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

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Quotations from the Therapists’ Manual on Cognitive Behaviour Therapy
This 162 page Manual “draws a distinction between factors that precipitate and those that maintain” “CFS/ME”
and focuses on “lifestyle, life events and personality”. Therapists are taught that perpetuating factors include
“fear about activity making the illness worse” and “avoidance of activities” but also – confusingly ‐‐ that “over‐
vigorous activity” perpetuates the illness, as well as “symptom focussing”, “life stress and low mood” and
“perfectionism”.
On page 7 the authors (Mary Burgess and Trudie Chalder) state: “Common to these illnesses are the symptoms
of physical and mental fatigue, usually made worse by exertion. Other symptoms may include difficulty with memory
and concentration muscular and joint pain, unrefreshing sleep, headache, tender lymph glands, and sore throats”.
There are three points of note: (i) ME/CFS/PVFS is classified as one neurological disorder, not several (“these
illnesses”), and the defining feature is post‐exertional malaise with physiological exhaustion, so by their
choice of words the authors are acknowledging that more than one disorder has been included in the PACE
Trial; (ii) cardinal symptoms of ME are not mentioned and (iii) the authors state “other symptoms may
include…”, but if the patient has only fatigue and no other symptoms, that patient does not have ME and
should not be included in a trial that purports to be studying ME.
On page 12 the authors state: “Participants are encouraged to see symptoms as temporary and reversible and not as
signs of harm or evidence of fixed disease pathology”. How can such advice be given when the authors have no
evidence that symptoms are either temporary or reversible? For non‐medical therapists to give such
incorrect advice to participants who may actually have ME is potentially dangerous.
Also on page 12 the authors state: “The aim of this treatment is to change the behavioural and cognitive factors,
which are assumed to be partially responsible for perpetuating the participant’s symptoms”: if “behavioural and
cognitive factors” are only “partially” responsible, then there must be something else causing the symptoms,
such as a physical disease process, which contradicts the Investigators’ assumption that there is no
pathology involved, and which further illustrates the lack of intellectual rigour of their “CBT model”.
On page 12, under “Theoretical Model”, the authors state: “This model acknowledges that the participant’s beliefs
and behaviours are influenced by available information and attitudes of families and friends and that these may also
need to be addressed”, which indicates that, no matter if those beliefs are correct, family and friends are to be
similarly cajoled into changing their beliefs, even though family and friends have not signed consent forms
agreeing to have their thinking restructured. This does seem to be akin to a cult that is determined to impose
its own ideology as widely as possible.
On page 14 the authors state: “It is their planned physical activity, and not their symptoms, that determines what
they are asked to do”, which once again appears to be indoctrinating participants to ignore what may be
serious symptoms.
On page 15 the authors state: “A mild and transient increase in symptoms is explained as a normal response to an
increase in physical activity”. Symptoms may not be mild and transient and may be an abnormal response
caused by underlying pathology. How can therapists know that this is a “normal response” and not caused
by underlying pathology?
This is an assumption, not a fact, and therefore participants and therapists should be made aware of this.
Post‐exertional symptoms may be indicative of cardiac output being unable to meet increased metabolic
demand which, if exceeded only momentarily, results in death.
On page 17, Burgess and Chalder make an astonishing assertion: “There is no clear evidence of the virus
persisting once CFS/ME has become established”. Such an assertion is readily disproved by the literature that