BPS attempts at psychologizing Long Covid

Sean · Feb 4, 2022

https://www.theguardian.com/society/2022/feb/03/long-covid-fight-recognition-gaslighting-pandemic

We are arguably among the most despised and abused minorities on the planet.

Sean · Feb 4, 2022

In March 2021, Davis co-wrote an opinion piece with Fiona Lowenstein for the New York Times. “Long Covid is not a footnote to the pandemic or a curious human-interest story,” they declared, but rather “could be one of the largest mass disabling events in modern history”.
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This.

Art Vandelay · Feb 5, 2022

Someone on reddit has posted an English translation of an appalling interview with a "leading doctor for Long Covid" in Germany:

With long covid there is too much panic
...
We carry out extensive sets of tests with the patients : This ranges from ultrasound and MRI, to neurological examinations such as measuring the nervous system or examining cerebrospinal fluid, to lung and laboratory tests. The first presentation therefore lasts several hours. In the evaluation, the findings are unremarkable in all areas in 85 to 95 percent of the patients. This also applies to the inflammation values.

Many long-Covid patients have previous psychiatric illnesses
...
On the other hand, it was noticeable in the initial tests of the psychosomatics that 20 percent of those affected had previous psychiatric illnesses such as post-traumatic stress disorders or anxiety disorders. A psychiatric history is therefore a risk factor for Long Covid. However, these patients are also convinced that their symptoms – including anxiety or depression – are caused by Covid.
...
We have no plausible explanation for the colorful mixture of symptoms and no panacea either. However, the Clinic for Psychosomatic Medicine at the LVR Clinic has had good success with the "Cope it" program, in which patients train how to deal with stressful situations. Because it seems as if something is wrong with the way those affected deal with the disease. This also happens after other serious illnesses: sometimes individual symptoms are so overrated that a cycle of fear occurs.
...
I have come to the conclusion that the prospects for many of those affected are good if they don't chase after a laboratory value, but entrust themselves to a psychologist or coach. We doctors could encourage them to dare to do something, to become active, to do sports again. If more heeded, I'm not afraid of Long Covid.
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Wonko · Feb 5, 2022

Of course it occurs to nobody that a reason many people presenting may have prior psych diagnoses is because this is what doctors tend to give out when they don't know what's wrong, and in most medical systems I am aware of most people will go via a GP to get to a 'leading doctor for long covid' picking up these psych diagnoses on the way, even if previously in perfect health, and never having seen a doctor before in their lives.

Nope, nobody in medicine is capable of thinking this, of understanding how their own systems actually work in reality.

Hutan · Feb 6, 2022

Wonko said: ↑

Of course it occurs to nobody that a reason many people presenting may have prior psych diagnoses is because this is what doctors tend to give out when they don't know what's wrong
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Yes. Another thing that doesn't seem to occur to many is that the reason that this is true:

I have come to the conclusion that the prospects for many of those affected are good if they don't chase after a laboratory value, but entrust themselves to a psychologist or coach.
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is that many, actually most, people recover from their post-infection syndrome regardless of what they do or don't do. The fact that someone recovers after entrusting themselves to a psychologist or coach is not proof that their illness was psychosomatic.

Kalliope · Feb 8, 2022

Weird article about Long Covid yesterday in Norwegian TV2.

The "case" is a woman who tested positive for Covid just two weeks ago and is feeling reduced, but now out skiing. So not a very good example for the subject of the article..

Then a Danish senior doctor says they see Long Covid more often in women, and that most of the patients they now see with Long Covid weren't hospitalised during the infection so had milder infections. 74% were previously perfectly healthy.

It is speculated whether or not different immune systems in men and women can explain why more women are getting Long Covid, but the senior doctor also wonders if a different "health seeking behaviour" in men may be the reason for them having a higher threshold for reporting symptoms.

Signe Flottorp from The Norwegian Institute for Public Health on the other hand says there's reason to believe that Omicron will lead to less Long Covid, as it's milder. So seems she still believe Long Covid appears mainly in those who are hospitalised..

Prime Minister Jonas Gahr Støre also gives a comment concerning long term effects of Covid-19:
- It's important that prepare ourselves and deal with it. We have what's called "long covid" which is a physiological illness, fatigue, that one doesn't recover and the psychological effects of that.

