Views of Simon Wesseley
Margaret Williams answers a question posed by Dr John Greensmith
about the views of Professor Simon Wessely on M.E.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
posted at the request of the author, Margaret Williams, with permission to
re-post anywhere.
In his response to Simon Wessely's article of 5th January 2004 in The Scotsman, on 8th January 2004 Dr John Greensmith wrote "I think (Wessely) should
grasp this opportunity to say clearly how he does define ME, whether he has
ever, or never, denied its existence (or) averred that it is exclusively a
psychological illness".
In case Wessely fails to grasp this opportunity, the following quotations from
his published works may shed some light on the issue.
It was not only in his 9th Eliot Slater Memorial Lecture given at the Institute
of Psychiatry on 12th May 1994 that Wessely unequivocally denied the existence
of ME, he specifically denies it in the following terms:
"The epidemiology of environmental illness is reminiscent of the
difficulties encountered in distinguishing between the epidemiology of myalgic
encephalomyelitis (ME), a belief, and
chronic fatigue syndrome, an operationally -defined syndrome" (Psychiatry
in the allergy clinic: the nature and management of patients with
non-allergic symptoms. LM Howard S Wessely.
Clinical and Experimental Allergy 1995:25:503-514)
For information, 30 quotations from Wessely's published papers are appended
below. Many more have been collected into the two spiral-bound volumes of
"Denigration by Design?" (copies available at cost price from DM
Jones on 0208-554-3832).
A few are worthy of special mention, for example:
In 1990, Wessely wrote that ME exists "only because well-meaning
doctors have not learnt to deal effectively with suggestible
patients" (Psychological Medicine 1990:20:35-53)
Also in 1990 Wessely wrote in a medical textbook: "It is this
author's belief that the interactions of the attributional, behavioural and
affective factors is responsible for both the
initial presentation to a physician and for the poor prognosis". In
the same chapter, he stated: "The description given by a leading (doctor)
at The Mayo Clinic remains accurate: 'the doctor will see that they are
neurotic and he will often be disgusted with them' " (Chronic
fatigue and myalgia syndromes. Wessely S.
In: Psychological Disorders in General Medical Practice. Eds. N Sartorius
et al Hogrefe & Huber 1990).
In 1991, in his major Review in the British Medical Bulletin, Wessely cited
medical comments made between 1880 and 1908 on patients with neurasthenia, with
the clear implication that such descriptions apply equally well to today's ME
patients:
"always ailing, seldom ill; a useless, noxious element of society;
purely mental cases; laziness, weakness of mind and supersensitiveness
characterizes them all; the terror of the busy physician" (BMB
1991:47:4:919-941
In 1994 Wessely wrote: "These patients are generally viewed as an
unavoidable, untreatable and unattractive burden" (British Journal
of Hospital Medicine 1994:51:8:421-427).
Perhaps of special interest is what he wrote in 2003 about he use of the
combined term "CFS/ME" in both the CMO's Working Group Report of 2002
and in the MRC Strategy document of 2003: "One challenge arises when
patients have named their condition in a way that leaves doctors uncomfortable,
as occurred with chronic fatigue syndrome. It may seem that adopting the
lay label reinforces the perceived disability. A compromise strategy is
'constructive labelling': it would mean treating chronic fatigue syndrome
as a legitimate illness while gradually expanding the understanding of the
condition to incorporate the psychological and social dimensions"
(BMJ 2003:326:595-597).
Quotations from the published works of Professor Simon Wessely on ME/CFS
1988
Postviral fatigue syndrome: time for a new approach. David AS, Wessely S,
Pelosi AJ
BMJ 1988:296:696-699
"Future investigations and clinical practice must take into account
the similarities between the symptomatology of the post-viral fatigue syndrome
and that of common psychiatric
disorders in the community"
1989
What your patients may be reading. Wessely S. BMJ
1989:298:1532-1533
"Beard and Mitchell have returned to obscurity, but their disease
(neurasthenia) is back with a vengeance. My local bookshop has just given
ME the final seal of approval, its own shelf. A little more psychology
and a little less T-cells would be welcome".
