Interesting finding from my reading of a 1993 CIBA conference on ME/CFS including a range of researchers in early 90s. The role of viruses was largely dismissed but 1 virologist raised concerns about the role of viruses that can clearly cause fatigue and immune changes. 
A black box in ME/CFS from 1990s has been virologists uncertain "how" viruses cause fatigue in eg mono-EBV natural history studies show 10% of EBV sufferers may experience prolonged fatigue. Today we could think LongCovid. Psychiatrists theorised 'reasons' for fatigue continuing.
We do not know how or why one patient suffers prolonged fatigue and others do not following #Covid-19, or #ME/CFS, or EBV, our medical technology is not good enough to detect why at a cellular level. What do know is viruses and bacteria eg Lyme, Bart, can trigger chronic illness.
Psychiatrists noted fatigue in depressed patients and cross-tabulated with CFS that a central unknown process must generate this fatigue - given "pathology" to explain fatigue remains unknown! CBT was introduced to change depressive thoughts, and beliefs in a viral illness.
In this slide, we see one psychiatrist and author of the PACE trial, tell that the CBT they developed for CFS had no real control in trials, and was compared against usual care - which was really no care! So 1-to-1 therapist care and asking patient to change thoughts on symptoms!
The role of psychosocial factors as 'perpetuators of fatigue and symptoms' has never been proven and remains as obsecure at the pathogenesis of viruses in ME/CFS. The CBT model of ME/CFS MUS rests on conjecture not evidence psych factors continue fatigue. journals.sagepub.com/doi/full/10.11…
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