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Professor Wessely: Knocking the Docs & Overstepping the Mark

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I feel that my last post ended on a somewhat cryptic note  regarding Professor Wessely, and that I need to support the claim I made about the  undermining of physical medical authority within his ‘doctrine’. This I feel I have previously done to an certain degree with regard to Professor Aylward and his colleagues (here and here), though the potential certainly exists for more to be highlighted.

An insight into what could be termed the ‘under-the-radar‘ approach to undermining the integrity of medical personnel, such as GPs, is provided by Professor Wessely’s article for Unum’s Annual Chief Medical Officer’s Report 2007 entitled “Why and When do Doctors Collude With Patients?” (The CMO for this publication was Michael O’Donnell, now occupying the same role with Atos Healthcare.)

Subtle But Significant

This notion may seem to be introduced with apparent goodwill, even humour, but the important fact is that it is introduced at all. The question should always be asked about corporately financed material “Who is set to benefit from the dissemination of these ideas?”. Is there anything to gain on the part of the Insurance firm Unum who produced the report? – Such as carving a first chink in the hitherto resilient armour of the authority of physical medicine, perhaps. This, by suggesting that doctors can be psychologically ‘vulnerable’ to forms of ‘collusion’ with those in their care in ways which might work against the patient’s welfare.

Might it not in fact be an attempt to first, construct such a thing as this type of ‘psychological failing‘ of a doctor, and second, draw it into the classification of ‘iatrogenesis‘, a term historically limited to the adverse effects on patients of drugs, medical error, or negligence through decisions taken by medical personnel. Note should be taken of Professor Wessely’s reference to the naivety of  ‘ethically pure’ young doctors, new to practice, who will come to the realisation that “in real life things are not neat and simple, but grey and ambiguous”, ultimately, presumably, succumbing to this ‘necessary collusion’. Some of the reasons for colluding that Wessely lists give anything but a favourable impression of our medical practioners, including as it does such things as  financial reward, lack of time and fear of complaint.

Poor NHS. Also deluded.

Just prior to introducing Professor Wessely’s article Michael O’Donnell bemoans the way that “our NHS managers [are] fixated on providing those treatments which can be measured” such as operations and injections. As opposed perhaps to psychological interventions which rest solely on, and the success of which is evaluated only by, certain ‘experts’ in that field. He then states that “until return to work is included as the objective and final measure of success, it seems likely that the NHS will continue to miss the point.” This is of course an ‘objective’ perspective, and nothing whatsoever to do with the fact that it serves insurers such as Unum’s best interests (and saves them money) to get the sick back to work.

Wessely’s ‘Previous’

If what I’m claiming seems a little exaggerated, or ‘conspiracy theory-ish’ perhaps you should also take a look at this paper by Professor Wessely from 2003. The main thrust of of which is that doctors who accept the possibility that their patients suffering from (ahem) ‘Medically Unexplained Symptoms’ (MUS) may actually be physically ill are in danger of committing an ‘iatrogenic’ offence against them. He does this by arguing that patients with ‘MUS’ conditions (an important and expensive group he alleges) are in effect made worse by doctors taking their illnesses seriously and organising physical investigations and treatments. There are, Wessely concludes, “points within the doctor-patient encounter where MUS may be iatrogenically maintained“. In simple terms, doctors need to stop ‘colluding’ with these patients because it is doing them harm.

Note: Professor Wessely’s list of MUS illnesses in the paper (detailed below) correlates very closely with those listed by fellow psychiatrist Dr Christopher Bass at the 2004 Atos Conference referenced in my earlier post. (Though he omits chronic back pain in favour of irritable bowel syndrome)

Non-cardiac chest pain

Fibromyalgia

Chronic fatigue syndrome

Repetitive strain injury

Caution: Unbridled Arrogance Ahead. 

