Moderator's Note: A more recent and more comprehensive thread covering the same subject, with citations, can be found here: http://forums.phoenixrising.me/index.php?threads/simon-wessely-quotes.21025/ Inspired by Andrew B., I put together a list of quotes from Simon Wessely. Would anyone like to help me to gather more of them? Thanks, Lisa * Though disordered immunity and persisting viral infection have recently attracted attention, it is important that immunologists do not deflect attention away from the wider aspects of the chronic fatigue/postviral syndrome. Anthony David, Simon Wessely, Anthony Pelosi. Lancet 1988:July 9th: 100?101 * My local book shop has just given ME the final seal of approval, its own shelf. A little more psychology and a little less T cells would be welcome. Wessely S. BMJ 1989:298:1532?1533 * Many patients referred to a specialised hospital with chronic fatigue syndrome have embarked on a struggle. One of the principal functions of therapy at this stage is to allow the patient to call a halt without loss of face... The patient should be told it is now time to pick up the pieces. ....[T]he process is a transfer of responsibility from the doctor to the patient, confirming his or her duty to participate in the process of rehabilitation in collaboration with the doctor. Simon Wessely, Anthony David, Trudie Chalder et al. JRCP 1989:39:26?29 * It is this authors belief that the interactions of the attributional, behavioural and affective factors is responsible for both the initial presentation to a physician and the poor prognosis. Chronic fatigue and myalgia syndromes. Wessely S. In: Psychological Disorders in General Medical Settings. Ed: N Sartorius et al. Hogrefe & Huber, 1990 * External attribution protects the patient from being exposed to the stigma of being labelled psychiatrically disordered, [affording] diminished responsibility for ones own health...Inappropriate referrals to physicians can lead to extensive physical investigation that may then perpetuate the... pattern of physical attribution. R Powell, R Dolan, S Wessely. J Psychsom Res 1990:34:6:665?667 * Suggestible patients with a tendency to somatize will continue to be found among sufferers from diseases with ill?defined symptomatology until doctors learn to deal with them more effectively. Simon Wessely. Psychological Medicine 1990:20:35?53 * The description given by a leading gastroenterologist at the Mayo Clinic remains accurate: The average doctor will see they are neurotic and he will often be disgusted with them. Wessely S. In: Psychological Disorders in General Medical Settings. Ed: N Sartorius et al. Hogrefe & Huber, 1990 * Continuing attribution of all symptoms to a persistent virus preserves self?esteem. Butler S, Chalder T, Wessely S et al. JNNP 1991:54:153?158 * The prognosis may depend on maladaptive coping strategies and the attitude of the medical profession. Wessely S. Pulse of Medicine 14th December 1991:58 * Blaming symptoms on a viral infection conveys certain advantages, irrespective of its validity....It is also beneficial to self?esteem by protecting the individual from guilt and blame. The germ has its own volition and cannot be controlled by the host. The victim of a germ infection is therefore blameless...Many patients become hypervigilant and over? sensitised to physical sensations....The behaviour of family and friends may inadvertently reinforce the sick role... Fear of illness is an important part of [the disorder]...the approach we favour is provided by professionals whose training and background is mental health. Simon Wessely, Trudie Chalder et al. In: Post?viral Fatigue Syndrome. Ed: Rachel Jenkins and James Mowbray. John Wiley & Sons, Chichester, 1991 * [In our graded exercise programme, there were] a very large number of drop? outs from treatment, largely related to the fear these patients had, albeit inappropriately, of accepting that their disorder was all in the mind. Simon Wessely. Eradicating Myalgic Encephalomyelitis. Pfizer/Invicta Symposium, Belfast Castle, April 15, 1992. * Validation is needed from the doctor. Once that is granted, the patient may assume the privileges of the sick role sympathy, time off work, benefits etc. Wessely S. Reviews in Medical Microbiology 1992:3:211?216 * Studies usually find a high prevalence of psychiatric disorder among those with CFS, confirming that physicians are poor at detecting such disorders. Lewis G, Wessely S. Journal of Epidemiology and Community Health 1992:46:92?97 * The inclusion [in World Health Organization ICD?10] of benign myalgic encephalomyelitis as a synonym for postviral fatigue under Diseases of the Nervous System seems to represent an important moral victory for self?help groups in the UK...Neurasthenia remains in the Mental and Behavioural Disorders chapter under Other Neurotic Disorders...Neurasthenia would readily suffice for ME. Simon Wessely, Lancet 1993:342:1247?1248. * There is another condition with which ME might easily be confused, and it is hysteria....Royal Free disease is itself part of the world of myth.....It is a tragedy that the label of ME has been transferred from [the Royal Free outbreak to CFS], and brought with it its burden of hysteria.....Organic diseases lose their credibility as their psychological causes are recognised.....No matter how bad doctors are, sufferers still need to keep going doctors are still the main passport to acceptance and validation of suffering, not least because we control access to support and benefits. Simon Wessely, Microbes, Mental illness, the Media and ME: The Construction of Disease, May 12, 1994. http://www.meactionuk.org.uk/wessely_speech_120594.htm * I will argue that ME is simply a belief, the belief that one has an illness called ME..... .I will argue that this line here [overhead slide] represents not the line between low and high