Ms H is a 56-year-old educator currently on medical leave of absence. She has an 11-year history of chronic fatigue that at times has been disabling. She has commercial managed care health insurance through her work.Prior to her illness, Ms H was well, a successful and energetic teacher who was physically very active. In 1986 she developed the sudden onset of profound fatigue, about 1 month after a flulike illness characterized by fever, chills, myalgias, and sore throat. She thought she had infectious mononucleosis, but laboratory tests did not confirm the diagnosis. Titers for Epstein-Barr infection were found to be elevated soon thereafter. Since that time, she has noted extraordinary weakness, finding herself able to walk only a few blocks, followed by exhaustion that forces her to spend many hours in bed. She often finds herself unable to concentrate. She reports she periodically has had "swollen glands"