An unexpected  interjection to the article under the sub-heading ‘Social’ is yet more evidence of just how entitled proponents of the Biopsychosocial model perceive themselves to be in stepping out of their own field and usurping theories from Sociology to twist into their arguments. Aylward from his ‘Medical’ expertise, and Wessely from Psychiatry. It is very telling indeed that there are no qualifed Sociologists involved in the Biopsychosocial lobby. A small matter of ethics, perhaps.

Wessely’s A Sociologist Now?

In this instance Wessely attempts to appropriate Ivan Illich’s notion of ‘Social Iatrogenesis and ‘invent’ his own version for his own purposes.
Illich explains the meaning of his term as referring to the “impairments to health that are due precisely to those socio-economic transformations which have been made attractive, possible, or necessary by the institutional shape health care has taken“.  Note the use of the word ‘institutional’ here.
Illich’s main concern is that autonomy has been removed from the people, and he speaks about the danger of ‘radical monopolies’ such as is expressed in the idea that “When cities are built around vehicles, they devalue human feet“.

Illich asserts that “Ordinary monopolies corner the market; radical monopolies disable people from doing or making things on their own”. Disregarding this core idea, Wessely feels entitled to put his own spin on ‘Social Iatrogenesis’. Describing it as “a term for illness caused or prolonged by wider sociopolitical inputs” he uses it to discredit ‘Patient Support Groups, no less! It would be quite one thing were he a qualified Sociologist to make that assertion, and accordingly be ethically required to back it up with a full argument as to why that could be a reasonable (though inexplicably contradictory) interpretation of Illich’s theory. It is quite an extraordinary presumption to appropriate that theory towards the opposite aim of its originator.  Patient Support Groups are nothing if not an attempt to restore a measure of  autonomy to ‘the people’ within what has become an ever more  bureaucratised, institutionalised healthcare system.  This is nothing short of  abominable arrogance on Wessely’s part, but oh so very symptomatic of this group of ‘experts’ including Aylward et al.

Could He Possibly Be More Wrong?

Wessely just couldn’t be more wrong in citing Illich in this context, when the latter complains that the spread of medicine “turns mutual care and self-medication into misdemeanors or felonies”. Please compare against Wessely’s rubbishing in the Unum Report of any steps that that an individual may take outside of traditional medicine to ‘self-medicate’. These potential treatments he disparages as ‘”cod-immunology [mixed with] pseudo radiation science interspersed with New Age homilies” directing us towards that reknowed ‘quack-busting’ site ‘BadScience.com’. Hardly comments or sentiments in line with Illich’s philosophy is it? No, it’s quite the opposite. Perhaps Professor needs to sign up for a beginner’s course in Sociology, or better still refrain from playing with concepts that he doesn’t understand.

I’ll leave the final word to Illich on “nosology” (the system of classification of diseases, which he notes “changes with history”)

 In our society nosology is almost totally medicalized; ill-health that is not labeled by the physician is written off either as malingering or as illusion.

Oh deary me, Professor Wessely, oh deary me…

Written by bigleyma

October 5, 2012 at 11:54 pm

7 Responses

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  1. Wow. This article really shocked me. People with M.E. haven’t really got a chance, have they, with people like this around ‘advising’ ‘treatment’?

    friend

    October 9, 2012 at 8:14 pm

  2. lets trast with a much overlooked fact.our word ” democracy” is taken from the greek ” demokratia” which means ” rule of the people.”virtually everyone I have spoken to from many levels of society state they are totally dissatisfied with this and other governments dating back 50+ years behaviour once elected which follows a depressingly familiar pattern where promises to make change,reform,improve the electorates lot are totally ignored or ,when,questioned,denied. “rule of the people?” I think not.self serving,inveterate liars who greedily line their pockets and generally rob the governments coffers for their own greedy ends these people continue until a totally dispirited and angry public vote ghem out.cue the next bunch of liars and conmen/women to take centre stage and repeat the exact same process.ATOS,who are aggressively pursuing a policy of ” covert eugenics” already have the blood of many of our aged,frail,infirm and mentally ill on their hands is a FRENCH based company being paid hundred million pounds a year to throw EVERYONE off benefits whether entitled or not.for full details of the activities of the butchers google “ATOS SCANDAL” and read the truth about what these dictators who are crushing this country are REALLY doing.