1989
Management of chronic (post-viral) fatigue syndrome. Simon Wessely, Anthony
David, Sue Butler, Trudie Chalder. Journal
of the Royal College of General Practitioners 1989:39:26-29
"Many patients referred to a specialized hospital with chronic fatigue
syndrome have embarked on a struggle. This may take the form of trying to find
an acceptable diagnosis, or indeed any diagnosis and may involve reading the
scientific literature. One of the principal functions of therapy at this stage
is to allow the patient to call a halt without loss of face. [ME patients
are in] a vicious circle of increasing avoidance, inactivity and fatigue. The
patient should be told that it is now time to 'pick up the pieces' (and) the
process is a transfer of responsibility from the doctor to the patient,
confirming his or her duty to participate in the
process of rehabilitation in collaboration with the doctor.
Occasionally patients may say they cannot take drugs (but) there is no clinical
evidence that allergies exist in anything but a small number of sufferers, and
their existence may be coincidental.
Anxiety is often part of the syndrome (and) sexual problems occur in the
majority of patients referred to hospital. The notion of allergies reinforce
the view that the sufferer is under attack
from outside elements which have nothing to do with himself or herself".
1990
Attribution and self-esteem in depression and Chronic Fatigue
Syndrome. R Powell, R Dolan, S Wessely. J Psychosom Res 1990:34:6:665-673.
"This research shows that in CFS, (patients) experience less guilt: such
an external style of attribution has certain advantages; external attribution
protects the patient from being exposed to the stigma of being labelled
psychiatrically disordered, (affording) diminished responsibility for one's own
health. Our results are close to those predicted by 'learned
helplessness'.
Inappropriate referrals to physicians can lead to extensive physical
investigation that may then perpetuate the symptom pattern of physical
attribution"
1990
Chronic fatigue and myalgia syndromes. Wessely S. In: Psychological
Disorders in General Medical Settings. eds: N Sartorius et al
pub: Hogrefe & Huber 1990
"Most CFS patients fulfil diagnostic criteria for psychiatric
disorder. Symptoms include muscle pain and many somatic symptoms,
especially cardiac, gastrointestinal and neurological.
Do any of these symptoms possess diagnostic significance?
The answer is basically negative. It is of interest that the 'germ
theory' is gaining popularity at the expense of a decline in the acceptance of
personal responsibility for illness. Such
attribution conveys certain benefits, in other words, there is avoidance of
guilt and blame. It is this author's belief that the interactions of the
attributional, behavioural and affective factors
is responsible for both the initial presentation to a physician and for the
poor prognosis".
1990
Old wine in new bottles: neurasthenia and ME. Simon Wessely.
Psychological Medicine - 1990:20:35-53
"It is assumed that ME is an organic disorder of the peripheral or central
nervous system. In the initial reports this was indicated by frank
neurological signs (but) the concept of ME has
shifted.as in neurasthenia, the emphasis is on muscle fatigability..in a
current leading neurology text book (Adams and Victor, 1985) chronic fatigue,
neurasthenia and depression are seen as synonymous. Mood disorder is
found in many cases of ME but it is not the only psychiatric disorder (and)
some patients do satisfy the criteria for anxiety and phobic disorders.Beard's
neurasthenia began as a physical disease.it provided the most
respectable label for distressing, but not life-threatening complaints, one
that conferred many of the benefits - and fewest of the liabilities- associated
with illness..it was preferable to the
alternatives --- hypochondria, malingering and insanity. There is little
evidence of any change in the current era. Suggestible patients with a
tendency to somatize will continue to be found
among sufferers from diseases with ill-defined symptomatology until doctors
learn to deal with them more effectively. The social processes that
govern the creation of such illnesses remain obscure but one may argue that
they represent culturally sanctioned expressions of distress. It has been
shown that some patients have always preferred to receive, and
well-meaning doctors to give, a physical rather than a psychological
explanation for ill-defined illnesses associated with fatigue. Such
uncritical diagnoses may reinforce
maladaptive behaviour".
1990
Possible ME. Simon Wessely. The Practitioner 8 March
1990:234:195-198
"ME is a description, not a diagnosis".
1990
The chronic fatigue syndrome-myalgic encephalomyelitis or postviral fatigue.
