Wessely school

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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.[1][2] The Wessely school is based in the UK and is extremely influential,[3][2] 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).[4]

The Wessely school is dominated by psychiatrists and psychologists, but also includes some physiotherapists, occupational health clinicians, and a few general practitioners.[5]

Beliefs and Evidence[edit | edit source]

  • 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[2][6]
  • 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. [7][4][8]
  • Conducting biological or physical tests is actively avoided
  • Patients with Chronic Fatigue Syndrome or CFS/ME do not have an organic (meaning physical) illness[3][9]
  • The role of the physical symptoms of patients should be minimized, they are based on severe deconditioning (or exist only in the patients' beliefs)[3]
  • Patients "simulate" muscle weakness[10]
  • 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[11]
  • Maes and Twisk refer to Harvey and Wessely's model of Chronic Fatigue Syndrome as "psychosocial" rather than "biopsychosocial"[9][7]
  • 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[7]

Notable people[edit | edit source]

Members of the Wessely school[edit | edit source]

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 [5]
psychiatrist and Wessely school proponent[1][3]
formerly of Oxford and now at Edinburgh [5][4]
psychiatrist and Wessely school proponent[1]
St Bartholomew’s Hospital, London
PACE trial lead author
  • Trudie Chalder - Professor of Cognitive Behavioural Psychotherapy at King's College London. [12]
proponent of CBT for CFS[3]
creator of the Chalder Fatigue Scale
former Registered Mental Nurse, author of books on "Chronic Fatigue"[7][5][11]
  • Elena Garralda - Professor of Child and Adolescent Psychiatry at St Mary's Hospital Medical School, London[5][11]

Possible members of the Wessely school[edit | edit source]

Supporters of the Wessely school[edit | edit source]

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

Notable studies[edit | edit source]

Location[edit | edit source]

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[edit | edit source]

The UK's Medical Research Council provides a great deal of funding to research by Wessley school proponents.[4] 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[edit | edit source]

The Wessely school is extremely influential, and Prof Simon Wessely is a past president of the Royal College of Psychiatrists.[13]

Criticism of the Wessley school[edit | edit source]

Online presence[edit | edit source]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. 1.01.11.21.3 The Committee Office, House of Commons. "Malcolm Hopper | House of Commons - Health - Written Evidence". publications.parliament.uk. Retrieved Oct 14, 2018. Within their own discipline, Wessely School psychiatrists are regarded as mavericks. They are known colloquially as the "Wessely School" after their prime mover Professor Simon Wessely of Kings College Hospital and the Institute of Psychiatry (ref: Hansard [Lords] 19 December 1998:1013). Key members are Professors Michael Sharpe, now at Edinburgh, and Peter White of St Bartholomew's, London (who holds the "CFS/ME" reins at the Department for Work and Pensions, whose own forthcoming DWP Guidance about "CFS/ME" has been rejected as unfit for purpose by a coalition of ME charities). The work of the Wessely School on "CFS/ME" has been stringently criticised in the international literature for flawed methodology; for use of a heterogeneous patient population (studies using mixed populations are not useful unless researchers disaggregate their findings); for selective manipulation of others' work, claiming it supports their own findings when such is not the case; for their focus on the single symptom of "fatigue" whilst ignoring other significant signs and symptoms. 
  2. 2.02.12.2 Department of the Official Report (Hansard), House of Lords, Westminster (Jan 22, 2004). "Lords Hansard text for 22 Jan 2004 (240122-12)". publications.parliament.uk. Countess of Mar. Retrieved Oct 15, 2018. How has that situation arisen? A very small group of UK psychiatrists, known colloquially as the "Wessely school", led by Professor Simon Wessely of Kings College, claims to specialise in ME—a discrete term denoting a discrete disorder, but a term that it uses interchangeably with chronic fatigue or tiredness; with psychiatric states of ongoing fatigue; with its own interpretation of chronic fatigue syndrome; and even with neurasthenia—all different terms representing different conditions but which that group insists are synonymous. That is despite the fact that chronic fatigue has been shown time and again to be biologically different from ME. 
  3. 3.03.13.23.33.43.53.6 Tuller, David (Oct 21, 2015). "TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study". www.virology.ws (Blog). PART ONR. Retrieved Oct 14, 2018. 'The PACE Trial, Deconstructed
    On Feb 17, 2011, at a press conference in London, psychiatrist Michael Sharpe and behavioral psychologist Trudie Chalder, members of the British medical and academic establishments, unveiled the results of a controversial clinical trial of more than 600 people diagnosed with chronic fatigue syndrome. The findings were being published in The Lancet. As with many things about the illness, the news was expected to cause a stir.
    The study, known as the PACE trial, was the largest ever of treatments for chronic fatigue syndrome. The authors were among a prominent group of British mental health professionals who had long argued that the devastating symptoms were caused by severe physical deconditioning. They recognized that many people experienced an acute viral infection or other illness as an initial trigger. However, they believed that the syndrome was perpetuated by patients’ “unhelpful” and “dysfunctional” notion that they continued to suffer from an organic disease—and that exertion would make them worse. According to the experts’ theory, patients’ decision to remain sedentary for prolonged periods led to muscle atrophy and other negative systemic physiological impacts, which then caused even more fatigue and other symptoms in a self-perpetuating cycle.
     