    brian peacock

    October 19, 2012 at 7:28 pm

  3. Professor Simon Wessely
    Military Psychiatrist
    Maudsley Hospital
    London England
    http://www.simonwessely.com/
    http://rg.kcl.ac.uk/staffprofiles/staffprofile.php?pid=932
    http://www.gresham.ac.uk/professors-and-speakers/professor-simon-wessely
    Dear Professor Wessely,
    I have looked at dozen’s of pages of your military psychiatric history. For you to tell me you cannot help me, undermines everything you represent as a doctor of psychiatry. Please give careful thought to my request and refer me to one of your colleagues who can help me, if you do not have the stomach to do your job and help the victims of military technology crimes. What on earth are you doing in psychiatry if you are not helping the victims of modern mental warfare?
    There are 100′s of t.i. victims in the United Kingdom and all of them need your help. I have posted your work in my websites, facebook and in 100′s of e-mails to the other victims, expert witnesses and colleagues. How can I tell all the other victims, you do not want to do your job and help us? Whatever your reputation was or is, will now be disputed in the future if you do not help us. Harry Farr would be disappointed to know about your poor attitude towards the fellow victims of modern day (shell shock) technology crimes. The good thing poor ole Harry is dead!
    I can petition the court and ask the Lordship for a court order to see you. You are the Top Military Psychiatrist in the United Kingdom and everyone knows that. The Lordship will probably suggest you and agree with me and grant my order for you to see all of us. Meanwhile I will suffer as I have for over 8 years with V2K and stereo in my head.http://www.liveleak.com/view?i=5d5_1194548311. http://www.youtube.com/watch?v=SWNbE8E0m0g
    It’s very simple Professor, I can stop all my technology problems, in a court of law. I can do it the hard way or the easy way. It was good speaking with you even though you have not realized, this is your cup of tea! You will be on the cover of the American Journal of Medicine one day.
    Happy Christmas&Cheers,
    David J. Ross
    Professor Simon Wessely

    Professor Simon Wessely is Vice Dean of Academic Psychiatry, Teaching and Training, Head of the Department of Psychological Medicine at the Institute of Psychiatry, King’s College London. He is also the Director of the King’s Centre for Military Health Research, Institute of Psychiatry, King’s College London.

    Simon Wessely is Professor of Psychological Medicine at the Institute of Psychiatry, King’s College London, and Honorary Consultant Psychiatrist at King’s and Maudsley Hospitals. He started at Cambridge, and read Art for his Part 2, developing an abiding love for Vassily Kandinsky and equal dislike for the work of Marc Chagall. He then attended clinical school at Oxford, followed by two years on a medical rotation in Newcastle being a real doctor and getting medical membership. However, he always intended to study psychiatry, and started training at the Maudsley in 1984, and has not really left Camberwell since, other than a year at the National Hospital for Neurology, and a year studying epidemiology at the London School of Hygiene. He also spent a sabbatical in the Department of War Studies at King’s College London.

    His research interests are in the grey areas between medicine and psychiatry, clinical epidemiology, psychiatric injury and military health. His first paper was called “Dementia and Mrs Thatcher”, but since then he has published over 600 papers on many subjects (H index = 55). His research has covered epidemiology, post traumatic stress, psychological debriefing, chronic fatigue syndrome, history, chronic pain, somatisation, Gulf War illness, military health and terrorism. In the first part of his career his main areas of research focused around clinical epidemiology, and with special emphasis on unexplained symptoms and syndromes, most particularly the chronic fatigue syndrome. He established the first NHS only service for sufferers, and the first academic unit in this country dedicated to researching the illness. Over the years the unit has produced research looking at many aspects of the illness, including biochemistry, epidemiology, history, immunology, neuroimaging, neurology, psychology, psychiatry, sociology, virology and other areas.

