"Treatment of neurotic disorders" by Simon Wessely (2008 presentation)

[Dolphin]

@maxwhd (who finds some interesting stuff in his trawls) posted this to Twitter today:

"Treatment of neurotic disorders: Simon Wessely" Palermo 2008 #mecfs https://dl.dropboxusercontent.com/u/89858260/Treatment%20of%20neurotic%20disorders.%20Prof%20Wessley.pdf Original file https://dl.dropboxusercontent.com/u/89858260/Treatment%20of%20neurotic%20disorders.%20Prof%20Wessley.pptm #rcpsych
https://twitter.com/maxwhd/status/520392830423142400

I hadn't seen it before so thought I'd post it. It's about CFS.

By the way, I think Peter White is a more influential person on the CFS scene at the moment (and for a number of years). Also, Peter White's/Barts' submission on the draft NICE guidelines was more hardline than the KCL one (where S Wessely and T Chalder among others are based) (see link in my signature).

 

[Valentijn]

... So much bad research, with all of the spin focused in one small space. I'm amazed it hasn't imploded and left a black hole behind.

 

[Snow Leopard]

Well the most insulting thing is that he thinks "Treatment of Neurotic disorders" = "Treatment of CFS"

Plus, some of the slides. The last one would be nice if the tables were turned... Therapist no good? Press button...

 

[alex3619]

Ummm, great science guys! Avoiding alcohol = we don't get well? Are they just claiming association, or is it more?

 

[Sidereal]

All that and not one objective outcome measure in sight.

 

[A.B.]

The one anecdote is interesting.

I have been diagnosed with ME, and I believe that antidepressants have been largely responsible for the improvements in my condition. However I'm convinced that this has nothing to do with the antidepressant activity of these drugs, and everything to do with their effect on neurotransmitters in the central nervous system.

Wessely seems to believe that ME sufferers are just depressed and in denial. At least, that is the message behind this anecdote. He could have picked different ones, but picked this one, presumably the one that gives the most insight into this conditions (from his point of view).

Is CBT/GET just a convoluted scheme to get supposedly depressed but in denial people to treat their depression with exercise?

 

[Valentijn]

Ummm, great science guys! Avoiding alcohol = we don't get well? Are they just claiming association, or is it more?

They're definitely implying quite a bit more. Apparently "the crazy" makes us both avoid alcohol AND think we're ill! Though I'm not quite sure how that fits into the theories of being ill to reap the supposed benefits of it.

 

[Research 1st]

There are neurotic people with ME and CFS, and there are neurotic people with Cancer. Acquired diseases don't discriminate and select if the host is mentally unwell or not. All doctors know this, but it seems some forget this. I wonder why, what is the appeal of denying safety protocol taught in medical school? Would considering this logic nullify their theories and expose them as modern day snake oil salespersons?

A definite problem occurs when people with M E nd CFS are thought of as universally neurotic, when they too can develop complications such as cancers and die just like anyone else. The consequent on-going risk to the ME and CFS patients is considerable due to undeniable influence from the powerful psychiatric lobby who keep them away from doctors through the process of community doctors negative attitudes towards them. ME and CFS patients can develop real ongoing shame and embarrassment in reporting their symptoms to health care professionals that they fear will be dismissed as evidence of neurotic behavioral patterns.

Official fatigue based 'guidelines' coercing physicians to send the worried well home are in place. ME and CFS patients genuine physical symptoms are going to be disbelieved as neurosis in the GP practices up and down the country, and without challenge because it is rubber stamped as 'evidence based'.

It is very dangerous to have psychiatry owning ME and CFS as their own little project. The social management of chronic illness of unexplained origin should be directed by appropriate areas of medicine. To do so otherwise is neglectful and dangerous to the patient.

One benefit of these denial of organic CFS documents attached in this thread, is the disinformation is saved for prosperity for future generations of medics to learn how not to practice medicine.

Aside from this, the ME and CFS patients and their familys and carers will continue to suffer with no appropriate medical care due to lack of research funding, and the 'treatment' remaining in the wrong sector of medicine. Sadly in severe cases this is for decades until the ageing process and (ironically) destruction of mental health from iatrogenic harm finally takes it final breath along with the unfortunate victim, the now aged patient who has spent a lift time neglected.

