Who is Simon Wessely?

[bobbler]

Experimental psychology well understood fifty years ago that open label trials with subjective outcome measures were inherently unreliable, and as I have pointed before the main proponents of the BPS approach to ME from Wessely to White to Chalder to Crawley are not research psychologists but rather people with various medical or medical related backgrounds. As a psychology undergraduate getting on for half a century ago I clearly understood that concepts such as ‘conversion disorders’ were inherently unscientific.

Medicine rather than psychology is the source of this snake oil. Just as Freud was a medical doctor who deliberately abandoned the experimental method as too restrictive, researchers like Wessely have diverted into mythology and beliefs. Though I do agree that scientific psychology, though not the origin of this medical belief system, it is at fault for standing back and allowing this pseudoscience to prosper.

Also though Wessely is a high profile devotee, it is important to remember he is part of a larger movement where medicine and government policy combined. He just happened to be in the right place at the right time (or from our view point, the wrong place at the wrong time) when adopting the misnamed bio psychosocial approach to long term disabilities was politically advantageous here in the UK.

I think I’ve obviously worded things slightly wrongly. In summary I agree with what you’ve said / you’ve put it better!

I was noting that this not being scientific was being highlighted by psychology decades ago. And that psychosomatic isn’t ‘from’ psychology.

yes it was supposed to be scientific psychology leading the charge but to be fair I suspect one issue has been the setting up of IAPT to move power over jobs into different hands/ideologies creating issues re: hierarchy and careers etc. And it also meaning training now is narrow in certain types of CBT etc rather than the gamut where people would be expected to or able to critique whether it was the right thing.

You now also have people training eg in CBT only or being professors in it without a broad degree about ‘whether it is the right thing’ which seems somewhat strange because it’s like being a specialist in a technique of changing someone’s thinking rather than one in what might be the actual issue etc or whether it is appropriate- which I find an interesting angle too

 

[Peter T]

You now also have people training eg in CBT only or being professors in it without a broad degree about ‘whether it is the right thing’ which seems somewhat strange because it’s like being a specialist in a technique of changing someone’s thinking rather than one in what might be the actual issue etc or whether it is appropriate- which I find an interesting angle too

Yes, although CBT was initially seen as neutral about the origins or causes of psychological distress, rather a belief free way to modify thought patterns and behaviour, it does not seem to have thought objectively about what the targets of that change should be. Though it was established as an antidote to psychoanalysis it seems to have become a belief system in itself. Certainly PACE type CBT for ME and other conditions has nothing to do with scientific evidence but rather an attempt to indoctrinate patients in the beliefs of a narrow section of clinicians and researchers that their condition does not exist and consequently to encourage behaviour that is likely to result in harm.

 

[Ash]

Experimental psychology well understood fifty years ago that open label trials with subjective outcome measures were inherently unreliable, and as I have pointed before the main proponents of the BPS approach to ME from Wessely to White to Chalder to Crawley are not research psychologists but rather people with various medical or medical related backgrounds. As a psychology undergraduate getting on for half a century ago I clearly understood that concepts such as ‘conversion disorders’ were inherently unscientific.

Medicine rather than psychology is the source of this snake oil. Just as Freud was a medical doctor who deliberately abandoned the experimental method as too restrictive, researchers like Wessely have diverted into mythology and beliefs. Though I do agree that scientific psychology, though not the origin of this medical belief system, it is at fault for standing back and allowing this pseudoscience to prosper.

Also though Wessely is a high profile devotee, it is important to remember he is part of a larger movement where medicine and government policy combined. He just happened to be in the right place at the right time (or from our view point, the wrong place at the wrong time) when adopting the misnamed bio psychosocial approach to long term disabilities was politically advantageous here in the UK.

Absolutely.

