It is possible that this Review could be of some importance in helping us understand something about the origins of CFS. I am sure that this is wholly unintended.
There is much to be said against this reviewer but there are others who will undertake that. Anyone capable of writing "may God forgive me for the part I played in destroying the lives of some of these vulnerable patients" is deserving of some understanding and sympathy.
1. In one of his papers Wessely indicated that aetiology was unimportant. Some (well, to be precise, I) assumed that this was a considered, fundamental, philosophical position. We now learn that "We never took a social history and never carried out a mental state examination. Come to think of it we never even took a proper past medical history". Little wonder that they didn't wish to consider aetiology. Para 4) or red 7.
2. At Para 1) "These authors make no attempt whatsoever to acknowledge the heterogeneity of patients who are labelled with a diagnosis of Chronic Fatigue Syndrome (and in my experience the even greater heterogeneity of the smaller number of patients who are labelled using the diagnostic concept of (ME))."
This is a double edged sword. If it has been clear from the beginning that CFS was designed as a heterogenous diagnosis, what reason could there be for believing that all with the diagnosis would respond similarly to any given treatment? This seems to admit the failure of the whole "intellectual" basis of PACE.
3. The admission as to heterogeneity together with the emotional comments -"They have insulted and demeaned a subgroup of patients with severe and prolonged fatigue"-"Shame on you"-tends to show what this is all about. "Have they never met anybody with near 100% disability due to fearful cognitions...have they never spoken with patients who are at risk of dying due to fearful cognitions and their consequences? I have" Para 11, red 13.
There is a saying "Difficult cases make bad law." The same is no doubt true in medicine. It seems that what was required was what was always suspected - a solution that offered some sort of answer for some of the patients seen in the clinics of some psychiatrists. Those not seen by them seem not to have been worthy of consideration.