cortisol responses [but] the line between real and unreal illness. Simon Wessely, Microbes, Mental Illness, the Media and ME: The Construction of Disease, 9th Eliot Slater Memorial Lecture, Institute of Psychiatry, April 1994. * Most doctors in hospital practice will be familiar with patients who complain about a wide variety of symptoms but whose physical examination and investigations show no abnormality. [Such] symptoms have no anatomical or physiological basis....Patients with inexplicable physical symptoms are...generally viewed as an unavoidable, untreatable and unattractive burden. Alcuin Wilkie, Simon Wessely. Brit J Hosp Med 1994:51:8:421?427 * The epidemiology of environmental illness is reminiscent of the difficulties encountered in distinguishing between the epidemiology of myalgic encephalomyelitis (ME), a belief, and chronic fatigue syndrome, an operationally?defined syndrome...These patient populations recruited from the environmental subculture are a subgroup of patients who can be expected to show unusually strong beliefs about the nature of their symptoms, associated with a high percentage of psychiatric disorder...These total allergy syndromes are akin to culture?bound syndromes afflicting modern developed societies where sufferers from unexplained symptoms no longer see themselves as possessed by devils or spirits but instead by gases, toxins and viruses. LM Howard, S Wessely. Clinical and Experimental Allergy 1995:25:503?514 * As an observer of the social scene, I know that ME is defined by the sufferers themselves. Simon Wessely, JCFS 1995:3:2:111?122 * Chronic fatigue may be better understood by focusing on perpetuating factors and the way in which they interact in self?perpetuating vicious circles of fatigue, behaviour, beliefs and disability...The perpetuating factors include inactivity, illness beliefs and fear about symptoms [and] symptom focusing...CFS is dogged by unhelpful and inaccurate illness beliefs, reinforced by much ill?informed media coverage; they include fears and beliefs that CFS is caused by a persistent virus infection or immune disorder. Anthony J. Cleare, Simon C. Wessely. Update 1996:14th August: 61 * The term ME may mislead patients into believing they have a serious and specific pathological process...Several studies suggest that poor outcome is associated with social, psychological and cultural factors...We have concerns about the dangers of labelling someone with an ill?defined condition which may be associated with unhelpful illness beliefs...No investigation should be performed to confirm the diagnosis. Simon Wessely, Peter White, Leszek Borysiewicz [now Chief Executive of the MRC], Anthony David, Tim Peto et al. Report of a Joint Working Group of the Royal College of Physicians, Psychiatrists and General Practitioners. RSM (CR54), 1996. * The clinical problem we address is the assessment and management of the patient with a belief that he/she has an illness such as CFS, CFIDS or ME...The majority of patients seen in specialist clinics typically believe that their symptoms are the result of an organic disease process...Many doctors believe the converse...[Patients] beliefs are probable illness?maintaining factors and targets for therapeutic intervention...many patients receive financial benefits and payments which may be contingent upon their remaining unwell...An important task of treatment is to return responsibility to the patient for management and rehabilitation without inducing a sense of guilt, blame or culpability for his/her predicament. Sharpe M, Chalder T, Wessely S et al. General Hospital Psychiatry 1997:19:3:185?199 * In a previous era, spirits and demons oppressed us. Although they have been replaced by our contemporary concern about invisible viruses, chemicals and toxins, the mechanisms of contagious fear remain the same...To the majority of observers, including most professionals, these symptoms are indeed all in the mind. Simon Wessely. Editorial. NEJM 2000:342:2:129?130 * The greater the number of symptoms and the greater the perceived disability, the more likely clinicians are to identify psychological, behavioural or social contributors to illness...If the chronic fatigue syndrome did not exist, our current medical and social care systems might force us to invent it. Wessely S. Annals of Internal Medicine 2001:134:9S:838?843 * This paper proposes that well?intentioned actions by medical practitioners can exacerbate or maintain medically unexplained symptoms (MUS). This term is now used in preference to somatisation.... The adoption of a label such as CFS affords the sufferer legitimacy in other words, it allows entry into the sick role.... If sections of the media advocate an exclusively organic model, as has happened with CFS, the biomedical model may become firmly enshrined for patients and families at the expense of the psychosocial model. LA Page, S Wessely. JRSM 2003:96:223?227). * It is only human for doctors to view the public as foolish, uncomprehending, hysterical or malingering....One challenge arises when patients have named their condition in a way that leaves doctors uncomfortable, as occurred with chronic fatigue syndrome....It may seem that adopting the lay label (ME) reinforced the perceived disability. A compromise strategy is constructive labelling; it would mean treating chronic fatigue syndrome as a legitimate illness while gradually expanding understanding of the condition to incorporate the psychological and social dimensions. The recent adoption by the UK Medical Research Council and the chief medical officers report of the term CFS/ME reflects such a compromise, albeit an uneasy one. B Fischhoff, S Wessely. BMJ 2003:326:595?597 * Functional somatic syndromes....include chronic fatigue syndrome....Perpetuating factors have particular importance in understanding CFS... Physical