David J Black

It is one of those facts which cries out to be universally acknowledged: when it came to understanding the nature of such illnesses as ME/CFS, Lord Freud, despite being Sigmund’s great grandson, was almost wantonly ignorant, yet he was the ‘expert’ to whom the government had turned for advice. He had once wittered: “Our approach is – and this is rather a mouthful – akin to the biopsychosocial model.” This speculative doctrine would later resurface in Sir Mansel Aylward and Gordon Waddell’s 2009 manual Models of Sickness and Disability. Aylward, medical director and head scientific adviser to the DWP, and a promoter of the Woodstock conference, would become director of the UnumProvident Centre for Psychosocial Research at Cardiff University. The phrase “conflict of interest” should not be overlooked. The stark conclusion of Aylward/Waddell manual was that

Thus we have, in its essentials, a ‘blame the patient’ reconfiguring of the Victorian disdain for the undeserving – indeed the allegedly criminal – poor. At the heart of the biopsychosocial doctrine lies the unproven conviction that welfare reliant citizens beset by “unhelpful cognitions” should be cajoled out of a dependency mindset through the agency of Cognitive Behavioural Therapy. The leading proponent of the doctrine was psychiatrist Simon Wessely, whose contribution to the Woodstock conference had been the voicing of a fundamentally right-wing libertarian thesis that welfarism was a decadent indulgence which only encouraged the poor-sick to become spongers and ne’er do wells.

His malingering paper stated:

The ‘biopsychosocial paradigm’ ousted such near-breakthroughs in biomedical research as clinical neurologist Peter Behan’s electron microscopy studies, which were on the point of discovering a ‘signature’ for ME/CFS until, in 2005, the Scottish Enterprise Council cut his project’s funding. Professor Behan had written an introduction to Dr Melvin Ramsay’s 1986 Postviral Fatigue Syndrome: The Saga of Royal Free Disease which had not endeared him to the biopsychosocial palace guard, and had declared:

In a supposedly devolved Scotland, however, UK rules prevailed. Dr Michael Cornbleet, originally from University College, London, and later senior medical officer to the Scottish Executive, swallowed the biopsychosocial Kool-Aid undiluted, notifying the Holyrood Health Committee that:

Down south the triumph of the biopsychosocial cult would reach its apogee with the appointment of the eponymous head of the Wessely school, Sir Simon himself, to the board of NHS England. Thus the high priest of the biopsychosocial model is now, arguably, the most powerful doctor in the land – indeed one must truly wonder how it came about that he was, until recently, a member of England’s judicial appointments commission, among other strangely irrelevant things. Might this have bestowed upon him a right to block any proposed inquiry or tribunal concerning, say, the scandalous failure of the all-powerful Wessely School sect?

This question is very much in point given the recent directive from Deborah Archer, Exeter Crown Court coroner, following her inquest into the death of 27-year-old Maeve Boothby O’Neill from complications arising from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Her coruscating Prevention of Future Deaths Report has been sent to the Department of Health and Social Care, NHS England, the National Institute for Health and Care Excellence, the Medical Research Council, the National Institute for Health care and Research, and the Medical Schools Council, and must be responded to by December 3rd.

The outcome could be embarrassing, to say the least, for the more determined advocates of the biopsychosocial cult. It might even threaten their hold on the commanding heights of UK health policy, particularly if an interesting departure from standard research methodology known as ‘The PACE trial’ comes to the attention of an appropriate investigative body.

‘PACE-gate’, as some have called it, is a matter best dealt with by, say, a scrutiny session of a newly-formed House of Commons Health select committee under its well-regarded chair, Layla Moran MP. After all, at £5 million, PACE was the most expensive ever publicly funded study of ME/CFS, the very illness which ended the life of Maeve Boothby O’Neill. There are many other victims besides. If PACE’s methodology was manipulated by the biopsychosocial lobby and its findings distorted shouldn’t we know about it? And isn’t some accountability in point?

The roll call of the victims of ME/CFS is, indeed, a chilling litany. The grim list of those whose lives were ended by it begins, provisionally, in 2005 with Sophia Mirzi, thought to be the first to have ME/CFS recorded on her death certificate, though she was certainly not the first victim. Brynmor John MP collapsed and died outside the House of Commons gym in 1988 after being told to “exercise his way back to fitness” by his doctor, while Alison Hunter, aged 19, is said to have died of ME/CFS in a Sydney hospital in 1996.

Emily Collingridge, who had endured ME since the age of six, was 30 when she died in 2012 “after a quite unbelievable narrative of institutional incompetence, disregard, and abuse” (Solve ME). Oliver Coles from Bristol died in the same year, at the same age; Lynn Gilderdale had died in 2008, aged 31. Hannah Randhawa died in January 2022, also aged 31. Almost exactly a year later singer-songwriter Kara Janes Spencer died; she was 32. Merryn Crofts, the second victim to have ME on her death certificate, died aged 21 in May 2017.

This, we may be sure, is the tip of an iceberg, and a question inevitably arises of the responsibility of the biopsychosocial faction insofar as its dominance was manifestly taking support away from areas of biomedical research and non-psychological treatments which might have saved lives. It can certainly be posited under any accepted rubric of medical ethics that such an outcome falls abysmally short of the principles enshrined in the World Medical Association’s 1964 Declaration of Helsinki, which is binding upon UK physicians and health practitioners A shocking fact revealed by the director of Maeve Boothby O’Neill’s health trust in the course of her inquest was that there is absolutely no in-patient provision in any UK hospital for victims of severe ME/CFS, while, astonishingly, no such future provision is planned. This manifestly breaches Helsinki principles.

Is such institutional negligence compliant with UK national law? The legal opinion set out by Lord Mackay of Clashfern in Regina v Adomako in 1995, should be noted:

A further consideration should also concern us. For the best part of half a century the political perception has been that the psychiatric interpretation of ME/CFS which replaced the supposedly ‘reductive’ biomedical one would have a cost-effective outcome for HM Treasury. With ethics and morality relegated to secondary status, the mindset was, and remains, fiscally driven, and it is, ironically, the biopsychosocial model itself which has become ruthlessly reductive. With 127,000 additional benefit claimants in the past year pushing the total of working-age sick towards 3 million we might detect a note of despair in a recent speech by health minister Wes Streeting, who has turbo-charged the old, failed mantra about ‘helping’ the pre-retirement sick back to work. 

Mr Streeting insists his health ministry “is no longer a public services department – this is an economic growth department - I want to end the begging bowl culture, where the Health Secretary only ever goes to the Treasury to ask for more money. I want to deliver the Treasury billions of pounds of economic growth.”

You might have thought the infamous dogma of “Arbeit Macht Frei”, with its singularly authoritarian connotations, has been long discredited. You might, on the other hand, be very slightly mistaken.