My own personal belief is that in the late eighties the Wessely school really believed in what they were doing, that they were trying to help. As the years rolled by they became increasingly powerful just as the evidence against their stance began to increase. This seems like a strange dichotomy; that two
threads of evidence so diametrically opposed could grow alongside each other at the same time, until you consider why the Wessely school have become extremely powerful. It is my belief that the fertile ground upon which they grew was ploughed and seeded by HMG. The bottom line, it's always the bottom line.
Kind regards, Mark
(Sorry - this is a poorly constructed post - I don't really have time to write today, and shouldn't have started typing. I'd been thinking about these things myself yesterday, but I've not really decided on anything yet. Feel free to ignore it.)
People's beliefs can certainly be influenced by how they think these different views of reality will affect them. If you've spent your career treating CFS patients as if they were psychologically disturbed, then it will certainly be emotionally uncomfortable to then recognise evidence which indicates this is not the case. Apparently we tend to be very poor at accepting evidence which goes against our own prejudices - I've read that such information triggers the same neural correlates as the disgust we feel when smelling something terrible, and we just want to get away from it.
There are also vested interests in treating CFS as psychological. Some of this is not entirely illegitimate: you can understand why the government would not be keen to pay for lots of expensive tests unless they lead to a clear and effective treatment.
I think CFS also throws up confusing philisophical and political issues about free will, personal responsibility and the commitment to equality of opportunity. We're increasingly coming to realise that a number of traits that society morally condemns have a biological and genetic basis. A tendency towards violence seems to correlate with various hormonal imbalances and genetic markers. Yet we do not treat the violent as patients, but as criminals. We also venerate those who work especially hard, and achieve a lot, while condemning those who seem to lack the motivation and drive to do so. At what point do people deserve to be condemned for their behaviour? Should those who only became violent after a virus caused neurological damage be treated more leniantly than those whose whose gene are associated with violence?
Some of Wesseley's earlier papers seem to touch upon such issues. (I'm afraid I'm not well read enough, and my memory is not good enough to speak authoritively about this, so please correct me if I'm wrong). I think it's possible that the psycho-social model of CFS is not the same as saying CFS has no physical cause - rather than indicating that any physical cause is irrelevent ("Etiological theories for CFS abound but none are established. Some of these theories are clinically unhelpful whatever their scientific merits. Thus, the belief that symptoms are due to a persistent viral infection of muscle may or may not be true but more importantly is clinically unhelpful").
There's a widespread sense that we create our own reality. That our beliefs are more important than what the evidence shows, and that these beliefs should be guided not by an honest attempt to understand reality, but by a desire to find the most 'useful' or 'healthy' beliefs. Even if CFS was the result of a neurological or biological cause, patients should be encouraged to take responsibility for their own perceptions anyway, and be trained to muddle through their illness, causing as little trouble for society and the medical profession as they can. People have no right to be healthy, and the notion of 'equality of opportunity' is a lie which raises expectation to unrealistic heights. It could well be that those with CFS will never recover, but they should be convinced otherwise so as to minimse the inconvenience they cause others.
This is a rather meaningless sample of two, but I have spoken with two people who have 'recovered' from CFS. They were certainly far more healthy than I, but the way they spoke about their illness was very strange, describing symptoms they still had, which were clearly unlike the experiences of a healthy person, but also insisting they were fully recovered, or even that these continuing symptoms were somehow an advantage, by giving htem early warning of when they needed to rest. They also seemed to have adopted a very strang view of life, an exagerated version of the misplaced contentment we can all fall into ('Everything in life happens for a reason', 'People get what they deserve.'). It was as if they'd adopted world views that made legitimate concerns or anxieties impossible. I still have a slight fear that I may have to choose over becoming a demented simpleton or staying ill - that maybe my brain is incapable of dealing with reality, and that my fatigue is a symptom of my sanity. If this were the case, I don't think that much of the psychological lobby would see any problem with the trade off: there's no reason to tie beliefs to reality, they're merely tools to be used to guide people's behaviour.
Brief attempt at a psycho-social model: Some people are psycholoigcaly and neurologically unsuited for dealing with reality, this could be the result of genetics, neurological damage, infection, it makes no difference. Prior to the rise of liberal notions of equality of opportunity, most of those those who were chronically fatigued had to choose between starvation, or pushing themselves to survive, in our current social setting, people can choose to maintian their sanity and place the burdon on others, thus allowing for an illness like CFS. If people are unsuited for dealing with reality - tough. Graded Exercise allows people to become used to and desensitised towards the problems of fatigue that they will have to experience in order to stop being a burden on others - it will also allow for the body to recondition itself, and exertion to become less of a problem. There may be some whose body cannot withstand such exertion, but the overall benefits to society of adopting such a policy will be enough to legitimise the setbacks of individuals. This should also be seen as part of a fightback over the increasing medicalisation of personal attributes which is serving to undermine notions of personal responsibility.
I'm afraid I will not have been clear enough in this post. I was thinking and changing my mind while typing. I don't think my psycho-social model is the same as the one Wesseley etc promote (I have no reason to thikn he has any interest in the 'rationality' of his patients one way or the other), but I tried to include some elements which I think do play a role in his thinking and don't seem to be mentioned much by others here. From my reading of his earlier work, he does see his CFS research as part of a social, politcal and philisophical project. It's all quite interesting, but I wish he'd been doing it in a philosophy department where it could have been safely ignored.
I'd meant to mention the recent Wesseley paper on treating fatigue in those with cancer, MS, etc, as if it were psychological, but I'm not sure where to slip that in.