Assessing Fatigue in Multiple Sclerosis: Shedding Light on the Elephant in the Dark Commentary on Braley and Chervin. Fatigue in multiple sclerosis: mechanisms, evaluation, and treatment. SLEEP 2010;33:1061-1067.

A POPULAR STORY DESCRIBES A GROUP OF MEN, WANDERING THROUGH THE DARK OF NIGHT, WHO HAPPEN UPON AN ELEPHANT. AS THEIR outstretched hands fall upon different parts of its body, each conjures up an image of the beast. As the men call out descrip-tions of the animal blocking their path, an argument ensues. The man grasping the leg proclaims the elephant to be shaped like a pillar. His friend, whose hand fell upon the ear protests that the elephant must resemble a large hand-fan. Not surprisingly, the chap holding the tusk retorts the elephant to be as slender as a snake. As the elephant’s handler comes upon the scene, he ex-claims that all are correct, but only partially. Their understand-ing of the elephant’s size and shape is constrained to only that portion that they touch.Establishing a standardized approach to evaluating and treat-ing fatigue is fraught with issues similar to those of grappling with an elephant in the dark. This may reflect the multiple sub-jective experiences associated with the term fatigue.