The essay below was presented at Philosophy, Disability and Social Change on Friday, December 11, 2020.

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Capitalism and Chronic Fatigue

By

Michelle Ciurria

In this presentation, I am going to offer a biopolitical explanation of chronic fatigue syndrome or CFS. First, I’ll explain what CFS is. Then, I’ll explain why I consider CFS to be a disability, which is not scientifically explainable due to the nature of disability. Then I will expand on this argument by showing that different rates of CFS in different social groups have roots in expropriation under capitalism. More specifically, I will say that expropriated groups are more susceptible to CFS because expropriation puts them at risk of neglect, trauma, and exhaustion.

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Chronic fatigue syndrome is defined as “unexplained fatigue that lasts for at least 6 months, accompanied by symptoms including headaches, unrefreshing sleep, muscle pain and cognitive difficulties such as memory and concentration problems.”[1] I have these types of experiences most of the time. I’m almost always tired and sometimes I can’t get out of bed. I have episodic headaches, muscle pains, difficulty concentrating, and difficulty speaking. At times I feel relatively energized, but most of the time I have experiences that fit the so-called “symptomatic profile” of CFS.

Because I take CFS to be a disability, I prefer to say that I am chronically fatigued, rather than that I have chronic fatigue syndrome, as I take disability to be a sociopolitical construct, similar to gender and race, rather than a biological phenomenon or medical problem. To quote Shelley Tremain, disability is a “historically contingent apparatus of power,” not a natural feature of the world.[2] So, just as I take myself to be a white woman, not a person with whiteness and feminine-coded gender, I take myself to be a chronically fatigued person, not a person with CFS.

The notion that CFS is a disability is controversial, but I think it has the features that critical disability theorists tend to attribute to disability. Namely, I take CFS to be (i) “constituted by and through a complex and complicated [set of biopower apparatuses]”[3], (ii) which produce distinct types of oppression (such as ableist prejudice and workplace exclusion), as per Tremain’s definition. And I take conditions (i) and (ii) to make CFS (iii) something that the disability rights movement has a reason to promote justice for, as per Elizabeth Barnes’ definition.[4] I should note that Tremain and Barnes provide substantively different conceptions of disability. But the point is that on either one, CFS would plausibly count as a disability. I also take CFS to be something that one can have reason to celebrate, as it can confer epistemic and emotional advantages (such as privileged knowledge of ableist oppression and a passion for justice), and it can form the basis for meaningful relationships and political solidarity. These advantages are consistent with the understanding of disability espoused by the disability pride movement, as is the recognition that CFS is a target of ableist oppression, which leads to adversity.

Precisely because CFS is a disability, it cannot be reduced to a medical condition, since neither the biopolitical apparatuses implicated in CFS, nor the political adversities and epistemic/emotional advantages that come with it, can be explained by mainstream medical science. This follows straightforwardly from the definition of CFS as a political construct.

Of course, these claims are controversial, especially (i). In this presentation, I want to lend credence to (i) by unearthing some of the “hidden” political factors that play a role in CFS. Due to time constraints, I will focus on just one dimension of CFS: its prevalence in politically oppressed groups. This a fruitful point of entry because, as Adriel M. Trott argues, physiological differences across social groups are, on close scrutiny, partly if not fully caused by political factors.[5] For example, women experience disproportionately high levels of irritable bowel syndrome (IBS) partly because they suffer high levels of sexual assault, and sexual assault changes the gut microbiome; thus, patriarchal violence partially explains high rates of IBS in women.

Along the same lines, I want to argue that capitalist labour relations party explain high rates of CFS in expropriated groups, by which I mean groups that have their resources and capacities confiscated without the minimal level of protection afforded by standard labour laws. This analysis will contribute to Marta Russell’s claim that disability is “a product of the exploitative economic structure of capitalist society: one which creates (and then oppresses) the so-called disabled body as one of the conditions that allow the capitalist class to accumulate wealth.”[6]

In what follows, I will outline the different rates of CFS in different groups, and then explain how capitalism, as understood by Marxists, partially explains these group-level differences.

Most people know that women are more susceptible to CFS than men, but few know that it is also prevalent in racialized groups. Historically, “CFS was thought to be most common among White women of higher socio-economic status,” due to the medical racism and classism of the time, but recent studies have revealed that African Americans, Native Americans,[7] and Hispanic Americans[8] have higher rates of CFS “compared with the White American majority,” as do “people in lower socioeconomic groups” compared to higher SES people.[9] In other words, the groups most susceptible to oppression under capitalism are also more likely to experience CFS.