  4. 4.04.14.24.3 "Countess of Mar | Myalgic Encephalomyelitis - Hansard". hansard.parliament.uk. Retrieved Oct 14, 2018. 
  5. 5.05.15.25.35.45.55.65.75.85.9 Hooper, Malcolm (2003). "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"
    (PDF). Retrieved Oct 15, 2018.
     
  6. Sharpe, Michael; Wessely, Simon (2012). "Chronic fatigue syndrome". New Oxford Textbook of Psychiatry. Oxford University Press. pp. 1036–1043. doi:10.1093/med/9780199696758.001.0001/med-9780199696758-chapter-002008. Neurasthenia remains in the ICD-10 psychiatric classification as a fatigue syndrome unexplained by depressive or anxiety disorder, whilst the equivalent in DSM-IV is undifferentiated somatoform disorder. Myalgic encephalomyelitis or (encephalopathy) is in the neurological section of ICD-10 and is used by some to imply that the illness is neurological as opposed to a psychiatric one. Unfortunately the case descriptions under these different labels make it clear that they all reflect similar symptomatic presentations, adding to confusion. 
  7. 7.07.17.27.37.47.5 Group on Scientific Research into Myalgic Encephalomyelitis (November 2006). "Inquiry into the status of CFS / M.E. and research into causes and treatment (The Gibson Report)" (PDF). Retrieved Oct 14, 2018.
    Simon Wessely
    Professor Wessely is considered by many to be the leading expert on treating CFS/ME and the CFS/ME treatment centres set up by the NHS have been to his model. Many patient groups oppose these treatments because, although they are founded on the positive results of controlled clinical trials, they are psychologically based. There is great dispute over the findings and beliefs of Professor Simon Wessely. Many patient groups believe Wessely and his colleagues are responsible for maintaining the perception that ME is a psychosocial illness. Wessely gave up the research side of his work possibly due to extreme harassment he received from a very small fringe section of the ME community.
    There is conflicting evidence available regarding Wessely’s true opinions. The Group invited Wesseley to speak at an Oral Hearing, however he declined the offer and sent his colleagues Dr Trudie Chandler and Dr Anthony Cleare. The Group were disappointed not to have the opportunity to discuss this important issue with such a key figure. Wessely did not submit a written piece to the Inquiry, however in a letter to the Inquiry he did set out his belief that CFS/ME has a biological element which needs further research and investigation.
     
  8. Dimmock, Mary (2015). "Chronic Fatigue Disposition Comments" (PDF). 
  9. 9.09.19.29.39.4 Maes, Michael; Twisk, Frank NM (Jun 15, 2010). "Chronic fatigue syndrome: Harvey and Wessely's (bio)psychosocial model versus a bio(psychosocial) model based on inflammatory and oxidative and nitrosative stress pathways". BMC Medicine. 8 (1). doi:10.1186/1741-7015-8-35. ISSN 1741-7015. PMC 2901228Freely accessible. PMID 20550693. In the biopsychosocial view, the patient can 'recover' by adjusting dysfunctional beliefs and behaviour and reversing deconditioning, which are proposed to be the maintaining factors in ME/CFS. CBT is aimed at eliminating psychogenic maintaining factors, for example illness beliefs, unhelpful, anxiety-provoking thoughts and kinesiophobia ('fear of movement'); CBT challenges the negative cognitions and dysfunctional beliefs of the patients [3]. CBT is indissolubly attached with GET, a rehabilitative approach of graded increase in activity to address deconditioning [3]. 
  10. Hooper, Malcolm. "Onward Through the Fog: Corporate Collusion?". Onward Through the Fog. Retrieved Oct 14, 2018. 
  11. 11.011.111.2 One Click Group. "Evidence to the Gibson Enquiry" (PDF). Retrieved Oct 14, 2018. 
  12. "Trudie Chalder - Research Portal, King's College, London". kclpure.kcl.ac.uk. Retrieved Oct 14, 2018. 
  13. "Past President". www.rcpsych.ac.uk. Retrieved Oct 14, 2018. 

Biopsychosocial model (BPS) - A school of thought, usually based in psychology, which claims illness and disease to be the result of the intermingling of biological, psychological and social causes. (Learn more: en.wikipedia.org)

Cognitive behavioral therapy (CBT) - A type of psychotherapy geared toward modifying alleged unhealthy thinking, behaviors or illness beliefs. One of the treatment arms used in the controversial PACE trial.

Graded exercise therapy (GET) - A gradual increase in exercise or activity, according to a pre-defined plan. Focuses on overcoming the patient's alleged unhelpful illness beliefs that exertion can exacerbate symptoms, rather than on reversing physical deconditioning. Considered controversial, and possibly harmful, in the treatment or management of ME. One of the treatment arms of the controversial PACE trial.

ME/CFS - An acronym that combines myalgic encephalomyelitis with chronic fatigue syndrome. Sometimes they are combined because people have trouble distinguishing one from the other. Sometimes they are combined because people see them as synonyms of each other.

World Health Organization (WHO) - "A specialized agency of the United Nations that is concerned with public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations." The International Statistical Classification of Diseases and Related Health Problems (ICD) is maintained by WHO.

Myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

Oxford University - a prestigious university located in Oxford, England renowned for its teaching and research in health and medicine

Myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

Myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

Cognition - Thought processes, including attention, reasoning, and memory.

The information provided at this site is not intended to diagnose or treat any illness.
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.