Stephen E. Ralph

12th June 2013

A formal request for Liaison Psychiatry to cease and desist

Dear Professor Sir Simon Wessely and members of “the Wessely School”,

In recent months I have made you and your colleagues in “liaison psychiatry” aware of the plight of those who have become victims of medical misdiagnosis due to the serious flaws created by the wholly unstructured introduction of Chronic Fatigue Syndrome across the National Health Service more than 20 years ago.

People with rare biomedical diseases such as Behçet’s Disease (BD), Ehlers Danlos Syndrome (EDS), Familial Mediterranean Fever (FMF) et al are being clinically misdiagnosed as having Chronic Fatigue Syndrome (CFS/ME) by clinicians at GP and general specialist level who do not have sufficient specialist awareness of the wide spectrum of presentation of rare and complex pathologies.

In the case of Chronic Fatigue Syndrome (CFS) and Myalgic Encephalomyelitis (ME), all the symptoms you and your colleagues assert as “medically unexplained physical symptoms” (MUPS) that you all say have “no known cause” are all in fact fully medically explainable when related to Behçet’s disease. The cause is in fact known.

In the case of Behçet’s disease, I have established from research that it is possible to suffer Behçet’s disease without clusters of mouth or genital ulcers, or active uveitis or gastrointestinal ulcers leaving very few visible signs for any clinician to identify in relation to a presenting pathology they may know very little about.

Having made you and your colleagues fully aware of these issues I now request that you and your colleagues cease and desist from making any further claims in future research papers or in media articles concerning a specific group of “invisible” symptoms that you and your colleagues persist in claiming are “medically unexplained” when your collective belief is wholly untrue in fact.

It is my view that the longer “liaison psychiatry” perpetuates false facts, the more harm such false statements will do to patients and the reputation of your wider profession as more and more patients will become victims of further clinical misdiagnoses given unwittingly by clinicians unaware of rare alternative diagnostic explanations.

For 25 years patients have had absolutely no protection whatsoever from any clinician diagnosing Chronic Fatigue Syndrome when those clinicians had no knowledge that what they presumed were “medically unexplained physical symptoms” caused by somatisation, were in truth fully medically explainable physical symptoms outwith the artificial psycho-social construct of Chronic Fatigue Syndrome now also being referred to as Somatic Symptom Disorder or Functional Somatic Syndrome or Bodily Distress Disorder.

Should “liaison psychiatry” continue to perpetuate your “medically unexplained” psychogenic claims surrounding a group of symptoms that are also fully medically explainable; I will have no choice other than to lodge formal complaints with your professional organisations for the sake of both patients and other victims of misdiagnosis.

As a retired diagnostic radiographer who was clinically misdiagnosed by one GP and two general rheumatologists at two district NHS hospitals in different counties for 12 years; I hold the view supported by evidence that “the chronic fatigue syndrome” broke the process of accurate differential diagnosis spanning more than two decades.

When “liaison psychiatry” started promoting its views on “CFS” and then “CFS/ME” you should have firstly ensured that there were no other pre-existing rare diseases that might be confused or totally missed by general clinicians. It is now clear that none of you gave a “watch list” as a precaution to the rest of the medical profession.

This is when patients like me started becoming victims of your MUPS, SSD, FSS, BDD, CFS/ME project.

Today, nobody knows how many misdiagnosed victims there are suffering without treatment or clinical support?

Yours sincerely,

Stephen Ralph DCR(D) Retired.