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

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APPENDIX VI: The Wessely’ School’s autopoietic theory of their “CBT model”.
In 2007, two of the PACE Trial Principal Investigators, Professors Trudie Chalder and Michael Sharpe,
together with mental nurse Vincent Deary (described in the PACE Trial literature as a “First wave therapist
(CBT)” and as a contributor to the treatment design), published a paper entitled “The cognitive behavioural
model of medically unexplained symptoms: A theoretical and empirical review” (Clinical Psychology
Review 2007:27:7:781‐797) in which they explain the rationale for their “CBT model” of CFS.
These authors conducted a literature search of Medline and Psychinfo from 1966 to 2007 using MUS
(medically unexplained symptoms) “and related terms”. They reviewed “all relevant articles” and their search
was then limited in stages by CBT, condition, treatment and type of trial. They say they found evidence for
“genetic, neurological, psychophysiological, immunological, personality, attentional, attributional, affective,
behavioural, social and inter‐personal factors in the onset and maintenance of MUS”.
From this, they deduce that MUS are the result of “individual factors and their autopoietic interaction (as
hypothesised by the CBT model” (surely “individual factors” is broad enough to mean that virtually anything
can cause MUS?).
However, these authors mostly disregard the genetic, neurological and immunological factors and
concentrate on the psychosocial factors as constituents of their “CBT model”.
The authors say: “The evidence for the contribution of individual factors, and their autopoietic interaction in MUS
(as hypothesised by the cognitive behavioural model) is examined. The evidence from the treatment trial of CBT for
MUS, CFS and IBS is reviewed from an experimental test of the cognitive behavioural models”.
The “CBT model” cannot, however, be tested experimentally; all that can be said is that CBT may be a useful
intervention in some subjects in some disorders, but this does not provide evidence for a “CBT model” of
CFS or IBS.
However, the authors state: “We conclude that a broadly conceptualised cognitive behavioural model of MUS
suggests a novel and plausible mechanism of symptoms generation and has heuristic value”.
Deary has previously written about heuristic value. What he seems to be saying is that if one approaches
the treatment of a patient heuristically – literally, by trial and error – one may find practical ways to help the
patient.
Such an approach ignores causality – for example, giving a patient laudanum tincture will make them feel
better by lessening their pain but it does not tell one anything about the cause of their pain. If, whenever
one reads the “CBT model” one replaces it with the “laudanum tincture model” one will get the same result,
indicating that CBT does not take the cause of the disease into account.
The authors then state: “ ‘The term medically unexplained symptoms names a predicament, not a specific disorder’
wrote Kirmayer, Groleau, Looper and Dao (2004)”. Although Deary, Chalder and Sharpe rely on it, this is
logically wrong. Medically unexplained symptoms in an individual may in fact refer to a specific disorder –
until an explanation is found, it is unknown what type of disorder is being described. It is also the case that
since MUS contains whatever remains from medically explained investigation, it is most unlikely to be one
disorder. Furthermore, it is incorrect to describe MUS as a “predicament”. For example, before the
pathoaetiology of Parkinson’s Disease (PD) was established, using the authors’ model PD would have been
considered a MUS, and therefore, by their reasoning, a “predicament”. Would they refer to PD as a
“predicament” today? This assumes that any symptom that has not yet been explained by contemporary
biomedical knowledge will always be “medically unexplained”, which is clearly untrue (but the Wessely
School are strongly opposed to seeking biomedical evidence for what they insist are “medically
unexplained” ‐‐ and therefore psychosomatic ‐‐ symptoms: see above).