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]
- Dysfunctional illness beliefs are believed to exist in patients with ME/CFS[3][9]
- Fear of exercise is a behavior that acts as a maintaining factor in CFS, and prevents recovery[9]
- Patients can "recover" by adjusting dysfunctional beliefs and behaviors, and reversing deconditioning[9][7]
- 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]
- Simon Wessely - psychiatrist and Wessely school founder[1]
- 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]
- 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]
- Clare Gerada
Possible members of the Wessely school[edit | edit source]
- 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[5]
Supporters of the Wessely school[edit | edit source]
Malcolm Hooper lists the following as supporters of the Wessely school.
- Tony Pelosi - Glasgow
- Stephen Lawrie - Edinburgh
- Alison Wearden - psychologist, University of Manchester [5]
Notable studies[edit | edit source]
- PACE trial[3]
- 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[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]
- 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
- Tom Kindlon and Alem Matthees, both advocates with ME, have re-analyzes the PACE trial data
- Brian Hughes and Keith Geraghty, psychologists[14]
- 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[edit | edit source]
The influence of the Wessely school began to wane in the late 2010s,[15] with a combination of
- the 2016 release of the full PACE trial data showing that graded exercise therapy and cognitive behavioral therapy were ineffective[16] and caused high rates of harm,[17][18]
- 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[19]
- Cochrane's exercise therapy review, 2019 update[20][21]
- 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,[22][23] and the ARHQ recommendation in 2016[24]
- increasing scientific evidence of abnormal findings in ME/CFS which were incompatible with the Wessely school's theories[25][26]
- increasing evidence that the associated treatments were not resulting in recovery, and research establishing that significant rates of harm were present and not monitored[27][28][29]</ref>[30][31]
- 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[32][33]
- the abandonment of the biopsychosocial model including GET and CBT by the United States,[23] Netherlands, and finally by England and Wales in 2021.[34]
See also[edit | edit source]
- Simon Wessely
- Graded exercise therapy
- Cognitive behavioral therapy
- Illness beliefs
- Biopsychosocial model
- NICE guidelines
- Medical neglect and abuse
Learn more[edit | edit source]
- The Rise and Fall of the Wessely School[15] - 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
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 The Committee Office, House of Commons. "Malcolm Hopper | House of Commons - Health - Written Evidence". publications.parliament.uk. Retrieved October 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.
- ↑ 2.0 2.1 2.2 Department of the Official Report (Hansard), House of Lords, Westminster (January 22, 2004). "Lords Hansard text for 22 Jan 2004 (240122-12)". publications.parliament.uk. Countess of Mar. Retrieved October 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.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Tuller, David (October 21, 2015). "TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study". Virology blog (Blog). PART ONR. Retrieved October 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. - ↑ 4.0 4.1 4.2 4.3 "Countess of Mar | Myalgic Encephalomyelitis - Hansard". hansard.parliament.uk. Retrieved October 14, 2018.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 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 October 15, 2018. - ↑ 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.
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 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 October 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. - ↑ Dimmock, Mary (2015). "Chronic Fatigue Disposition Comments" (PDF).
- ↑ 9.0 9.1 9.2 9.3 9.4 Maes, Michael; Twisk, Frank NM (June 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 2901228. 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].
- ↑ Hooper, Malcolm. "Onward Through the Fog: Corporate Collusion?". Onward Through the Fog. Retrieved October 14, 2018.
- ↑ 11.0 11.1 11.2 One Click Group. "Evidence to the Gibson Enquiry" (PDF). Retrieved October 14, 2018.
- ↑ "Trudie Chalder - Research Portal, King's College, London". kclpure.kcl.ac.uk. Retrieved October 14, 2018.
- ↑ "Past President". rcpsych.ac.uk. Retrieved October 14, 2018.
- ↑ Hughes, Brian (March 21, 2019). "If you spend 20 years gaslighting your patients, perhaps you should think twice before accusing *them* of trolling *you*". The Science Bit. Retrieved October 24, 2020.
- ↑ 15.0 15.1 Marks, David Francis (June 10, 2021), THE RISE AND FALL OF THE WESSELY SCHOOL, Center for Open Science, doi:10.31234/osf.io/jpzaw
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<ref>tag; name "Marks2021" defined multiple times with different content - ↑ Vink, Mark; Vink-Niese, Alexandra (October 8, 2018). "Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review". Health Psychology Open. 5 (2). doi:10.1177/2055102918805187. ISSN 2055-1029. PMID 30305916.
- ↑ Wilshire, Carolyn; Kindlon, Tom; Matthees, Alem; McGrath, Simon (December 14, 2016). "Can patients with chronic fatigue syndrome really recover after graded exercise or cognitive behavioural therapy? A critical commentary and preliminary re-analysis of the PACE trial". Fatigue: Biomedicine, Health & Behavior. 5 (1): 43–56. doi:10.1080/21641846.2017.1259724. ISSN 2164-1846.
