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

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benefit receipt ‐‐ are important. Even though they admit that their model cannot be tested, they have stated
that the dismantling of social support, including benefits on which sick people rely, may be necessary for
“recovery”. How does the removal of vital support assist recovery in any disorder?
Deary et al continue: “the evidence does support the conclusion that MUS in general, and IBS and CFS specifically,
are multi‐factorial conditions caused and perpetuated by several distinct processes…the research bears out the over‐
arching CBT hypothesis that the autopoietic interaction of distinct but linked systems could serve to produce physical
symptoms in the absence of physical pathology”, a statement that seems to reveal the extent of the authors’ lack
of biomedical knowledge about ME/CFS.
Deary et al state: “In CFS inconsistent and reduced activity, disturbed sleep and catastrophic beliefs regarding
activity and symptoms are the most commonly identified set of factors and therapeutic targets” (commonly identified
and targeted by whom? Certainly not by biomedical scientists and clinicians).
In the section that is specifically on chronic fatigue syndrome, the authors state: “It is hard to disentangle the
active ingredients in these treatments (CBT and GET). The CBT tends to involve pacing, graded increases in activity,
sometimes exercise, work on a variety of cognitions including perfectionist beliefs, catastrophic illness beliefs and
schema work. The GET trials provide a relatively more focused intervention, and we could easily conclude that the
reversal of deconditioning is the effective component of this form of treatment”.
Given the previous well‐documented hostility of the Wessely School towards rest and pacing, not only in
the literature but also in the press and in the magazines of the patients’ charities, the authors’ claim about
pacing in their 2007 paper is noteworthy, as it seems to be only since they were awarded millions of pounds
sterling for their PACE Trial that they have revised their attitude towards it and have recorded their
changed attitude in an article published during the life of the PACE Trial.
Deary et al say: “We suggest that we are now at the stage where research should pay more attention to some of the
components of the model and their interaction…The CBT model of MUS offers a previously undescribed illness
mechanism maintaining a distinct group of disorders that we might call autopoietic conditions. Treatment is aimed
at…dismantling the autopoietic mechanism by making changes in target areas”.
Having noted that Hotopf (a colleague and frequent co‐author with Wessely) has compared the role of
doctors in MUS to the role of parents of sick children, and having stated that “illness related beliefs have also
emerged as potentially important factors in the maintenance of symptoms”, Deary et al end their paper thus:
“Hotopf (2004) has drawn our attention to the vital role that both doctors and parents (most people with ME/CFS
are middle‐aged and their parents are deceased) can play in the development, or prevention, of MUS…The right
advice derived from a collaboratively constructed model of symptoms experience could be crucial in preventing or
ameliorating MUS. In the CBT model, we may just have the means to do this”.
Deary et al make no mention that in 1996 Scheper and Scheper argued convincingly that the autopoietic
system theory as developed by Maturana and Varela is unscientific (Behavioural Science: January 1996:41:1)
and that the autopoietic theory is ignored in contemporary biology because the theory’s core constructs
cannot be determined, which means that it cannot be empirically tested. Scheper and Scheper concluded
that the autopoietic theory has no explanatory power (ie. theoretical models that cannot be empirically
tested do not have explanatory power, because any theoretical model that claims to provide explanations of
empirical phenomena must be testable).
Scheper and Scheper are clear; having noted that the Maturana and Varela autopoietic concept “receives
much attention across the behavioural sciences” but having carried out an autopsy on autopoiesis, they conclude
about those who adhere to the notion of autopioesis: “we believe that they should rethink their use of it. The
version of autopoiesis as proposed by Maturana and Varela is unscientific, which means that it cannot be used as a
suitable reference in scientific endeavours”.