Simon Wessely

Sir Simon Charles Wessely, FMedSci (born 1956, in Sheffield) is a British psychiatrist. He is professor of psychological medicine at the Institute of Psychiatry, King's College London and head of its department of psychological medicine, vice dean for academic psychiatry, teaching and training at the Institute of Psychiatry, as well as Director of the King's Centre for Military Health Research. He is also honorary consultant psychiatrist at King's College Hospital and the Maudsley Hospital, as well as civilian consultant advisor in psychiatry to the British Army.^[1] He was knighted in the 2013 New Year Honours for services to military healthcare and to psychological medicine.^[2] In 2014 he was elected president of the Royal College of Psychiatrists.^[3]

Training and interests

After attending King Edward VII School in Sheffield from 1968 to 1975, Wessely studied at Trinity Hall, Cambridge (BA 1978), University College, Oxford (BM BCh 1981), and the London School of Hygiene and Tropical Medicine (MSc 1989). In 1993 the University of London conferred upon him the degree of Doctor of Medicine.^[4]

Wessely completed a medical rotation in Newcastle. After attaining medical membership he studied psychiatry (his primary interest) at the Maudsley in 1984. His 1993 doctoral thesis was on the relationship between crime and schizophrenia. Post-doctoral studies included a year at the National Hospital for Neurology and Neurosurgery and a year studying epidemiology at the London School of Hygiene and Tropical Medicine.^[1] In 1999 he was elected fellow of the UK Academy of Medical Sciences (FMedSci).^[5]

Wessely's main research interests lie in the "grey areas" between medicine and psychiatry, clinical epidemiology and military health. His first paper was entitled "Dementia and Mrs. Thatcher",^[6] since when he has published over 600 papers on subjects including epidemiology, post traumatic stress, medicine and law, history of psychiatry, chronic pain, somatisation, Gulf War illness, chemical and biological terrorism and deliberate self-harm. He has published most widely on aspects of chronic fatigue syndrome, including its aetiology, history, psychology, immunology, sociology, epidemiology and treatment.^[1]

In private life, Wessely is married and has two sons. His interests include skiing and history, and he cycled annually from London to Paris between 2006 and 2012, to raise money for veterans' charities.^[7]

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".^[8] Wessely and his co-workers verified that this stereotype was inaccurate, substantiating an association between autonomic dysfunction and chronic fatigue syndrome^[9] and providing reliable data on the prevalence of CFS in the community, showing that it has become an important public health issue.^[10] Other work on CFS included the development of new measurement tools,^[11] establishing the lack of relationship between hyperventilation and CFS,^[12] 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.^[13]

Wessely and his colleagues, using randomised controlled trials and follow-up studies,^[14] developed a rehabilitation strategy for patients that involved cognitive behavioural 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.^[15][16] Other studies looked at the professional and popular views of CFS,^[17] neuropsychological impairment in CFS,^[18] and cytokine activation in the illness.^[19] Some of his other written works include a history of CFS,^[20] numerous reviews and co-authoring the 1998 book Chronic fatigue and its syndromes.^[21] 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.^[22]

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".^[15][23][24]

In an interview with the BMJ, Wessely indicated that although viruses and other infections are clearly involved in triggering the onset of CFS, he would not endlessly investigate for infective causes, 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".^[25]

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.^[26]

Opposition and criticism

In an interview published by The Lancet,^[27] Wessely discusses the controversy relating to his work on Gulf War syndrome and chronic fatigue syndrome. With hindsight he states that he was keen to get published, could have been more diplomatic, and is now better at handling controversy.^[28] He has been described as both "the most hated doctor in Britain" and "one of the most respected psychiatrists working in Britain today".^[29][30]

Although Wessely has studied physical markers and allows the possibility of a biological basis to CFS, he is not confident of such a basis and remains sceptical.^[31] He has also suggested that campaigners are motivated "not so much by a dispassionate thirst for knowledge but more by an overwhelming desire to get rid of the psychiatrists" from the area of chronic fatigue syndrome, despite having himself published research which concluded that "the stereotype of CFS sufferers as perfectionists with negative attitudes toward psychiatry was not supported".^[32][33] When asked about severely affected bed-ridden patients, Wessely said "in that kind of disability, psychological factors are important and I don't care how unpopular that statement makes me."^[23]

Some activists who favour a physical aetiology for CFS have strongly criticised Wessely, including Prof. Malcolm Hooper,^[34] and the Countess of Mar.^[35] In an article on chronic fatigue syndrome, The Guardian calls criticism from these activists a "vendetta".^[31] Wessely has been the subject of numerous threats and personal attacks, and extremists have even made threats to his life.^[36] "It is a relentless, vicious, vile campaign designed to hurt and intimidate...For some years now all my mail has been x rayed. I have speed dial phones and panic buttons at police request and receive a regular briefing on my safety and specific threats." Wessely claims to have given up research into CFS 10 years ago although he continues his clinical work with sufferers but his main research interests are now in the health of serving and ex serving member of the armed forces. "I now go to Iraq and Afghanistan, where I feel a lot safer".^[37]

Military health

More recently, Wessely's work was the first to show that service in the 1991 Gulf War had had a significant effect on the health of UK servicemen and women. Other work suggested a link to particular vaccination schedules used to protect against biological warfare, and also a link with psychological stress. His group also confirmed that classic psychiatric injury, post-traumatic stress disorder (PTSD), was not a sufficient explanation for the observed health problems. He and his colleagues in the medical school showed persisting evidence of immune activation, but failed to show that exposure to organophosphate or cholinesterase inhibitor agents had caused chronic neurological damage. The group also showed that many veterans who left the Armed Forces with persisting mental health problems have found it difficult to access National Health Service (NHS) services.

