Wessely gets touchy feely

[Obermann]

Actually it goes back to the 1930s at least.

Agreed. Most propositions like the biopsychosocial model don't appear in a vacuum, but are developments and refinements of older ideas. Engel started to discuss the topic already in 1960. However, his paper in 1977 was influential and is usually quoted as the starting point of the biopsychosocial model in review papers (Borrell-Carrió et al., Ann Fam Med, 2004).

 

[Mithriel]

I think that the main concern here is bad scientific practices in psychology, rather than the personality of Sir Simon. He didn’t invent anything himself. The biopsychosocial paradigm was proposed by Engel in 1977. The precursors of cognitive behavioral therapy (CBT) had been around for a long time, but finally merged into CBT in the 1980s. The idea that ME was purely psychological was aggressively promoted in 1970 by McEvedy and Beard. They suggested that epidemic ME was mass hysteria, so Sir Simon’s initial proposal in 1988 that ME probably was triggered by an infection and perpetuated by psychological factors actually was a moderation.

The mass hysteria thing was something that the average doctor thought but didn't care about, it was just a medical curiosity. A lot of work was being done in the early 80s and ME was moving back into the mainstream as it was acknowledged that it could be sporadic as well as epidemic. It had retreated into the past for most doctors like polio, diptheria etc.

SWs contribution was to revitalise the Victorian concept of neurasthenia which really had disappeared into the past. He insisted this was ME and then renamed it CFS. His King's College website for many years described neurasthenia as having faded for decades and then returned as CFS. It did not acknowledge ME or the epidemics at all.

He then conflated ME with a form of depression in woman - or as the editor of the Sunday Times put it "A disease of middle aged women with psychosexual problems" It was not a moderation, it was a blitzkreig. This unknown group of doctors suddenly swept in and took over and ruined all our lives.

It was years before they admitted to the infectious start. The goalposts have been continually moved, one thing said to patients, another to government and another to insurance companies, all with one single outcome of denying patient experience and ignoring any medical evidence. If he used bad practice in psychology, he twisted it to suit himself.

 

[chrisb]

I blame Anthony Clare. They thought psychiatry was all about becoming a media luvvie.

 

[Obermann]

The mass hysteria thing was something that the average doctor thought but didn't care about, it was just a medical curiosity.

Melvin Ramsay wrote in his account of the Royal Free epidemic: "So radically did McEvedy & Beard influence medical opinion that when I attempted to put the case for an organic explanation of the disease to younger present-day consultants I have encountered an attitude of pitying disbelief and the remark, 'Oh, but that was long ago shown to have been the result of mass hysteria'. I can only say that a whole generation of unfortunate victims of the disease have been driven to despair by the failure of doctors to recognize their symptoms."

Patients were dismissed as psychosomatic even long before McEvedy and Beard. In the same book, Ramsay described a case from 1969: "[She] was seen by a senior neurologist who considered her to be a case of 'near-delusional self-deception' and described ME as a 'figment in the imagination both on the part of the patients who think they are suffering from it and the doctors who make the diagnosis'. The prejudice harboured against those of us who hold the view that ME is an organically determined disease defies rational explanation."

It was years before they admitted to the infectious start.

Wessely et al. suggested an infectous trigger already in the first paper outlining the treatment model in 1989: "You have had an acute illness, probably infectious in origin, which forced you to become inactive for a period of time. Subsequently you have begun to experience fatigue on exertion and as a result you have started to limit or avoid activity of all sorts."

It is also clear from the paper in 1989 that Wessely didn't invent the treatment model. He took the cognitive–behavioural model for pain and adapted it to ME. This is probably why he conflates chronic fatigue with ME. He presumed that the symptom fatigue plays the same role in the treatment of ME as the symptom pain in the pain model.

It was pointed out already in 2001 in a review that the lack of objective outcomes in studies of CBT for ME was problematic (Whiting et al, JAMA, 2001). If they had applied the same standards in CBT and GET studies as in pharmacological studies, they would never have been accepted for publication.

 

[chrisb]

The problem for Wessely and David is the evidence that they knew precisely what they were doing. We were acceptable collateral damage.

"Sufferers have been told that "physical and mental exertion is to be avoided" (ME Action Campaign factsheet 1988). This may be correct in some cases, but there is as yet no way that these cases can be identified. In general such advice is counterproductive and must be set against the following......"

Management of chronic (post viral) fatigue syndrome

Wessely, David, Butler, Chalder http://bjgp.org/content/bjgp/39/318/26.full.pdf Page 27 Top Right

I started a thread on this elsewhere, but it received little interest. My view is that knowing this there should, at the very least, have been proper protocols established to assist in identification of those at risk of harm.

 

[alex3619]

If they had applied the same standards in CBT and GET studies as in pharmacological studies, they would never have been accepted for publication.

I agree. This is a problem that is widespread in psychopsychiatry though, and the entire field has very lax standards.