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

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Deary et al continue: “In the papers we have reviewed it is used in three overlapping ways: (a) to refer to the
occurrence of symptoms in the absence of obvious pathology (there may be no obvious pathology, but they do not
consider the possibility of occult pathology); (b) to refer to individual clinical syndromes such as CFS and IBS
(this is inconsistent ‐‐ having said that MUS “names a predicament, not a specific disorder”, in their point (b)
Deary et al describe CFS and IBS as specific disorders, ie. as “individual clinical syndromes”); (c) to refer to a
subset of the DSM‐IV somatoform disorders category” (but DSM‐IV does not include CFS as a somatoform
disorder).
Deary et al claim that: “there is consensus that a cognitive behavioural therapy (CBT) approach offers a useful
explanatory model of MUS…and an effective treatment”. Such a statement has no validity because “an approach”
does not and cannot offer “a useful explanatory model”.
Furthermore, there is no consensus that it provides “a useful explanatory model”; equally there is no consensus
that CBT is “an effective treatment”. Deary et al then claim that: “These recent reviews have validated the efficacy
of CBT (the efficacy of CBT for ME/CFS patients has not been validated) but there has been less focus on the
model on which these treatments are based” (perhaps because CBT is a therapy, not a model).
Although Deary et al refer to their “CBT model” of MUS (which does not exist) and whilst there may be
empirical evidence that CBT can help some people with a behavioural diagnosis, this tells us nothing about
the underlying cause of ME/CFS or indeed of any other illnesses in which CBT may be employed as an
adjunctive therapy, be it cancer, multiple sclerosis or diabetes.
The authors continue: “We will then summarise the evidence for its effectiveness as a treatment with a view to how
this evidence can contribute to our evaluation of the CBT models”, which seems to indicate that Deary, Chalder
and Sharpe do not accept that evidence of efficacy of CBT in some patients (who are likely to suffer not from
ME/CFS but from chronic “fatigue”) proves nothing about their “CBT model” of causation in ME/CFS or
IBS.
More internal contradictions follow: the authors state: “For the purposes of our literature search we adopted a
broad definition of MUS…we looked specifically at IBS and CFS. Pain was largely excluded because the scope of the
literature would have made the review unwieldy”. Clearly therefore, the authors did not conduct a literature
search that adopted “a broad definition of MUS”. They focused on IBS and CFS and they deliberately excluded
anything they considered “unwieldy”. Their study thus can have no academic value because their terms of
reference are elastic and arbitrary.
Deary et al say that they employed the search terms “functional symptoms; functional syndromes; functional
illness; functional somatic symptoms; functional somatic syndromes; functional somatic illness and medically
unexplained illness” which means that the authors intentionally skewed their results towards psychosomatic
disorders, whereas neither ME/CFS nor IBS is a psychosomatic disorder.
Deary et al say: “As a first analytic step, we reviewed all the abstracts and reports obtained by using ‘Medically
(near) Unexplained (near) Symptoms’ as a search term”. They then claim that this material was “used to conduct
the narrative review of the CBT model of MUS”, which is an unsustainable claim because it is not possible to test
“the CBT model” of causation of MUS, only the efficacy or otherwise of CBT in loosely defined patients (who
may or may not have ME).
Deary et al then claim that their “body of evidence” contributed to their “understanding of the model” (no body
of evidence can contribute to the understanding of a model that does not exist); all it proves is that Deary,
Chalder and Sharpe were reading the literature with a predefined agenda – ie. they were looking for
evidence to support their own ideological convictions about ME/CFS and IBS.
In order to validate their own beliefs, Deary et al have fallen back on the theory of autopoiesis as the
explanation for their putative model.