Now, let me explain what I mean by capitalism. I follow the Marxist tradition in understanding capitalism to be an industrial mode of production that allows an elite few to accumulate wealth by subjugating the majority of people, especially members of historically disenfranchised groups, through regimes of exploitation and expropriation. Capitalism, then, is not simply a system of economic exchange: it is a system of oppression that submits historically disenfranchised groups to subjugation. To quote Nancy Fraser, capitalism is “a mode of accumulation that is simultaneously a system of domination.”[10] The disproportionate impact of capitalism on historically disenfranchised groups is captured in the terms “racial capitalism,” popularized by scholars like Cedric J. Robinson, Olufemi Taiwo, and Liam Kofi Bright,[11] and “patriarchal capitalism,” popularized by the likes of Zillah Eisenstein and Christine Delphy. These labels indicate that capitalism and oppression are inextricable linked, such that we cannot have one without the other. As Eisenstein puts it, “capitalist class structures and hierarchical sexual structuring,” as well as racial structuring, are locked in a “mutually reinforcing dialectical relationship,”[12] which gives rise to inevitable hierarchies of oppression.

One reason for thinking that these systems can’t be decoupled is that capitalism doesn’t just submit subjects to oppression: it creates exploitable and expropriable subjects. As Kathy Weeks puts it,

the wage relation generates not just income and capital, but disciplined individuals, governable subjects, worthy citizens, and responsible family members [as defined by the logic of patriarchal-racial capitalism]. Indeed, given its centrality both to individuals’ lives and to the social imaginary, work constitutes a particularly important site of interpellation into a range of subjectivities.[13]

Nancy Fraser agrees that capitalism “constructs” exploitable subjects through “political subjectivation.”[14] But Fraser adds a new subject-position to Marxist thought by delineating between two oppressed classes: “the free exploitable citizen-worker, on the one hand, and the dependent expropriable subject, on the other.”[15] This division is a contribution to classic Marxism’s emphasis on two main classes: capitalists, who own the means of production, and propertyless producers, who must sell their labour power to survive. Capitalism as such allows corporate owners to exploit the working class by paying them less than what their work is worth – that is, by confiscating the “surplus value” of their labour. Fraser points out that, along with the proletariat class, capitalism creates a racialized underclass that is subject not only to exploitation but also expropriation, a regime that “works by confiscating capacities and resources and conscripting them into capital’s circuits of self-expansion.”[16]

Expropriation is, in many ways, more akin to the colonial settler state’s “original accumulation” of assets through slavery and genocide than to exploitation through work, as it is not regulated by labour laws. In modern times, expropriation tends to take the form of “predatory loans,” “prison labour…, corporate land grabs,” and similar acts of confiscation.[17] These expropriative practices don’t just oppress their target, but racialize the target group by marking it as a proper object of non-contractual, often violent, modes of confiscation, rather than a subject of full citizenship rights.

While Fraser focuses on racial expropriation in the article in question, she acknowledges that other oppressed groups are susceptible to other regimes of expropriation. Women, for example, are expropriated through unpaid caregiving, unpaid housework, and sexual violence.

These regimes of expropriation may partially explain why rates of CFS are higher in women, BIPOC, and the poor, since expropriation puts people at risk for conditions that could trigger CFS according to the leading scientific theories (which, I should note, are ultimately inadequate because they fail to situate biological factors in political contexts). Although the CDC says that there is no known cause of CFS, two of the leading speculative explanations are (a) viral infections and (b) physical and emotional trauma.[18] These triggers are more likely to affect members of expropriated groups due to the nature of expropriation.

Consider the forms of racial expropriation highlighted by Fraser: predatory loans, corporate land-grabs, and prison labour. People susceptible to predatory loans and corporate land-grabs are vulnerable to homelessness, which is a risk factor for viral infection, especially airborne infections like the flu, TB, diptheria, and covid-19.[19] Imprisonment is another risk factor for infection.[20] In fact, some prisons have released inmates on humanitarian grounds due to the high rate of coronavirus transmission and death.[21] In addition, both forced displacement and imprisonment, partly due to inhumane shelter and prison conditions, correlate with physical and emotional trauma. If these “triggers” do play a role in CFS, then racial expropriation is an underlying political cause.

