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Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of, and finding treatments for, complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia, long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.
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One of the consequences of neuromuscular deconditioning is delayed onset postexertional muscle pain, partly resulting from eccentric muscle contractions, where the muscle lengthens whilst doing work, especially in the untrained person . . . .
Wessely S, Chalder T. Chronic Fatigue. In; "Neurological Rehabilitation". (eds Greenwood, Barnes, McMillan, Ward). Edinburgh; Churchill Livingstone, 2nd edition, in press.
"... far from merely representing the “worried well”, many such patients are severely disabled. For example, chronic fatigue syndrome is associated with worse disability than conditions such as heart failure."
... is directly contradicted by Wessely's earlier work here:No one has ever advocated that CBT or GET should be made compulsory, but surely patients must be able to make informed choices on the basis of an unbiased quality assessment of the evidence, after which they are free to choose either way.
Smith Ch, Wessely S. Unity of opposites? Chronic fatigue syndrome and the challenge of divergent perspectives in guideline development. JNNP 2012.
... and here:Sickness benefits....At present individual [CFS] cases should be treated on their merits, but it is reasonable to expect a patient to cooperate with treatment before being labelled as chronically disabled.
Wessely S, David A, Butler S, Chalder T. The Management of the Chronic Postviral Fatigue Syndrome. J Roy Coll General Practitioners 1989; 39: 26-29.
When asked to comment on benefits or insurance claims we support the patient as much as is possible, but do not support claims for permanent disability or medical retirement until all reasonable efforts at rehabilitation have been tried.
Sharpe M, Chalder T, Palmer I, Wessely S. Assessment and management of chronic fatigue syndrome. General Hospital Psychiatry 1997:19:185-199
While reviewing quotes today, I realized that this recent one:
... is directly contradicted by Wessely's earlier work here:
... and here:
Though perhaps he could claim it wasn't strictly compulsory, since the patient could always opt to starve on the street if benefits were withheld pending a course of CBT
Most people instinctively know that when bad things happen, they affect your body. You can't sleep, you feel anxious, you've got butterflies in your stomach…you feel awful…Such symptoms only become a problem when they become trapped in excessively narrow explanations for illness - when they exclude any broader explanation for the many reasons why we feel the way we do. This is where the internet can do real harm. And sometimes people fall into the hands of charlatans who give them bogus explanations
Often there's an organic trigger, like glandular fever. That's the start and usually most people get over it, albeit after some weeks or months. But others can get trapped in vicious circles of monitoring their symptoms, restricting their activities beyond what is necessary and getting frustrated or demoralised. This causes more symptoms, more concerns and more physical changes, so much so that what started it all off is no longer what is keeping it going.
In that kind of disability, psychological factors are important and I don't care how unpopular that statement makes me.
Roughly a third of people recover and a third show good improvement. About a third we can't do much for.
If you ask people with IBS if they suffer from fatigue they all say yes…Likewise, if you talk to someone with CFS, you find that nearly all of them have gut problems. If you systematically interview people with these illnesses, you find that a big proportion of these so-called discrete syndromes have a large overlap with the others. You have to think that we have got the classifications wrong.
Yeah, you're a real hero.I don't care how unpopular that statement makes me.
Liar.Roughly a third of people recover and a third show good improvement.
Agree. He nailed his views to the mast for all to see in this interview.I think his views are unusually clear in this interview - I can't think of any way this could be spun as anything other than an insistence on this being a primary psychological problem.
Roughly a third of people recover and a third show good improvement.
When it comes to ME/CFS that appears after mononucleosis,
If Wessely's comment about thirds was clearly confined to that subset, then he is probably on safe ground (as far as it goes)
In the interview, he is commenting on the question, "How successful is your treatment of CFS?", which may indicate use in his own practice. No reference is given as regards the reply.I'd like to know where his figures come from. Presumably they must be from some study or other.
What matters is that the research we do is good quality. That's what you stand or fall by.