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

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to work...ʺ and concludes ʺThese worries may at times trigger feelings of anxietyʺ, thus guiding the participant,
step by step, from the ʺphysicalʺ sounding ʺautonomic arousalʺ to the conclusion that they may experience
ʺanxiety.ʺ
The description of anxiety begins: ʺThe physical effects of anxiety…ʺ (thus transferring the focus back to
ʺphysicalʺ language) and concludes (p 16) ʺEveryone experiences the physical symptoms of anxiety in a different
way...An increase in nerve activity and adrenaline production can precipitate feelings of exhaustion....During periods
of prolonged physical exertion....there is increased activity of the nervous systems and increased adrenaline
production...Limiting activity can perpetuate the physical effects of anxiety and lead to a further reduction of fitness
and muscle strength.ʺ
The sections on ʺPhysiological Aspects of CFS/MEʺ and ʺAutonomic Arousal in CFS/MEʺ seem intended to
provide participants with a “physiological” (ie. “physical”) explanation for the cause of their symptoms and
are presented as fact. The possibility that the symptoms may have a serious underlying pathoaetiology is
never mentioned.
To reduce the complex multi‐system organic disease ME/CFS to little more than phobic avoidance of activity
is profoundly insulting to sufferers.
In summary, CBT participants are told by Burgess and Chalder that “CFS/ME” is (i) the result of reduced
or irregular activity; (ii) loss of fitness; (iii) the “physical” effects of anxiety, and they are told that it is
reversible with CBT, all of which are gravely misleading statements that do not apply to people with
ME/CFS.
There is the usual emphasis on the Wessely School’s assumption that there are differences between “factors
that precipitate and those that maintain it” and on their model of “a vicious circle of fatigue” and participants are
patronised as if in a kindergarten: “In order to help you understand your CFS/ME better, you may like to draw
your own vicious circle”.
Participants are given the Wessely School’s explanation of the “CBT Model of CFS/ME”; they must set
targets (eg. go for two ten minute walks daily); increase activity; learn to challenge and overcome unhelpful
thoughts and beliefs; overcome “blocks” that make it difficult to progress (such as being in receipt of
incapacity benefit or income protection); ignore symptoms and not succumb to them (“set‐backs can be
irritating”); keep activity diaries and, above all, they must break the “vicious circle” of “fatigue”. No mention
is made of the cardinal symptomatology of ME/CFS; all the emphasis is on “fatigue”.
The usual inconsistencies reappear: participants are told how to plan activities for “people who generally do too
much” (“CFS/ME” is said to be caused by deconditioning but the authors do not explain how people who
usually do too much are also deconditioned); Burgess and Chalder are clearly not talking about people with
ME/CFS but about people with chronic “fatigue”.
As in the Therapists’ CBT Manual, assumptions are stated as fact and are regularly repeated as though the
authors know they have to keep reiterating them to convince participants that they are true.
The authors seem to be exploiting what Chalder herself knows to be the non‐specific factors that underpin
cognitive behavioural therapy, such as support, therapist time and attention, and “expectation” by using
components traditionally associated with CBT such as collaboration, active participation, agenda setting,
session format, use of Manuals, and homework, which Chalder knows cannot be reliably measured because
“self‐reports are amenable to response bias and social desirability effects” (K van Kessel, R Moss‐Morris, T Chalder
et al. Psychosomatic Medicine 2008:70:205‐213).
Participants are expressly told that: “the way you think about the situation will determine how you feel” (page 40).
This declarative statement (“will determine”) is grossly misleading. Neurobiological evidence is not