Fatigue syndromes. Wessely and Powell 1989

http://jnnp.bmj.com/content/jnnp/52/8/940.full.pdf

Journal ofNeurology, Neurosurgery, and Psychiatry 1989;52:940-948

Fatigue syndromes: a comparison of chronic"postviral" fatigue with neuromuscular and affective
disorders

S WESSELY,* R POWELL

This is an old paper and has no doubt been analysed before. It is however significant and seems to be related to a number of current threads. It contains what looks to be the first public outing for the Fatigue Scale and it also seems to show how people with psychiatric diagnoses were included in the CFS trial cohort potentially creating a false narrative, which was to have long term effects.

To put this in context 1989 was the year that Wessely wrote his article
Old wine in new bottles; Neurasthenia and ME
https://www.researchgate.net/publication/20973575_Old_wine_in_new_bottles_Neurasthenia_and_'ME'

and White wrote
Fatigue Syndrome; Neurasthenia revived.
http://europepmc.org/articles/PMC1836256

There seems to be common ground in these papers that between 28% and 33% of patients with chronic fatigue do not have a psychiatric diagnosis.

Yet Wessely and Powell seem not to have distinguished between the results of those CF patients with or without a psychiatric diagnosis and lumped them into one pool, before comparing them with the group with a psychiatric diagnosis and the control group of neuromuscular disorders.

This looks very odd to me, but I cannot write at length on the subject. Any other views would be appreciated.

EDIT This paper also appears to initiate the view that aetiology should not be considered important/

 

Old Wessely papers are a trip.

Group 1 is CFS, 6 months of unexplained fatigue not meeting another medical condition. So, Oxford Criteria? We can see this is bad, because 3 patients were subsequently found to have another condition, but none were subsequently found to be suffering from MDD?

Group 2 is is a control for neuromuscular fatigue, which has 4-9 different diseases! Mostly metabolic and MG.

Group 3 is "affective" fatigue patient controls at in-patient psychiatric hospital w/ MDD.

Outcome is based on questionnaires, two of which Wessley designed, where the answers are construed to produced either a physical fatigue score or a mental fatigue score. The mental fatigue is not fatigue, but brain fog.

I.e. it doesn't ask if MG patients get worse as they do mental tasks. It asks if you have trouble thinking. So, unsurprisingly disorders of the muscle are less impactful in this regard.


His approach is basically to say, because CFS patients score more similar to group 3, their symptoms are more affective. All groups have physical fatigue, but the neuromuscular group has less mental fatigue, while CFS & Affective had similar mental fatigue scores. And he heavily implies that neuromuscular groups w/o comorbid psychiatric illness basically doesn't have mental fatigue at all. hmm. I find that hard to believe.

Interestingly, while he epmhasizes in the conclusion, if x & y share something but z doesn't, they are similar, he glosses over the fact that basically the exact same phenomenon happens in the opposite direction. CFS & neuromuscular disease are universally worsened by physical fatigue, but only 56% of affective disease. If his logic were true, CFS would be unlike both affective and neuromuscular disease.

OK that's all I can do right now

 

Thanks for that contribution.

I find that the difficulty in understanding group 1 lies in the comments in the initial summary. It says "Seventy two per cent of the CFS patients were cases of psychiatric disorder, using criteria that excluded fatigue as a symptom, compared with 36% of the neuromuscular group."

Perhaps I am reading this wrongly, but I do not understand why one would use an undifferentiated group of people for research when you are apparently able to distinguish between them. Why would you not separate your "CFS" group into those who also suffered from a psychiatric disorder and those who did not?

The only reason I can see is that you do not wish to give yourself a chance of making the distinction.

 

So, he used the Oxford-criteria to find people diagnosed with CFS. That's group 1. What comes next is he decided, let's pretend fatigue doesn't exist as a reportable symptom. What then would people be diagnosed with? It was purely hypothetical exercise and the methods are unclear, afai could tell it did not effect the grouping or group 1 criteria.

/rant
Wessely does this thing, I call it "priming". Where he takes something unscientific, gets the result he wants (CFS is psychosomatic) then introduces his actual study. Obviously cherry picking a symptom then making up a diagnosis insaninty, but it's all about priming for them mental fatigue scores be similar to the affect group later in the paper.

I think it 2000(?) Wessely had to write this big report on what CFS to the British Government. When he talked about research, he has literally 4 sentences on biological research and about 2-3 pages on BPS research.

He starts the BPS research by writing 4 sentences about a study of his that found more incidents of mental illness and psychosomatic illness in the CFS. Whoops, at the end he briefly notes it's not statistically significant and can't be considered accurate.

But the reader is already primed and now reads 2 pages of mixed, BPS gibberish.

I know it will never happen but I would love to have him under oath. Why did you say the entirety of biological CFS studies are not valid, but then devote equal length to a study that isn't valid? How is that rational?

/rant

 

He is a master at framing and misdirection. It is his core tactic.

 

I do wonder about the combination of questionnaire design and his involvement with GWS.
Squaddies were assessed for psychiatric impact by a questionnaire - in true squaddie fashion this was widely discussed and compared. No doubt many submissions were similar , with a " group" response potentially prevalent.
Given SW views on GWS it would be interesting to see/ analyze the questionnaire.