S.Wessely PK Thomas. In: Recent Advances in Clinical Neurology.
ed: Christopher Kennard. pub: Churchill Livingstone 1990
pp85-131
"There is no doubt that at least half of CFS patients have a disorder of
mood. The management of affective disorders is an essential part of the
treatment of CFS/ME. Numerous trials attest to the efficacy of tricyclic
antidepressants in the treatment
of fatigue states. Patients who fail to respond should be treated along
similar lines to those proposed for treatment-resistant depression, especially
(with) lithium".
1991
Editorial. Wessely S. Journal of Neurology, Neurosurgery and
Psychiatry 1991:54:669-671
"Studies of dynamic muscle function have demonstrated essentially normal
muscle strength, endurance and fatigability, other than as a consequence of
physical inactivity. Advice that
antidepressants may be counter-productive is misguided".
1991
Cognitive behaviour therapy in chronic fatigue syndrome. Butler S, Chalder T, Ron M, Wessely S. JNNP 1991:54:153-158
"Continuing attribution of all symptoms to a persistent 'virus' preserves
self-esteem".
1991
The psychological basis for the treatment of CFS. Wessely S.Pulse of
Medicine 14th December 1991:58
"The prognosis may depend on maladaptive coping strategies and the
attitude of the medical profession".
1992
The epidemiology of fatigue: more questions than answers.
Lewis G, Wessely S. Journal of Epidemiology and Community Health 1992:46:92-97
"We suggest that many patients currently labelled as having 'CFS' may lie
at the extreme end of a continuum that begins with the common feeling of
tiredness. Studies usually find a high
prevalence of psychiatric disorder amongst those with CFS, confirming that
physicians are poor at detecting such disorders".
1992
Chronic fatigue syndrome: current issues. Wessely S. Reviews in Medical
Microbiology 1992:3:211-216.
"Validation is needed from the doctor. Once that is granted, the patient
may assume the privileges of the sick role (sympathy, time off work,
benefits etc)"
On 10th January 1992 Wessely wrote a letter to Dr Mansel Aylward at the
Department of Social Security in which he stated
"It is certainly true that I and my colleagues consider that anxiety about
the consequences of activity is one of the factors perpetuating disability in
CFS. I have previously been involved
in advising the DSS that CFS should not be grounds for permanent
disability".
Following Wessely's advice, the 1994 Disability Living Allowance Handbook entry
on CFS states "The general consensus of informed medical opinion is that
treatment should
be by graded exercise and rehabilitation (and) antidepressant drugs may be
helpful".
1993
The psychology of multiple allergy. LM Howard, S Wessely.BMJ:1993:307:747-748.
"Many people present to their doctor with multiple unexplained
symptomatology which they attribute to allergy. Those at the extreme end
of this range often attract a diagnosis of total
allergy syndrome, multiple chemical sensitivity, or environmental
illness. A recent study confirmed that psychological symptoms were a
central component of chemical sensitivity. Inherent in the concept of
allergy is the avoidance of any blame. Sufferers from
allergies feel no guilt about their condition and are not subject to moral
sanction. Sufferers from mysterious condition that lie outside
conventional medical practice no longer consider
themselves to be oppressed by spirits and demons but by mystery gases, toxins
and viruses. This is particularly visible in the changing nature of mass
hysteria".
1994
Patients with medically unexplained symptoms. Alcuin Wilkie, Simon
Wessely. British Journal of Hospital Medicine: 1994:51:8:421-427
" Most doctors in hospital practice will be familiar with patients who
complain about a wide variety of symptoms but whose physical examination and
investigations show no
abnormality.(Such) symptoms have no anatomical or physiological basis.
Patients at the severe end of the spectrum exert a disproportionately large and
avoidable financial burden
on the health and social services..Patients with inexplicable physical symptoms
are usually strongly resistant to any psychological interpretation (and) are
generally viewed as an
unavoidable, untreatable and unattractive burden".
1994
Population based study of fatigue and social distress.
Pawlikowska T, Chalder T, Wallace P, Wright DJM, Wessely S.BMJ 1994:308:763-766
"In recent years, fatigue has attracted renewed attention, largely because
of the prominence given to the chronic fatigue syndrome. The infective
characteristics may be the result of
referral patterns and illness behaviour. The chronic fatigue syndrome may
represent a morbid excess of fatigue rather than a discrete entity. The
definition may have arisen as a result of
referral patterns to specialists. Muscle pain was related to
psychological morbidity".
