Simon Wessely

Simon Wessely (born Sheffield, 1956) is a British psychiatrist. He is professor of epidemiological and liaison psychiatry 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.

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.

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. In 1999 he was elected fellow of the U.K. Academy of Medical Sciences (FMedSci).

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", since then 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.

In private life, Wessely is married and has two sons. His interests include skiing and history, and he has cycled from London to Paris in 2006 and again in 2007, to raise money for veterans' charities.

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 a misnomer, 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 also developed a rehabilitation strategy for patients that involved cognitive behavioral and graded exercise therapy; research using randomised controlled trials and follow-up studies, which have been demonstrated as effective at reducing symptoms of the condition in ambulant (non-severely affected) patients, which otherwise lacks a cure or unequivocally successful treatment. 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 and treatments centred around these factors can be effective. He sees viral attribution in CFS as 'somatisation par excellence'. In a BMJ interview, Wessely indicated that the cause of CFS onset is irrelevant to management of the condition, and he would not treat viruses in CFS patients even if detected, because he is "in the business of rehabilitation". Commenting on a study 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.

For his work on CFS, he has been awarded a medal by the Royal College of Physicians.

Opposition and criticism
In an interview published by The Lancet, Wessely admits to both regretting and enjoying 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. The Times of 6 August 2011 described him as "the most hated doctor in Britain": "Curiously, most of the people who hate Professor Wessely have never met him. But over the past two decades they have followed his work from afar, mostly over the internet and what has been written, or — sometimes incorrectly — implied, about him in the papers."

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. 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. 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."

Some CFS patient activist groups have strongly criticized Wessely, while extremists have gone to the extent of threatening his life. In an article on chronic fatigue syndrome, The Guardian calls criticism from CFS patient advocates a "vendetta". Wessely has been the subject of numerous threats and personal attacks. "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 gave up active research into CFS 10 years ago and now specialises in working with war veterans. "I now go to Iraq and Afghanistan, where I feel a lot safer".

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.

This work, Wessely's evidence to the Lloyd Inquiry, and the work of other investigators was crucial in categorising Gulf War Syndrome as a verifiable consequence of service in the Gulf. As a result, affected Gulf War veterans were able to receive war pensions.

He recently spent a sabbatical in the Department of War Studies at King's College London.

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.

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. Since then he has published on civilian reactions to the Blitz, and latterly an early study of reactions to the July 7, 2005 London bombings.

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. 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.

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