Politiek Engeland Mar Wessely 2012

De Countess of Mar schreef op 4 december een open brief aan Simon Wessely.

Zij schreef die brief naar aanleiding van

een adhesiebetuiging van "geloofsgenoten" van Wessely in the Independent.

Die adhesieverklaring was op zijn beurt

een reactie op een open brief van prof. Malcolm Hooper aan Wessely.

De aanleiding van deze brief van prof. Malcolm Hooper was

het toekennen van de John Maddox-prijs voor prof. Wessely.

De brief van 4 december was de aanleiding voor

een boeiende e-mail correspondentie tussen de Countess of Mar en prof. Simon Wessely.

Deze e-mail correspondentie kunt U hier (HTML) of hier (PDF) lezen.

Omdat prof. Wessely om de hete brij heen blijft draaien,

blijft Countess of Mar om heldere antwoorden op concrete vragen aandringen.

En dat laatste geldt vooral voor dé kernvraag:

Kunnen mensen met ME herstellen met CGT/GET

of is CGT/GET slechts ondersteunend (om om te gaan met de ziekte, "pallilatief")?

Vooral de laatste drie mails (zie hieronder) zijn erg verhelderend.

Prof. Wessely geeft in de laatste mail eindelijk een "antwoord" op die vraag,

maar geeft zichzelf "vanzelfsprekend" nog niet gewonnen.

In tegenstelling tot wat velen denken, creëert een hij voor zichzelf "open eind".

Want terwijl hij stelt dat de meerderheid niet symptoomvrij is na CGT/GET,

beweren hij en zijn "geloofsgenoten" vaak dat dat niet nodig is voor "herstel"/werkhervatting.

En waar hij aan de ene kant stelt dat ME/CS geen somatoforme aandoening is,

stelt hij tevens dat de definitie van "somatoforme aandoening" veranderd moet worden.

De antwoorden van Wessely op de kernvraag:

In general I think that CBT/GET improves outcomes in CFS

but does not make the majority of sufferers symptom free.

I don't particularly like the word palliative in this context,

but I think we mean the same thing.

However, on the basis of my extensive clinical experience

and the published literature I do know that

rehabilitative treatment can in a smaller proportion lead to a resolution of the illness.

My hypothesis would be that

in these instances the original factors have resolved,

but the secondary handicaps of chronic illness remained.

I emphasise again that

this is not the reason that I recommend CBT or GET to patients.

CFS is not classified as a somatoform disorder. Nor do I believe it should be.

In addition, like many of my colleagues in liaison psychiatry,

I think that the classification of somatoform disorders is unsatisfactory.

Maar Simon Wessely geeft zich echt niet zo maar gewonnen en blijft met woorden goochelen.

Dat beseft de Countess of Mar ook (zie haar laatste mail).

From: MAR, Countess

Sent: 17 December 2012 12:03

To: 'Wessely, Simon'

Subject: RE: your letter.

Dear Professor Wessely

Thank you for your letter of 15 December 2012.

I have read your letter several times and it is still not clear to me whether you believe that ME/CFS can be reversed fully by CBT or GET, as set out in the models described in the PACE trial, published in the Lancet in February 2011, or whether you consider them to be palliative interventions only, to be offered in the hope that they will increase functionality.

You may recall from the Lancet report:

CBT was done on the basis of the fear avoidance theory of chronic fatigue syndrome. This theory regards chronic fatigue syndrome as being reversible and that cognitive responses (fear of engaging in activity) and behavioural responses (avoidance of activity) are linked and interact with physiological processes to perpetuate fatigue.

GET was done on the basis of deconditioning and exercise intolerance theories of chronic fatigue syndrome. These theories assume that the syndrome is perpetuated by reversible physiological changes of deconditioning and avoidance activity.

There is abundant evidence on the record that you did believe ME/CFS to be a somatoform disorder. Is this still the case?

I look forward to a definitive answer.

Mar

From: Wessely, Simon

Sent: 21 December 2012 09:15

To: MAR, Countess

Subject: RE: your letter.

Dear Lady Mar,

Thank you for your letter of Dec 17th 2012.

In general I think that CBT/GET improves outcomes in CFS but does not make the majority of sufferers symptom free. I don't particularly like the word palliative in this context, but I think we mean the same thing.

However, on the basis of my extensive clinical experience and the published literature I do know that rehabilitative treatment can in a smaller proportion lead to a resolution of the illness. My hypothesis would be that in these instances the original factors have resolved, but the secondary handicaps of chronic illness remained. I emphasise again that this is not the reason that I recommend CBT or GET to patients.

CFS is not classified as a somatoform disorder. Nor do I believe it should be. In addition, like many of my colleagues in liaison psychiatry, I think that the classification of somatoform disorders is unsatisfactory.

May I take this opportunity to wish you the compliments of the season.

Yours sincerely

Professor Simon Wessely

Vice Dean, Institute of Psychiatry

Head, Department of Psychological Medicine Director,

King's Centre for Military Health Research King's College London