1994
The patient with chronic fatigue. Simon Wessely et al West of
England Medical Journal
"The aims of treatment were to provide alternative explanations for
symptoms. The methods chosen included the use of established techniques
to treat depression, namely, dothiepin".
1994
A cognitive-behavioural approach to chronic fatigue syndrome.
Alicia Deale Simon Wessely The Therapist 1994:2;1:11-14
"Behavioural, attributional and cognitive factors are central to the
perpetuation of fatigue. It is important to note that the rates of
depression and anxiety in CFS are far too high to be explained solely as
reactions to chronic illness".
1995
Psychiatry in the allergy clinic: the nature and management of patients with
non- allergic symptoms. LM Howard, S Wessely.
Clinical and Experimental Allergy 1995:25:503-514.
"Many doctors are frequently consulted by patients with persistent
unexplained
symptoms attributed to allergy or chemical sensitivity.when patients are
told there is no evidence of any underlying immunological or allergic cause,
they can be difficult to manage.
In some cases patients claim allergy to almost all of the environmental
products of the Western world. The illness is usually sporadic but
epidemics have been described. Such
epidemics overlap with the related subject of mass psychogenic illness, a term
which has partly replaced mass hysteria. The epidemiology of
environmental illness is reminiscent of the difficulties encountered in
distinguishing between the epidemiology of myalgic encephalomyelitis (ME), a
belief, and chronic fatigue syndrome, an operationally-defined syndrome.
[
Note: The World Health Organisation does not regard ME as " a
belief", but as a neurological disorder ].
These patient populations recruited from
the environmental subculture are a subgroup of patients who can be expected to
show unusually strong beliefs about the nature of their symptoms, associated
with a high prevalence of psychiatric disorder. These patients
typically resist any attempt to discuss the possibility of a psychological
cause. Somatization sufferers consume vast amounts of health resources
for little benefit. Between a quarter
and a half of new patients attending medical clinics do not have an organic
explanation for their symptoms, (receiving) a diagnosis of chronic fatigue
syndrome. The risk of psychiatric
diagnosis is known to increase linearly with the number of symptoms with which
the patient presents. Attribution of unexplained symptoms to a
"virus", as happens in most patients
with the label of ME, may preserve self-esteem and protect against the stigma
of psychiatric disorder. These total allergy syndromes are akin to
culture-bound syndromes afflicting
modern developed societies where sufferers from unexplained symptoms no longer
see themselves as possessed by devils or spirits but instead by gases, toxins
and viruses. When a
psychiatric disorder is not recognised, patients are often investigated
extensively for organic disease; there are hazards in these inappropriate
investigations, as patients' beliefs in
organic pathology are reinforced. Further investigations will add nothing
to the management but will reinforce the patient's beliefs in organic pathology
(and) add to the cost of the consultation.
Patients will benefit from training in cognitive coping skills; (and some)
patients should be treated with psychotropic drugs.
Liaison between the physician and the liaison psychiatrist is necessary so that
patient acceptance of psychiatric referrals can be facilitated".
1996
Chronic fatigue syndrome: an update. Anthony J Cleare, Simon C
Wessely. Update 1996:14 August:61.
" Chronic fatigue may be better understood by focusing on
perpetuating factors and the way in which they interact in self-perpetuating
vicious circles of fatigue, behaviour, beliefs
and disability. The perpetuating factors include inactivity, illness
beliefs and fear about symptoms, symptom focusing, and emotional state.
CFS is dogged by unhelpful and inaccurate illness beliefs, reinforced by much
ill-informed media coverage;
they include fears and beliefs that CFS is caused by a persistent virus
infection or immune disorder. Increased symptom focusing occurs in CFS
sufferers; (this) increased concern leads to selective attention and
'body watching': this can intensify the perceived frequency of symptoms,
thereby confirming illness beliefs and reinforcing illness behaviour".
1996
Chronic fatigue syndrome: a stress disorder? Anthony J Cleare
Simon C Wessely
British Journal of Hospital Medicine: 1996:55:9:571-574
"Between half and two thirds of patients with CFS have a co-morbid
psychiatric disorder".
