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

The Handbook continues:
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“Maintaining or perpetuating risk markers are most important in determining treatment programmes, since
reversing of maintaining factors should lead to improvement. Reasonably well established factors include
mood disorders, such as dysthymia, illness beliefs such as believing the whole condition is physical,
pervasive inactivity, avoidant coping, membership of a patient support group, and being in receipt of or
dispute about financial benefits.
“Few pathophysiological findings in CFS have been replicated in independent studies”.
It should be noted that White cites Wessely’s 2003 paper (A systematic review and critical evaluation of the
immunology of chronic fatigue syndrome: J Psychosom Res 2003:55:2:79‐90) in which Wessely referred to
“the sheer number of papers” but then – seemingly failing to acknowledge that just such criticisms have been
levelled at his own work ‐‐ asserted that “non‐systematic general reviews in the field of CFS are associated with
bias, influenced by professional affiliations” and asserting that any association between CFS and low NK cells
may be “erroneous. ..There was an inverse association between study quality and finding low levels of natural killer
cells, suggesting that the association may be related to study methodology…. The conclusions of this systematic
review differ from a recent traditional narrative of the immunology of CFS. No consistent pattern of
immunological abnormalities is identified”.
This seems to show that despite the abundance of immunological papers published since 1996 when he gave
similar advice in the Joint Royal College’s Report, Wessely persists in his long‐held belief that
immunological abnormalities are of no significance: “Some use the results of immunological tests as evidence for a
so‐called ‘organic’ component in CFS…Such abnormalities should not deflect the clinician away from the
biopsychosocial approach…and should not focus attention solely towards a search for an ‘organic’ cause” (Chronic
Fatigue Syndrome. Joint Royal Colleges’ Report CR54, RCP, October 1996).
White’s BNA presentation continued: “Those (findings that have been replicated) include…physical
deconditioning, and discrepant reports between perception of symptoms and disability and their objective tests.
“The discrepancy between subjective states and objective tests…may be related to enhanced interoception (the
perception of visceral phenomena)…One hypothesis currently being tested is that the predisposition to functional
somatic syndromes is caused by enhanced interoception. Recent work suggests that these factors may be reversed by
rehabilitation.
“The essence of specialist care is rehabilitation…The two approaches with the greatest evidence of efficacy
are CBT and GET. Approximately 60% of patients report significant improvement with these approaches and about
25% report full recovery, which lasts” (an assertion that is disputed by many).
(Attention is drawn to the Statement for the High Court of immunologists Professors Nancy Klimas and
Mary Ann Fletcher referred to above, who voiced their scepticism about Peter White’s claim of 25%
recovery: “Dr Peter White of the UK presented his work using behavioural modification and graded exercise. He
reported a recovery rate of about 25%, a figure much higher than seen in US studies in (ME)CFS and, even if possible,
simply not hopeful enough to the 75% who fail to recover”).
Peter White continued: “Is CFS neurological or psychological? This is a nonsensical question”.
White’s attempt to overcome Cartesian dualism may be thought to justify the stance of the Wessely School,
but it may well be thought that it is the work of the Wessely School that has done so much to perpetuate the
stigma of a mental health label, with the consequent denial or removal of benefits for those with ME/CFS.