Will anyone ever challenge this legally? How can ME and CFS patients affected by such obvious discrimination (who are often too sick to work), ever take legal action against such things if they are effectively forced into poverty? It would appear the ability to take advantage of a disabled and ignored minority is perfectly acceptable in our society, as it was for previous ignored diseases, racial and religious minorities.

What a complete tragedy for the patients, and more importantly a shame on the medical profession this whole situation is. Without a change in the CDC's case definition I see no realistic chance for this to ever change.

 

[misskatniss]

I can see one person in neurotic denial. Which is Mr Wessely.

And I strongly wish to remind (him) that correlation does never say anything about cause and effect, you learn this in your very first lesson of statistics. That in mind, you could for example conclude that those avoiding alcohol did not recover as well as the others as it is more likely that severe ME sufferers avoid alcohol while other persons can tollerate it.

And I still think there is a horrible misunderstanding which he made common sense. There is only one way in which exercise can be safe in ME: If you count any kind of activity as exercise (bath, eating, dressing, whatsoever) and as long as the daily amount stays below the relapse line (which often is known only later!) it is ok and even necessary to keep joints going etc. But as we never know exactly how much activity we can tollerate without relapsing, and as anyone who has tried to push through PEM knows what that means, it is so shortsighted to state that GET might be safe. Only if the patient with lots of knowledge upon his disease selects the level of activity and is neither pushed nor encouraged to exceed it by any means. We are not neurotic. You just don´t fix a broken leg by jogging regularly with increasing intensity.

And what I dislike most is how he plays the victim regarding the anger of ME sufferers about his work. Who is the victim? Who stays in a neurocentre in the hands of people who are too arrogant to accept that people may remain sick not because they want to and neither because the docs failed, but only because ME is so complicated it will need lots of time and effort to be understood...?

PS: How on earth could one believe that being an ME sufferer is less threatening to self esteem etc. than depression???

No, no, no. Need some heavy dosis of vanilla pudding to GET over this!

 

[chipmunk1]

I can see one person in neurotic denial. Which is Mr Wessely.

Denial is when you don't want to see something. Psychosis is when you see something that isn't there.

Which one is it here?

 

[misskatniss]

He doesn´t want to see that ME is physical and not psych. So for me he meets the neurosis criteria ;-) Biut sticking to an erroneous belief with no evidence in reality is quite psychotic. So he meets both. Ha! Borderline! ^^ Sorry, couldn´t help but be ironic seen how easily he attaches psych labels to people... So can I ^^

 

[chipmunk1]

So he meets both. Ha! Borderline!

No that doesn't fit. Borderline people are said to be quite manipulative.

 

[liverock]

Denial is when you don't want to see something. Psychosis is when you see something that isn't there.

Which one is it here?

I think its more a case of 'when all you have is a hammer,everything looks like a nail'. Psychiatry has to have an answer for every facet of human behaviour both healthy and sick, otherwise it becomes the god that failed. This is clearly emphasised in the amount of ' new' mental illnesses they bring forth every year.

 

[alex3619]

And I strongly wish to remind (him) that correlation does never say anything about cause and effect, you learn this in your very first lesson of statistics. That in mind, you could for example conclude that those avoiding alcohol did not recover as well as the others as it is more likely that severe ME sufferers avoid alcohol while other persons can tollerate it.

[Start satire, black hat on] Oh, but they have so many different correlates, and its well known that the mind causes it, the great high priest Freud said so.

Like it probably even correlates with how many chickens crossed the road! So there! [END SATIRE]

So many statements made by proponents of these theories are completely lacking in substantive evidence. They do however appeal to those who believe much of the unproven psychiatric dogma of yesteryear. Its about plausible stories, not scientific fact, hypothesis or testing. Its about consistency with unproven hypotheses of the past, many of which are in disrepute.

This is all theory driven. What evidence there is has usually been interpreted in light of that theory. Its the fallacy of begging the question. Other alternatives are rejected, usually with nothing more substantive than a snort of derision.

We do not have a proven model of CFS or ME, and do not have a widely recognized diagnostic test. That makes us vulnerable. The history of these kinds of theories is that they will latch onto anything for which there is not a widely recognized physical cause, and claim it as psychiatric. Every disease for which this has been done, every single one to my knowledge, either still lies in medical limbo or has been shown to be physical.

