BPS attempts at psychologizing Long Covid

Idiocracy is a given. My money has long been on "a" (with a train of dark suspicions).

 

Henrik Vogt has participated in a "pandemic panel" together with two philosophers in a radio programme about ethics. He talks about Long Covid.

Apparently doctors talking about Long Covid is a driving mechanism of Long Covid.

Here's link to the programme: Verdibørsen

Here's a google translated transcription of what Vogt says:

These types of ailments are quite well known in medicine. Common. After many different kinds of strains. Large parts of what general practitioners, for example, do and what comes into the emergency department in Norwegian hospitals are things that are so-called medically unexplained.

These ailments seem to fall largely into this category. Some people have injuries after a serious illness, which to some extent can explain the symptoms. But many do not have aspects with their body that can clearly explain the symptoms or that go into the classic medical explanatory model of what is disease.

You actually have a "pandemic" of these symptoms, and then you have a medicine that I think is very poorly prepared for this, when it comes to the philosophy of science. The way of thinking in which medicine largely encounters these problems is a reductionist, classical biomedical way of thinking.

And it is about health related things being explained exclusively by looking at parts of the human body. That is, molecules and cells. X-rays and MRI images. The problem is that this type of access then causes many things to stay unexplained. One can not see many of human health problems with that approach. So it is not surprising to me that there then will be a big wave of people who hear that this is something we do not understand. Medicine simply does not have the glasses, very large parts of it that is, to simply understand things that have a cause also on the level of thought and on the level of emotion.

And what I'm focusing on is that the brain is the central organ here. It interprets symptoms from the body and it can then create symptoms in the whole body when the person is stressed. If the discourse in society, if the communication, is constantly of an alarm, and saying something about this being dangerous, you are injured for life, this can never go away. Then it can simply become a self-fulfilling prophecy. Where people focus a lot on their symptoms. Stressing over this dangerous and unknown, then it becomes persistent simply as a result of that stress. That's what I'm worried about.

Journalist: and that means you have to be a little bit careful about how you talk about it?

I think so. But the most important thing is to give people a credible scientific explanation that is broader, biologically, about how this can be connected. If it is not the case that something cannot be explained by a defective mechanism in the lungs, it is not necessarily the case that it cannot be explained medically. But it happens on a massive scale around the world being told that you can be injured for life and we do not understand what this is. I think we have some knowledge which can explain it.


....

There are probably no patient groups ever that have been as thoroughly examined as these Covid-19 patients. Literally. In such a short time. If you scan people, you will find a lot.

If all these findings are spread in the media and social media .. I often find researchers, also in Norway, to speak very unwisely and based on a reductive understanding of disease, that we have now found something in the body. They will be inclined to say that this may explain it.

But one will also find things in a body that have anxiety or depression. It is not necessarily the molecule or the change found in the brain that can explain the whole problem. I think this is very important for research ethics and medical ethics, it is a form of harm that can be created by doctors and researchers by constantly throwing such rather frightening explanations into the public that are grinded around in social media and media.

I think we have to be more aware of this. It is important to think in terms of disease theory that one can have quite a lot of symptoms. One can be quite afflicted, without the body having broken in
a classic medical way.

I usually say if a patient with this type of symptoms comes in that imagine a car that is in first gear and you speed up and is raised off the ground. You get an engine rushing, being overheated. And it might smoke a bit. It won't move. But it is not destroyed. At least not yet. So you can be quite pressured by having a lot of symptoms without your body breaking. I think that is more comparable here.

...

What I think is so interesting about these long-lasting symptoms, as I think about it, if it is in the way I think about it. This distinction between ethics and mind and culture and body on the one hand ceases completely. One of the interesting things here is that the actual communication from researchers can be disease-causing, part of the illness mechanism itself. It's not just that we have an illness, and then we talk about it. And then we have an ethic, and it is somewhat detached. It is so that our communication, how we relate to the health problem, can alter it. It's not just that we stand and objectively observe something out there that is unchangeable and independent of how we talk about it. It changes depending on how doctors and researchers talk about it.

 

So...how does he account for similar waves of sequelae after previous pandemics? Some of which were long, long, long, before social media and largely kept out of the newspapers - using the simple expedient of having people like him commit sufferers to asylums.

 

It's funny how Vogt unironically goes on about the harm resulting from doctors carelessly spreading false ideas about illness, while spreading his own evidence-free ideas with large potential for harm.

He apparently thinks it's ethical to label, without any proof, large groups of patients as grossly exaggerating or imagining a health problem.

