Can people think themselves sick?16th March 2009
In the New Scientist psychiatrist Simon Wessely, adviser to the Home Office and Ministry of Defence, looks into the idea that people can "think themselves sick".
Dr Wessely has researched how illnesses such as chronic fatigue syndrome and Gulf war syndrome are caused. This has led to controversy and he has received angry letters from people who believe he has dismissed their conditions.
However Dr Wessely has devoted himself to the finding ways of treating these conditions. Speaking to Claire Wilson, Dr Wessley explains how a person's brain can affect their health.
How does a person's mindset affect their physical health?
On a weekly basis one would experience many manifestations of "how what's going on around you affects your subjective health". When unpleasant experiences occur, they affect a person physically. One might suffer a number of reactions including insomnia, anxiety and other symptoms.
At what point does that make someone ill?
The physical reactions "only become a problem when people get trapped in excessively narrow explanations for illness". Going online to diagnose ourselves can potentially be harmful.
How does chronic fatigue syndrome (CFS) relate to this?
In many cases, it is caused by an illness such as glandular fever. After a few weeks or months most people will have recovered from it. Unfortunately some people decide to monitor their symptoms and can "get trapped in vicious circles...so that what started it all off is no longer what is keeping it going".
We still do not understand why some infections and not others trigger CFS, or why depressed people have double the risk of developing it. It is important to consider both the "infective trigger" and the mental factors in order to understand the condition.
How is CFS treated?
The first step is to make people engage with their treatment. I speak with them for 2 hours and let them know I want to understand their problems.
Although I may not know why many of the patients I see are unwell, the most important thing "is what happens next". I encourage cognitive behavioural therapy and for the patient to become more active.
Is your method of treating CFS a success?
About one third of people improve, one third "completely recover" and the remaining third do not.
You have claimed that CFS, irritable bowel syndrome and fibromyalgia "are all the same illness".
Many of these conditions share overlapping symptoms - people with IBS say they are tired and people with CFS report intestinal problems.
So the "syndrome labels" are too random?
You find that countries around the world have "different syndromes". For example, in France CFS does not exist and in Germany low blood pressure is not good.
What about Gulf war syndrome?
I asked the question: "What are the rates of illness in those we sent to the Gulf compared with those we haven't?" Our research found that being sent to the Gulf had caused a definite effect to the health of some of those serving there.
How has your work affected military policy?
Our research has gathered data about psychiatric disorders in soldiers. We discoverd that alcohol is more of an issue than post-traumatic stress disorder (PTSD).
You have recently been exploring the claims of people who say their mobile phones have made them unwell. What's this about?
My co-worker James Rubin and I found that people who say they are affected by mobile phones could not "tell the difference between sham and real phone signals". These people are not inventing the problem - they have put themselves in a trap where a mobile phone is the trigger for their problems.
What does it feel like to be sent hate mail?
It has been "pretty unpleasant" in some cases, but my work covers a controversial area.
My patients do not send me hate mail and I would be concerned if my colleagues or patients thought I was not a good person. What is important is producing "good quality" research.
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Monday 16th March 2009 @ 18:02
This article has been roundly criticised and deconstructed in its original place of publication, leading to record numbers of comments for the magazine. Professor Wessely has a telling use of language; when he is asked what the treatment for CFS is, he replies: "The first step is to make people engage with their treatment." "Make" is a coercive word; and apparently puts him in conflict with the NICE Guidelines which states there should be no compulsion on patients to attend particular treatments.
As the only treatments Wessely provides/thinks should be provided for sufferers are psychological treatments, this is extremely important, as ME/CFS is a physical neurological illness, not a psychiatric one; it is not clear why Wessely's theory is given web-space in articles when it so clearly deviates not only from the WHO definition of ME/CFS but also from the wealth of biomedical research which - if he would read it - would finally put to bed the theory that ME/CFS is a psychological illness.
Monday 16th March 2009 @ 19:31
I very much doubt that the timing of this piece in New Scientist was co-incidental. I consider that this cobbled together "interview" was most likely orchestrated as a potential damage limitation exercise, published just a couple of days before the anticipated handing down of the judgement on the Judicial Review of the NICE CFS/ME Guideline (CG53).
In March/April 2008, the Royal Society of Medicine received a large number of complaints because the Planning Committee for a CFS conference had been dominated by psychiatrists and because a significant number of those selected to give presentations were also from predominately psychological/psychiatric backgrounds.
Towards the end of his own presentation at this CFS Conference, Prof Wessely (who had been a member of the conference planning committee) had remarked, "...it is not possible, really though, to completely avoid the outside world much as we would like...I also think it is a great mistake, because if you really actually want to understand Chronic fatigue syndrome - ME, whatever we are going to call it, you have to do so in possession of all the facts - not just those facts that you like, but all of them. You cannot pick and choose, and the history of science tells us very clearly that turning your back on things that you do not like, things that are not going the way you want them to, and there are many, many examples of this, at best leads to false conclusions and bad decisions, and at worst, leads to bigotry and intolerance."
So can we expect to see Prof Wessely at the 29 May Invest in ME Conference?
Prof Wessely appears to have problems with consistency when it comes to setting on record, in the media, the status of his involvement with the field of "Chronic fatigue syndrome".
In September 2001, the Guardian published an article by Heath Editor, Sarah Boseley, called:
"Storm brews over "all in mind" theory of ME"
You can still read the article here:
In this exceedingly emotive piece, in which a number of unsubstantiated claims were made, Ms Boseley reported:
"Prof Wessely has quit the field - and is not the only professional to have ceased involvement with CFS."