The only case of disorders in which I would have to agree are purely due to thoughts (and I can quibble about that too) is from brainwashing, typically but not exclusively used by cults. People can be indoctrinated into false beliefs, but its not an easy thing to do.

Most other cases of false beliefs are probably just due to someone being mistaken ... either the believer, or the analyst. This does not include people who have brain disorders of one sort or another. If the machinery is broken you should expect problems.

Much of this research, and claims, is Swiss cheese being claimed as Edam.

 

[Sean]

Denial is when you don't want to see something. Psychosis is when you see something that isn't there.

Which one is it here?

Neither. Or both.

It's Wessely-Chalder-White (WCW) Syndrome, one of the most serious of the so-called 'hybrid paradoxical' disorders. The defining symptom being persistently seeing things that are not there, while simultaneously denying the things that are there.

Sufferers are typically (though not exclusively) smug middle-class Anglophone pseudo-scientists, and they can often be high achievers who insinuate themselves deep into power structures, though the basis for their elaborate and often fantastical claims to authority rarely survives even modest scrutiny.

Interestingly, it seems to be an entirely culturally transmitted functional disorder, as sufferers have apparently normal brain structure and chemistry. Sufferers also spend inappropriately large amounts of time together, usually in some sort of frenetic circular arrangement, the exact nature of which is unclear, but which clearly only reinforces their delusions and denials.

According to the latest sciencey stuff, the best treatment is enforced retirement, isolation from fellow sufferers (including no unsupervised access to the internet or medical journals), cold gruel-and-garlic enemas twice daily, and strictly no wheelchairs or disabled parking.

 

[biophile]

What is the point of all this?
• because it is all true
• and it doesn’t challenge patient illness views or self esteem
• But prescribing exercise remains tricky…

CONCLUSIONS:
REHABILITATION
• Worth doing
• You don’t have to get fit to get better
• Effective treatment takes at least 6 sessions
• Engagement and explanation are critical
• CBT and graded exercise are safe

So what is the result of introducing graded exercise and CBT into the clinic?

Universal peace, love and brotherhood.

Here is a modified version of the therapist button artwork which better reflects the situation:

 

[chipmunk1]

What is the point of all this?
• because it is all true
• and it doesn’t challenge patient illness views or self esteem
• But prescribing exercise remains tricky…
CONCLUSIONS:
REHABILITATION
• Worth doing
• You don’t have to get fit to get better
• Effective treatment takes at least 6 sessions
• Engagement and explanation are critical
• CBT and graded exercise are safe

So what is the result of introducing graded exercise and CBT into the clinic?

Universal peace, love and brotherhood.​

Did he really write this?????

I think what he applies are principles of classic psychoanalysis.(i wonder if S.W was trained in it or got exposed to it in his earlier years.) :

Make the patient look incapable, confused, driven by emotions, unaware, childish, foolish, lazy, weak-minded but don't says it directly to not offend people too much and to pretend that you "want to help".

Now you can pretend you are an expert and not the lazy, incapable, incompetent, unaware, childish, foolish, weak-minded individual that you really are.

No matter what happens it will always, ALWAYS be the fault of the patient and everyone will agree with you.

You don't even have to have some expertise or knowledge because no matter what you do, if something isn't working it is obviously the patient's fault.

This approach has worked very well for the past 100 years and it continues to work well for the people that make use of it.

Here is a modified version of the therapist button artwork which better reflects the situation:

There should be another term in the picture: "Reality"

 

[worldbackwards]

Ummm, great science guys! Avoiding alcohol = we don't get well? Are they just claiming association, or is it more?

Presumably the corollary to this is that alcoholics are all fighting fit?

 

[chipmunk1]

Ummm, great science guys! Avoiding alcohol = we don't get well? Are they just claiming association, or is it more?
Presumably the corollary to this is that alcoholics are all fighting fit?

Is this a new theory? We drink too little?

I thought that some KCL researchers had suggested that CFS sufferers just go to the pub too much?

If we start drinking they will probably suggest again that we don't have CFS we are just alcoholics.

 

[Valentijn]

Is this a new theory? We drink too little?

I thought that some KCL researchers had suggested that CFS sufferers just go to the pub too much?

That was one of the scenarios in that hilarious series of videos from the psychobabblers some years ago. "I'm going to school, I work all night as a bartender, and I drink a lot. I'm so worn out." "You must have ME/CFS!"