Who is Simon Wessely?

I'm beginning to think that because genuine mental illness cannot easily be measured objectively, psychiatry seems to get away with making their "science" up as they go along, full of self-fulfilling fallacies that are as hard to disprove as to prove. The self-proclaimed 'experts' win the day. That is, until they start applying their cockeyed science onto conditions that do have objectively measurable parameters.

 

Basically, as SW seems to say, they don't do objectivity.

 

Outside of the PACE trial I would also think that there are cases where patients are giving answers the therapists want just to get themselves out of the system and away from treatments that are not only unhelpful, but may actually harm.

Also it strikes me that while for most people a treatment that isn't helpful means that no harm has been done in trying it. For the ME patient, even if a treatment in is not harmful in itself, the cost in exertion may set the patient back considerably. I would consider that harm and it's something which they wilfully ignore.

 

I would like to see the harm they do highlighted.

 

I wonder if this is more than just about their trials with ME, but maybe psychiatric studies in general? Objective measures will be more sparsely available with genuine mental conditions, so there are probably many psychiatric trials with only subjective outcome measures, combined with open label behavioural interventions. I mean lets face it, what are the chances that ME trials are the first ones they did that with; more likely the first time they were spotted doing it. The psychiatry-dominated ME trials debacle very possibly calls into question not just those trials, but maybe many of the trials that the "science" of psychiatry is founded on. Which would be a strong motivation for those involved to "not understand".

Also, there are objective outcomes that would presumably still work even for 100% mental illnesses, such as work/school attendance, social engagement, etc. But I suppose these are "second level" (sorry, don't know what the proper terminology would be) measures, rather than directly objective physiological measures. So I'm not sure how SW can mean there are no objective measures.

Edit: I also begin to see how psychiatry might attract a certain kind of researcher.

 

I am quite sure this is the case. People reviewing my manuscripts on PACE have more or less admitted it and used it as a reason for asking me to remove references to the problem. At least their lack of rigour is transparent.

 

Can I just check I've understood you correctly...

You've been asked to hide or disguise the fact that psychiatry is mostly based on bullshit?

Can you give us an idea how many requests you've had to hide information? I'm not asking for names or anything identifiable, just numbers.

 

I think it has been explicit on two occasions and maybe implicit on one or two others. I have also come across it in conversations with psychologists and psychiatrists in relation to criticising PACE in general rather than specifically refereeing my manuscripts.

 

Good grief. Because although trials into behavioural interventions for purely mental conditions may be much harder to do without serious bias, that still doesn't change the fact that results from many trials are likely deeply flawed. Just because nobody has previously spotted that fact, and the poor patients are the last people able to tell them otherwise (or be listened to), does not make it all OK.

 

I am certainly not the first to spot it or write about it. I cannot give chapter and verse though.

 

Reminds of a bit in the film "A Bug's Life", where the circus troupe that has been mistaken for a group of mercenaries are revealed for who they actually are:-

[My bold]

http://tvtropes.org/pmwiki/pmwiki.php/TearJerker/ABugsLife

For "defensive strategy" maybe replace with "science of psychiatry"?

 

From the Hippocratic Oath.

 

Objective outcome measures, though limited, are indeed available for psychopsychiatric interventions, even on purely psychiatric disorders. I suspect that the difficulty involved, and the likely outcome such as showing their interventions are without value, is why they do not happen. For example, you could use actometers, document increased hours able to work, document prescription drug usage, doctors hours and other medical interventions such as the number of days hospitalised. This would be about getting a broad objective framework. Or could it be they know the result, and that much of what they do results in no documentable improvements, or even documentable worsening?

Instead what we often see is a deliberately laxity in experimental design. Psychiatric research is often given special privileges as a result. While this is permitted, tolerated or excused, how can we trust any of their research? I am sure there is some good research there, but perhaps I am expecting too much of them to expect that most of it should be good quality research.

The brain is about the hardest thing scientists have ever studied. That does not mean they can be excused for low quality science.

 

I'm guessing you are not flavour of the month in some circles then

 

Let me point out one big issue with objective outcomes in treatments for psychiatric diagnoses. There are no diagnostic tests for nearly all psychiatric diagnoses, if not all. The very diagnoses are not objective. Yet this does not prevent objective outcome measures. It just means we cannot be sure who is being tested and so the generalizability of findings is low.

 

Yes, analysis of objective outcomes goes a bit awry if the condition you think you are investigating is not what your trial participants are actually suffering from. Hmm ... I seem to have heard that somewhere before.

 

Like they buried the fact that the PACE patients showed no improvement in fitness until they could write a paper giving a positive spin on it ... five years later. Suppressing data critical to interpreting PACE for five years is ... ?

 

Funny, that is what I have been calling it. Its being used more and more in academia in relation to this as well.