Good point. I'm open to the hypothesis that in some sudden onset cases triggered by a virus, ME/CFS is the final result of an already developing underlying disease process which may manifest subtle symptoms in the "premorbid" state. Would be unsurprising, some neurological diseases show this trait as well. This is one of the studies I must have been referring to, Harvey et al inc Wessely 2008 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196526). Although it was prospective, it did not properly evaluate their participants for CFS so is therefore probably unreliable on the issue of risk factors. "Those with psychiatric illness between the ages of 15 and 36 years were more likely to report CFS/ME later in life with an odds ratio (OR, adjusted for sex) of 2.65 [95% confidence interval (CI) 1.265.57, p=0.01]. [...] At age 53 years, participants were again interviewed at home by trained nurses. During this semi-structured interview they were asked if they had ever been diagnosed with CFS or ME. [...] Although the use of self-reported CFS/ME is the main limitation of this study, <insert a series of unconvincing justifications for why this isn't really a significant weakness>." They point out that the association with premorbid psychiatric symptoms is even stronger when excluding non-doctor diagnosis of CFS. But relying on the accuracy of real world GP diagnoses of CFS for an epidemiological study is a major stretch. Well said, I wish I was that concise in my previous rant! This isn't the first time I have seen Wessely refer to psychiatric as "whatever that means". I think he is taking a dig at those he believes holds the opinion of naive Cartesian dualism. He and other fellow CFS biopsychosocialists apparently see themselves as the illuminators of the grey area between mind and body. However, he/they have not really made any significant contributions to elucidating the supposed mechanisms between mind and body in CFS. He/they just like to say that such a grey area exists and sometimes include a few simplistic arguments, and then say that a distinction between mind and body is "unhelpful" for CFS, then use these to dismiss criticism of the cognitive behavioural approach.