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

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The APT Manual for Participants advises them that: “Recreational activities are what you may have previously
described as relaxation…for example, going to the pub after a busy day at work. Recreational activities (such as going
to the pub) need to be reintroduced as part of your programme of rest and activity”, yet this particular
recommendation is advised against in the Participants’ CBT and GET Manuals: “alcohol…can affect sleep by
making it difficult to go to sleep” (CBT Participants’ Manual, page 28); “Most people with CFS/ME will avoid or
take little alcohol due to them (sic) exacerbating their symptoms” (CBT Therapists’ Manual, page 42); ”We know
that it is unusual for people with CFS/ME to drink much alcohol” (GET Participants’ Manual, page 62).
The message for participants about alcohol is therefore dependent upon the arm of the trial to which they
have been randomised: APT participants are encouraged to drink but CBT and GET participants are advised
to avoid drinking.
There seems to be the clear intention running through all the Manuals to regard “CFS/ME” as neurasthenia,
which is the Wessely’s School’s long‐held conviction.
In 1991, John Wiley & Sons published “Post‐Viral Fatigue Syndrome” edited by Rachel Jenkins and James
Mowbray; in her own contribution, Professor Jenkins, a Principal Medical Officer at the Department of
Health and currently Director of the WHO Collaborating Centre for Mental Health at the Institute of
Psychiatry, made it clear on page 242 that there is no anhedonia (loss of any pleasure/interest in life) in ME.
However, in his official role as Parliamentary Under Secretary of State for Health / Community Care, Dr
Stephen Ladyman MP went on record on 28 th July 2003 stating that the WHO was initially “eager” to refer to
CFS/ME in the Guide to Mental Health in Primary Care as “neurasthenia”, but that it was eventually
decided to call it “chronic fatigue syndrome (may be referred to as ME)”. It will be recalled that the WHO has
confirmed that it has no intention to re‐classify to ME/CFS as neurasthenia.
The cardinal feature of neurasthenia is anhedonia, yet Professor Jenkins is on published record as stating
that there is no anhedonia in ME.
To which disorder are the PACE Trial Manuals referring? It cannot be ME/CFS because the entry criteria for
the PACE Trial (the Wessely School’s own Oxford criteria) exclude those with neurological disorders. It is,
in fact, “CFS/ME”, which the Wessely School regard as a behavioural disorder (chronic “fatigue” or
neurasthenia).
Once the Trial’s many internal inconsistencies become known, the validity of the whole Trial comes under
suspicion, and consequently the results may not be relied upon.
Background to some of the authors of the PACE Trial Manuals
Before continuing, it should be borne in mind that the same people who wrote the CBT Manuals for the
PACE Trial (Mary Burgess and Trudie Chalder) wrote the book “Overcoming Chronic Fatigue” (February
2004, ISBN 9781841199429), some background to which may be helpful.
Although the title refers to “Chronic Fatigue”, the book addresses Chronic Fatigue Syndrome: “Chronic
Fatigue Syndrome is a debilitating illness…..Via recognised CBT techniques that change our attitudes and coping
strategies, this approach is successful in breaking the cycle of fatigue, with a reduction in symptoms and disability in
up to two thirds of sufferers”.
The authors state about the trials upon which they rely in their book: “The effectiveness of CBT in treating CFS
has been evaluated in three well‐conducted research studies undertaken since the 1990s. All three were conducted as
randomised controlled trials; that is, trials in which there are more than one treatment group, and participating