Since COVID-19 hit we’ve seen how very superstitious the medical profession is. No the virus causing this disease isn’t airborne. No need for respirators just wash your hands to ward off the bad spirits, whilst you’re at it wash your mind of all the news and death. Get a vax that we already told you doesn’t stop you passing the virus on then go and spread the virus about to ‘the vulnerable’. I know we said they’d all die and you’d be a bad person for killing them, but now you’re a ‘brave getting back to normal soldier’

 

[rvallee]

Humans haves a long history of believing in all sorts of magical powers of the mind. With such powers the mind can surely make the body sick too. You have an ulcer? Might it be your stressed mind causing this? (the guy next door's answer). Then science comes along and discovers a culprit bacteria…

Oddly enough, people have long believed in powers but outside of psychosomatic ideology, it's never really about the powers of the mind. Things like magic, astrology, occult stuff, always have that power existing outside people, in the universe, and some people simply tap into a higher power. More often they were divine, the powers of the gods, which people sometimes borrowed, or stumbled upon such as finding objects of power left by the gods. Magical swords left in ponds, or whatever.

I have never once in my life seen anyone talking about the mind being very powerful in itself, without channeling a higher power, outside of the power to create sickness. Which is basically an anti-power, literally the worst power one could imagine having.

It is the only power ascribed entirely to the mind. The rest of what human minds can do that isn't divine or magical always involves a lot of work, effort and dedication. Or is about being special, being ordained, being chosen for some vague destiny. The power to create sickness is basically the only truly magical power ascribed to the human mind. It's so beyond time to let this nonsense go.

 

[Sid]

Oddly enough, people have long believed in powers but outside of psychosomatic ideology, it's never really about the powers of the mind. Things like magic, astrology, occult stuff, always have that power existing outside people, in the universe, and some people simply tap into a higher power.

Definitely. The goal of science is to lay waste to superstitious nonsense, not help amplify it and wrap it in pseudoscientific jargon. SW and the likes of him took the worst of human nature (magical beliefs about thoughts etc.) and spun a pseudoscientific discipline out of it in 1980s. It literally validates the worst human impulses to blame the victim, think magical thoughts to ward off demons etc. That's literally all CBT is.

 

[Wonko]

Isn't the true goal of science, as practiced, to make money, garner power, and crush all opposition before their feet?

 

[Peter T]

Definitely. The goal of science is to lay waste to superstitious nonsense, not help amplify it and wrap it in pseudoscientific jargon. SW and the likes of him took the worst of human nature (magical beliefs about thoughts etc.) and spun a pseudoscientific discipline out of it in 1980s. It literally validates the worst human impulses to blame the victim, think magical thoughts to ward off demons etc. That's literally all CBT is.

To be fair I am not sure that the original developers of CBT envisaged it as being marketed to cure biological illnesses à la PACE. CBT like mindfulness may have some specific uses and it’s explosion to a miraculous cure all was not a necessary consequence of its development.

 

[Ash]

Oddly enough, people have long believed in powers but outside of psychosomatic ideology, it's never really about the powers of the mind. Things like magic, astrology, occult stuff, always have that power existing outside people, in the universe, and some people simply tap into a higher power. More often they were divine, the powers of the gods, which people sometimes borrowed, or stumbled upon such as finding objects of power left by the gods. Magical swords left in ponds, or whatever.

I have never once in my life seen anyone talking about the mind being very powerful in itself, without channeling a higher power, outside of the power to create sickness. Which is basically an anti-power, literally the worst power one could imagine having.

It is the only power ascribed entirely to the mind. The rest of what human minds can do that isn't divine or magical always involves a lot of work, effort and dedication. Or is about being special, being ordained, being chosen for some vague destiny. The power to create sickness is basically the only truly magical power ascribed to the human mind. It's so beyond time to let this nonsense go.

Absolutely. This not a belief in any power of spirit or science around the patient. This is the belief of the practitioner that a practitioner such as themselves can tell just by looking at a patient whether or not the patient has a medical condition that requires attention. Or it is the practitioner deciding in advance of meeting with the patient that certain types of patient can be assumed not to have a medical condition.
Or a practitioner who works for a system that rewards non treatment and his mind tells him it’s okay to blame his patients minds for all possible symptoms to his career advantage.

I guess it’s a pyramid scheme. Now there’s a high chance that the teachers and trainers will have entered the scheme done well out of it and are now selling it on. There is a very high incentive for one and all who have at one stage or another bought into it to keep emphasising the value of the product, the faulty mindset of patients that is causing all this sickness.