1997
Chronic fatigue syndrome: a practical guide to assessment and management.
Sharpe M, Chalder T, Wessely S et al General Hospital Psychiatry 1997:19:3:185-199.
" The majority of patients seen in specialist clinics typically
believe that their symptoms are the result of an organic disease process, and
resent any suggestion that they are psychological
in origin or psychiatric in nature. Many doctors believe the
converse. (Patients') beliefs are probable
illness-maintaining factors and targets for therapeutic intervention.
Many patients receive financial benefits and payment which may be contingent
upon their remaining unwell. Gradual recovery may therefore pose a
threat of financial loss. Abnormal physical signs should not be accepted
as compatible with a diagnosis of CFS. The
only treatment strategies of proven efficacy are cognitive behavioural
ones. We have developed a more intensive (CBT) therapy (which) is
acceptable to patients, safe, and more
effective than either standard medical care or relaxation therapy. It has
also been shown to be cost-effective. An important task of treatment is
to return responsibility to the
patient for management and rehabilitation without inducing a sense of guilt,
blame or culpability for his / her predicament".
1998
Clinics in Controversy: Chronic Fatigue Syndrome.
Anthony J Cleare Simon C Wessely. Update 20 May
1998:1016-1026.
"CFS may be better understood as the extreme end of a spectrum that
starts with 'feeling tired all the time'. Many people suggest that
the condition should be called ME, but doctors and the editors of journals have
taken a firm stand against this label.
The GP's response may be important. A sick note and unclear diagnosis are
both associated with development of CFS".
1999
Functional somatic syndromes: one or many? S Wessely, C Nimnuan, M
Sharpe. Lancet 1999:354:936-939.
" We postulate that the existence of specific somatic syndromes is largely
an artefact of medical specialisation. That is to say that the differentiation
of specific functional (ie. psychiatric) syndromes reflects the tendency of
specialists to focus on only those symptoms pertinent to their speciality,
rather than any real differences between patients.Various names have been given
to medically unexplained symptoms. These include somatisation, somatoform
disorders.and functional somatic symptoms. We define a functional somatic
symptom as one that, after appropriate medical assessment, cannot be explained
in terms of a conventionally defined disease. Functional somatic
syndromes pose a major challenge to medicine. Those symptoms are
associated with unnecessary expenditure of
medical resources. Chronic fatigue syndrome is associated with worse
disability than conditions such as heart failure. Three quarters of patients
had symptoms more than 10 years after presentation. Thus, functional
somatic complaints constitute a large.and costly health-care issue that
urgently requires improved management. Many of these (functional somatic)
syndromes are dignified by their own formal case definition and body of
research. We question this orthodoxy and ask whether these
syndromes represent specific diagnostic entities (eg.irritable bowel syndrome,
premenstrual syndrome, fibromyalgia,hyperventilation syndrome, tension
headaches, globus hystericus, multiple chemical sensitivity, chronic fatigue
syndrome) or are rather more like the elephant to the blind man --- simply
different parts of a larger animal?..Such patients may have variants of a
general functional somatic syndrome. If we accept that functional somatic
syndromes are considered together, we open the way for more general strategies
for their management..Functional somatic symptoms
and syndromes are a major health
issue. They are common, and may be costly.
Most of the current literature pertains to specific syndromes. We have
put forward the hypothesis that the acceptance of distinct syndromes as defined
in the medical literature should be challenged. We contend that the patients so
identified.have much in common.We propose an end to the belief that each
different syndrome requires its own particular sub specialist.A previous
generation of physicians noted overlaps between "psychosomatic
syndromes". Unfortunately, none of these theories were accompanied
by empirical support and consequently have disappeared from our current
thinking. We argue that their re-instatement is overdue".
