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

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SECTION 1: BACKGROUND TO THE MRC PACE TRIAL
Since 1987, a prominent theme running through the Wessely School’s psychiatric literature on “CFS/ME”
has been that patients who present with symptoms that the psychiatrists and those they advise
(Government agencies and the medical and permanent health insurance industry) wish to eradicate are
an “unjustified” and “undeserving” financial burden, and that it is neither cost‐effective, necessary nor
appropriate to investigate their “non‐existent” disorder.
The Wessely School believes that patients with “CFS/ME” have “dysfunctional thinking” and “personality
problems” and are susceptible because of their “female gender”, and that they must be managed by those who
know best (ie. by Wessely School psychiatrists and their adherents) by means of behavioural interventions
which include graded aerobic exercise. The basis of the Wessely School’s beliefs about “CFS/ME” upon
which the PACE trial is based is that, together with fibromyalgia, irritable bowel syndrome, multiple
chemical sensitivity and premenstrual syndrome, “CFS/ME” is a one functional somatic syndrome (ie. a
behavioural / somatisation disorder) which, due to an “artefact of medical specialisation”, naïve clinicians fail
to recognise and thus treat as different disorders (S Wessely, C Nimnuan, M Sharpe, Lancet 1999:354:936‐
939; S Wessely, Psychol Med 1990:20:35‐53).
The Wessely School assumes that a person’s thoughts are dictating their feelings, so the objective is to
modify the patients’ thoughts in order to effect a cure. However, the concept that “thinking” changes
“behaviour” has never been proven.
To quote William M Epstein, Professor in the School of Social Work at the University of Nevada: “the
central notion of causal direction, that cognition rules emotion, behaviour, and perhaps even physiology,
has not been adequately proven by any test”.
According to Epstein, CBT is: “barren of credible evidence to support its efficacy” and “the best research offers no
credible evidence of any successful psychotherapy for any condition”. He says: “CBT is constantly pressing, chiding,
encouraging, and inveighing the patient, through the demands of the therapeutic relationship, to believe, believe, believe
in the curative ability of treatment and the authority of the therapist” and he says: “This is precisely the promise of
organisations seeking members: your current behaviour is wrong (and) we can teach you better ways of living”.
Epstein points out that advocates of CBT are “choosing the benefits of subjectivity over the trials of objective proof”
(Psychotherapy as Religion (Chapter 9), University of Nevada Press, Reno, Nevada, 2006).
The Wessely School and the MRC, however, seem oblivious of the work of Epstein. Their proselytizing has
gone on for over two decades yet has failed to produce any evidence to support their theories about ME or
any cure for patients, perhaps because their use their own definition which excludes people with signs of
neurological disorder, as occur in ME.
The Wessely School Perspective
The MRC PACE Trial is managed by a Trial Management Group, most of whose members are considered to
support the beliefs of the Wessely School and, as noted above, Wessely himself will oversee the PACE
Clinical Trial Unit.
Wessely himself set up and directed The Mental Health & Neuroscience Clinical Trials Unit in 2002. It is the
first in the UK to specialise in mental health and the neurosciences. In its first six years of operation it has
provided advice and support to a large number of grant applications, which may explain why, despite the
MRC’s denial of bias, approximately 91% of its total grant spend on “CFS/ME” since 2002 (over £3 million)
was awarded to psychiatric trials of behavioural interventions and why at least 33 funding applications for