David J Black: Cherchez la shrink
It seems odd that a psychiatrist once described in a Times interview with Stephanie Marsh as “the most hated doctor in Britain” should suddenly become the most all-powerful doctor in that very same benighted realm – yet that is precisely what has happened. On January 27th Sir Simon Wessely took up a new role as a member of the board of NHS England, a body with responsibilities for guiding government policymaking and overseeing an NHS budget of some £152.6 billion.
For over quarter of a century Sir Simon had been a tireless advocate of something called “the biopsychosocial (BPS) model” of diagnosis and treatment. This held that sufferers from the debilitating illness ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome) were not so much experiencing an adverse organic response to post-viral or post bacterial infections, or poisonous neurotoxins, as deluding themselves into believing such things by virtue of their “maladaptive beliefs” and “false cognitions”. The disorder, in other words, was psychosomatic, and so the fault lay with the patient, who should be counselled out of his or her feckless hypochondria.
In 1999 the cultural commentator Ziauddin Sardar asked how it had come about that a man who “denies the existence of Gulf war syndrome – and ME (had) a key position in our socio-medical order – who has chosen and vetted him – and by what criteria and procedures? Where is the debate over the shaping of such research?” That debate might have included a discussion as to why the UK had opted to become a healthcare rogue state by classifying ME/CFS as a psychiatric disorder in defiance of the World Health Organisation’s strictly neurological classification.
Another critic was Dr Margaret Cook, ex-wife of former foreign secretary Robin and a consultant haematologist, who wrote in her regular Scotsman column in 2003 that Wessely had been “central to the psychiatric perspective that ME does not exist at all, and that the related ‘Chronic Fatigue Syndrome’ is a mental condition best managed by a psychiatric therapeutic approach”. She claimed he had “downplayed the need for research into diagnostic markers and such is his influence that no state funding is forthcoming to support any other research than his own”. When Sir Simon threatened to sue, The Scotsman wimpishly sacked Dr Cook and deleted her article from its archive.
So why has Sir Simon Wessely’s doctrine been so enthusiastically embraced by the political classes, do I hear you ask? Even if I don’t, the answer is simple: the psychiatric dominance of ME/CFS appealed to successive governments for the shabby reason that people who ‘imagined’ they were ill received less in the way of welfare benefits than those who suffered from ‘real’ disabling illnesses.
The dream of a ‘Wessely School’ BPS hegemony would suffer reverses however when its two favoured remedies, cognitive behavioural therapy and graded exercise therapy (CBT and GET) turned out to be not only largely ineffective, but possibly even dangerous – so much so that US regulator The Centers for Disease Control deleted them as approved treatments in 2015, with Britain’s NICE, after much shilly-shallying, dropping them in 2021.
These damning advisories rather called into question the findings a £5 million study, the PACE trial, which had had Sir Simon on its management group. This was published in The Lancet in 2011, and sought to vindicate the BPS elite’s faith in CBT and GET. Responses from sceptics included a letter to The Lancet from over a hundred leading academics, researchers, members of parliament, and patient representative groups who were concerned – not to say convinced – that the authors of PACE had manipulated data and rigged outcomes, raising serious ethical and legal issues.
Even with allegations of fraud looming in the matter of the possible conduct of PACE, Lancet editor Richard Horton refused to retract the article, informing The Wall Street Journal that “The Lancet stands by the trial findings”, but that failed to staunch the complaints. In October 2015 an 11,000 strong petition urged the regulatory authorities in both the UK and the US to abandon the primary PACE recommendations of CBT and GET. By February 2018 MP Carol Monaghan was describing it in a House of Commons debate as “one of the biggest medical scandals of the 21st century”.
The bid to downgrade CBT and GET would ultimately succeed, though NICE held out until 2021, when the emergence of Long Covid was beginning to spook the boffins. “The two conditions (ME/CFS and Long Covid) are one and the same” said Dr Avindra Nath of the US National Institute of Neurological Disorders and Stroke, which naturally suggests that quarter of a century’s lack of research into the organic causes of ME/CFS had compromised any understanding of the causes and possible treatments of Long Covid. For Simon Wessely and his discredited coterie the controversy over the PACE trial should have been game over, yet we should never underestimate the conniving tendencies of a state authority which had been buying into the BPS ideology ever since funding a bizarre and sinister “Malingering and Illness Deception Conference” in 2001.
The government’s later default position was to elevate Wessely. Having been knighted for “services to military healthcare” in 2013 and elected president of the Royal College of Psychiatrists the following year, Theresa May appointed him to chair a review of the 1983 Mental Health Act in 2017, prompting a letter of protest to the campaigning journalism blog The Canary from several dozen medical professionals who denounced him as “resoundingly unfit to lead an inquiry into mental health injustice”.
In that same year he became a member of the Judicial Appointments Board, a body responsible not only for selecting England’s judges, but – perhaps more germane in Sir Simon’s case – with advisory powers in appointing the heads of tribunals throughout the UK. It thus follows that if consideration were to be given to, say, setting up a statutory inquiry into allegations of manipulation or fraud in the case of the PACE trial, or a general inquiry into the failures of the BPS model along the lines of Sir Brian Langstaff’s infected blood inquiry, Sir Simon might, in theory, be in a position to exert a restraining influence.
Psychiatry’s supremo might also seek to help out other actors, such as NICE, which from 2007 inexplicably (or possibly for reasons yet to be extracted by means of an FoI request) recommended against the use of anti-virals for a severe illness which is often characterised as post-viral. In the USA, where researchers were free to pursue such things, progress was being made in this very area.
One New York based ME/CFS sufferer has stated that tests carried out on her in 2015 indicated that there was a sequela of the SARS 1 virus in her bloodstream from the 2003 outbreak which was implicated in her condition. Luckily for her she wasn’t in Britain, where NICE would have been recommending against her anti-viral treatment. NICE’s recommended prohibition could, arguably, even have been a breach of Article 35 of the Charter of Fundamental Rights of the European Union states which guarantees “Everyone - the right of access to preventive health care.”
The latest jewel in our Psychiatrist General’s glittering crown, however, is without doubt his recent investiture as a participant in the inner chamber of NHS England. We should reflect upon possible outcomes. On the very day that Sir Simon placed his feet under his new NHS desk minister for social care Helen Whately answered a written question which Conservative MP David Warburton had put down for health minister Steve Barclay “to ask the Secretary of State for Health – if he will increase funding for (a) the treatment of and (b) research into myalgic encephalomyelitis”.
Despite much fatuous waffle about a “cross government delivery plan” and “integrated care boards” Ms Whately essentially responded with a resounding ‘no’. Other MPs’ questions on the same subject received similar dusty replies.
Might it be possible that Sir Simon, only hours into his new job, had offered her heartfelt advice on a subject so dear to his heart?
David J Black’s forthcoming book The Great Psycho Heist: How the Management and Treatment of a Crippling Illness was Hijacked by a Cabal of Psychiatrists in Britain and America, and Why is currently in preparation.