2000
Responding to Mass Psychogenic Illness. Editorial: Simon Wessely. The New England Journal of Medicine
2000:342:2:129-130
"Such outbreaks are not novel. In a previous era, spirits and demons
oppressed us. Although they have been replaced by our contemporary concern
about invisible viruses, chemicals
and toxins, the mechanisms of contagious fear remain the same. The term
'psychogenic illness' and its predecessor 'mass hysteria' exemplify the
problem. To the majority of observers, including most professionals, these
symptoms are indeed all in
the mind. It is now commonplace to blame our environment for many of our
ills. Should we investigate at all? How do you convey the
message that the main mechanisms for the
transmission of distress are psychosocial and behavioural? A firm public
message that certain symptoms are probably psychological in origin will
probably help prevent their spread".
2001
Chronic fatigue syndrome: Symptom and Syndrome. Wessely S.Annals of Internal
Medicine 2001:134: 9S:838-843
"Social, behavioural and psychological variables are important in both
chronic fatigue and chronic fatigue syndrome. The lack of congruence
between the patient's report of feeling tired and exhausted and objective
measures of fatigability further frustrate clinicians and investigators.
Compelling evidence of abnormal neuromuscular fatigability in patients with the
chronic fatigue syndrome is lacking. Fatigue can be related to
psychological variables such as belief and expectation. Some of the
desire to split the chronic fatigue syndrome into subgroups is driven by
emotion. It is interesting to note how some of those who advance this
argument assume that "their" condition (the one they suffer from,
research or treat) will fall on the physical side of the divide. The
greater the number of symptoms and the greater
the perceived disability, the more likely clinicians are to identify
psychological, behavioural or social contributors to illness. The
pressure to reify the chronic fatigue syndrome comes from the way in which the
developed world organizes medical services and reimbursement systems.
Some of the modern impetus to 'allow' a specific chronic fatigue syndrome
arises from the various compensation and social insurance schemes operating in
developed countries. If the chronic fatigue syndrome did not exist, our
current medical and social care systems might force us to invent it.
Other symptoms identified in the chronic fatigue
syndrome (include) increased symptom-monitoring and increased anxiety".
In correspondence arising from this paper, Wessely wrote "I can
sleep easy at night when it comes to treatment. I know that we have done
more good than harm. You mention the views of Paul Cheney, but I must say
I disagree profoundly with them – and more importantly, so does every
neurologist I have ever met. All I know is that I am quietly proud of
what our group has achieved over the years".
2001
How many functional somatic syndromes? C Nimnuan, S Rabe-Hesketh, Simon
Wessely, Matthew Hotopf. Journal of Psychosomatic Research
2001:51:4:549-557
"Experiencing symptoms is part of normality. Most of these symptoms are
not associated with clear-cut biomedical diagnosis and are then referred to as
"medically unexplained" or
"functional". Functional somatic symptoms are an important
problem in general medicine on account of the high associated consumption of
health service resources. Such symptoms may
be elevated to the status of a syndrome to which a specific name is
attached. These include irritable bowel syndrome, pre-menstrual pain,
fibromyalgia and chronic fatigue syndrome.
Physicians instinctively seek and treat only conditions they know well.
Patients may be seen in several clinics, which increases the risk of
over-investigation. We argue that such an approach is outdated.
Instead, an appreciation of the fundamental unity of those syndromes may reduce
the potential for iatrogenic harm ".
2002
Modern worries, new technology, and medicine Keith
Petrie Simon Wessely Editorial: BMJ 2002:324:690-691
" People's suspicion of modernity has increased to such an extent that it
has increased their worries about environmental causes of poor health and
fostered a migration to
complementary medicine. We believe that these concerns have important
implications for the way patients interact with health services. In clinical
settings patients are reluctant to start
medication for fear of putting 'unnatural chemicals' into their body. At
the same time the consumption of unproved herbal and alternative 'natural' remedies
is increasing. This anxiety is reflected in the presentation of psychosomatic
illness: the number of illnesses attributed to environmental factors --- for
example, multiple chemical sensitivity, total allergy syndrome has
increased. Normal everyday symptoms such as headache and fatigue
are now more easily interpreted as signs of disease or ill health.
Attributions made by patients about the cause of their illness often involve
environmental pollution, and they see
the effects of modern life as undermining the effectiveness of their immune
system. Distrust of experts is now commonplace, and at its extreme it can
merge into the conspiratorial thinking that is part of a modern paranoid
style. Mismanaged environmental incidents add to the fear of the
public. New and unsubstantiated health worries can be instantly
transmitted to an internet audience eagerly seeking information on health, or
to special interest networks such as illness support groups. We believe
it is only a matter of time before a mass psychogenic illness is identified as
being spread electronically".