I don't really understand what the Prime Minister is trying to say here, and it doesn't help to know he wrote a heart warming introduction to LP coach Live Landmarks book where she tells her story of recovering from ME with LP. Signe Flottorp is also an eager fan of LP. It seems we're heading straight in to a BPS approach to Long Covid in this country

TV2 Nye tall viser klar long covid-tendens: - Ville vært litt krise for meg
google translation: New numbers show a clear long covid trend: - Would have been quite a crisis for me

Charles B. · Feb 13, 2022

This stops short of wholeheartedly endorsing PACE and the edifice undergirding it, but to those engrossed in this discourse, the rhetoric is all too familiar.

For context, this is Adam Gaffney’s wife recycling the same hackneyed tropes used to denigrate and vilify ME patients for decades. The small group of irascible activists (never patients irreparably harmed by GET) leading impressionable rustics astray with their anti-psychiatry bigotry. If one closes their eyes, they can replace Shure with Sharpe, Wessely, Vogt, etc.

I realize that friends in the UK may not be as familiar with Gaffney and Shure, but they’re meticulously cultivating positions as public intellectuals through the sedulous psychologizing of Long Covid. I’m always reticent about platforming these denialist missives further, but I wanted to ensure that everyone here is aware of these figures and their fervent ideological commitments.

rvallee · Feb 13, 2022

It's amazing how most reporting somehow manages to advance a fringe activist cause. Truly amazing. Especially since it doesn't, denialist voices are still dominant. But let's not let facts get in the way of a good circular reasoning.

Andy · Feb 13, 2022

Long Covid now major cause of long-term job absence, say quarter of UK employers
https://www.ft.com/content/33444f29-bab1-4655-85b5-c0b1f68d9653

May, or may not, be paywalled, seems to depend on how recently you have visited their website.

Wonko · Feb 13, 2022

...all whilst most of medicine says it doesn't exist, as a thing, as opposed to a cultural delusion.

I wonder at which point medicine will change it's mind - 50% off work, 75%?

Haveyoutriedyoga · Feb 14, 2022

Andy said: ↑

Trial By Error: Does “Long Covid” Need Rebranding As “Ongoing Covid-19 Recovery”?

"Now here’s a paper called “The Effects of Messaging on Expectations and Understanding of Long COVID: An Online Randomised Trial,” from researchers at the UK’s Health Security Agency. Two of the nine authors, including the senior author who conceived the study, are also affiliated with a National Institute for Health Research unit that partners with a King’s College London team led by Professor Sir Simon Wessely.

This paper is a pre-print, posted before peer review—so we have no idea what will happen once it undergoes more scrutiny. But the research appears designed to reinforce the notion that psychological and emotional responses to public discussion and framing of post-Covid-19 symptoms could account for much of what patients report about their own condition."

https://www.virology.ws/2022/01/26/...need-rebranding-as-ongoing-covid-19-recovery/
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"We carried out stakeholder involvement in the form of discussions with GPs....We did not carry out patient and public involvement"

Primary outcome measures: Expected symptom severity...Expected symptom duration...Expected personal control....Expected treatment control...Expected illness coherence...Expected QOL...".

"We found that changing the way in which Long COVID symptoms and the support available were described affected negative expectations of illness outcomes. Our findings are in line with the extant literature regarding illness uncertainty and health outcomes, as illness uncertainty is associated with increased symptom severity, lack of personal control, decline in mental health, and diminished quality of life, amongst other outcomes in those living with a chronic condition (10). The study also provides support for the Common-Sense Model of Self-Regulation which posits that illness description and symptoms help to shape illness perceptions (7)."

They seem to have made a huge leap from "telling people to expect bad things makes people expect bad things" to "expecting bad things leads to negative outcomes".

Andy · Feb 19, 2022

I don't think anybody here will be surprised to see this.
https://twitter.com/user/status/1494724731639115777

Sean · Feb 19, 2022

Haveyoutriedyoga · Feb 19, 2022

Andy said: ↑

I don't think anybody here will be surprised to see this.
https://twitter.com/user/status/1494724731639115777

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Would he have been rejected if he scored as 'depressed'?

Arnie Pye · Feb 19, 2022

Haveyoutriedyoga said: ↑

Would he have been rejected if he scored as 'depressed'?
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I assumed so. If doctors think they can fix everything with anti-depressants then they wouldn't see a need to have anyone investigated properly for issues caused by Covid.