It is a semi plausible thing to say with great confidence. A passable product offer. But there is always the fear that you will be found out for flogging empty cardboard boxes. So hype is important. Threats are important. Having doubts? I’ve got two words for you “unnecessary tests”
That’ll do it.

 

[bobbler]

Oddly enough, people have long believed in powers but outside of psychosomatic ideology, it's never really about the powers of the mind. Things like magic, astrology, occult stuff, always have that power existing outside people, in the universe, and some people simply tap into a higher power. More often they were divine, the powers of the gods, which people sometimes borrowed, or stumbled upon such as finding objects of power left by the gods. Magical swords left in ponds, or whatever.

I have never once in my life seen anyone talking about the mind being very powerful in itself, without channeling a higher power, outside of the power to create sickness. Which is basically an anti-power, literally the worst power one could imagine having.

It is the only power ascribed entirely to the mind. The rest of what human minds can do that isn't divine or magical always involves a lot of work, effort and dedication. Or is about being special, being ordained, being chosen for some vague destiny. The power to create sickness is basically the only truly magical power ascribed to the human mind. It's so beyond time to let this nonsense go.

I think sadly the nature of mis-described disability for CFS also puts it right in the territory of the more simple ‘mind over matter’ mantra - and the ‘push through’ from eg Gerada and Chalder videos are the give-away of that being sold, and the ‘malingering’ conference most of the rest had bring the other.

the thing is that PEM is caused by those with ME ‘pushing’ rather than the opposite but they’ve rebranded it as ‘thinking you feel tired’ - as everyone else does until they get used getting up everyday for work’ sort of wind ups (pains in the mind, it’s a problematic thinking pattern that you think hard work hurts you type priming). So ‘the mind’ is also just pseudo words for basic disses like ‘lazy’, ‘weak’ and ‘not trying hard enough’ in some of these - hence the interesting change to now claiming ‘psych-education’ which isn’t far from re-education but still allows the ‘mental health insinuation to be used both as a weapon and as a fake shield pretending it’s ’based On care’ vs saying what they mean directly without ‘these allusions’

the point with PEM is that people are going beyond their body’s limit at the time leading to serious illness and symptoms hitting them 12hrs + later. Pretty different to the fatigue ‘ I feel tired’. They got away with it because in PEM and particularly rolling PEM that this policy and incitement that others treat those who have ME (don’t give them actual leeway , just soft faux sympathy whilst you encourage them to push through when in PEM) people were exhausted too, as well as all these symptoms, and they’d so badly and broadly described the symptom and suggested it was the only one to look for by incorporating it into the brand-name

 

[bobbler]

I think sadly the nature of mis-described disability for CFS also puts it right in the territory of the more simple ‘mind over matter’ mantra - and the ‘push through’ from eg Gerada and Chalder videos are the give-away of that being sold, and the ‘malingering’ conference most of the rest had bring the other.

the thing is that PEM is caused by those with ME ‘pushing’ rather than the opposite but they’ve rebranded it as ‘thinking you feel tired’ - as everyone else does until they get used getting up everyday for work’ sort of wind ups (pains in the mind, it’s a problematic thinking pattern that you think hard work hurts you type priming). So ‘the mind’ is also just pseudo words for basic disses like ‘lazy’, ‘weak’ and ‘not trying hard enough’ in some of these - hence the interesting change to now claiming ‘psych-education’ which isn’t far from re-education but still allows the ‘mental health insinuation to be used both as a weapon and as a fake shield pretending it’s ’based On care’ vs saying what they mean directly without ‘these allusions’

On that note the Heins et al (2013) ‘finding’ where fatigue increased with objective activity but decreased with perceived activity theoretically (and it is written down) blows that one out of the water. The more people thought they’d done the lower their perceived fatigue (like what they’d interpreted from the question is ‘do you feel less fatigued than you expected to after all that’)

goodness knows why the authors were surprised that increased objective activity led to increased fatigue though. And also of course the four graphs being fascinating that whatever their ‘mind response’ or ‘behaviour response’ they all ended up with the same limited function regarding objectivity activity being the same plateau as exampled by the four graphs.

