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>