Yuppie Flu: Why does M.E Affect High Acheivers?

Yuppie Flu: Why does M.E affect high achievers?

‘I was such a high achiever before I became unwell’. I have heard this statement in many patient testimonials since I began reading about M.E CFS over a decade ago. As a high achiever living with the chronic illness myself, I wonder whether M.E really does affect high achievers more frequently? I’m not the first person to ask this question. M.E was known as yuppie flu in the 1980s because it was believed to be a disease of young, high achieving, burnt out professionals. In this essay I shall address questions such as ‘what is a high achiever?’ ‘when might M.E affect more doctors than patients?’ and ‘is the yuppie flu stereotype true after all?’

Firstly, some background. M.E/CFS (myalgic encephalomyelitis/ chronic fatigue syndrome) is a chronic illness classified by the World Health Organisation as a disorder of the nervous system(“Chronic fatigue syndrome,” n.d.). Blacks medical dictionary 43^rd edition defines ME as having a combination of extreme fatigue, muscle pain, lack of concentration, panic attacks, memory loss and depression.(Marcovitch, 2023) I quote this definition only because there is no standard criteria for diagnosing M.E, and no agreed upon definition or exhaustive symptom list. A key feature described by many patients and doctors as a defining feature is post exertional malaise- the marked worsening of symptoms following even minor physical or mental exertion. For the purpose of this essay, it is enough to understand that almost all people with M.E have a marked reduction in functioning compared to their premorbid states. Action for M.E says “even in its so called mildest form, M.E can have a significant impact on a patient’s life.” (ME, n.d.)

Secondly, what is yuppie flu? The term M.E/CFS is hotly contested, and M.E has been known by many other names throughout medical history. In 1984 an M.E epidemic occurred in the US near Lake Tahoe. 160 people became unwell with CFS. Although the CDC were notified, they did not examine any of the patients. Stephen Straus, a highly awarded virologist at the National Institute Of Health called the illness ‘a disease of depressed menopausal women’. The media went on to term the illness ‘yuppie flu’. (“The Incline Village Outbreak,” 2014). Yuppies are young upwardly mobile professionals, and the insinuation behind the name was that M.E was an illness imagined by burnt out successful young people who couldn’t keep up with their commitments. M.E was billed as an excuse. In the 1990s, Dr Anne McIntyre writes ‘yuppie flu, now hopefully obsolete… M.E was mistakenly believed to hit middle class high achievers’. (Macintyre and Francis, 2009)

There are two terms that need definition: ‘yuppie’ and ‘high achiever’. They are not interchangeable, although yuppie is a stereotype based on high achievers. For the purpose of this essay, a high achiever is someone who is hard working, self motivated and achieves success in their area of choice. A yuppie is a young, middle class high achiever. The limit of these definitions is that they are arbitrary and not backed by evidence based research. However, research is lacking. The key point is the yuppie flu stereotype suggests a young ‘high achiever’ becomes a yuppie, the yuppie gets burnt out and becomes a person with M.E.

In the first section of this essay I’ll consider whether the yuppie flu stereotype is true. Is it true that young middle class high achievers are more likely to have M.E?

I’ll start with young people- the answer is yes! The M.E Association states that ‘the commonest age of onset for M.E/ CFS is during the early 20s to mid 40s.’ (“The ME Association,” 2024)

Next: are middle class people more likely to develop M.E? In her book M.E CFS A Practical Guide, Dr Anne McIntyre quotes a telephone survey of residents in San Fransisco lead by Steel, Dobbins and Fukuda from the CDC in 1996. The survey looked at prevalence and characteristics of chronic fatigue in a diverse urban population. The survey found there was a higher incidence of M.E in people with low income backgrounds. (Macintyre and Francis, 2009)There are many flaws with this survey: M.E cannot be accurately identified through one telephone call, and the sample of subjects may not have been representative of the population. However, this evidence shows M.E is not a disease solely of the middle classes.

Thirdly, are high achievers more likely to be affected? This is unclear due to a lack of research into M.E/CFS. However, there is evidence that working hard and ‘pushing through’ during the early stages of a viral illness can increase the risk of developing M.E. Recall that working hard was one of the characteristics I used to define a high achiever.

An example of hard work making M.E more likely comes from the 1995 M.E outbreak at the Royal Free Hospital in London. 292 people became unwell with M.E following an outbreak of an upper respiratory tract infection. Almost all the people who developed M.E were doctors, nurses or other hospital personnel. The patients with the infection recovered, and it has been theorised their bed rest was a protective factor. This suggests hard work during an infection increases the likelihood of developing M.E. (Macintyre and Francis, 2009)

Another piece of evidence that M.E affects high achievers comes from Houdenhove’s 1995 study. Recall that I included self motivation in my definition of a high achiever. Houdenhove defined ‘action-proneness’ as a personality feature and asked whether action-proneness makes people more vulnerable to CFS. He found that patients with M.E/ CFS are significantly more action prone than ‘neurotic or chronic organic’ patients. (Van Houdenhove et al., 1995) This study’s explanation for why M.E patients are action prone has been discredited, but the data suggests self motivation may be a feature of M.E.

To summarise the discussion so far: M.E is a chronic illness of the nervous system causing post- exertional malaise. M.E was nicknamed yuppie flu in the 1980s because it was believed to affect young middle class high achievers. There is some evidence for this- the commonest age of onset is earl 20s to mid 40s, the Royal Free outbreak affected mainly hospital staff, people with M.E are more action prone than control groups. However, M.E is not a disease of the middle class. I argue that if we put the middle class yuppie stereotype aside, there is evidence that M.E is more likely to affect hard workers. This is different to high achievers, but my definition of high achievers includes hard workers.