 

[Robert 1973]

From: https://www.s4me.info/threads/nice-...nce-2024-barry-et-al.37429/page-2#post-518119

https://twitter.com/user/status/1762988605209722917

(Credit to @cassava7 and @MSEsperanza for spotting this.)

I seem to recall that this isn't the first time that SW has applied different rules to ME/CFS and other illnesses (eg depression). Am I right in thinking that he once wrote to someone at the DWP (or equivalent at the time) suggesting that benefits can make people with ME/CFS worse, and that he also wrote at least one article (Guardian? BMJ?) about the importance of giving people with mental health conditions benefits.

Can anyone confirm or correct, along with the relevant references?

Also, can anyone think of any other particular instances where SW has applied different rules to ME/CFS than other illnesses, other than his general approach to ME/CFS?

 

[Robert 1973]

I seem to recall that this isn't the first time that SW has applied different rules to ME/CFS and other illnesses (eg depression). Am I right in thinking that he once wrote to someone at the DWP (or equivalent at the time) suggesting that benefits can make people with ME/CFS worse, and that he also wrote at least one article (Guardian? BMJ?) about the importance of giving people with mental health conditions benefits.

Can anyone confirm or correct, along with the relevant references?

I’ve done some research:

From an Open letter from The Countess of Mar to Professor Simon Wessely | 4 December 2012 (https://meassociation.org.uk/2012/1...r-to-professor-simon-wessely-4-december-2012/):

“So much of the friction comes from people not knowing what you think because you are so inconsistent. For example, in your presentation to the full Board Meeting of the DLAAB on 2 November 1993 which was considering those with ME/CFS you said: “Benefits can often make people worse”, yet in your letter to Dr Mansell Aylward at the DSS you wrote: “CFS sufferers should be entitled to the full range of benefits”. Given that, in 1990 you had written: “A number of patients diagnosed as having myalgic encephalomyelitis……… were examined ……..in many of them, the usual findings of simulated muscle weakness were present” (Recent advances in Clinical Neurology, 1990, pp 85-131), I am wondering how a genuine condition can also be simulated and am curious to know what your position is regarding benefits for people with ME.”
​

From: https://www.healthcarehubris.com/post/toward-a-critical-psychology-of-medically-unexplained-symptoms

“The empirically unsupported ‘benefits can often make patients worse’ story can be noted in the minutes of a 1993 talk given by Simon Wessely and another academic-clinician (Prof Peter Thomas) to the UK DLA advisory board - in fact this was the exact phrase attributed to Wessely (see Wessely cited in McGrath, 1993). The DLA (Disability Living Allowance) advisory board was involved in determining who would qualify for disability benefits, and was presided over for some time by Mansel Aylward, who held a number of positions in the UK Department of Work and Pensions (DWP).”​

McGrath, M. (1993, November, 2). Chronic Fatigue Syndrome Summary of the talk given by Professor PK Thomas CBE DSc MD FRCP and Dr S Wessely BM BCh MRCP MRCPsych on 2.11.93. The National Archives. https://valerieeliotsmith.files.wordpress.com/2015/01/natarchbn141dss.pdf

From page 10 of the above pdf:




Guardian article by SW: “Linking benefits to treatment is unethical, and probably illegal” (https://amp.theguardian.com/comment...-people-mental-health-problems-work-treatment):

“Threatening to remove benefits if people do not agree to treatment puts doctors (and indeed all health professionals) in conflict with core principles of the law and medical ethics. Furthermore, it could have serious unintended consequences”​

From my letter to JGIM, 2022:

“In 1989, Wessely et al. acknowledged that it ‘may be correct in some cases’ that physical and mental exertion should be avoided by people with ME/CFS, but they went on to recommend behavioural and cognitive therapies which encouraged patients to ignore their symptoms and gradually increase exercise, as there was ‘as yet no way’ to identify the cases where such approaches may be harmful. Furthermore, the authors suggested that ‘it is reasonable to expect a patient to cooperate with treatment before being labelled as chronically disabled’ for the purposes of receiving sickness benefits.”​

Refs:

Wessely et al, 1989: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1711569

My letter JGIM, 2022:
https://link.springer.com/article/10.1007/s11606-022-07715-x

The above begs the question as to whether SW would consider his own 1989 article to be “in conflict with the law and medical ethics”.

