RSM The NHS at 70 Podcast: Episode 8: Prof Sir Simon Wessely - The Challenges for Mental Health

RSM The NHS at 70 Podcast: Episode 8: Prof Sir Simon Wessely, President of the RSM - The Challenges for Mental Health

In this episode, Professor Sir Simon Wessely, Regius Professor of Psychiatry & Past President of the Royal College of Psychiatrists, discusses the changing attitude towards Mental Health Illness, Recruitment to Psychiatry, the Mental Health Act, Chronic Fatigue Syndrome and Antidepressants.

Duration: 29 minutes

 

One of those really irritating lines where a layperson would see "well of course psychological and social factors affect the outcome". Someone with an illness with a very tumultuous home life or say, something like ptsd in addition to their illness is definitely going to have a much harder time than someone who is wealthy, has a supportive family and good access to doctors.

The problem is that he's shown that his usage of that is much more insidious, it's just a pity that he phrases things so carefully, haha.

 

Yes, it is from 12.45 - 16.35

Here are some notes I took while listening..

He says of course CFS exists and that psychological factors can affect the outcome as with all chronic illnesses.
Maybe they were not attuned to some of the feelings people had and could have done better. These days they are much better.
They didn't spend enough time talking to people who didn't agree with them and were too quick to say it was about stigma and prejudice.
He played a part in the NICE guidelines and they are better than nothing and certainly safe. He finds some of the opposition to the treatments, that are modestly effective, surprising. The patients they see are fine. They haven't done the best job they could to tell that story and thought the evidence would speak for itself.

 

Well you have to agree that nothing works better than CBT and GET.

 

He goes on to talk about his research in the military. He thinks it was great being in Iraq where the soldiers were dripping of contempt for him. That was good for him, according to himself..

Sounds like they were rather tough with him actually.

I remember he gave an interview to a Norwegian newspaper back then and said he felt much safer in Iraq than with working with ME patients. That was a tough blow for the ME cause in Norway and it is still being used by the BPS crowd to show how horrible this patient group is. Thanks, Simon..

 

I think that the evidence of harm from CBT/GET is still very weak, and it's hard to say much with any confidence.

 

"They didn't spend enough time talking to people who didn't agree with them and were too quick to say it was about stigma and prejudice."

"He says he should have listened more to patients who oppose his approach."

Sounds like some clever slight re-positioning from Wessely.

Of course, he continues to be utterly evasive when awkward facts & concerns are raised by critics who've approached him, but no need to let that get in the way of his personal brand management.

"13:40:

Yes, as you're quite right there's a lot of opposition and there always has been, but possibly getting worse. Maybe we were not, back then, 30 years ago, when we started this career and my colleagues as well, maybe we weren't attune to some of the feelings people had, I think that we probably got have dealt with that better looking back. These days we're much more better at engaging with patients than we were.

So in what way? What might you have done better?

If I had my time again, I don't know, I think we spent not enough time working with, talking with, people who didn't agree with us. It's always easier to talk to people who agree with you, but actually it's far more important to talk to people who disagree with you. And in the work we're doing now with the Mental Health Act, I remember, I really do, some of the mistakes we made all those years ago and we're determined not to repeat them. Ditto in the work with the military. But I think that we probably didn't take it as seriously as we should have done. I think we were possibly too quick to say this is about stigma and prejudice, some of it was, some of it wasn't. It maybe would have made no difference at all. We'll never know will we? But as I've got older I think that probably we could have done better.

And interestingly you say there that possibly it's getting worse, the opposition, the feeling about it. Why's that?

That is a hard one and sometimes I do find it baffling. I find the fact that I played a part, my colleagues played a bigger part in what is still, according to the NICE guidelines, the only two treatments that are found to be better than nothing in this area. They're not magic bullets, but they are better than nothing and they're certainly safe. Cognitive Behvioual Therapy, Graded Exercise, I played a part in developing the former. And still, thirty years later nothing better has come along. It probably will, I don't know where but it probably will, just because of the nature of medical advances. I do find the opposition from some quarters to these treatments which are, as I say, moderately modestly effective, I do find that sometimes surprising. On the other hand, I can also say having run a clinic for thirty years, dealt with thousands of patients, I've lost track, that actually the patients we see in the clinics in south London are fine. What they want from you is number one that you agree that they're ill, number two you don't go into a battle over diagnosis, as I say CFS exists, got it. And finally they want someone who takes it seriously, spends a lot of time with them and has got something not too stupid to offer. And actually, that's what most people seem to want. But we haven;t done the best job we can in actually telling that story, and I think that probably goes back to the fact that we also thought that the evidence will speak for itself, and I'm not sure that's true.

