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

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Physical factors, such as infection, are only considered to play a role in triggering the illness; the Wessely
School model does not allow for physical factors to play any part in perpetuating the illness.
Any viral or bacterial infection that was present at the start of the illness is assumed to have fully resolved.
The symptoms and disability experienced by the participant are therefore ʺmaintainedʺ by what the
participant believes and how the participant behaves, which seems remarkably like “blaming the patient”.
It is notable that in numerous places throughout the CBT Manual for Therapists, reference is made to
alleged personality traits of people with “CFS/ME”, a prominent one being alleged “perfectionism”: on page
54, “perfectionism” is listed as a trigger for the disorder; on page 101 the authors state: “Any regular themes
that occur should be discussed with a view to identifying unhelpful core beliefs. Themes may include not being good
enough (related to perfectionism)”; on page 124 (“What causes CFS/ME”) the authors list “Having high personal
expectations and driving to do things ‘perfectly’ can cause…fatigue” and on page 158, in “Evaluation of Progress”
the authors suggest that factors which may have preceded the participant’s “CFS/ME” are “constantly being
busy…aiming for perfection”.
This does not accord with the published evidence of Professor Wessely himself. As noted by Twisk and
Maes (Neuroendocrinol Lett 2009:30(3):284‐299): “Another misconception is the central role of specific personality
traits presumed by the (bio)psychosocial model. Wood and Wessely, the captain of the (bio)psychosocial school, for
example pointed out very clearly (J Psychosom Res 1999:47: (4):385‐397) that no differences between patients
with ME/CFS and rheumatoid arthritis in measures of perfectionism, attitudes toward mental illness,
defensiveness, social desirability, or sensitivity to punishment (a concept related to neuroticism) were found. The
authors stated their study also invalidated the ‘stereotype of CFS sufferers as perfectionists with negative
attitudes towards psychiatry’ ”.
Seemingly, as Chief Investigator, Professor Peter White was content to permit Trudie Chalder and Mary
Burgess to disregard the evidence of Professor Wessely (who is in charge of the PACE Clinical Trial Unit).
Establishing a shared multifactorial understanding
Therapy will commence by ʺEstablishing with the participant a shared multifactorial understanding of their illness
that takes into account predisposing, precipitating and maintaining factorsʺ (p 22).
There are two important observations to be made at this point:
i) the therapists appear not to have been taught about the extensive biomedical evidence on ME/CFS but
only about the Wessely School’s psycho‐behavioural model presented in the Manual, thereby denying them
what could be vital information in determining the suitability of the therapy for an individual participant
ii) what if a ʺshared multifactorial understanding of the illnessʺ cannot be established? The therapist has been
taught to work within a very particular view of what ME/CFS is and therefore a shared understanding can
only occur if the participant is willing to change his/her beliefs to match those of the therapist.
Given that participants have been informed on five separate occasions in their own CBT Manual that they
can “overcome their CFS/ME” (ie. they can expect to be cured) by the application of CBT, it is possible, indeed
likely, that some participants would feel pressurised into agreeing with their therapist: for instance, any
participant who thought s/he had a physical disease would have to change that belief, as such a belief is
considered within the CBT model to be a barrier to recovery.