If anyone else can provide any other references for these or any other contradictory statements, please share.

I seem to recall that there is an article whether he (rightly) advocates for people with mental illness to have better access to benefits. Please share if you can find it.

 

[Arvo]

If anyone else can provide any other references for these or any other contradictory statements, please share.

I don't have the energytime to go through everything I have atm (docs from the 80s & early 90s), but I vaguely recalled remarks on benefits by Wessely in a letter, so I went looking. (If you plan to do some writing with this then I'll gladly spend some time looking through what I have if I can.) It was the letter the Countess of Mar refers to in your quotes above.

Wessely wrote to Mansel Aylward on 10 January 1992:

"The guidelines also suggest that because laboratory testing of muscle function is normal, a person should be able to be self
caring without the assistance of another. I believe that this is a non sequitur. There are many illnesses in which muscle
function is objectively normal, but nevertheless a person abilities to look after themselves are severely impaired. For example in the field of psychiatry, patients with severe depressive illnesses are often completely unable to look after themselves, and yet have totally normal neuromuscular functions. There are also many disorders of cerebral function in both the psychiatric and non psychiatric fields in which this is also true. Given that research shows a considerable overlap between depression and CFS , that the two are often difficult to distinguish, and that cerebral dysfunction is almost certainly present in both, I think it is essential that the guidelines should not suggest that any forms of benefits are denied to a patient with CFS that would be available if the diagnosis was of depression. This would appear to be both unjust and inconsistent.

My final point concerns the prognosis of CFS. This is a very difficult subject, but I hope that the guidelines will not perpetuate the idea that CFS is both of poor prognosis and untreatable . Research is at an early stage, but the prospects for rehabilitation look promising, and there are undoubtedly many major medical discoveries to be made, all of which may have dramatic effects on treatments. I have previously been involved in advising the DSS that as CFS in undoubtedly a genuine condition and is as legitimate an illness as any encountered in the field of both medicine and psychiatry, CFS sufferers should be entitled to the full range of benefits. In particular it should be emphasise that symptoms and disability are genuine, and suggestions to the contrary ill founded. On the other hand I have also advised that CFS should not be grounds for permanent disability but provision should be made for regular reassessment of what may well be changing circumstances."

[OCR used for text conversion]

 

[Arvo]

Btw, that same letter also contains the snippet:

"It is certainly true that I and my colleagues consider that anxiety about the consequences of activity is one factor perpetuating disability in CFS patients. However, I should point out that, unlike the studies of muscle function, this is by no means proven. Furthermore it is probably only one of many factors contributing to disability, and even then may only be of importance in a small sub group."

(He then goes on about a hysterical origin of symptoms and abnormal motivation being the cause of fatigue, refuting the last with a paper by Andrew Lloyd.)

This is remarkable because afaik the early stage research he refers to -that he claims is promising in providing rehabilitation- is CBT, which hinges on the notion that activity avoidance because of discomfort and fear about the consequences of activity is the hub cause of perpetuating disability in ME. CBT then targets that avoidance with behaviour therapy (exposure to the avoided behaviour in order to trigger the effects of Operant Conditioning) while adding cognitive therapy (reframing untrue thoughts that keep the wrong behaviour in place) to support it in order to achieve the desired behaviour change.

(I'm glad I looked this up @Robert 1973, as this is relevant to my writing on CBT.)

 

[Fizzlou]

https://simonwessely.com/

Sorry if I have missed someone else posting this. There is a statement page on entitled “CFS personal story”.

 

[Hutan]

From the CFS personal story on his website - it's an interesting read.

He suggests there that recovery doesn't happen very often.

There were, and probably always will be, those who pushed various unproven and untested therapies, often from plush clinics in Harley Street, but for your average patient, the single most common piece of advice given was to rest, and wait either for the illness to go away of its own accord (and we soon showed that didn’t happen very often) or for doctors to come up with a magic bullet. It was very nihilistic, and pretty demoralising and depressing if you were unlucky enough to be a sufferer.