Haveyoutriedyoga · Feb 19, 2022

Arnie Pye said: ↑

I assumed so. If doctors think they can fix everything with anti-depressants then they wouldn't see a need to have anyone investigated properly for issues caused by Covid.
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I expect clinics ready accept people who score as depressed but I know that GPs will assume depression or anxiety and not even refer the patient in the first place.

When I went in for a trapped nerve in my foot I got screened for depression and was told it would go away on its own (it didn't, had surgery).

When I started coming down with ME I got told I had anxiety and that if I couldn't lift weights anymore then a walk should be good enough.

lycaena · Feb 21, 2022

UNIVERSITY HOSPITAL ESSEN
Professor of medicine: I don't share the panic about Long Covid
https://www.waz.de/staedte/essen/me...k-gemacht-id234479215.html#Echobox=1643954140
automatic translation with deepl

(The Long Covid outpatient clinic at Essen University Hospital is well attended. More than 500 patients have already been examined here. )

The fear of Long Covid is great - and largely unfounded, says a doctor at Essen University Hospital. Organically, there is often nothing wrong with the patients.

Many people today are more afraid of Long Covid than of the Covid disease itself. In fact, those affected often suffer from considerable limitations for a long time. Nevertheless, there is no reason to panic, says Prof. Dr. K., Director of the Clinic for Neurology at Essen University Hospital. In the Long Covid outpatient clinic of the hospital, numerous patients have been examined - most of them can be helped.

Moreover, people suffer from common diseases permanently, or at least for many years. We don't see that at Long Covid: far more than 90 percent of our patients are completely or almost symptom-free after six to twelve months. I therefore do not share the panic about Long Covid.

Together with colleagues from infectious diseases and psychosomatics, the Department of Neurology has been running the Long Covid Outpatient Clinic at Essen University Hospital since autumn 2020. Are patients more likely to be affected who have had a severe course of the disease?

No! Only a good five percent of the patients were in a normal ward in hospital, less than one percent in intensive care. Most of the 170 or so Long Covid patients we examined in our study had a mild or moderate course of the disease. Among them are no mere suspected cases: We only included affected people who had a covid infection confirmed by a PCR test.

Symptoms range from heart palpitations to hair loss
In August 2021, the medical journal "The Lancet" listed more than 200 possible Long Covid symptoms: from heart palpitations to hair loss. What symptoms do your patients suffer from?

First and foremost is fatigue syndrome, i.e. pathological tiredness, which, by the way, also occurs after other serious illnesses. In addition, many patients suffer from headaches, concentration and memory disorders, word-finding difficulties and brain fog, i.e. the feeling that their thinking is clouded. Overall, they are severely limited in activity, performance and resilience.

How can this be explained?

We do extensive batteries of tests with the patients: This ranges from ultrasound and MRI, to neurological examinations such as the measurement of the nervous system or the examination of nervous fluid, to lung and laboratory tests. The initial presentation therefore takes several hours. At the time of evaluation, the findings in all areas are unremarkable in 85 to 95 percent of the patients. This also applies to the inflammation values.

Many Long Covid patients have previous psychiatric illnesses.
In other words, there are no organic causes?

At least they are not measurable. With the exception of individual cases of multiple sclerosis or polyneuropathy, which were discovered during the examinations and had nothing to do with Corona.

On the other hand, the entrance tests of the psychosomatics revealed that 20 per cent of those affected had previous psychiatric illnesses such as post-traumatic stress disorder or anxiety disorders. A psychiatric history is thus a risk factor for Long Covid. However, even these patients are convinced that their symptoms - including anxiety or depression - are Covid-related.

Are you saying that they are imagining Long Covid?

This is a common misconception: we neither think these patients are malingering nor do we doubt that they are actually suffering. Some of them were marathon runners who now fail at climbing stairs; they no longer recognise themselves. And in fact, neuropsychological testing also shows abnormalities more frequently. There is just not the one causal - preferably organic - explanation that some patients might expect.

The literature also includes patients with heart and lung problems. In others, the coronavirus is still discovered in the organs months after the infection. In these cases, one can hardly speak of psychiatric diseases . . .

True, heart and respiratory problems also occur. As a rule, these are still likely to be direct consequences of the acute covid-19 disease. We refer such patients to other places. We concentrate on the nervous system - and we have never found virus particles in the nervous fluid in any of our examinations.

