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Archive for the ‘Simon Wessely’ Category

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

Worsening of Mental Health, Self Harm and Suicides Directly Attributable to WCA

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Investigative news outfit Exaro have revealed that a recent survey commissioned by mental health charity ‘Rethink Mental Illness demonstrates the devastating effect that the, now notorious, Work Capability Assessment is having on the sick and disabled across the country. Of a thousand GPs surveyed it was reported that 6% had disabled patients who had either attempted, or actually committed, suicide due to the distress the process is causing. One in five (21%) revealed that they had patients who have considered suicide in connection with the WCA, either as a result of undergoing it, or fear of having to. 14% of GPs also confirmed self harming behaviour among patients forced to undergo the Atos administered test.

“These shocking statistics show that the work-capability assessment is pushing some of the most unwell and vulnerable people in our society to the edge.” – Paul Jenkins, chief executive, Rethink Mental Health.

Further, Rethink’s survey indicates that not only is the WCA exacerbating  ill-heath for those with existing mental health problems, such as schizophrenia or bipolar disorder, but

More than eight out of ten GPs say they have patients who have developed mental health problems due to [the] controversial benefits test” [italics added]

Only ‘Anecdotal’  

an·ec·do·tal [an-ik-doht-l, an-ik-doht-l]
adjective
based on personal observation, case study reports, or random investigations rather than systematic scientific evaluation”

Attempts to undermine the vast amounts of incriminating evidence discrediting the WCA include comments such as this by Conservative MSP Alex Johnstone reported in the Daily Record:

“But many of the stories we have heard are anecdotal. It is difficult to find a statistical or empirical set of figures to tell us exactly what these problems are.”

Is this survey ‘statistical’ and ’empirical’ enough for those such as Mr Johnstone? Or will they find some other means of dismissing the facts? There is material which has been expressly designed for just that purpose, including the means by which GPs and other doctors’ authority can be undermined or dismissed. It can be found among the output from proponents of the BioPsychoSocial model of illness, and adherents to the ‘Wessely’ psychogenic doctrine.

The Problem of ‘Scientifically Unfounded Attitudes’: A BioPsychoSocial Analysis

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A small, but select, number of individuals in our society can be seen to be suffering from the mysterious problem of “Scientifically Unfounded Attitudes“. This is a significant issue for society as a whole since those afflicted tend to hold high status, influential positions in the academic, state and corporate medical community, and have been complicit in cobbling together a rag bag of ideas (under the guise of a theory) which has had profoundly negative effects on many people’s lives, economically, socially and personally. This is also true of its effects on taxpayers money, a great deal of which has been wasted on spurious processes whose only objective, it seems, is to channel vast amounts of money into the pockets of private companies.

So how has this situation arisen? A biopsychosocial model is very helpful in the analysis of these individuals:
First it is necessary to address the ‘bio-medical’ element (in order to get it out of the way, which is the usual concern of these adherents). Exhaustive medical data is not available for this group, but considering their fairly advanced average  age, and the fact that they are still furiously active, and able to travel extensively around the world touting their ‘theories’ suggests that they belong to a privileged sector of the health spectrum. That is, they are those in whom illness is relatively absent. This is confirmed visibly by the absence of any ‘aids’ in their conduct of work. It can be reasonably assumed, then, that they have been in the main favoured with good health.

Further, and here we introduce a social aspect into the analysis, a singular feature which connects all these individuals is their tenancy of high profile positions within state, academic or corporate agencies. Occupying, as they do, the top strata of the employment scale, which attracts to it a slew of benefits extra to the significantly high salaries these positions command, they are comfortably placed should they ever find the spectre of ill-health casting a shadow across their lives. This ‘social’ lens, then helps to explain how their distorted perspective on illness may have been reinforced by their privileged social location. The protection of affluence provides an impenetrable buffer against physical or mental affliction.

And it is the second of these, the mental, which perhaps offers the greatest insight into the behaviour and attitudes of this group. The psychological element of this model is able to highlight the source of shared distortions in beliefs that manifest within this sector of the population. Significantly this group place an excessive value upon psychological explanations of illness. Perhaps this is an instinctive acknowledgement of the fact that they, themselves, suffer from psychologically deluded ideas about the sources of illness (for reasons not unconnected to their own bio and social circumstances). Many of them, some explicitly, some tacitly, derive their understanding of illness from what is termed ‘positive’ psychology (or the rather more respectable ‘cognitive behavioural’ theory). The ideas underpinning this minority field of the discipline is that it is not the circumstances of people’s lives which determine the outcomes for them but their ‘attitude of mind‘. More rational people consider this ‘wishful thinking’, or when applied to the dire circumstances of some people’s lives by an outside agent, abuse. Other psychological dysfunctions are also visible among this group, particularly that of the persecution complex which is evidenced in ‘knee-jerk’ responses to any legitimate criticism that those actually suffering from illness have the temerity to raise.

