Wessely school

The Wessely school is an informal name used to refer to the school of thought followed by a group of researchers and clinicians who promote psychiatrist Prof. Simon Wessely's biopsychosocial model (BPS) understanding ME/CFS. The Wessely school is based in the UK and is extremely influential, and research conducted by participants in the Wessley school has received millions [ of British pounds] in UK funding for highly controversial clinical trials of cognitive behavioral therapy (CBT) and Graded Exercise Therapy (GET).

The Wessely school is dominated by psychiatrists and psychologists, but also includes some physiotherapists, occupational health clinicians, and a few general practitioners.

Beliefs and Evidence

 * Simon Wessely has referred to chronic fatigue syndrome (CFS) and CFS/ME as "medically unexplained symptoms" on many occasions, meaning a (psycho)somatic disorder (mental illness)
 * Simon Wessely has also referred to neurasthenia as the previous name for ME/CFS, and Wessely & Sharpe have suggested it is not a neurological disorder
 * Simon Wessley wrote a textbook on behalf of the Institute of Psychiatry, a World Health Organization (WHO) collaborating center which started that CFS was classed as a psychiatric illness; the WHO released a letter in response stating that the WHO classified ME/CFS/PVFS as only a neurological illness, and that the use of the logo did not imply that they had endorsed the views in it. The second edition of the book was altered to refer to it as only a neurological illness.


 * Conducting biological or physical tests is actively avoided
 * Patients with Chronic Fatigue Syndrome or CFS/ME do not have an organic (meaning physical) illness


 * Dysfunctional illness beliefs are believed to exist in patients with ME/CFS
 * Fear of exercise is a behavior that acts as a maintaining factor in CFS, and prevents recovery
 * Patients can "recover" by adjusting dysfunctional beliefs and behaviors, and reversing deconditioning


 * The role of the physical symptoms of patients should be minimized, they are based on severe deconditioning (or exist only in the patients' beliefs)
 * Patients "simulate" muscle weakness


 * Patients who receive health insurance payouts or disability benefits are believed to have a lower prospect of recovery; "secondary gain" and assuming a "sick role" allow them to "manipulate" others, and are considered obstacles to recovery


 * Patients have been criticized by some of the Wessely school for "harassment", including submitting Freedom of Information Act requests for data resulting from clinical trials involving some if the Wessley school
 * CFS/ME is the preferred term for both CFS and myalgic encephalomyelitis (ME), which are the same
 * ME is a belief in an illness, rather than an illness
 * Maes and Twisk refer to Harvey and Wessely's model of Chronic Fatigue Syndrome as "psychosocial" rather than "biopsychosocial"
 * There has been some confusion over Professor Wessely's beliefs; he declined to give a written or oral statement to clarify them to the Group on Scientific Research into ME

Members of the Wessely school

 * Simon Wessely - psychiatrist and Wessely school founder
 * Professor of Epidemiological and Liaison Psychiatry at Guy’s, King’s and St Thomas’ Medical School (GKT) based at King's College Hospital (KCH)
 * also based at The Institute of Psychiatry (IOP)
 * Director of the Chronic Fatigue Syndrome Research Unit and of the Gulf War Illnesses Research Unit, King's College Hospital


 * Michael Sharpe
 * psychiatrist and Wessely school proponent
 * formerly of Oxford and now at Edinburgh


 * Peter White
 * psychiatrist and Wessely school proponent
 * St Bartholomew’s Hospital, London
 * PACE trial lead author


 * Trudie Chalder - Professor of Cognitive Behavioural Psychotherapy at King's College London.
 * proponent of CBT for CFS
 * creator of the Chalder Fatigue Scale
 * former Registered Mental Nurse, author of books on "Chronic Fatigue"


 * Anthony David


 * Stephen Reid


 * Anthony Cleare


 * Elena Garralda - Professor of Child and Adolescent Psychiatry at St Mary's Hospital Medical School, London
 * Clare Gerada

Possible members of the Wessely school

 * Alastair Miller, medical advisor to Action for ME during their participation in the PACE trial, and former clinic lead for Liverpool ME/CFS Clinic, UK
 * Matthew Hotopf - The Institute of Psychiatry and King's College Hospital, co-author of a book with Michael Sharpe
 * Richard Mayou
 * Keith Hawton
 * Christopher Bass - Oxford
 * Leonie Ridsdale - Senior Lecturer in General Practice at Guy’s, King’s and St Thomas’, London

Supporters of the Wessely school
Malcolm Hooper lists the following as supporters of the Wessely school.