    For the last ten years his research has shifted towards various aspects of military health. He is Director of the King’s Centre for Military Health Research Unit at King’s College London. Beginning with a series of multi disciplinary studies into Gulf War Illness, the unit has studied psychological stressors of military life, PTSD, risk communication, risk and benefits of military service, screening and health surveillance within the Armed Forces, social and psychological outcomes of ex service personnel, and historical aspects of war and psychiatry In 2006 the unit published the first results of a study of the physical and psychological health of 12,000 UK military personnel, half of whom had served in the Iraq conflict. Further work has looked at issues such as vaccination, risk taking, screening, stigma and barriers to care, stress management, “over stretch”, health of reservists, outcomes of treatment, and developing new interventions. In 2010 the team published the results of follow up of the cohort in the Lancet, successfully tracing 10,000 serving and ex serving personnel. This data showed that overall the mental health of the Armed Forces remained robust, despite the impact of the wars in Iraq and Afghanistan. There was no evidence of a “tidal” or “bow” wave of mental health problems, as some have predicted, but Reservists and combat troops continued to have elevated rates of mental health problems after deployment, whilst alcohol misuse had increased. New work is continuing on transition to civilian life, differences between regulars and reserves, impact of new policies and interventions and crime and violence, New studies include randomised controlled trials of different ways of psychological support after deployment, a unique RCT of post deployment screening, and the impact of deployment on family life and children. Professor Wessely remains Honorary Civilian Consultant Advisor in Psychiatry to the Army.

    Professor Wessely has a long standing interest in how people and populations react to adversity. He has received support from the Home Office, Department of Health and Health Protection Agency to look at issues such as how ordinary Londoners reacted to the 2005 bombs, and then how people did react to issues such as the polonium incident and swine flu, and how they might react to CBRN terrorism. At the same time he and Professor Edgar Jones, Chair of History of Psychiatry in the department, have looked at the same issues in the past, such as psychological impact of chemical weapons in World War 1, or why didn’t Londoners’ panic during the Blitz. All of this is part of a general programme of research suggesting that ordinary people are more resilient than professionals sometimes credit, and that interventions need to build upon, and not detract from, that essential resilience.

    Professor Wessely was elected to the Academy of Medical Sciences in 1999, and became a Foundation Senior Investigator of the National Institute of Health Research (NIHR) in 2008. In 2010 he became Vice Dean for Academic Psychiatry at the Institute of Psychiatry, with a major responsibility for undergraduate and postgraduate training. He is committed to ensuring that King’s School of Medicine becomes the premier destination for students with an interest in psychiatry/neurosciences, and that the Maudsley rotation remains Europe’s not just largest, but also best, postgraduate training scheme.

    Finally, he has recently co authored books on chronic fatigue syndrome, the randomised controlled trial in psychiatry, and a new history of shell shock – but none has yet reached the best seller lists. He is more proud of the fact, contrary to the expectations of his friends and family, he has now completed the Pedal to Paris to raise money for the Royal British Legion on five occasions.

    Latest lecture

    Shell Shock or Cowardice?
    The case of Harry Farr
    Private Harry Farr was a British soldier executed for alleged cowardice during the Battle of the Somme.

  4. p.s. I quote from one of your papers. Also in the attachments.

    ABOUT
    “I am currently the Chair and Head of the Department of Psychological Medicine at the Institute of Psychiatry, King’s College London. I am also a Consultant Liaison Psychiatrist at King’s and Maudsley Hospitals, which means that my main clinical work is in the general hospital or seeing patients with chronic fatigue syndrome. I am Vice Dean for Academic Psychiatry at the Institute of Psychiatry, with a wide range of responsibilities including medical education.

    First of all, I became very interested in the general area of medically unexplained symptoms and syndromes, and chronic fatigue syndrome in particular. For those who want to learn more, there is a lot more detail elsewhere on this site about the actual research that I and my colleagues did during this time. We looked at all aspects of the condition – biochemistry, epidemiology, genetics, history, immunology, psychology, psychiatry, sociology and virology. We studied the aetiology of CFS, the prognosis, the background, and perhaps most importantly of all, treatment.

