Small Wins Matter in Advocacy Movements: Giving Voice to Patients

In this article, the various players are delineated in a story of a contested illness and patient advocacy, played out within
the corridors of federal power. It is suggested that the mistreatment and negative attitudes that health care providers and
others have towards those with chronic fatigue syndrome (CFS) is possibly due to the social construction of this illness as
being a “Yuppie flu” disease. Institutional factors are identified that created these norms and attributions, as well as the
multiple stakeholders and constituent groups invested in exerting pressure on policy makers to effect systemic change. This
article also provides examples of how the field of Community Psychology, which is fundamentally committed to/based on listening
to and giving voice to patients, is broadly relevant to patient activism communities. This approach focused, over time, on
epidemiological studies, the name, the case definition, and ultimately the change in CFS leadership at the Centers for Disease
Control and Prevention. Keys to this “small wins” approach were coalition building, use of “oppositional experts” (professionals
in the scientific community who support patient advocacy goals) to challenge federal research, and taking advantage of developing
events/shifts in power. Ultimately, this approach can result in significant scientific and policy gains, and changes in medical
and public perception of an illness.