The next question is why are high achievers more likely to be affected by M.E? Firstly I will present the contrary argument: M.E does not predominantly affect high achievers. There are several explanations for why M.E appears to affect high achievers. Firstly, M.E’s primary age of onset is 20s to 40s, which is traditionally thought of as the prime of athletic life. If a sample of people with M.E is compared to the general population, patients may appear disproportionately high achieving. I don’t agree with this argument. Many people do not peak in their professional careers until later in life. Also, comparing people with M.E to an age-controlled sample of the general population would remove this error. This is a phenomenon restricted to the anecdotal and unscientific perception of M.E, such as patient testimonials or the media.

Furthermore, yuppie flu is a term coined by the media.(“Chicago’s Yuppie Turns 35. Do We Celebrate Yet?,” n.d.) I wonder whether high achievers or yuppies are more likely to speak to the media about their illnesses and experiences? Every year M.E charities share patient stories. I wonder whether the people sharing their experiences- the sample- are reflective of the population of people with M.E. Due to a lack of research, this question cannot currently be answered.

Having explored some reasons M.E might erroneously appear predominantly to affect high achievers, I’m now going to assume M.E does affect more high achievers and explore some theories to explain why.  

Being a high achiever is an aspect of someone’s personality. In their book Personality, Individual Difference and Intelligence Maltby, Day and Mackaskill postulate three models by which personality may influence illness. Number one is psychosomatic: personality causes biological processes causes illness. For example, being a hard worker causes stress causes raised blood pressure causes heart disease. Dr Anne McIntyre lists stress as a predisposing factor for M.E. Psychosomatic theories of M.E/CFS are widely rejected by patients because it is seen as attributing ME to mental illness or fabrication. There is insufficient research to draw a conclusion on whether there is a psychosomatic component to M.E. It is worth noting that Maltby et al cite stomach ulcers as a psychosomatic illness (Maltby et al., 2022). It is now known H. pylori infections are responsible for stomach ulcers. The stomach ulcers example demonstrates the harm caused by assuming conditions are psychosomatic- patients go without treatment that would improve their symptoms.

The second mechanism by which personality may affect illness cited by Maltby et al is a correlational link: A gene causes a personality trait and also separately increases the likelihood of developing a specific illness. There is emerging research into a genetic component of M.E, such as the Decode M.E study. Dr Anne McIntyre outlines predisposing factors to ME which include a genetic link. It is well established that M.E sometimes runs in families. However, the specific genes are yet to be identified and it’s not possible at present to assess whether the genes associated with M.E are also associated with high achieving.

The third mechanism postulated by Maltby et al is personality causes a behaviour causes an illness. There is evidence this may be at play in M.E. Lets consider the Royal Free outbreak discussed earlier. High achieving or hard working people may be more likely to put stress on their body when unwell with a viral illness, which puts them at greater risk for M.E. Without more research into M.E, its impossible to know whether this is a causal relationship.

To summarise the second half of this essay: Why are high achievers more likely to be affected by M.E? The most valid answer is that we don’t know. Far more research is needed before the causes of M.E can be identified, and therefore causal links between illness and personality are hard to demonstrate. However, there is evidence of a genetic component, a stress component and a behaviour component to risk of developing M.E.

There were two questions postulated in the essay title- firstly is it true that M.E predominantly affects high achievers, and secondly why does M.E affect high achievers? For me the key piece of evidence is the Royal Free outbreak. This is the clearest example we have of M.E developing in those who were working, and not those who were resting. Based on this combined with the other evidence discussed, I conclude M.E is more likely to affect those who work/ stress/ push their bodies during a viral infection.

Whether M.E predominantly affects high achievers is difficult to pin down due to arbitrary definitions, stigma in the media and scientific community and an overwhelming lack of research. However it is clear to me from my years as a person with M.E, that many M.E patients led extraordinary lives before developing the illness, and many continue to lead extraordinary lives now they are ill.

 

Bibliography:

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Chronic fatigue syndrome [WWW Document], n.d. URL https://www.who.int/standards/classifications/frequently-asked-questions/chronic-fatigue-syndrome (accessed 5.27.24).

Macintyre, A., Francis, C., 2009. M.e.: Chronic fatigue syndrome: A practical guide. Thorsons, London.

Maltby, J., Day, L., Macaskill, A., 2022. Personality, individual differences and intelligence, Fifth Edition. ed. Pearson, Harlow, England London New York Boston San Francisco Toronto Sydney Dubai Singapore Hong Kong Tokyo Seoul Taipei New Delhi Cape Town Sao Paulo Mexico City Madrid Amsterdam Munich Paris Milan.

Marcovitch, H. (Ed.), 2023. Black’s medical dictionary, 43rd edition. ed. Bloomsbury Business, London.

ME, A. for, n.d. Severe M.E. [WWW Document]. Action ME. URL https://www.actionforme.org.uk/get-information/what-is-me/severe-me/ (accessed 1.11.21).

The Incline Village Outbreak, 2014. . Myth. Pict.

The ME Association [WWW Document], 2024. . ME Assoc. URL https://meassociation.org.uk/ (accessed 5.27.24).

Van Houdenhove, B., Onghena, P., Neerinckx, E., Hellin, J., 1995. Does high ‘action-proneness’ make people more vulnerable to chronic fatigue syndrome? A controlled psychometric study. J. Psychosom. Res. 39, 633–640. https://doi.org/10.1016/0022-3999(95)00008-9