If we do find something organic in our complex diagnostics, we treat it as a matter of course. But we have the impression that a large part of the symptoms are triggered by subconscious psychological processes. This can also be treated very well. But the willingness to do so is less pronounced because psychological suffering is not so socially accepted. Many prefer to run from doctor to doctor until there is some random finding - or an adventurous diagnosis. This can not only be expensive, but also dangerous if the desperate patients are recommended unproven therapies such as blood washing.

What do you advise instead?

There is no one therapy for Long Covid, but individual symptoms such as headaches or sleeping problems can be treated very well with medication. We have no plausible explanation for the colourful mixture of symptoms, nor do we have a panacea. However, the Clinic for Psychosomatic Medicine at the LVR Hospital has had good success with the "Cope it" programme, in which patients train to deal with stressful situations. Because it seems as if something is going wrong with the way the patients deal with their illness. This also happens after other serious illnesses: Sometimes individual symptoms are so overrated that a cycle of anxiety develops.

School and health care workers are often affected - construction workers almost never.
Is there a typical patient?

Psychosomatics say there is no Long Covid character. Our data show that it affects more women than men and that many are between their mid-30s and mid-50s, i.e. at an age when they are fully involved in their working lives and often have a strong family. It is interesting that people from the education and health sectors as well as from the service and administration sectors are represented much more frequently than, for example, craftsmen or construction workers. It seems to affect more people who are interested in health issues and who observe themselves more closely.

Science also pays a lot of attention to Long Covid ...

Medicine is also subject to fashions. Currently, Long Covid is made bigger than it is - probably for different motives. There is a growing market for rehabilitation measures that sometimes resemble wellness holidays. Politicians justify restrictions with Long Covid, doctors use the research funds. All this is accompanied by the media and leads to a kind of package insert effect: there are more and more people affected with Long Covid symptoms - even those who never had Covid. In the long run, I think research on tumours, strokes and heart attacks is more socially purposeful.

You do research on Long Covid yourself, and the outpatient clinic is well attended, people wait a long time for an appointment.

That's right, and my finding is that the prospects are good for many sufferers if they don't chase a lab value but confide in a psychologist or coach. We doctors could encourage them to dare to do something, to become active, to do sport again. If this is taken more to heart, I am not afraid of Long Covid.

Long Covid and Post Covid
Acute covid 19 usually lasts up to four weeks. If new symptoms appear after this period, it is called long covid. If the symptoms last longer than twelve weeks and cannot be explained by any other diagnosis, this is called post covid.

Long and post covid are, however, difficult to distinguish, says Prof. K. The very academic distinction is therefore hardly ever made in everyday clinical practice.
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Jonathan Edwards · Feb 21, 2022

lycaena said: ↑

UNIVERSITY HOSPITAL ESSEN
Professor of medicine: I don't share the panic about Long Covid
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A clear case of a beam in one's own eye.
Only 10% of patients are deluded enough to think they are still ill after a year.
But 100% of rehabilitationists are deluded enough to think they can take the credit for this.

Wonko · Feb 21, 2022

He really doesn't like, well, patients, it seems.

Or mathematics.

If 20 percent had a prior psych diagnosis that means 80 percent did not, so how can that 20 percent, even if valid, be used as an explanation for 100 percent.

Hutan · Feb 21, 2022

Wonko said: ↑

He really doesn't like, well, patients, it seems.

Or mathematics.
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Or logic.

the article said:

On the other hand, the entrance tests of the psychosomatics revealed that 20 per cent of those affected had previous psychiatric illnesses such as post-traumatic stress disorder or anxiety disorders. A psychiatric history is thus a risk factor for Long Covid. However, even these patients are convinced that their symptoms - including anxiety or depression - are Covid-related.
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Wonko said: ↑

If 20 percent had a prior psych diagnosis that means 80 percent did not, so how can that 20 percent, even if valid, be used as an explanation for 100 percent.
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It gets very hard to use the prevalence of psych diagnoses as suggesting something about the 100% when you realise that probably 20% of the entire adult population of Germany have a prior psych diagnosis these days.

e.g. for depression alone

Around 5.3 million people in Germany suffer from depression each year, and around 17 percent of German adults will experience a persistent depressive disorder in their lifetime, the foundation said.
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