Cortisol - I must write a paper on cortisol in ME/CFS one day:

That led to a long series of neuro endocrine studies, largely led by my then lecturer, and now Professor, Tony Cleare. The work showed that the hypothalamic pituitary axis functioned differently in CFS to how it does in well people – with a particular pattern of low diurnal cortisol. This finding is now I think the single most replicated biological abnormality in CFS

We looked at personality – linked to the “yuppie flu” stereotype was a perception that sufferers tended to be perfectionistic, hard driving people. We found that once you controlled for the effect of chronic illness, there was no such thing as a “CFS prone personality”.

Whilst at Queen Square I had met up with Trudie Chalder, then working as a behavioural nurse therapist on the same ward. It was the start of a 20 year collaboration that is still going strong. We talked a lot about CFS, and why everyone seemed to think that nothing could be done. So in 1989 we wrote a paper advancing a theory, which was that cognitive and behavioural factors might help explain not why patients got ill in the first place, but why they weren’t getting better. And from that we developed a specific intervention for CFS, adapting something known as cognitive behaviour therapy, which was already achieving considerable success in the pain world. So we first of all simply tried treating 50 patients at Queen Square, with good results (1991), and perhaps most interestingly, with improvements that could still be detected some years later.
Then in 1991 I got a consultant/senior lecturer post at King’s College Hospital. I set up what was one of the first NHS only services exclusively devoted to CFS patients – still going strong today, with Trudie, now Professor Chalder, in charge. We got a grant to do what was needed, which was an randomised controlled trial (RCT) of CBT, comparing it with the same number of sessions of relaxation therapy. CBT performed well. At the same time Mike Sharpe at Oxford, now Professor Sharpe, had independently developed a cognitively behavioural approach to treatment and carried out a trial that had similarly positive results. We both published our results in 1997.

I do not think that CFS will be solved in a “eureka” single moment, but that progress will come, as it does in most of science, from a series of slow incremental steps. I would hazard a guess that the most fruitful area of research will come from a combination of neurosciences and psychology, and will be focussed around the sense of physical effort and effortful cognition, but we shall see. As it is, I don’t regret being involved in CFS research, and I think that with all my colleagues we made a very positive contribution to improving patient care.

But there has been a downside I and others have indeed gone public recently documenting some of the intimidation and threats that we have all received over a long period of time from a very small number of activists. But because I do still stay in contact with sufferers in the clinic, I know for sure that these extremists are a tiny minority, and do not speak for real patients in any shape or form, indeed they do them a major disservice.

So next time you come across something that purports to be an unfavourable or unflattering quote from myself or one of my colleagues, make sure you check it out first with the actual article. By all means then feel free to disagree – that’s fine. Because in the end science proceeds by debate, discussion and disagreement. What it doesn’t do is proceed by distortion.

 

[Ash]

We would check. But usually that’s a formality since we are all by now, thanks to VES’s excellent work especially, so horribly familiar with the original sources. Plus to my knowledge he’s never claimed his Twitter was hacked. Or his photo trampered with outside a certain conference.

 

[Ash]

From the CFS personal story on his website - it's an interesting read.

He suggests there that recovery doesn't happen very often.


Cortisol - I must write a paper on cortisol in ME/CFS one day:

Yeah none the of this is news. It was our lack of spontaneous recovery that was the justification for his whole career in that area, from the beginning.

 

[Arvo]

https://simonwessely.com/

Sorry if I have missed someone else posting this. There is a statement page on entitled “CFS personal story”.

Thanks! Glad you posted it, as it contained some info that aligned with a conclusion I drew from puzzling together info from other sources.

I also made a PDF of a couple of sections to put into my archive.

 

[Lindberg]

Simon Wessely: ”I would hazard a guess that the most fruitful area of research will come from a combination of neurosciences and psychology, and will be focussed around the sense of physical effort and effortful cognition, but we shall see.” (From @Hutans post above.)

Seems very much in line with Brian Walitts work and hypothesis.