    I also had decided that my particular research expertise would be in epidemiology, the study of illness in populations. I did the Master’s course at the London School of Hygiene, one of the best in the world, and then returned to the Maudsley/Institute of Psychiatry, where I wrote my doctorate carrying out an epidemiological study of the relationship between crime and schizophrenia.”

    _______________________________________________________________________________________________

    “These studies confirmed that there was indeed a problem, and over the next few years we carried out a series of studies with colleagues in immunology, neurology, and public health to take the research further. You can find a description of all of this in our 15 year report.

    King’s Centre for Military Health Research, a collaboration between psychiatry, medicine, history and war studies, and of the Academic Centre for Defence Mental Health (ACDMH), a partnership between the Ministry of Defence and King’s College London, in which serving military medics are seconded to the unit to carry out research and teaching in military mental health.

    KCMHR have completed a randomised trial of a new system of peer-led support (TRIM) intended to reduce stigma and encourage help-seeking, now being rolled out across the Services, and a randomised controlled trial of the new US system of “Battlemind”. A study of the impact of deployment on the mental health and adjustment of military children started in 2010, and the first ever controlled trial of post-deployment mental health screening in 2011.”

  5. Please read my joint commentary with Dr Allen Frances, M.D., on the perils of the American Psychiatric Association’s DSM-5 category “Somatic Symptom Disorder.”

    Dr Frances had chaired the Task Force for DSM-IV, was chair of Department of Psychiatry at Duke and is currently professor emeritus, Duke. For three years, he has been at the forefront of public criticism of many of the APA’s controversial proposals for new disorders for DSM-5 and for the lowering of thresholds for existing disorders.

    Professor Wessely has presented at DSM-5 symposia and Professors Michael Sharpe and Francis Creed are members of the DSM-5 Work Group for “Somatic Symptom Disorders.” What goes through to DSM-5 will likely influence the revision of ICD-10 to ICD-11. Already Prof Francis Creed is pushing “Bodily Distress Disorder” to replace the ICD-10 “Somatoform Disorders”. BDD is said to encompass the DSM-5 “Somatic Symptom Disorder” construct.

    The texts for DSM-5 are in the process of being finalized over the next few weeks and the SSD Work Group is being asked to review their proposed criteria for SSD. This requires public and professional pressure for 11th hour changes.

    Leaving a comment on our post will help demonstrate to the DSM-5 SSD Work Group and Task Force the level of concern for this new category that will hurt all illness groups, but especially the so-called “Functional somatic syndromes” and “MUSs.”

    Please visit Dr Frances’ post, today, leave a comment and then repost this link on other platforms:

    http://www.psychologytoday.com/blog/dsm5-in-distress/201212/mislabeling-medical-illness-mental-disorder/

    meagenda

    December 30, 2012 at 10:32 am

  6. There is a small error in the article

    ” This is of course an ‘objective’ perspective, and nothing whatsoever to do with the fact that it serves insurers such as Unum’s best interests (and saves them money) to get the sick back to work.”

    I think you mean to say this is of course a “subjective” perspective. It is the subjective that serves insurers.

    Jango

    February 5, 2013 at 9:21 pm

  7. Wessely, denier of Camelford. Denier of Gulf War syndrome. Denier of the illness Myalgic Encephalomylitis. Darling of the Elite, now a Knight FFS. Prefers his career and his pocketbook to helping people – in fact us plebs are just canon fodder, and we can go hang. Pretends to care, convinces the lazy. See the Woodstock Conference for how he was one of the architects of the current roll-back of citizens rights. Here’s one view of Simon http://www.meactionuk.org.uk/Wessely_Woodstock_and_Warfare.htm and the same author can tell you more, much more.

    clouty

    March 23, 2013 at 10:11 pm


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