by Diagnosis of Exclusion, which means it's a medical condition whose presence cannot be established with complete confidence from examination or testing.
Interestingly, based on a 1999 study of adults in the United States, CFS is thought to affect approximately 4 per 1,000 adults. For unknown reasons, CFS occurs more often in women, and adults in their 40s and 50s.
The occurence of dysautonomia is at a ratio of 4:1 female-male. So both conditions are more often contracted by women than men, but are not exclusively gender-based.
Whereas there is agreement on the genuine threat to health, happiness, and productivity posed by CFS, various physicians' groups, researchers, and patient activists champion very different nomenclature, diagnostic criteria, etiologic hypotheses, and treatments, resulting in controversy about nearly all aspects of the disorder.
CFS occurs on a wide scale, and there are numerous symptoms. 8 categories of symptoms are Pain, Sleep Dyscfunction, Fatigue, Post-Exercise Malaise, Immune System Dysfunctions, Cognitive Dysfunctions, Autonomic Dysfunctions, Neuroendocrine Manifestations.
In Japan the occurence of Dysautonomia is very high. Obviously if research suggests CFS occurs in 4 in 1000 people, then not all of the cases of Dysautonomia in Japan are actually CFS, although some of them may be. To blame the doctors is unfair, as CFS is very difficult to diagnose. In addition, CFS is not cureable, and notoriously difficult to treat as well.
I have seen doctors in Japan about my dizzy spells. They have been thorough, well-informed, supportive and professional. But I agree with you that greater understanding of CFS is needed, and recognition of the effects of environmental stress on the autonomic system remains significantly unrecognised.
I am glad to see your post and for letting me know about Dysautonomia. We are all busy these days, so I am glad you took the time to write and correct me.
Indeed I wasn't informed about it and I'm not an expert in medical science by any chance.
However, I take that your comprehensive and well written post will add the necessary value to this article. I added note to the top of the page.
I wish you all the best!
Sincerely,
Jaakko Saari
Thank you for such a good explanation, my mother in law seems to have CFS according to your description, and we actually don't really know what to do. She lives in Japan and we are trying to help her and research more over the web.
Thank you
Natalia
First of all, CFS is not ME. ME is a extreme form of CFS, that remains not well understood. I have read a lot about it, but there seems few definite conclusions about its causes and treatment.
CFS is what we often call overtraining. CFS is just the effects of overtraining which last for a while.
In the post above I said there no cure for CFS. I mean there is no medicine for it.
This does not mean there is no treatment. Usually sufficient sleep, good nutrition, and avoidance of significant stressors will bring recovery.
Overtraining and CFS is common in athletes. If s/he overtrains, lacks sleep and depletes his/her mineral and nutrient reserves, overtraining is the body's reaction to force rest. The athlete will fully recover when time is taken to rest, eat well, sleep well, and destress.
There is no time frame for recovery, this is individual and depends on the causes of CFS, and the period of stress that caused it.
As I mention above, I was diagnosed with Dysautonomia - Jiritsushinkei in July last year while living in Japan. Jiritsushinkei is the Japanese name for overtraining, for CFS and for ME. It is very commmon in Japan, with perhaps as many as 1/3 of Japanese adults having been diagnosed with it at some point during their working lives. This seems awfully high, but working life in Japan is a high stress environment. Jiritsushinkei may also come from seasonal tiredness disorder which is rather unique to Japan, as Spring and Autumn there are very brief and night time temperatures shift from around -2.C at the beginning of Spring to +26.C within just the four weeks. The blood thins rapidly as temperatures change, and autonomic imbalances causing dizziness and fatigue is a commmon result.
In my case, at the time of posting the above comment I had been diagnosed with Jiritsushinkei. I was unsure of the extent of the problem, and learned a lot about the condition. As it turned out, my case was just the result of changing seasons and overtrained.
I had overtraining during Spring, and the combined effects of this, along with the standard stresses of living in densely populated urban Japan, had given me overtiredness and dizzy spells.
To recover, I rested from training for four weeks, slept well in the evenings after work, ate good nutritious food, and walked in the mountains on the weekends. Within four weeks symptoms had cleared up.
Jiritsushinkei seems uncommon in most other countries, where environmental stressors are less significant, working hours are considerably shorter than in Japan, and work holidays are more frequent and longer.
Apparently levels of overtraining and overtiredness are high in a Korea as well, a comparable society to Japan. However in Korea dietary supplements, such as ginseng, and traditional high-nutrition diets, help keep incidents and lower than in Japan.
At the time of overtraining, I typically worked a 12-hour day, slept 6 hours a night, ran a household on my own, and trained around 8 hours a week.
Lack of sleep seems to be the biggest trigger.
The overtiredness last four weeks. My body adjusted to the summer heat, recovered, and jiritsushineki has not been a problem since.
I am certainly more aware of overtraining now though.