deconditioning as a consequence of reduced activity may contribute towards greater experience of symptoms. Hyong Jin Cho, Simon Wessely, Rev Bras Psiquiatr 2005:27:3). * Like it or not, (ME) CFS is not simply an illness, but a cultural phenomenon and metaphor of our times. Simon Wessely, Psychol Med 2006: 36: (7):895?900 * Functional somatic syndromes: definition and terminology The functional somatic syndromes refer to a number of related syndromes that have been characterised by the reporting of somatic symptoms and resultant disability rather than on the evidence of underlying conventional disease pathology....all however share the feature of a disconnection between subjective symptomatology and objective biomedical pathology. Chronic fatigue syndrome, irritable bowel syndrome and fibromyalgia have been more extensively researched than most other FSS which has led to specific pathophysiological mechanisms being advanced for each. Nevertheless...it remains the case that the similarities between the different FSS are sufficiently striking for there to be a compelling case for considering them together (Barksy & Borus, 1999; Wessely et al, 1999). The standard (medical) diagnostic criteria for FSS usually require specific symptoms to be present, whereas psychiatric classification (under the somatoform disorders) emphasises the number of symptoms. Patients with FSS have been rated as one of the three most common types of patients that are difficult to help (Sharpe 1994)....The tendency of those with FSS to turn to alternative medicines for treatment is likely to be ...because alternative remedies often endorse the FSS patients own physical illness attributions (Moss?Morris et al 2003). Illness beliefs At present, chronic fatigue syndrome is the functional somatic syndrome for which there is most evidence that beliefs about the illness may impact on the course of the illness itself. Patients with chronic fatigue syndrome are more likely to make physical illness attributions (rather than normalising or psychologising attributions) for a selection of common symptoms compared to controls (Butler et al 2001) and are more likely to believe their illness will be chronic... These beliefs and attitudes about symptoms may act as a mechanism that then guides the patient to adopt avoidant behaviours....In fact, it is a change to beliefs about avoidance...that predicts good outcome from cognitive behavioural therapy in chronic fatigue syndrome (Deale et al 1998), highlighting the need for more research into the way illness attributions maintain ill?health. Social factors Several of the functional somatic syndromes, including chronic fatigue syndrome, GWS (Gulf War Syndrome) and repetitive strain injury have gained public credibility in spite of widespread medical scepticism as to their very existence. This phenomenon has been attributed to changes within society, including the erosion of the physicians traditional role...Patient support groups...may have some negative consequences, for example, membership of a chronic fatigue syndrome support group has been associated with poorer prognosis (Bentall et al 2002, Sharpe et al 1992). The financial reward to be gained from disability payments or litigation has been argued as playing a role in the maintenance of ill health in those suffering from functional somatic syndromes...For example being in receipt of sickness benefit has been shown to be a poor prognostic sign in chronic fatigue syndrome (Bentall et al 2002, Cope et al 1994). Treatments Psychosocial treatments such as cognitive behavioural therapy have been shown to be beneficial in a range of somatoform disorders...including the most researched functional somatic syndromes (i.e. chronic fatigue syndrome, irritable bowel syndrome and fibromyalgia). Conclusion The functional somatic syndromes share many similarities in terms of symptomatic overlap and effective treatments as well as non?symptomatic characteristics; these observations imply that it may be unhelpful to regard each as a separate condition. Simon Wessely and Lisa Page. Functional Somatic Syndromes. In Handbook of Liaison Psychiatry, edited by Geoffrey Lloyd and Elspeth Guthrie, CUP 2007. * I run a clinic for sufferers with chronic fatigue syndrome (CFS), sometimes also called myalgic encephalomyelitis (ME), and known to a previous generation of neurologists as neurasthenia or nerve weakness...... Psychiatry, its patients and its practitioners, continue to be stigmatised like no other branch of medicine. In 2008 I spoke at a meeting on chronic fatigue syndrome organised by the Royal Society of Medicine (RSM). There was a concentrated effort by some campaigners to have my invitation and that of my two psychiatric colleagues rescinded. Others wrote to the President of the RSM asking why psychiatrists could be permitted to attend a meeting at a society with the name medicine in its title, and seemed perplexed to learn that psychiatrists were actually permitted not just to attend, but to be members of the organisation. If one reads the angry responses to any article that mentions chronic fatigue syndrome and psychiatry in the same breath, it is clear that the drive to find a somatic biomarker for chronic fatigue syndrome is driven not so much by a dispassionate thirst for knowledge but more by an overwhelming desire to get rid of the psychiatrists. That it is psychiatry that to date has made the most progress in treating chronic fatigue syndrome is at best an irrelevance, and at worst just a further insult. Simon Wessely, Surgery for the Treatment of Psychiatric Illness: The Need to Test Untested Theories. Journal of the Royal Society of Medicine 2009;102:445-451. http://www.jameslindlibrary.org/ill...eatment-of-psychiatric-illness-the-need-to-te * http://www.ncbi.nlm.nih.gov/pubmed?term="Wessely S"[Author] "chronic fatigue syndrome"