4 ms·

Psychological theories for CFS have been around for decades and have yielded very little by way of testable hypotheses or treatment, despite millions of dollars

Psychological theories for CFS have been around for decades and have yielded very little by way of testable hypotheses or treatment, despite millions of dollars spent on research. Wessley's highly controversial views and work have been subject to much criticism -- absolutely none of which is reflected in this disappointing puff piece. There's plenty of more news-worthy stuff that's been happening in the CFS world (both good and bad) in recent times than years-old revelation that people don't much like Simon Wessley. The core problem is simply that this conclusion isn't true: "But a psychiatric explanation would not delegitimise CFS. And it might improve treatment and help patients get better, at last." Wessley's theories have been studied. They offer very little to very sick people. They don't get better. It does delegitimise the extremely severe nature of the illness. If they did legitimise, and -- far more importantly -- cure sick patients, great! That would be wonderful. But they don't. We know they don't. Shame on the Economist for not saying so. Psycho-social explanations of CFS seem to be nothing more than "hysteria" rebadged for more modern times. It's easier to say "Well, maybe it's your fault!" than to accept the hopelessness of not knowing what's going on. Actually, that's not true, there has been (and is) plenty of work on the physical abnormalities. For those interested in current happenings in the CFS world, it's worth following: http://phoenixrising.me/ http://phoenixrising.me/ .

vsync 15y ago
Your other objections are interesting and I want to research them further. But I wonder how this comment doesn't prove the editorial's point: > It does delegitimise the extremely severe nature of the illness. How does merely positing a psychosomatic origin for the syndrome "delegitimise" its "extreme severity"? Or is it you thinking that mental health is somehow less important than physical health, which doesn't even make sense considering the brain is an organ too? > Psycho-social explanations of CFS seem to be nothing more than "hysteria" rebadged for more modern times. It's easier to say "Well, maybe it's your fault!" than to accept the hopelessness of not knowing what's going on. Uh huh. And it's easier to take the idea of mental health being relevant as a personal insult, like people are saying it's one's own fault, than to accept the hopelessness of not knowing there's a magical cure as soon as the doctors discover the sole physical cause. Again, I really want to read further on research being done on CFS and other subjective and idiopathic syndromes. It's interesting from a medical and social standpoint and I'm close with several people who suffer with such issues. But I've also seen their blind spots related to the issue. I'd like to hear more on the work that's disproven psychiatric origins of the syndrome, since while the editorial touched on Wessley it seemed more to be talking about the need to explore all possible causes and solutions of a problem affecting many.
- cfshacker 15y ago
  Thanks! Generally speaking, I think you have to understand the nature of "mental" illness that's being discussed. Depression, for example, is taken seriously as a "mental" illness but is quite comfortably discussed in medical terms (hence SSRI's, NDMA antagonists, etc); as well as Cognitive Behavior Therapy where it's been reasonably demonstrated that improving your thought patterns can improve your emotional wellbeing. I'd describe this as the modern form of "mental illness". The kind of "mental illness" we're talking about here with CFS & the Wessely/UK psychiatry school of though though is old school _neurosis_. You're not sick, you're neurotic. You want to save face by coming up with symptoms. You need validation from a doctor. You remain sick because of the 'secondary gain' you receive in terms of attention. You need to avoid personal responsibility and blame, and so on. It's horrible stuff. For quotes from the horse's mouth, see: http://www.cfsinfo.be/Documentatie/AA%20%20Strijd%20classificatie%20ME/Views%20of%20Simon%20Wesseley.htm http://www.cfsinfo.be/Documentatie/AA%20%20Strijd%20classifi... , and hopefully you can see why his views have been so controversial. It's true that CFS is something of a catch-all for a variety of illnesses, from post-viral syndromes (see Dr Lerner), hypothyroid problems, diet and gut-related illnesses (undiagnosed coeliac patients, for example), neurological syndroms (some people are helped by neurofeedback, and Jay Goldstein wrote some fascinating books on the neuroscience of CFS/ME), hormone disorders (e.g. adrenal, but also others), possible retroviruses (XMRV looks 95% unlikely, but a handful of people did well on antiretrovirals), possible hit-and-run viral brain injury (as Australian research has indicated) and on and on. Hell, I recently came across a guy who recovered almost immediately and totally after 30 years of debilitating fatigue by taking a relatively recent IGE-binding drug (Xolair). Plus, there's the potential of an underlying viral or other cause that in turn causes a differing array of symptoms. The problem is not just that we don't know what CFS/ME is (to the extent that it's a uniform thing), but we're pretty lousy at dealing with all the other surrounding illnesses as well. (Hypothyroid is a great case in point, IGE is relatively new, etc etc,.) What's pretty clear, however, is the vast, vast majority of these patients, whether suffering CFS for known or unknown reasons, are not neurotic, and for The Economist, or anyone, to insist that "neurosis" should be taken seriously as a basis for medical diagnosis and treatment in 2011 is simply appalling. edit: ugh, Wessely, not Wessley. my bad.
  - 15y ago

