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Hi David,
If you are still here, please don't run away! I have had a lot of experience with CFS, both in my own experience and that of people I have worked with as a therapist for 35 years. I'm glad to see you are familiar with Sarno's work, enough to post here. I understand that it really does seem to be a "real" illness. When I first came down with it, in the 1980s, nobody had heard of it. My family, who were academics, shamed me and quite literally rejected me, saying it was "all in my head," since at that time the phenomenon didn't even have a name. I was also shamed and more or less ostracized by a spiritual group I was in at that time. Yet I was disabled, unable to get out of bed for long each day, for several years: I wasn't particularly depressed -- no more so than many other people, and I continued to be skilled at working with other people who were depressed.

So, it is not just a simple matter of saying "you have a mind-body syndrome," which might sound the same as "it's all in your head." No one is judging anyone here (hopefully, although it's really, really hard for human beings not to use anything to gain rank and advantage, even "being the ones who understand TMS.") Although Dr. Sarno IS saying that these illnesses are not caused by a physical disease process, the actual message is that they are caused by a brain process, which is a response to certain unconscious emotional activity. He has noticed that there is a personality type that tends to respond to unconscious emotional activity by creating an absolute smorgasbord of symptoms. It is like a special effect in consciousness. An example is that certain religious people develop "stigmata" -- bleeding wounds on their hands, that are believed to mimic Jesus on the cross. Except that they have discovered that in Jesus' day, they used to crucify people with nails through the wrists! The image of nails in the palms has been in our culture for 2000 years, to the point where you might say its in our collective unconscious. So the person's brain creates that extraordinary symptom, and everyone thinks, "how spiritual!" (And the person may, in fact, be very humble and devoted and so on).

But in chronic fatigue, no one says, "Brilliant!" "How spiritual!" "What a realistic special effect, honey!" Well, I do say that, and encourage patients to say that, and I find it helps a lot to sincerely admire the brain's total control of the body palette of art in its symptomology.

The thing is, it takes a while in many cases to believe that our "brains" could create these elaborate designs in our flesh––too weird! And also, most of Sarno's work has focused on back pain, and I have to say that it took care of my chronic back pain relatively easily. But there has not been so much experience and emphasis on the fatigue side of things, because most people are too tired to write ;-) And some people claim to have "recovered" from CFS and yet by "chronic" they mean a year or two. In my case, I had decades of miserable experience under my belt before I came across Sarno.

So it's easy to believe it is an exception to the TMS theory. It must be a "germ," or whatever. But why do we give more power to a germ (or virus, etc.) than to our own brains? Because it is spooky and creepy to believe that our own brains could be acting against us in this way. And yet, from its primitive point of view, our brain is trying to save us, even in chronic fatigue. The careful and brilliant explanation for all this takes a little while to understand and sink in (especially if you are tired and have brain fog.) I HIGHLY recommend reading Schubiner's article quoted above and linked here https://www.psychologytoday.com/blog/unlearn-your-pain/201606/explaining-the-unexplainable-chronic-fatigue-syndrome (Explaining the Unexplainable: Chronic Fatigue Syndrome) (Unlearn Your Pain) I have extracted a couple of very helpful paragraphs here:

(From Schubiner's article linked above): "The idea that the brain is powerful enough to create such severe symptoms is simply not part of the common knowledge in our world. Doctors are not trained to understand the power of the brain. They do not look for the brain-body connection to understand symptoms that are not clearly caused by a disease process. Therefore, they never find it and tend to ridicule anyone who suggests that the brain is causing CFS, fibromyalgia, headaches, neck or back pain, irritable bowel or bladder syndrome and other disorders commonly classified as “medically unexplained symptoms.” I spoke to a physician who suffered with chronic pain and fatigue for several years. She works at a university medical center in a large city and saw all of the relevant medical specialists at her institution. None suggested the course of action that Michael took and that I recommend to my patients. After following the program in my book, Unlearn Your Pain, and seeking counseling for TMS, she has recovered fully. Since then, she has gone back to her physicians and while they are happy for her success, they have all shown disbelief, lack of interest, and even ridicule for this approach. And yet, she is not alone in being able to recover from chronic pain and fatigue.

There is a great stigma attached to the idea that physical symptoms can be caused by psychological reactions. We tend to belittle this idea because it seems as though it blames the person for the illness and makes it seem that the symptoms are not real, i.e., just something “made up” or “all in your head.” However, nothing could be further from the truth. The symptoms of CFS, fibromyalgia and other associated disorders are real, are not made up, and are not the fault of the sufferer. They are due to the incredible power of the brain to create and perpetuate real symptoms. The brain is programmed to respond to stress and the pressures that we put on ourselves by enforcing a rest and recovery mode that is very hard to understand and overcome. However, this is the truth for many people who continue to suffer."