Who is Simon Wessely?

https://twitter.com/user/status/1081691777948704769


The origins of factitious disorder
Richard A. A. Kanaan & Simon C. Wessely

https://philpapers.org/rec/KANTOO

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00228-X/fulltext

https://twitter.com/user/status/1109541267334148096

 

Does that mean that in CFS the patients are faking it, they just don't know that they are?

 

This is what Keith laws had been studying in the area of schizophrenia. He has found that, when you use methods that control for various biases ( for example, you include an active Control condition, and you use an objective measure as your outcome) psychotherapy has no reliable effect on outcomes in schizophrenia.

 

It would be interesting to know why anyone ever thought it would be, and whether the reasons are s spurious as in ME/CFS.

 

Not exactly. I think he believes that CFS/ME is a psychiatric condition whereby the brain [eta: or part thereof (see below)] deludes the patient into believing they are ill and behaving as such when they are not. If they do then show physical signs of illness, it is because of that behaviour and not due to any external, organic cause. Circular reasoning at its best.

 

In the Clarke and Fairburn book on CBT I came across a paragraph in the chapter by someone called John D Teasdale entitled "We do not have one mind but many". Overcoming initial objections on the basis of, what is it that stands outside mind yet has the capacity to possess it?, and should that not be "Many minds have us"?, I did read some of it.

If the metaphor holds good it would seem quite possible for one mind to be "faking", in some use of the word, and another mind not to know. These are complex and highly speculative areas. I seem to recall discussion in Wittgenstein about whether one can have a pain and not know it, and what, linguistically, that would entail. Fortunately I have forgotten most of that.

 

Simon Wessely: it is ridiculous to say that I have suggested that ME is "all in the head"

Also Simon Wessely: I will argue that ME is a belief, a belief in having a disease called ME

Also Simon Wessely: PACE proves that ME is "all in the head"

Also Simon Wessely: I have "left" the field of ME in 2001, and in 2010, and in 2019

How does anyone take this hack seriously? He's not a serious person and unfit for the responsibility of medical care.

 

The correct answer is whichever one has you agree with him.

 

I don't think it's a coincidence that around the same time peptic ulcers, the quintessential psychosomatic illness, was put out of reach for this model and that the fictitious illness model of ME is nearly identical.

Old ideas don't always die, sometimes they're just recycled and rebranded.

 

That ME quote was about the diagnosis of ME, not about the symptoms of ME.

He didn't say anything like that and it's really important that people realise this. Any sort of unfair criticism is bad.

I stated a thread about Wessely and 'all in the mind' on PR in 2012: https://forums.phoenixrising.me/threads/simon-wessely-and-all-in-the-mind.13979/

Velentijn posted a lot of quotes from Wessely with links to the full papers here: https://www.s4me.info/threads/simon-wessely-research-related-quotes.1304/

 

He is probably reading this thread, you know...



[waves at Simon]

 

Saying that CFS is perpetuated by thoughts and behaviour is just a nicer way of saying it's all in the head of patients. The patient thinks they have a chronic neuroimmune illness, while Wessely et al claim the condition is reversible by challenging unhelpful beliefs and increasing activity levels. In particular the belief in PEM is considered unhelpful. This implies that the mental model the patient has constructed of their illness does not correspond to something that exists in reality. In other words, it only exists in the mind of the patient.

Of course they are technically still two different statements so he's not lying when he says that he never said it's all in the head of patients.

 

I am so glad that you forgot Wittgenstein. He is a phoney. But Hyperaspistes raised the issue in 1641 of whether Descartes thinking mind was necessarily the same as the mind that knew it thought. Descartes had in fact touched on the problem himself. I agree there is a lot to pursue there.

But my understanding of ME is that all the relevant processes are well 'below' anything we think of as mind. Wessely was wrong, I think we now know.

 

Don't know about that. Severe deconditioning isn't all in the head, I suppose.

Anyway, I don't think saying CFS is all in the head or not is the major issue here. The main problem lies with labeling CFS patients symptoms as unhelpful cognitive responses or behaviors without sufficient evidence. With falsely claiming that ME/CFS can be treated and even cured using simple rehabilitative interventions. With encouraging patients to increase their activity level even though this might make the patient worse. etc.

 

My impression is that BPS ideas are migrating in this direction - so as to avoid the 'all in the mind' charge - , but are framing the things going on 'below the mind' as substantially susceptible to influence from the mind. For example, Central Sensitization and BPS notions of FND - or am I misreading this stuff?

(This is not specifically about Wesseley, of course)

 

I think it's best to start from specific quotes as Wessely will often carefully phrase his claims with provisos with 'may', 'for some people', etc (ignoring the fact that he doesn't say it's 'all in the head'). Whenever patients make complaints about Wessely that ignore his precise phrasing then it's unhelpful for us.

 

It's all very well to state precise phrasing. The problem is that that often avoids the clear, obvious and, sometimes, almost certainly intended meaning implicit in the phrase. Even when direct quotes are given additional paraphrasing may be necessary.

It is not as though this problem is confined to patients' quotations of SW et al. They can be equally guilty. I have often drawn attention to the highly significant quote in the Wessely, Hotopf and Sharpe book (p129)where they apparently agree with Rachel Jenkins, quoting her as saying that the majority of the LA and Royal Free epidemics were "a hysterical reaction to a small number of poliomyelitis cases amongst the staff". These words were indeed written in the article cited but, as should have been abundantly clear to the authors, they were not her views. It would probably be necessary to directly quote two pages of her original paper to show that she was quoting Acheson, and that he was expressing the views merely to show that they were false.

I think this may be a more serious misattribution than any committed by patients. One has certain expectations.