 

It really is like gay conversion therapy. The goal is to make people stop believing that they have long covid or CFS or whatever. Presumably the driving force behind this is just the fragile ego of doctors who can't deal with the reality of having patients with an illness they don't understand and can't treat.

 

The same way that vain and unsympathetic physicians have always explained it. They are strong-minded and strong-willed and their patients are weak-minded and weak-willed; or they would just pull themselves together after their minor illness. A pandemic just gives more people the idea that they can get away with pretending to be unwell and it is the physician-commissar's job to disabuse them of that fantasy.

 

I wonder if it's even simpler. That Vogt perhaps believes the way he experiences symptoms is the universal way to experience them. Here from an interview in the Journal for the Norwegian Medical Association in 2018 where he among other talked about how devastating if was for him to get tinnitus. It sounds like a horrible thing to go through, and I'm glad he got help with his catastrophising, but that doesn't mean this approach will work for all people with tinnitus and it certainly doesn't mean the approach is the solution for Long Covid:

From the interview:
The tinnitus came when I stopped my medical studies for the first time, in a very stressful period. Occasionally I was walking with ear plugs out among people, something that is not uncommon for those who struggle with this. You think you have to protect your ears. I stopped listening to music, one of my greatest pleasures. All the time I thought "Is the sound there now?", "Is that the sound from the dishwasher or from my ear?". I got disaster thoughts. The perfectionist in me said that "you can not live a life with an imperfect body." It sounds ridiculous, but it was claustrophobic. Fortunately, I did not get to an ear nose throat specialist who would at worst have chained me to perceive myself as a patient with an ear injury.

- Then you got well?

- I can still hear the sound. But it does not have the same meaning. All people have sound in their ears. How did I recover? I looked up "tinnitus" in the phone book. When I found a name on my own address, I wondered if I had become psychotic. But the only one who worked with this, Atle Rønning Arnesen, actually lived on the floor below me. I walked downstairs in my slippers and met a wise man. One conversation was enough. He de-dramatized the problem, and then he said, "For God's sake, start listening to music again!" It is basically about getting the brain to change focus and turn a vicious circle of fear and increasing symptom focus.

ETA: An extra quote from the interview

 

It's really all projection with them. And yeah they are basically universalists, they fully generalize their own personal experience to be the universal experience everyone goes through.

It's also a real weird story as I've never heard of anyone with tinnitus talking about "protecting their ears" and wearing ear plugs because of it. If anything it's literally the opposite, background noise usually drowns out tinnitus and so would music. And I've frankly never heard of anyone talking about tinnitus and fear of... stuff I don't even know what he's talking about here.

Same with Garner. Clearly the same with Gerada. It's all projection with these people. They project their damn psychological issues on everyone else.

There is supposed to be a standard in medicine that physicians don't diagnose people at a distance, certainly not with mental illness, which they are neither trained nor equipped to deal with. This is something that should be pushed back against at every opportunity, and yet no one objects to it because we are exempted from consideration and basic respect.

Sorry you are a "catastrophizer" Henrik but most people aren't fragile like you are. Maybe it's medical training that does it, I sure heard that many times, physicians thinking about every possible thing can go wrong in their bodies. And for that I will gladly say that ignorance is bliss, almost no one but physicians think about this stuff and most people who do aren't disabled in any way.

Quit projecting, dammit. Your personal experience of the universe is yours and yours alone.

 

Refers to this merged post upthread: BPS attempts at psychologizing #LongCovid

Is "advertising" a mistranslation? Because it would be an ironic framing. Everything biopsychosocial has to be pushed through a PR and marketing process, working with medical authorities to go above and beyond what they normally do and hype everything. Like what the SMC has been doing and how Richard Horton bizarrely went to shill for PACE, throwing all pretense of a serious objective publishing process out the window. Especially when he lied about many of the details. That's a really big tell.

So they have to advertise and promote everything they do. We don't, all that's happening is people reporting reality. Which people who live in a manufactured reality cannot stand. It's pretty funny for other reasons too, including the fact that most people haven't heard of it anyway. Again someone projecting their own personal experience and obsessions onto everyone else. They keep hearing about it because they keep obsessing with and seeking it out. So they conclude that it must be everywhere, everyone is talking about it because this is their immediate environment.

It's really weird how "smoking gun" moments can be interpreted different ways. To some people they are proof positive that the gun is obviously fake, they literally take evidence for as if it argues against. Simply amazing, to the point of being solipsism. All these people know is themselves, the outside world only exists based on what they perceive.

That such people work in and around medical science explains a lot, and none of it good.

