The Mental Health Movement: Persecution of Patients?

'''The Mental Health Movement: Persecution of Patients? A consideration of the role of Simon Wessely and other members of the Wessely school in the perception of Myalgic Encephalomyelitis (ME) in the UK''' is a report written by Professor Malcolm Hooper that documents the ethical issues, injustice and obstacles faced by people with ME/CFS in the United Kingdom. The Mental Health Movement describes how the neurological illness myalgic encephalomyelitis has been incorrectly portrayed as a mental health condition, and the resulting effects on patients' health care, restrictions or denial of access to social security (for example, disability benefits), medical neglect and medical abuse, and forced treatment using controversial therapies.

Despite the title, The Mental Health Movement does not look at health care provision or policies in mental health services; it describes the psychologisation of patients with the chronic illness myalgic encephalomyelitis, and how the harm inflicted on patients by inappropriate treatment, and the damaging effects of a "behaviorist" approach being applied to an incurable illness.

Description
The Mental Health Movement describes the widespread influence of a small group of British psychiatrists known as the Wessely school on many politics and guides mentioning myalgic encephalomyelitis, including those by the NHS, the government, political, reports private medical insurance companies, medical journals, the British media and even mentioning the Official Secrets Act. One example is psychiatrist Simon Wessely providing his personal collection of research studies to the "expert" team tasked with deciding the "best available" evidence about the assessment and treatment of myalgic encephalomyelitis for the NICE guidelines, while also acting in the role of "medical advisor" to the same group. The resulting NICE treatment guidelines followed Simon Wessely's views, and included the controversial treatments of graded exercise therapy and cognitive behavioral therapy.

Tactics of denial employed by Wessely School psychiatrists
Professor Hooper's report describes in detail tactics of denial used by the Wessely school, including those used in relation to ME/CFS:
 * Grouping illnesses together and "denying the physical reality" of them, claiming that they are the same psychiatric condition - any syndrome that medicine does not yet have an "exact, confirmed pathoaetiology for" including fibromyalgia, multiple chemical sensitivity, chronic low-dose organophosphate poisoning, Gulf War Syndrome, pre-menstrual tension, irritable bowel syndrome, and atypical chest pain.


 * Denial of the "known and available evidence" including omitting evidence and manipulating, misrepresenting or downplaying the facts


 * systematic attempts to "deny the severity of the symptoms, the role of external causes and the nature of the illness"


 * Deniers may attempt to rename or reclassify ME/CFS (for example claiming it as a modern form of an old (psychiatric) illness).


 * Deniers "consistently ignore existing evidence which contradicts their own preferred theories: they disregard evidence, they misconstrue findings, they distort figures and they speculate"


 * Using double standards for evidence in support of their own claims by using a selective choice of studies, with "research which has been shown to be flawed in the medical literature," and with a mass of generalisations, and simultaneously insisting that the opposition "provides irrefutable proof". They "down-play and attempt to overlook inconsistencies in their own research."


 * Challenging the expertise anyone they disagree with, that the claims of others are based only on "myth" rather than scholarship


 * Revisionists re-writing medical history and altering it so that it "appears to support their own claims", for example "in the psychiatric interpretation of the ME literature)"


 * Deniers suggest or imply that patients have formidable powers, for instance that they are able to influence certain institutions; that they get the media on their side and even that they have managed to influence the World Health Organisation. It is also alleged that patients use such tactics to misrepresent the situation to lead others astray.

Tactics of denial that refer the character and personality of ME/CFS patients

 * Portraying sufferers as abusers (victimisers) who are "targetting psychiatrists" while portray themselves as "the vulnerable and wronged group," for example refering to "vicious campaigns" organised by "pressure groups" and claiming patients are unreasonably hostile


 * Unsupported and unevidenced suggestions that patients are motivated by "financial or secondary gain", and that their "claims for state benefits are unjustified"


 * Blaming patients for their illness, claiming that the problem is "not external but internal"


 * "Any negative characteristics of a minority of patients are typically generalised and ascribed to all ME/CFS patients, without any supportive evidence"


 * Minimizing or trivializing the distress and suffering of those with ME/CFS, "alleging that patients exaggerate their symptoms and suffering"

Examples of tactics of denial
The Mental Health Movement: Persecution of Patients? gives the following examples:


 * On 25th April 2000, Dr Michael Sharpe of Edinburgh wrote a letter to Mrs Ann Crocker in which he stated “I understand your desire to have the condition classified as a Neurological Disorder (but) trying to change doctor’s (sic) behaviour by altering classification probably will not work and might even provoke a paradoxical response”. The reality is that ME is already formally classified by the World Health Organisation in the ICD as a neurological disorder, and it is Wessely School psychiatrists (not patients) who are actively trying to “alter the classification” from neurological to psychiatric.


 * On 18th January 2000 Simon Wessely wrote to the Countess of Mar that the “ad hominen (sic) attacks” upon him “may have the unforseen outcome of re-inforcing unhelpful stereotypes of sufferers held by some in high office”. Again, this seems to be nothing less than a threat, with the use of an intimidation technique made, it must never be forgotten, to very sick human beings who have been trying since Wessely came to such prominence in 1987 to redress the wrongs perpetrated upon them by these powerful medical deniers.


 * In the Joint Royal Colleges’ Report on CFS (see below), the authors mention a paper by Buchwald, Gallo and Komaroff et al (reference 128 in the Joint Report) but dismiss it, stating “White matter abnormalities occur in a number of settings and their significance remains to be determined”, whereas the paper itself concludes that patients with ME/CFS “may have been experiencing a chronic, immunologically mediated inflammatory process of the central nervous system” and that the MRI scans revealed a punctate, subcortical area of high signal intensity consistent with oedema or demyelination in 78% of cases. This is a clear illustration of the biased and misleading personal interpretation of the available evidence by Wessely School psychiatrists.


 * Also in the Joint Royal Colleges’ Report, the authors mention a paper by Bombadier and Buchwald (reference 173 in the Report) and convey that this paper supports their own stance, whereas the paper itself actually contradicts the Joint Report and clearly states “The fact that the same prognostic indicators were not valid for the group with CFS challenges the assumption that previous outcome research on chronic fatigue is generalizable to patients with chronic fatigue syndrome”.


 * Another illustration is found in the Joint Royal Colleges’ Report: the authors rely on a paper by Sandman et al (reference 163 in the Joint Report) in apparent support of their own view that the results of neuropsychological testing have been inconsistent, but the paper in fact concludes “the performance of the CFIDS patients was sevenfold worse than either the control or the depressed group. These results indicated that the memory deficit in CFIDS was more severe than assumed by the CDC criteria. A pattern emerged of brain behaviour relationships supporting neurological compromise in (ME)CFS”. One would never know this from the way the authors of the Joint Royal Colleges’ Report deliberately downplayed, misrepresented and manipulated the references which they cited in supposed support of their own views.

Consequences of tactics of denial
Professor Hooper states: "'Such is the profundity of articles, reports and research papers produced by this group of psychiatrists that there is now a widespread belief that ME/CFS is not a disorder which requires money to be spent on specialist tests or on expensive virological or immunological research, let alone on long-term sickness benefits.'"

Funding
No funding was sought for the report.

Results
The Mental Health Movement: Persecution of Patients? was largely ignored.

Investigators

 * Malcolm Hooper

Learn more

 * THE MENTAL HEALTH MOVEMENT: PERSECUTION OF PATIENTS? A consideration of the role of Professor Simon Wessely and other members of the "Wessely School" in the perception of Myalgic Encephalomyelitis (ME) in the UK. Background Briefing for the House of Commons Select Health Committee