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

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consistent with the assumption that cognitions are necessary for emotions (A Critical Look at the
Assumptions of Cognitive Therapy. Glenn Shean. Psychiatry 2001:64:2:158) and physical reality cannot be
changed by changing one’s beliefs.
On page 56 of the participants’ CBT Manual, the authors divide the “therapy” into two sections: section 1 is
titled “Tackling unhelpful thoughts” (this section subtly invites participants to believe that they must have
“unhelpful thoughts” even if they have no such unhelpful thoughts) and section 2 “addresses the topic of
tackling unhelpful assumptions and core beliefs”.
The section “Unhelpful thoughts associated with CFS” (the authors forgot to add “ME” to their “CFS”)
addresses putative “unhelpful thoughts”, for example:
“Fears about their illness” (assumption stated as fact) and the authors notably state: “there are differing attitudes
from “experts”, relatives and friends not only about the illness itself, but also what you should and shouldn’t do” (by
putting “experts” in inverted commas, Burgess and Chalder seem to imply that people who disagree with
them cannot be considered experts about ME/CFS; furthermore, the authors are encouraging participants to
disregard the views of family and friends if those views deviate from Burgess and Chalder’s own views
expressed in the Manual, which could easily engender discord within the family and result in unacceptable
stress for the participant).
“Example of how an unhelpful thought related to fears about illness may affect other areas of a person’s life:
“Situation: Woke up feeling exhausted. Thought: I must be getting worse” (participants might well be getting
worse, but how would they know this if they are being systematically taught to ignore symptoms that may
be a warning of potential harm?)
“Behaviour: rest for most of the day”
“Emotions: ‘worried’ about making CFS/ME worse”
“Physical: more aware of symptoms e.g. fatigue and aching” (again, Burgess and Chalder are pathologising
normal human reactions – it is adaptive, not maladaptive, to pay attention when a particular activity causes
pain; evolution has provided the human body with a system of communicating when something is wrong:
the language of this system is called symptoms, and “hurt” may equal “harm”).
Burgess and Chalder then set out their own beliefs about “perpetuating factors”, in which they include
“having extremely high personal standards and self‐expectations” (there is no evidence that this is more true of
people with ME/CFS than the population as a whole); “worry about starting new things” and “doubting your
own judgement” (there is no evidence that these occur in ME/CFS patients).
Another “unhelpful thought” is said by Burgess and Chalder to be “feeling frustrated about doing so much less
than you used to be able to do” (there is no proof that this is any different in patients with other chronic
diseases such as multiple sclerosis; people with MS are not subjected to cognitive restructuring that is
intended to convince them they that do not have an organic illness).
Participants are asked: “Can you think of any personal examples of how ‘perfectionist’ thoughts have influenced
other aspects of your life since you developed CFS/ME?” (this seems to be a fishing expedition by Burgess and
Chalder, and the participant may feel pressurised to invent “perfectionist thoughts” to please the therapist).
On page 60, the Manual provides “characteristics of unhelpful thoughts” and the authors state that one
characteristic is that they are “automatic: as with all thoughts, unhelpful ones tend to pop into our head rapidly and
unexpectedly” (how is “automatic” a characteristic of an “unhelpful” thought if it is true of all thoughts?);
participants are informed that other characteristics of “unhelpful thoughts” include their being “distorted”;