Patriarchal regimes of expropriation also create distinct vulnerabilities. Caregiving carries a risk of viral infection insofar as caregivers may need to be in close proximity to someone with an airborne virus, without having access to the personal protective equipment afforded to (paid) emergency responders. Sexual violence is a risk factor for sexually transmitted infections, as well as a source of physical and emotional trauma. Caregiving may also trigger emotional trauma when caregivers do not receive the material and emotional support they need from their communities (including PPE and basic respect) – which is the case for many women. In fact, the UN says that women’s burden of “unpaid care work has increased” due to the pandemic, and the “rate of gender-based violence is increasing exponentially.”[22] Thus, patriarchal expropriation may be an unanalyzed political cause of high rates of CFS in women.

Having said this, we cannot know for sure whether viral infection and trauma play a role in CFS due to lack of sufficient data. But there is a ready-made explanation for the core feature of CFS: being tired for more than 6 months. Tiredness, in fact, is a focal point of Marxist critique, which theorizes tiredness as a biproduct of the capitalist mode of production. While ordinary tiredness may not be identical to chronic fatigue, there are similarities in the experiential qualities and group prevalence in both cases, which suggests that there could be similar causes.

Notably, there is significant overlap in rates of CFS and rates of tiredness. According to the CDC, women report being more tired than men, and the biggest tiredness gap is in the 18-44 age group, which is both prime working age and prime childrearing age.[23] There is also a racial sleep gap, which produces a racial tiredness gap: the CDC reports that “healthy sleep duration [is] lower among Native Hawaiians/Pacific Islanders…, non-Hispanic blacks…, multiracial non-Hispanics…, and American Indians/Alaska Natives…, compared with non-Hispanic whites… [white] Hispanics…, and Asians.[24]  Class also predicts poor sleep, with those “unable to work or… unemployed” reporting “lower healthy sleep duration [compared to] employed respondents.” Groups with poor sleep quality tend to be more tired during the day, which means that groups with high rates of CFS are also more likely to be tired.

According to Marxism, tiredness is an inevitable biproduct of capitalism. In “Exhaustion: a history,” Anna Schaffner explains how the industrial revolution transformed the “psyche of the individual, owing primarily to changing cultural conceptions of the value of work and an increasing commodification of time”.[25] In the industrial workplace, the pace of work was no longer determined by “nature, the seasons, and the weather,” as it had been for all of human history, but became dictated by “abstract rational principles, such as clock time and measurable productivity”.[26] Factory workers were forced to keep pace with machines, performing “the same repetitive movements over and over again, all day long.”[27] As Marx put it in 1867, 

In the factory we have a lifeless mechanism which is independent of the workers, who are incorporated into it as its living appendages. The wearisome routine of endless drudgery in which the same mechanical process is ever repeated, is like the torture of Sisyphus; the burden of toil, like the rock, is ever falling back upon the worn-out drudge.[28]

At the same time, people began to see work – the source of their exhaustion and alienation – as the primary source of value and meaning in life. Of course, this is quite irrational, but it was facilitated by the popularization of a secularized version of the Protestant work ethic, which treats work as an indefeasible moral obligation and social responsibility. Any resistance to the drudgery of the daily grind, then, is perceived as a sign of moral corruption. Through this ideology, capitalism managed to produce constitutively exhausted subjects. As Weeks puts it, “what is essential about the work ethic, as [Max] Weber originally described it, was what it could do: deliver workers to their exploitation, not just by manufacturing subjects’ consent to capitalist exploitation, but by constituting exploit[ative] and exploitable subjects.”[29] Although Protestantism is no longer the dominant religion, the ghost of the Protestant work ethic still haunts the capitalist machine, producing an exhausted and largely compliant working class.

Something missing from Weeks’ analysis, however, is an account of expropriation, which is exhausting in its own right. Due to limited time, I’ll just look at a couple of examples.   

Above, I discussed predatory lending. One of the more salient examples of predatory lending was the high rate of subprime loans given to Black and Hispanic homeowners just prior to the 2008 housing crisis. This practice resulted in high rates of foreclosures for Black and Hispanic households.[30] To get out of debt, expropriated families had to navigate repayment plans with banks, find provisional housing, work harder in their jobs to pay off their debts, and in some cases declare bankruptcy. That is, the burden of expropriation gave rise to hyper-exploitation.  These foreclosure victims were then doubly-exhausted under two brutal modes of confiscation.

Next, consider unpaid housework. Feminists have argued that, on top of the standard work shift, women often have to do a “second shift” in the home, providing the majority of uncompensated household labour. Naomi Wolf even argues that women are subject to a “third shift,” created by the demands of the Patriarchal beauty regime.[31] These extra shifts are forms of expropriation that impose additional burdens on many women. The combination of a standard work schedule along with unpaid, extra shifts creates a higher burden of exhaustion.