 

As I understand it, the evidence threshold for harm is much lower than it is for benefit.

 

Or should be!

Even so, when I see patients raising concerns about CBT/GET, I feel like they often do less well when they raise concerns about harm. It's just not the strongest point. Within the 'ME/CFS' diagnosis I expect that there probably are people who'd be harmed by CBT/GET, and people who'd benefit. When we have no evidence showing how to sort out who is who I think it's best to be cautious with our claims, and focus on the lack of good evidence of efficacy for these supposedly 'evidence based' treatments.

 

Point taken.

 

Never one to miss an opportunity to spin in his own interests, our simon, each considered response chosen to reflect best for him, a bit of veiled remorse “I’d be the first to say we weren’t perfect but” and plenty of disservice to us, the patients he doesn’t seem to give a hoot about by not remotely conveying that this is a devasting physical illness where people can be confined to bed etc. Whereas severe schizophrenia patients he really does seem to want a better deal for.
He took no responsibility for the lack of biomedical research progress for thirty years because his behavioral hype deterred researchers.
If a powerful man only listens to a small group of patients who are his kings ones, and ignores the CFS Charities, activists, world wide critics etc that’s pretty selective. And there’s been terrible consequences man!!!
The whole swag on being down with the army lads, laughingly brushing off their contempt, covers a man with a big ego and thin skin in his CFS dealings. And without that later Army work, what had he really achieved to be the Lord of all things he somehow became?

 

I can't wait for Nancy Klimas team to find a biomarker/ effective treatment for GWI.....how will Simon Wessely talk his way out of that one(?)

 

In the beginning of the episode he says doctors looked a bit down on him for being a psychiatrist. He was far too good for that speciality, they'd say. But in Simon's opinion psychiatry is a specialty for the very best doctors.

He welcomes jokes about psychiatrists, but speaks very clearly against any slur directed towards patients.

 

He seems to me to have some huge chip going on. I think he’s an egotistical man who dislikes not being esteemed as much as his colleagues in neurology or surgery who always seem the butt of his little side comments. I think he SAID he welcomed jokes about psychiatrists but not his patients, I’m not sure that’s entirely true, I think as I say he feels others feel he’s “less than”, also he’s cared little in any obvious way for the repeated trashing of us, probably worse than what his psychiatrist patients endure. He looks to have been title hunting and his Twitter is I’m Sir this Regius that , head of this from what I remember.

I think what he says and the absolute truth aren’t always aligned. I’m not saying always “lying”, often it’s what he doesnt say, but the name weasel not wessely has been used for a reason.

Saying the hostility in the field to the PACE trial is increasing, whilst true, isn’t helpful when it’s presented as irrational as he does, rather than understanding we are getting justifiably blinking fed up for many reasons, including that pace treatments don’t make many of us better.

 

A lot of things I've seen from Wessely over the years give the impression that his ego has played an important role in the problems around ME/CFS.

 

That seems to be something of a watershed statement. So basically the psychological and social components of ME are no more relevant than for diabetes and coronary artery disease. Maybe he should quietly tell the psychotherapists that. You don't get better from diabetes with CBT.

I get the strong impression that Wessely is looking for an exit route from his whole career. I think he knows he has been outmanoeuvred, unlike Sharpe.

And it seems he was too good for psychiatry yet screwed by insulting patients big time. If there was ever someone who might benefit from lying on a couch and unravelling their repressed emotions this might be the man! Tony Blair would be another maybe.

 

IMO, PACE style CBT/GET benefits no one. The only positive thing that could come out of it is what Wessely mentioned in the interview. Patients want to be believed and something that doesn't seem 'too stupid'. In other words, they want understanding and hope. I even think that things like Gupta et al. are more likely to help than CBT/GET.
On the other hand, supportive psychotherapy(not necessarily CBT) with someone who really understands ME/CFS could help a lot of people, I think.