I started writing a post about Wessely's recent reminiscence (http://jnnp.bmj.com/content/83/1/4.full) on the original paper (http://jnnp.bmj.com/content/52/8/940.full.pdf) earlier in the year when it first came out in January but never got around to posting ... The study was conducted in the late 1980's and no official CFS criteria was used in this study, instead Wessely sourced "cases of unexplained fatigue" (ie an absence of abnormalities on conventional neurological testing including muscle testing) from neurologists at a hospital for nervous diseases using an ad hoc criteria which seems remarkably similar to what the 1991 Oxford criteria would turn out to be, 6 months of unexplained fatigue as the primary complaint. The "striking" overlap of chronic fatigued patients with depressed patients compared to muscle disorder patients would be an unsurprising methodological artifact when considering that the vague criteria/symptom of fatigue has known overlap with depression and those with evidence of neurological and muscular abnormalities were actively excluded from the study. This would be like excluding anyone with elevated depression scores and then wondering why no one remaining meets the criteria for major depression. It is interesting that, as other have said, this study went on to form the Chalder Fatigue Scale without relevant questions for post-exertional symptoms. Perhaps because CFS patients aren't actually suffering at the core from what is labelled or diagnosed as depression? Then we also have the conclusion of Michielsen et al 2006: "In conclusion, an external attribution style does not protect the CFS or CFS+FM patients with a low self-esteem from depression." (http://www.ncbi.nlm.nih.gov/pubmed/16010445). Unfortunately other doctors are still overestimating the links with affective disorder 25 years later. Also, I have read the claim numerous times that Wessely discovered a neuroendocrine profile for CFS which differed from depression. I'm going to put a response to that in a separate post below so this post doesn't get too large. Ah yes, it just fitted into current "feelings"/prejudices of colleagues in the 1980's, that wonderfully enlightened decade in medicine and CFS, so all was well in the world. Especially when any patients with signs of organic dysfunction were actively excluded while patients with signs of depression were not. However, he may be partly correct in the sense that CFS may be more central than peripheral. If there was a proper control group to rule out deconditioning, then secondary to what exactly? (my guess of his perspective would be other cognitive behavioural factors?) The increased sense of effort is not unusual for anyone experiencing exhaustion, but does point towards something related being at the heart of the condition rather than the "sense of effort" itself being the problem to overcome. Wessely accepts CFS is a "real" disorder with symptoms "in the body" and has even explicitly stated that he does not think CFS is a psychiatric disorder. However, in his speculations the symptoms are "functional" (eg deconditioning and psychobehaviourally disturbed homeostasis) and the primary factors in perpetuation of symptoms and disability are indeed "all in the mind". Once you get past the veneer of pragmatism about supposed psychological factors in all medical conditions and the supposed laymens' conflation of "all in the mind" with imaginary/non-existent, it becomes clear that all the primary perpetuating factors in Wessely's model are mental (cognitive and behavioural). In the case of organic triggers, the assumption is that these cognitive behavioural factors are preventing the patient from natural recovery that occurs in everyone else. As the "pure mental disorder" interpretation of CFS is not accepted by most CFS researchers, Wessely (et al)'s views have now become the de facto psychological position rather than the reasonable grey area he makes it out to be. If current symptoms are bodily but perpetuating factors are primarily mental, this matches a classic definition of psycho>somatic illness. Yes, "psychosomatic medicine" is an multidisciplinary field which has moved on from simplistic Freudian arguments and includes mental health interactions with organic disease, but it is obvious that psychiatry plays a dominant role here and that many CFS-biopsychosocialists are psychiatrists or work in the field of mental health. Although Wessely often presents his work to certain audiences as an interest in the "biology" of CFS, he usually interprets the results in a psycho>somatic manner. Also note that there is little if any difference between treatment of MDD and CFS, both groups are usually presumed to have functional symptoms only, both are only offered CBT and GET and antidepressants. So the amateur philosophy of mind statements remain unchanged after 20 years. The distinction is not meaningless, especially for those who don't have a primary psychiatric illness. Ironically, ignoring the distinction under the guise of pragmatic biopsychosocialism has apparently resulted in similar "serious consequences" under Wessely's influence on the medical opinion of ME/CFS.