- ↑ Wilshire, Carolyn E.; Kindlon, Tom; Courtney, Robert; Matthees, Alem; Tuller, David; Geraghty, Keith; Levin, Bruce (March 22, 2018). "Rethinking the treatment of chronic fatigue syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT". BMC Psychology. 6 (1). doi:10.1186/s40359-018-0218-3. ISSN 2050-7283. PMC 5863477. PMID 29562932.
- ↑ Struthers, Caroline (November 29, 2018). "My complaint to the Cochrane Governing Board about the Cochrane review of Exercise for chronic fatigue syndrome". Healthy Control. Retrieved November 29, 2018.
- ↑ Larun L, Brurberg KG, Odgaard-Jensen J, Price JR (October 2019). "Exercise therapy for chronic fatigue syndrome". The Cochrane Database of Systematic Reviews. 10: CD003200. doi:10.1002/14651858.CD003200.pub8. PMC 6774399. PMID 31577366.
- ↑ Cochrane (May 21, 2020). "Publication of Cochrane Review: 'Exercise therapy for chronic fatigue syndrome'". cochrane.org. Retrieved May 24, 2020.
It now places more emphasis on the limited applicability of the evidence to definitions of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) used in the included studies, the long-term effects of exercise on symptoms of fatigue, and acknowledges the limitations of the evidence about harms that may occur.
- ↑ Institute of Medicine (2015), Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness, Washington, DC: The National Academies Press
- ↑ 23.0 23.1 "IOM 2015 Diagnostic Criteria | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". Centers for Disease Control and Prevention. January 27, 2021. Retrieved February 25, 2021.
- ↑ Smith ME, Nelson HD, Haney E, Pappas M, Daeges M, Wasson N, McDonagh M (December 2014). "Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome No. 219". Evidence Report/Technology Assessment. Agency for Healthcare Research and Quality (US): 1–433. doi:10.23970/AHRQEPCERTA219. PMID 30313001.
The results are consistent across trials with improvement in function, fatigue, and global improvement and provided moderate strength of evidence for improved function (4 trials, n=607) and global improvement (3 trials, n=539), low strength of evidence for reduced fatigue (4 trials, n=607) and decreased work impairment (1 trial, n=480), and insufficient evidence for improved quality of life (no trials)
- ↑ Nijs, Jo; Meeus, Mira; De Meirleir, Kenny (August 1, 2006). "Chronic musculoskeletal pain in chronic fatigue syndrome: Recent developments and therapeutic implications". Manual Therapy. Conference Proceedings from the 2nd International Conference on Movement Dysfunction. Pain and Performance: Evidence and Effect. 11 (3): 187–191. doi:10.1016/j.math.2006.03.008. ISSN 1356-689X.
- ↑ Núñez, Montserrat; Fernández-Solà, Joaquim; Nuñez, Esther; Fernández-Huerta, José-Manuel; Godás-Sieso, Teresa; Gomez-Gil, Esther (March 2011). "Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up". Clinical Rheumatology. 30 (3): 381–389. doi:10.1007/s10067-010-1677-y. ISSN 1434-9949. PMID 21234629.
- ↑ Kindlon, Tom. "Bulletin of the IACFS/ME 59 Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". IACFSME.
- ↑ Kindlon, Tom (March 20, 2017). "Do graded activity therapies cause harm in chronic fatigue syndrome?". Journal of Health Psychology. 22 (9): 1146–1154. doi:10.1177/1359105317697323. ISSN 1359-1053.
- ↑ Geraghty, Keith J.; Esmail, Aneez (August 1, 2016). "Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?". Br J Gen Pract. 66 (649): 437–438. doi:10.3399/bjgp16X686473. ISSN 0960-1643. PMID 27481982.
- ↑ Forward-ME (2017). "10 year surveillance report consultation comments | NICE CFS/ME guidelines" (PDF). Retrieved February 10, 2019.
- ↑ Oxford Clinical Allied Technology and Trials Services Unit (OxCATTS) (February 27, 2019). "Evaluation of a survey exploring the experiences of adults and children with ME/CFS who have participated in CBT and GET interventional programmes. FINAL REPORT" (PDF). Oxford Brookes University.
- ↑ "Press Statement NICE Guideline publication Oct 2021.pdf". British Association for CFS/ME. October 2021.
- ↑ "NICE 2021: A Triumph of Science over Discrimination". Doctors for M.E. November 1, 2021.
- ↑ NICE Guideline Development Group (October 29, 2021). "Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline". National Institute for Health and Care Excellence.
