Life situations and emotions may produce a symptom complex resulting in fatigue. The psychological condition can be described best as an asthenic

syndrome, with apathy, loss of zest, a general 'let-down' feeling, aimlessness and revulsion against the routine of everday life. Anxiety, rage attacks, and depressions are sometimes outspoken. There is experimental and clinical evidence to show that hyperinsulinism or relative hypoglycemia is a possible causal mechanism. These patients show a flattening of the sugar tolerance curve as in (relative) hypoglycemia. A combination of psychotherapy—worked out with Franz Alexander—and a diet—developed by Portis—have proven helpful.