This has been a brief analysis of this afflicted group, but it has also been a demonstration of just how widely it is possible to apply the BPS model. I believe it has been put to a far more realistic use here than it has by the group in question, who stretch one or two ideas to breaking point in their attempt to legitimise their theories, with their notably unbalanced emphasis on the (out-dated) psychological at the expense of those accompanying elements of the model. Interestingly this analysis too has found more significance of the ‘psycho‘ aspect in revealing underlying attitudes and distorted beliefs surrounding an issue. Perhaps that ultimately is this model’s failing, in that under the aegis of a purported ‘scientific’ paradigm it is able to provide a platform for the legitimisation of any, or all,  biased attitudes.

Hopefully this small exercise will have enlightened people as to the uses to which the BPS model can be put. Anyone who wishes to give an apparent scientific gloss to their biased propositions need only to remember to quickly dispense with the ‘bio’ and the ‘social’ and focus excessively on the ‘psycho’ where, given its controversial history, psychology is certain to furnish them with something with which to underpin their claims.

The ‘Psychologising’ of Illness and The Sanctification of Work

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I’ve been away a little while (longer than I intended), partly because I’ve been working on an article for the International Green Socialist online magazine. It turned into a larger project than I intended, but I hope visitors here will give it a go because I think it exposes some deliberate processes that have been going on behind the scenes of the new ‘reforms’ of health related benefits, to the disadvantage of the sick and disabled in this country. Despite its length I still feel there is more to be said about this and I hope to be following it up with more in depth analyses in the near future.

Fill your boots (as my darling daughter would say) here:

Illness as ‘Deviance’, Work as Glittering Salvation and the ‘Psyching-up’ of the Medical Model: Strategies for Getting The Sick ‘Back To Work’.

(You might need more than one pair :D)

Update: Noticed that the above link is not presently working so a copy of the article can be found here: https://dl.dropboxusercontent.com/u/32109159/Illness%20as%20Deviance.pdf

Regarding Professor Wessely’s Reply

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I am honoured to find that my humble blog has had a visit from the esteemed Professor Wessely. I had been going to comment on his comment, but found myself wishing to elaborate further so I shall address what he said in this post.

His comment:

always flattering to be the subject of a blog, even though it is wrong in almost every detail. However, am honoured to be quoted in the blog as barbara ehrenreich, one of my heroines for many years. Anyone who knows me or has heard me speak will know very well that i am sceptical, to put it mildly, of the current vogue for positive psychology. On the other hand, you are correct, i have long been of the view that it is better for your mental health to be in work than out of work.

best wishes

Simon Wessely

My response:

Thank-you for your comment Simon. It must have been surprising indeed for you, as a longtime fan of Barbara’s writing to see your own work compared so unfavourably to hers. I believe however that the most significant indicator of a person’s influence on society has to be the outcomes that result, the effects that are wrought upon everyday people. Those in a position of influence or power bear a greater burden of responsibility in that sense.

In Barbara’s case she is so furiously on the side of the disadvantaged in society, the sick, the low-paid and abused that I think she would be outraged at what is happening to people in this country as a result of welfare reforms that at least part of your work has contributed to, however indirectly.

I am aware that you yourself are no proponent of Positive Psychology, but you have certainly associated with those who are. You favour its more respectable cousin Cognitive Behavioural Therapy I think? I am unable to view that particular treatment strategy as anything other than a form of mind control which seeks to change ‘negative’ patterns of thinking into more positive ones.

What marks the difference between your approach and that of Ms Ehrenreich’s is that she believes society is in great need of change in order that a more equal and fair society can be constructed, whereas your discipline seeks to mould the individual to fit into what she and I consider to be a currently inhumane system.

Ideas from psychology filter through into the mainstream (especially when given a little push by rich corporations who are positioning themselves to benefit from them). Some of the ideas that have been released from your neck of the woods have influenced how people now consider the relationship between ill-health and work (to the detriment of the sick or disabled). I used to respect psychology until the moment that it lost its independence in service of the agendas of corporate sector profits, or in justification for the state’s cutting of welfare expenses. Not something Barbara would be pleased with at all.