The tiredness caused by expropriation could help to explain the core feature of CFS: “fatigue that lasts for more than 6 months,” as well as why chronic fatigue is more common in expropriated groups. If chronic fatigue has another cause, the tiredness caused by expropriation could still make the experience of chronic fatigue more intense or longer-lasting.

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To summarize the main points of this presentation, I have argued that capitalism and oppression and inextricably linked, and oppressed groups are susceptible not only to exploitation but also to expropriation. Expropriation makes people vulnerable to the hypothesized triggers of CFS, and also causes severe and inescapable forms of exhaustion. These political factors help to explain the high rates of CFS in women and BIPOC.  

Since CFS has irreducible political causes, it cannot be adequately explained by medical science, much less “cured” by medical science. The only adequate solution to the adversity experienced by chronically fatigued people is to abolish capitalism – by which I mean racial-patriarchal capitalism – which necessarily produces expropriated, exhausted, and disabled subjects.

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[1] Dinos, S., Khoshaba, B., Ashby, D., White, P. D., Nazroo, J., Wessely, S., & Bhui, K. S. (2009). A systematic review of chronic fatigue, its syndromes and ethnicity: prevalence, severity, co-morbidity and coping. International journal of epidemiology, 38(6), 1554-1570.

[2] Tremain, Shelley. (2020): Field Notes on the Naturalization and Denaturalization of Disability in (Feminist) Philosophy: What They Do and How They Do It. Feminist Philosophy Quarterly, 6(3), 1-22: 4

[3] Tremain (2020): 17

[4] Barnes, Elizabeth. (2016). The minority body: A theory of disability. Oxford University Press: 43

[5] Trott, Adriel M. (2019, Oct. 9). Racism’s guts? The physiology of oppression. Blog of the APA.

[6] Russell 2019: Capitalism and Disability: Selected Writings by Marta Russell. Haymarket Books: 16

[7] Dinos et al. 2009

[8] Harvard Health Publishing (Harvard Medical School 2018): Chronic Fatigue Syndrome.

[9] Ibid.

[10] Fraser, N. (2016). Expropriation and exploitation in racialized capitalism: A reply to Michael Dawson. Critical Historical Studies, 3(1), 163-178: 164-165

[11] Taiwo, O. & Bright, L. (2020). A response to Michael Walzer. Dissent Magazine.

[12] Eisenstein, Zillah R. (1979). Capitalist patriarchy and the case for socialist feminism. Monthly Review Press: 5

[13] Weeks, K. (2011). The problem with work: Feminism, Marxism, antiwork politics, and postwork imaginaries. Duke University Press: 9

[14]Fraser (2016): 170

[15] Fraser (2016): 173

[16] Fraser (2016): 166

[17] Fraser (2016): 165-167

[18] Mayo Clinic 2020: Chronic Fatigue Syndrome.

[19] Badiaga, S., Raoult, D., & Brouqui, P. (2008). Preventing and controlling emerging and reemerging transmissible diseases in the homeless. Emerging Infectious Diseases, 14(9), 1353-1359: 1353.

[20] Bick, J. A. (2007). Infection control in jails and prisons. Clinical Infectious Diseases, 45(8), 1047-1055.

[21] Prison Policy Initiative: Responses to the Covid-19 Pandemic (2020)

[22] United Nations 2020: Policy Brief: The Impact of Covid-19 on Women

[23] Hensley, Scott. (2013, April 12). Annals of the obvious: women way more tired than men. NPR: Your health.

[24] CDC 2016: “1 in 3 adults don’t get enough sleep”

[25] Schaffner, A. K. (2016). Exhaustion: a history. Columbia University Press: 289

[26] Schaffner (2016): 290

[27] Ibid.

[28] Marx, K. (2004). Capital: volume I. Penguin UK.: 1044.

[29] Weeks (2011): 53

[30] Rugh, J. S., & Massey, D. S. (2010). Racial segregation and the American foreclosure crisis. American sociological review, 75(5), 629-651.

[31] Wolf, N. (2013). The beauty myth: How images of beauty are used against women. Random House.

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Michelle Ciurria is a visiting scholar at the University of Missouri-St. Louis. She completed her PhD at York University in Toronto and then held postdoctoral fellowships at Washington University in St. Louis and the University of New South Wales in Sydney. She is the author of An Intersectional Feminist Theory of Moral Responsibility.