MAGICAL MEDICINE: HOW TO MAKE AN ILLNESS ... - Invest in ME

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illness (and) these biases have infiltrated the media. The traditional healthcare system often refuses to
treat people with ME. When treatment is offered, all too frequently social service personnel will refer people
with ME to psychiatric services. The patients of ‘Lost Voices’ and their carers are heroes in the best sense of the
term”.
Fourteen years earlier, in his Eliot Slater Memorial Lecture in May 1994 referred to above, Simon Wessely
said: “Organic diseases lose their credibility as their psychological causes are recognised”. Despite
Wessely’s confident assertion, it has not been possible to find an example of an organic disorder losing
its organic status when its psychological cause was recognised.
The Wessely School has ensured that virtually no biomedical research has been allowed to challenge their
steadfast belief that ME is a primary psychiatric disorder, and the result is the harrowing human suffering
revealed in ‘Lost Voices’.
Wessely did not mention that psychiatrists have a long track record of medical misattribution: the literature
is replete with examples of diseases with (then) “unexplained” symptoms that psychiatrists claimed – with
absolute certainty – as psychosomatic. These diseases include diabetes mellitus; epilepsy; multiple sclerosis,
Graves’ disease; pernicious anaemia; myasthenia gravis; Parkinson’s Disease; gastric ulcer; migraine;
Dupuytren’s contracture; gout; glaucoma; asthma; angina; ulcerative colitis and hay fever (Case Histories in
Psychosomatic Medicine. Miles HHW, Cobb S and Shands HC (eds); 1959; WW Norton & Co Inc., New
York).
As noted by George Davey‐Smith, Professor of Clinical Epidemiology at Bristol, a further example is that in
1948 – long before H‐Pylori was discovered in 1989‐‐ doctors in Mount Sinai Hospital advocated antibiotics
for peptic ulcers, a treatment they knew was successful. A patent for an antibiotic formulation was issued in
1961, but the “stress model” served to block people from building on this and moving towards an answer
that would have led to a treatment that could have dramatically improved the quality of life for millions of
people. Various psychological interventions for peptic ulcer were advocated and large numbers of people
were subjected to them. The usual claims for dramatic success were made, but properly conducted
randomised controlled trials demonstrated no benefit. The conclusion of one well‐conducted trial was that
“our study demonstrates a need for humility about the degree to which psychological interventions can effect powerful
biological processes”. Sick people were directed away from a treatment for peptic ulcers that really worked –
antibiotics – to ones that did not work, and the answer that could have led to an effective treatment was
missed because of a particular model ‐‐‐ essentially the BPS (biopsychosocial) model ‐‐‐ and the mindset that
it generated (Biopsychosocial Medicine, OUP 2005; ed. Peter White).
Davey‐Smith is the one dissenting voice in Biopsychosocial Medicine: his contribution (“The
biopsychosocial approach: a note of caution”) carries the torch for intellectual integrity.
Davey‐Smith showed that bias can generate spurious findings and that when interventional studies to
examine the efficacy of a psychosocial approach have been used, the results have been disappointing. To
quote from Davey Smith’s contribution: “Over the past 50 years many psychosocial factors have been proposed and
accepted as important aetiological agents for particular diseases and then they have quietly been dropped from
consideration and discussion”. The illustrations he cited included cholera, pellagra, asthma and peptic ulcer.
Davey‐Smith went on to quote Susan Sontag’s well‐known dictum: “Theories that diseases are caused by mental
state and can be cured by willpower are always an index of how much is not understood about the physical basis of the
disease” (Illness as a metaphor. Random House; New York. 1978).
In his book “The Greatest Benefit to Mankind” (Harper Collins, London, 1997) the late Roy Porter noted that
it was the biomedical model (not the psychosocial model) that has provided advances in the understanding
‐‐ and thus in the treatment and prevention ‐‐ of disease processes.