Simon Wessely - Work On Chronic Fatigue Syndrome

Work On Chronic Fatigue Syndrome

In the first years after the introduction of the diagnosis chronic fatigue syndrome the condition was often mocked in the media, for example being described as "yuppie flu". Wessely and his co-workers verified that this stereotype was inaccurate, substantiating an association between autonomic dysfunction and chronic fatigue syndrome and providing reliable data on the prevalence of CFS in the community, showing that it has become an important public health issue. Other work on CFS included the development of new measurement tools, establishing the lack of relationship between hyperventilation and CFS, discovery of an endocrine "signature" for CFS that differed from depression and that prior depressive illnesses were likely linked to the condition in some cases.

Wessely and his colleagues, using randomised controlled trials and follow-up studies, developed a rehabilitation strategy for patients that involved cognitive behavioral and graded exercise therapy, that is effective in reducing symptoms of CFS (a condition that otherwise lacks a cure or unequivocally successful treatment) in ambulant (non-severely affected) patients. Other studies looked at the professional and popular views of CFS, neuropsychological impairment in CFS, and cytokine activation in the illness. Some of his other written works include a history of CFS, numerous reviews and co-authoring the 1998 book Chronic fatigue and its syndromes. He has also established the first National Health Service programme solely devoted to patients with CFS, and continues to provide ongoing treatment with patients at King's College Hospital.

Wessely believes that CFS generally has some organic trigger, such as a virus, but that the role of psychological and social factors are more important in perpetuating the illness, otherwise known as the 'cognitive behavioural model' of CFS, and that treatments centred around these factors can be effective. Wessely describes the cognitive behavioural model as follows- "According to the model the symptoms and disability of CFS are perpetuated predominantly by dysfunctional illness beliefs and coping behaviours. These beliefs and behaviours interact with the patient's emotional and physiological state and interpersonal situation to form self-perpetuating vicious circles of fatigue and disability... The patient is encouraged to think of the illness as 'real but reversible by his or her own efforts' rather than (as many patients do) as a fixed unalterable disease".

In an interview with the BMJ, Wessely indicated although viruses and other infections are clearly involved in triggering the onset of CFS, treating them is at the moment not part of management, using the analogy of a hit and run accident in which finding out the make or number plate of the car that hits you doesn’t help the doctor trying to mend the injury, repeating that we are "in the business of rehabilitation".

Commenting on a now-retracted science paper that stated XMRV virus was found in two thirds of CFS patients, Wessely said this research fails to model the role childhood abuse, psychological factors, and other infections may play in the illness.