 * Tony Pelosi - Glasgow
 * Stephen Lawrie - Edinburgh
 * Alison Wearden - psychologist, University of Manchester

Notable studies

 * PACE trial
 * FINE trial
 * MAGENTA trial
 * The Oxford Criteria was developed at Oxford University, and may or may not have involved some of the Wessely school

Location
Followers of the Wessely school are based in a number of different locations:


 * Queen Mary University (see PACE trial)
 * King's College Hospital, London
 * Guy', Kings' and St Thomas's Medical School
 * Institute of Psychiatry, London
 * St Bartholomew's Hospital, London
 * St Mary's, London
 * Edinburgh
 * Glasgow
 * Oxford

Funding, Influence and Conflicts of interest
The UK's Medical Research Council provides a great deal of funding to research by Wessley school proponents. The UK's Department for Work and Pensions (DWP), which provides social security payments for people with disabilities or on very low incomes, also provided considerable funding to the PACE - despite never previously funding health research.

The initial Wessley school conference, which took place in 1988, was sponsored by drug company Novartis.

A number of members of the Wessely school have undertaken work for private health insurance companies including UNUM Insurance, the DWP, and pharmaceutical companies.

Simon Wessely played a key role in developing the previous National Health Service (NHS) treatment guidelines for ME/CFS, known as the NICE guidelines. He was not directly involved with the 2007 update, nor is he believed to be part of the current working group revising those guidelines.

Prof. Wessely also provided the previous Cochrane reviewers with extremely extensive publications.

Influence
The Wessely school is extremely influential, and Prof Simon Wessely is a past president of the Royal College of Psychiatrists.

Criticism of the Wessley school

 * Margaret Williams
 * Countess of Mar
 * The Group on Scientific Research into ME, which included Countess Mar
 * Thirty years of disdain - Mary Dimmock criticises Simon Wessely and the Wessely school, and others promoting biopsychosocial theories
 * David Tuller, public health professor


 * Malcolm Hooper


 * Tom Kindlon and Alem Matthees, both advocates with ME, have re-analyzes the PACE trial data


 * Jonathan Edwards


 * Brian Hughes and Keith Geraghty, psychologists


 * Forward-ME, ME Association, Invest in ME Research, ME Research UK, Tymes Trust, Hope 4 ME & Fibro NI, The MEAction Network, MEActionUK (unrelated to MEAction), Solve ME/CFS, Open Medicine Foundation

Fall of the Wessely school
The influence of the Wessely school began to wane in the late 2010s, with a combination of
 * the 2016 release of the full PACE trial data showing that graded exercise therapy and cognitive behavioral therapy were ineffective and caused high rates of harm,
 * the combined with the announced retirements of Simon Wessely, Peter White and Michael Sharpe from ME/CFS research,
 * the additional scrutiny of the biopsychosocial model in ME/CFS and in medically unexplained symptoms by Prof. David Tuller
 * the Cochrane withdrawal of the exercise data, resulting from complaints proving that Cochrane had failed to follow it's own scientific methodology
 * Cochrane's exercise therapy review, 2019 update
 * the Institute of Medicine report (2015) recommending significant changes and highlighting the role of post-exertional malaise rather than fatigue as the core symptom of ME/CFS, and the ARHQ recommendation in 2016
 * increasing scientific evidence of abnormal findings in ME/CFS which were incompatible with the Wessely school's theories
 * increasing evidence that the associated treatments were not resulting in recovery, and research establishing that significant rates of harm were present and not monitored
 * increasing opposition to CBT and GET from professional groups including Physios for ME, Doctors with M.E., and support for change from the British Association for CFS/ME, the UK's largest group of ME/CFS professionals
 * the abandonment of the biopsychosocial model including GET and CBT by the United States, Netherlands, and finally by England and Wales in 2021.

Learn more

 * The Rise and Fall of the Wessely School - David Marks
 * 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 - Malcolm Hooper
 * Countess of Mar - Hansard Debate, UK Parliament