While this work, Wessely's evidence to the Lloyd Inquiry,^[38] and the work of other investigators was crucial in categorising Gulf War Syndrome as a verifiable consequence of service in the Gulf, which resulted in affected Gulf War veterans being able to receive war pensions, Wessely does not believe that Gulf War Syndrome exists as a distinct illness, stating "Is there a problem? Yes there is. Is it Gulf War Syndrome or isn't it? I think that's a statistical and technical question that's of minor interest".^[39] Instead Wessely favours psychological explanations for what he views to be a 'Gulf War health effect' which he believes to be caused by stress, specifically troops' anxiety about chemical weapons and vaccines, as well as misinformation about Gulf War Syndrome.^[40]

Wessely's main current research is around various aspects of military health, including further work on the outcome of Gulf War illness, psychological stressors of military life, risk and risk communication, risk and benefits of military service, screening and health surveillance within the Armed Forces, social and psychological outcomes of ex service personnel, and historical aspects of military psychiatry. In 2006 he and his team completed a study on the health of 20,000 UK military personnel who took part in the invasion of Iraq. The results were published in the medical journal The Lancet.^[41]

In 2010 they published a second study^[42] looking at the impact of both Iraq and Afghanistan on the health of personnel showing that there had been no overall increase in mental health problems, despite the increased operational tempo and numbers of deployments, but that those in the reserves and those with direct combat exposure continued to be more at risk. Alcohol problems continued to be more frequent than post traumatic stress disorder.

He is a trustee of the charity Combat Stress^[43] that provides help for service personnel with mental health problems and recently spent a sabbatical in the Department of War Studies at King's College London.^[1]

Other interests

Wessely also has a long-standing interest in how normal people react to adversity, and what, if any, responses are appropriate. He was a co-author of an influential Cochrane Review showing that the conventional response – to offer people who have been involved in disaster immediate psychological debriefing – was not only ineffective, but possibly did more harm than good.^[44] Since then he has published on civilian reactions to the Blitz, and latterly an early study of reactions to the 7 July 2005 London bombings,^[45] the Litvenko affair,^[46] and swine flu.^[47]

In many venues, he has argued that people are more resilient than we give them credit for, and that the best thing we can do in the immediate aftermath of trauma is to offer practical support and encourage people to turn to their own social networks, such as family, friends, colleagues or family doctor.^[48][49] However, after a few months, when most distress has reduced, then for the minority who are still psychologically distressed or disabled it is appropriate to offer evidence-based psychological interventions.^[44]

Publications

Wessely has co-authored books on CFS, psychological reactions to terrorism, randomised controlled trials, and a history of military psychiatry, From Shell Shock to PTSD.^[50]

Honours

For his work on CFS, Wessely was awarded the Jean Hunter Prize in 1997 by the Royal College of Physicians^[51][52] and was co-winner of the John Maddox Prize 2012^[53] sponsored by Nature and the Ralph Kohn Foundation, and organised by Sense About Science on whose advisory council he serves.^[54] The award is given to individuals who have promoted sound science and evidence on a matter of public interest, with an emphasis on those who have faced extreme difficulty or opposition in doing so, as Wessely has done in researching neuropsychiatric elements to CFS despite threats to his life. Some, however, have objected to this award being given to him due to concerns over the quality of his research.^[55]

To balance these criticisms academic supporters would point out that he was appointed^[56] as a Foundation Senior Investigator of the National Institute for Health Research, which is given on very strict criteria^[57] including analysis of metrics/citations. The college of NIHR Senior Investigators is drawn from the most pre-eminent NIHR-funded researchers selected through annual competitions. He was also elected Fellow of the Academy of Medical Sciences,^[58][59] the medical equivalent of the Royal Society, in 1999. Only 40 are honoured per year, and it is the highest honour and professional recognition in UK academic medical science.

His 2013 Knighthood was for services to Military healthcare and psychological medicine.^[2]

In 2014, Wessely was elected president of the Royal College of Psychiatrists. He announced his priorities to include parity between physical and mental health, improving the image of psychiatry and psychiatrists, improving recruitment into the speciality, and ensuring excellence in education and training.^[3]

Notes

External links

• Official website
• KCL staff page
• KCL.ac.uk – The King's Centre For Military Health Research (KCMHR) is a joint initiative of the Institute of Psychiatry and the Department of War Studies at King's College London (Wessely's webpage at King's College)

• KCL.ac.uk – "Health & Wellbeing of UK Armed Forces Personnel: Professor Simon Wessely – Principal Investigator", KCMHR

• 'Something old, something new, something borrowed, something blue: The true story of Gulf War Syndrome', lecture given at Gresham College, 25 January 2006 (available in text, audio and video formats)
• NATO.int – 'NATO-Russia Advanced Research Workshop on Social and Psychological Consequences of Chemical, Biological, and Radiological Terrorism', Simon Wessely, North Atlantic Treaty Organization ( 25–27 March 2002)
• Project-Syndicate.org – 'The Trouble with Treating Trauma', Simon Wessely (August 2003)
• 'Shell Shock or Cowardice? – The case of Harry Farr', lecture given at Gresham College, 1 October 2008 (available in text, audio and video formats)