Remember, this was reported in September 2001 - over seven years ago.
But here is Professor Wessely, still seeing "CFS" patients, he tells the New Scientist...
...with a steady output of "CFS" reviews and papers...see PubMed...
...and still presenting around "CFS" at conferences and symposia, for example, the American Psychiatric Association DSM-V development planning conference "Somatic Presentations in Mental Health Symposium", Sept 2006, Beijing and the Royal Society of Medicine "CFS" Conference in April 2008.
Not bad for someone who had informed the Guardian, in 2001, that he had already quit the field.
Monday 23rd March 2009 @ 14:09
The World Health Organisation has classified M.E. as a neurological disorder since 1969 & the classification remains unchanged:
"ME/CFS is an acquired organic, pathophysiological, multi-systemic illness that occurs in both sporadic and epidemic forms. Myalgic Encephalomyelitis (ICD 10 G93.3), which includes CFS, is classified as a neurological disease in the World Health Organization's International Classification of Diseases (ICD). Chronic fatigue must not be confused with ME/CFS because the "fatigue" of ME/CFS represents pathophysiological exhaustion and is only one of many symptoms. Compelling research evidence of physiological and biochemical abnormalities identifies ME/CFS as a distinct, biological clinical disorder."
In the UK M.E. remains the only neurological illness to be treated solely by psychological interventions. It remains the only neurological illness for which all government research funding has gone to the psychiatric profession.
This is no somatoform disorder; people have died from it. A quarter of all sufferers are house or bed bound, some spending their lives in darkened rooms unable to talk, walk or swallow.
The incredible suffering caused as a result of certain members of the psychiatric profession using M.E. as their milch cow must be ended by properly funded biomedical research, testing and treatment. The chronic infections (viral, bacterial and parasitic) that are causing M.E. must be isolated and a cure found for them
(Despite Prof Wessley's stating that 'in France CFS does not exist', the French Association of Chronic Fatigue Syndrome and Fibromyalgia have confirmed to me by email that they do indeed have M.E./CFS in France, and 'more and more young people')
Monday 23rd March 2009 @ 14:41
Professor Simon Wessely treats all patients with CFS, an umbrella term including all 'medically unexplained' fatigue illnesses including ME, as if they all have the same illness and says that his one treatment i.e. CBT and Graded exercise, fits all.
Yet he admits that he cannot help 30% of his patients at all. The recent survey by Action for ME shows that Graded Exercise therapy (GET) made over 30% of ME patients worse even when administered by trained NHS personnel, the ME Association survey found that 78% said GET was either ineffective or harmful, and a survey by the 25% ME Group for the Severely Affected also showed over 30% made worse, some of whom had not been severely affected prior to trying GET.
Professor Wessely does not appear to consider the possibility that these unfortunate patients could in fact have a quite different illness from the one he is able to treat, ie the physical illness ME. I have never seen him comment on these distressing figures - not even in his reply to the New scientist.
I had had several bouts of Post Viral Fatigue Syndrome after flu like illnesses over 12 years and had always recovered 100% so when I got a similar bug in 1996 that was to become severe ME, I naturally assumed it was the same again and I would recover as before. Why should I be suddenly 'monitoring symptoms' and 'trapped in vicious circles'? I have never suffered from depression, and was very keen to return to a job I loved.
It is time for the MRC to put serious funding into biomedical research to distinguish the different subtypes that Dr Kerr at St George's has found, rather than wasting millions on the flawed 'PACE' trials which unbelievably have dropped objective testing using an actometer at the end of the trial (although they use it at the beginning) and are relying solely on subjective self reporting.
Monday 23rd March 2009 @ 18:52
Please could Prof Wessely explain how the people who have tragically died of M.E., Sophie Mirza, Casey Faro etc. etc. managed to think themselves dead? They were not believed to be physically ill by the medical profession before their deaths.
Could he also explain the massive long term infections found in their hearts and central nervous systems? Does Prof Wessely believe these infections existed solely in the minds of the people performing the autopsies?
Wednesday 1st April 2009 @ 18:55
Jenny Wilson rightly highlights Prof Wessely's use of the the phrase "MAKE people engage..." (my cap's). I think that the boot is on the other foot. I wish that I could make the so-called experts engage. Until then, I will avoid them like the plague. For I am tired of their attempts to force their dogma upon me I take this position at some considerable potential cost: I have no income apart from what my wife earns. If she dies, then so do I. If the point comes when she cannot work, then the same probably applies to us both
Another point to note from Wessely's interview is his assumption that sufferers are inactive. I am active for about two hours per day. I suffer for it, but, relatively, I am lucky. For one thing, it saves me from getting depressed. Nevertheless, the doctor hired by the benefits Agency - with the apparent objective of stopping claims for the sake of stopping them - told me that I should have CBT and GET. When I refused, she wrote her report misrepresenting what we discussed to make believe that I was active all of the time and was not ill. Despite my GP's knowledge of me for over ten years, he was not consulted.
As I said, I am avoiding these people from now on; and it was on that basis that I did not appeal my claim for Incapacity Benefit. I simply do not have the capacity to go through repeated farces such as the so-called medical examination that I had the first time around. I even have to pay National Insurance contributions out of my wife's income.
So, Prof Wessely et al, what you are achieving is to drive ME sufferers to suicide.
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Title: Can people think themselves sick?
Author: Jess Laurence
Article Id: 10612
Date Added: 16th Mar 2009