2003
Managing patients with inexplicable health problems. B
Fischhoff Simon Wessely BMJ 2003:326:595-597
"Those with medical mysteries will find some explanation. When a
medical explanation is slow in coming, physicians, officials and companies
often bear the brunt of (patients') anger, for example in chronic fatigue
syndrome and Gulf war sickness, authorities who denied sufferers' claims met
with scorn and contempt. In this article we discuss how illness beliefs
arise and suggest principles for dealing with patients. It is only
human for
doctors to view the public as foolish, uncomprehending, hysterical or
malingering. One challenge arises when patients have named their condition
in a way that leaves doctors
uncomfortable, as occurred with chronic fatigue syndrome. It may seem
that adopting the lay label reinforces the perceived disability. A
compromise strategy is 'constructive labelling': it
would mean treating chronic fatigue syndrome as a legitimate illness while
gradually expanding understanding of the condition to incorporate the
psychological and social dimensions. The recent adoption by the UK
Medical Research Council and the
chief medical officer's report of the term CFS/ME reflects such a compromise,
albeit it an uneasy one".
2003
Medically unexplained symptoms: exacerbating factors in the doctor-patient
encounter.
LA Page, S Wessely Journal of the Royal Society of
Medicine 2003:96:223-227
"This paper proposes that well-intentioned actions by medical
practitioners can exacerbate or maintain medically unexplained symptoms
(MUS). This term is now used in preference to
'somatisation'. The medical specialties employ shorthand descriptions for
particular clusters of MUS, including irritable bowel syndrome, fibromyalgia
and chronic fatigue syndrome.
Examples of precipitating events include muscle ache after unaccustomed
exercise. As one expert notes, 'It is a commonplace clinical observation
that somatising patients ---
more than any other group ---resent psychiatric referral'. Once a patient
feels discredited, the opportunity to explore psychosocial factors is
lost. For patients with MUS, the sensory experiences tend to outweigh the
negative results of a doctor's examination or investigations. Thus one
sees how the cycle of excessive investigation can begin. If enough
investigations are performed, minor and irrelevant abnormalities will be
detected and themselves become hypothesis-generating. Reassurance is
particularly important in patients who have hypochondriasis or MUS. The
adoption of a label such as CFS affords the sufferer
legitimacy --- in other words, it allows entry into the 'sick role'.
The external acknowledgement that the condition is 'legitimate' is both
reassuring and enabling. However, the conferring of a label is not a
neutral act, since specific labels are associated with specific beliefs and
attitudes. In CFS for example, use of this term or the alternative
'myalgic encephalomyelitis' implies underlying assumptions about aetiology and
treatment for both patients and doctors. (In relation to treatment),
there is evidence
to suggest that harm occurs at the hands of non-medical practitioners (who)
colluded with patients' abnormal illness beliefs. If sections of the
media advocate an exclusively organic
model, as has happened with CFS, the biomedical model may become firmly
enshrined for patients and families at the expense of psychosocial
models. Clearly there are implications for the way doctors are taught to
assess and treat these patients".
Only by assembling and distributing the great wealth of published medical and
scientific evidence which shows unequivocally that Wessely and his like-minded
psychiatrists are
wrong is there any hope of refuting their erroneous assertions and of limiting
the unquantifiable damage that flows from them.
Both the ME Association and Action for ME were set up as charities to promote
and protect the interests of their members, ie. those suffering from ME (and
the term is incorporated into
their charitable status). Neither currently does so, since the Chief
Executives of both charities seem only too happy to subscribe to the Wessely School view (which ensures continued
Government funding).
A Co-cure (internet) posting by Jill McLoughlin, Executive Director of The
National CFIDS Foundation Inc, expresses the nature of the problem succinctly:
"It is because our medical community, professional societies and public
health officials have not adequately gathered together, assimilated, integrated
and made public the strong
body of research pointing to the serious physical (not psychological) nature of
this illness".
From: "Dr John H Greensmith" <drjohnh@greensmith53.freeserve.co.uk>