 

It's actually quite a good translation ("reclame" = "PR"). Thank you for pointing out the irony. It hadn't been completely lost on me, but you word it so well. Note the heavy lifting that the symptom tracker study by Tim Spector's team does in the article: since it doesn't find a "tsunami of long covid" in the period March to September 2020 - when long covid wasn't widely acknowledged - long covid must be a phenomenon spread at a later point by the media. Rather than acknowledge that that study assumes symptoms stopped when symptom-logging stopped (which is just absurd).

 

Good to see this, some SFAM members are questioning the content.

https://twitter.com/user/status/1390957649223725056

The chairperson of SFAM has commented on Twitter too:

So, what is he trying to say? SFAM publishes medical training webinars for GPs, but takes no responsibility for the content?

ETA: BPS extremist Jörgen Malmquist was invited as a speaker by a regional chapter of SFAM in 2019, so this is not a one off thing.

Direct link to Malmquist's slides:
http://www.sfamorebrovarmland.se/files/user/MEDICINSKA KONTROVERSER I MEDIA allmänläkardagarna Örebro-Värmland 190116-17.pdf

http://www.sfamorebrovarmland.se/allmänläkardagar

 

The cultural enforcement of psychosomatic ideology is very obvious in how it's discussed. Everyone who minimally disagrees with it goes through great lengths to emphasize they mean no disrespect and are not trying to silence other people, which is absurd. It's very clear the belief system is so dominant it is taboo to question it at all, to even suggest it may be wrong is already a fault that must be pre-empted with profuse excuses for even daring to question the dogma.

So clearly there is a lot of bullying against those who question the psychosomatic narrative. Which is on brand, everything about it is projection, every fault they cast upon us is a reflection of a fault they recognize in themselves but accept as necessary.

And it's always talked in abstract terms, as a future ongoing project that must be researched anew endlessly, never acknowledging that it has been used in practice for decades to widespread failure, even when discussing about how "strong" the body of evidence is, the one that suggests that some people are saying it should work if only they could research it some more, always identically.

No one wants be in the first to point at the naked emperor's butt. The whole crowd reacts to the nakedness, applauds and cheers for it, and still the quality of the invisible clothes is emphasized. Truly the most textbook case of the power of groupthink.

 

Åsa K Hedlund, chairperson of the Swedish Covid Association, tweets about an earlier webinar by SFAM, held in October 2020.

The first speaker is Minna Johansson (Cochrane Sweden, whose BMJ article Henrik Vogt was promoting not too long ago, together with Garner's BMJ article), saying that "there is no opposition between the biomedical and the biopsychosocial perspectives", and she's worried that people/the narrative in the media and in the scientific debate don't seem to understand that. She's worried that will cause symptoms to become more chronic than they would have been otherwise.

At 5.45 minutes in she says that she's worried that there will be an epidemic "like there was in Norway, with ME patients who are lying in dark rooms for several years, unless we do something about this". (I'll stop there, won't be listening to the whole webinar )

https://www.youtube.com/watch?v=OK2TIvUkTYs

There's also this series of tweets:

 

A person could get mildly irked.

Not dangerous?

Only if you don't consider losing your home, your business, your ability to drive (without crashing), etc. as 'dangerous'.

 

Did anyone count how many times he said "dangerous"? Could get dangerous if we made it into a drinking game...

 

Jeepers! Poor long haulers.

On the plus side, it's one of the clearest statements yet that when the BPS proponents claim people get "better" from their interventions what they really mean is not a reduction in illness or symptoms, it's just about getting better at ignoring symptoms (at least temporarily, until you've answered all the questionnaires).

Also, anybody else get the sense that Dr Bengtsson may have read Feel the fear and do it anyway one too many times, and may have mistaken it for a medical textbook?

 

The recent posts and information here is intellectually stimulating. I realized that Vogt and I have vastly different experiences.

When I first had symptoms, I did not think I had a chronic illness and carried on as much as I could. When they got worse and I began asking for help, I met disbelief and denial and even hostility. For me, accepting that I had a chronic illness and stopping listening to the harmful opinion from others was an act of rebellion against a dysfunctional social environment that expected me to function normally even when it was obvious that I no longer could.

This disbelief almost killed me and I'm sure it worsened my long term outcomes.

I hope Vogt realizes eventually that some people he wants to apply his denialism to (because it worked so well for his psychological reaction to tinnitus) actually have a serious illness.

And I think this is also helping me understand how people like Vogt see ME, long covid and so on. As dysfunctional psychological reaction to a minor problem.

 

I read binkie for physicians as bikini , maybe that also works, an inadequate swimsuit, barely holding things in, seriously dodgy.

 

They really are societal leeches. Though an actual leech is a hundred times more useful.