Right. I did some digging into "Wolfe's" recent internet activity. He's been to Bart's and believes ME is a biopsychosocial disorder.
I want to go into this a bit more, so hopefully
John H Wolfe can understand the problem with his underlying premise. From what I can see, he only began taking a serious interest in ME and developing his protocol very recently, and his understanding of the biopsychosocial (BPS) theories is indeed quite superficial.
So what is BPS? It can sound good at first glance - biological, psychological, and social factors of disease are discussed, and how they can impact all disease. But the reality is that BPS theories limit biological roles to triggering or predisposing factors, and the disease itself is considered psychological, possibly aggravated by social factors such as ME patients being supported emotionally by their friends and family, or financially by their parents and the government.
In the case of ME, the "bio" of BPS is, at best, it being triggered by a virus. Then the "psycho" kicks in, and we are assumed to freak out as a result of being sick and continue to think we're sick after the virus goes away. Then there's more "psycho" as we engage in behaviors which are presumed to make us sicker, by not pushing our limits. Then there's a bit more "bio" acknowledged in the form of orthostatic intolerance(because ignoring low blood pressure problems would make the BPS school look extraordinarily stupid when any doctor can easily see them), but it is attributed entirely to deconditioning. Then there's a lot more "psycho" in the form of "medically unexplained symptoms", which is their nice way of saying "psychosomatic", and that is how anything that can't be explained by the deconditioning theory is dismissed.
So basically, the BPS school says that we make ourselves sick due to avoidant behavior based on the false belief that we are ill. The purpose of their version of CBT (not to be confused with normal CBT used to cope with chronic illness), is to stop us from thinking that we're ill and to put an end to our illness behavior. GET is used as the behavioral part of CBT, to supposedly show us that increasing activity won't hurt us - unfortunately, it has caused a lot of harm to many patients, as is discussed in Kindlon's paper posted above.
So how do we know the BPS school is so utterly wrong?
First of all, the group of researches and practitioners who form the BPS "school" is very small: a handful of psychologists and psychiatrists in England and the Netherlands. Simon Wessely is often considered to be their poster boy, but Peter White is also a prolific member, and Trudie Chalder and Esther Crawley also publish quite a bit of low-impact crap in the area. In contrast, there are thousands of biomedical papers published around the world which document biological dysfunctions which the BPS theories cannot account for.
The BPS school ignores this research, does not explain how it fits into a psychological/psychosomatic model, does not offer any proof for its theories, and badly spins weak results. One of the biggest weaknesses of the entire field of psychosomatic theory is that there is absolutely no proof of it - and there never can be. There is better discussion of this elsewhere on the forum (
alex3619 is our resident expert) - but basically a psychosomatic theory relies on symptoms being unexplained. Yet a symptom being unexplained does not logically mean that symptom must be psychosomatic. It could biological, yet undiscovered by modern technology. The existence of psychosomatic causation of a symptom is unproven, and essentially unprovable - it makes no sense to cite a lack of known physical causation as the proof of psychosomatic causation, when there is a similar lack of evidence of psychosomatic causation. And if a hypothesis is unprovable, than it is unscientific by definition.
Here's a couple examples of the huge mistakes which psychosomatic assumptions can make. Multiple Sclerosis (MS) was medically unexplained until a few decades ago, presumed psychosomatic, and patients were treated much the same way ME patients are now. Then MRI scans of the brain showed lesions, and suddenly that perception changed. MS was never psychosomatic, yet an unscientific assumption was made based on the then-current lack of biomedical evidence. Another recent example is stomach ulcers. Once assumed to be caused by stress, they are now known to be caused by a specific bacteria, and can easily be treated with antibiotics.
The ridiculous thing in the case of BPS theories and ME, is that vast evidence already exists of physiological dysfunction which is not explained by their vague theories of deconditioning and activity avoidance.
The ICC primer, for example, has a chart comparing documented objective physiological reactions of ME patients to exertion compared to normal or sedentary controls (pages 9 and 10), sources cited.
Another thing to know about BPS research is that objective measurements are almost never used. When objective measurements are used to assess the effectiveness of CBT, the show minimal or no improvement, though many BPS studies will not mention this, or will conclude that it proves that actually becoming more active is not needed to "cure fatigue". Questionnaires about symptoms are used to determine primary outcomes instead, and given that CBT consists of patients being told that their symptoms should be ignored or discounted, it is likely that that is reflected in their answers to some extent. Assumptions of mood disorders and mental illness are based upon the use of questionnaires where people are assumed to have a mental disorder if they have certain physical symptoms or behaviors - they'll label pretty much anyone with any multi-system illness as depressed, anxious, and psychosomatic. There is more discussion of these studies and questionnaires elsewhere on the forum.
Wolfe initially rejected CBT and GET on the basis that he doesn't have the problems that require those interventions - and he was right, but not just for himself. None of us have those problems, which is why a hypothesis and protocol based upon BPS treatments is inapplicable.