Your ending remark really requires a post of its own, and I hope to address it at a later date. But unqualified terms such as ‘Work’ and ‘Mental Health’ are abstract variables until given meaning by specific reference to real world situations, and the many and complex ways in which they manifest and are given meaning. It is like saying ‘Food’ is always a good thing, without taking into account volume or quality, or frequency of ingestion. Same thing with ‘Work’.

Written by bigleyma

October 18, 2011 at 5:02 pm

“The Cold Grip of Psychiatry”: Simon Wessely

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There are many people now who are trying to locate the source of the ideas that our government has taken up with respect to how illness/disability is regarded in the current social and economic climate. Since it forms the basis and the justification for their ‘reforms’ of welfare in the sphere of ‘health-related benefits’ it is quite evidently the most important factor that is affecting the lives of those who would seek support of this kind.

As ever with issues of human/social effect there is often a complexity which needs to be unravelled in order to identify streams and themes of thought and activity which have contributed to those effects. This blog, as I’ve indicated, is an attempt to work out those factors which have brought us to the situation we experience now, the matters detailed elsewhere on the blog under the ATOS Healthcare category. (Much more material can be found via my (unfinished) Blogroll links).

One theme that can be identified is the input that Psyciatry/Psychology has had on the new thinking surrounding incapacity and the relationship between health/ill-health and work.

Relatedly, Barbara Ehrenreich has written a wonderful (and darkly funny) account of the Cult of Positive Thinking that constitutes part of this psychology, I strongly recommend it for the insight it gives into how these people think. It’s an eye-opener not only for the present day but also as to the historical origins of the perspective, which are surprising. She illustrates how this idea, that by taking a positive slant on your life you can overcome everything from cancer to physical reality itself, has permeated western culture, often for the purpose of profit. I recommend everything Ms Ehrenreich has written, actually, she’s like a sharp breeze of reason amid the clammy fog of disinformation we’re constantly drenched in.

So my idol aside 🙂 let’s turn to Simon Wessely:

Professor Simon Wessely MA, BM BCh, MSc, MD, FRCP, FRCPsych, F Med Sci.

On the internet there’s a huge amount of information about this man, specifically in connection with the struggles of sufferers from ME/Chronic Fatigue Syndrome, to combat the campaign that he has led to have their condition designated as a ‘mental problem’, and the terrible consequences this has had for some people. I’ve held back from covering him due to this fact as I feel that people should read these accounts, and view the videos, and the reports by medical professionals first hand. It is a scandal, the worst aspect of which is the length of time it has been going on. I plan to assemble all the associated links that I’ve encountered in a separate post, later. For now I’ll just post one link as an introduction. It’s by Margaret Williams and was written in 2007 and published on the ME Action Org UK site. It’s entitled “Wessely, Woodstook and Warfare?”. As I seemed to have some problems loading it in I have also saved a copy to my dropbox, here, just in case anyone has trouble accessing the original.

I think what this piece, and many similar ones available online, demonstrates is that there is a web of connections between what would seem to be disparate personnel acting independently and impartially. At the heart of this, though, there is one central idea that they all share. This, for diverse reasons of varying advantage to their vested interests, is a motivation to transform the way that the public, and the medical world, thinks about health, illness and work. It is not difficult to perceive the slant that this unified group wish to impress upon the consciousness of the masses:

“In November 2001 a conference assembled at Woodstock, near Oxford. Its subject was
‘Malingering and Illness Deception’. Amongst the 39 academics and experts was
Malcolm Wicks, Parliamentary Under Secretary of State for Work, and Mansel Aylward,
his Chief Medical Officer at the Department of Work and Pensions (DWP). What linked
many of the participants together, including Aylward, was their association with the giant
US income protection company UnumProvident”.

Aylward himself has embraced the tenets of ‘Positive Psychology’ having spent many years researching it at both Cardiff and Harvard Universities.

There can be no confusion about the advantages that would accrue to Wessely’s profession should there be widespread mainstream medical acceptance of this new illness paradigm, based on the ‘bio-psycho-social’ model. Clearly it strongly serves the interests of the psychiatric/psychology professions to ‘pry open’ what has previously been the province of biological medicine, and insert themselves therein.

Coming soon: The rise of Cognitive Behavioural Therapy.

Written by bigleyma

October 17, 2011 at 1:09 pm