vsync 15y ago

Your other objections are interesting and I want to research them further. But I wonder how this comment doesn't prove the editorial's point: > It does delegitimise the extremely severe nature of the illness. How does merely positing a psychosomatic origin for the syndrome "delegitimise" its "extreme severity"? Or is it you thinking that mental health is somehow less important than physical health, which doesn't even make sense considering the brain is an organ too? > Psycho-social explanations of CFS seem to be nothing more than "hysteria" rebadged for more modern times. It's easier to say "Well, maybe it's your fault!" than to accept the hopelessness of not knowing what's going on. Uh huh. And it's easier to take the idea of mental health being relevant as a personal insult, like people are saying it's one's own fault, than to accept the hopelessness of not knowing there's a magical cure as soon as the doctors discover the sole physical cause. Again, I really want to read further on research being done on CFS and other subjective and idiopathic syndromes. It's interesting from a medical and social standpoint and I'm close with several people who suffer with such issues. But I've also seen their blind spots related to the issue. I'd like to hear more on the work that's disproven psychiatric origins of the syndrome, since while the editorial touched on Wessley it seemed more to be talking about the need to explore all possible causes and solutions of a problem affecting many.

cfshacker 15y ago
Thanks! Generally speaking, I think you have to understand the nature of "mental" illness that's being discussed. Depression, for example, is taken seriously as a "mental" illness but is quite comfortably discussed in medical terms (hence SSRI's, NDMA antagonists, etc); as well as Cognitive Behavior Therapy where it's been reasonably demonstrated that improving your thought patterns can improve your emotional wellbeing. I'd describe this as the modern form of "mental illness". The kind of "mental illness" we're talking about here with CFS & the Wessely/UK psychiatry school of though though is old school _neurosis_. You're not sick, you're neurotic. You want to save face by coming up with symptoms. You need validation from a doctor. You remain sick because of the 'secondary gain' you receive in terms of attention. You need to avoid personal responsibility and blame, and so on. It's horrible stuff. For quotes from the horse's mouth, see: http://www.cfsinfo.be/Documentatie/AA%20%20Strijd%20classificatie%20ME/Views%20of%20Simon%20Wesseley.htm http://www.cfsinfo.be/Documentatie/AA%20%20Strijd%20classifi... , and hopefully you can see why his views have been so controversial. It's true that CFS is something of a catch-all for a variety of illnesses, from post-viral syndromes (see Dr Lerner), hypothyroid problems, diet and gut-related illnesses (undiagnosed coeliac patients, for example), neurological syndroms (some people are helped by neurofeedback, and Jay Goldstein wrote some fascinating books on the neuroscience of CFS/ME), hormone disorders (e.g. adrenal, but also others), possible retroviruses (XMRV looks 95% unlikely, but a handful of people did well on antiretrovirals), possible hit-and-run viral brain injury (as Australian research has indicated) and on and on. Hell, I recently came across a guy who recovered almost immediately and totally after 30 years of debilitating fatigue by taking a relatively recent IGE-binding drug (Xolair). Plus, there's the potential of an underlying viral or other cause that in turn causes a differing array of symptoms. The problem is not just that we don't know what CFS/ME is (to the extent that it's a uniform thing), but we're pretty lousy at dealing with all the other surrounding illnesses as well. (Hypothyroid is a great case in point, IGE is relatively new, etc etc,.) What's pretty clear, however, is the vast, vast majority of these patients, whether suffering CFS for known or unknown reasons, are not neurotic, and for The Economist, or anyone, to insist that "neurosis" should be taken seriously as a basis for medical diagnosis and treatment in 2011 is simply appalling. edit: ugh, Wessely, not Wessley. my bad.
- 15y ago