Guardian: Long Covid is very far from ‘all in the mind’ – but psychology can still help us treat it - by Carmine M Pariante, April 2021

[Snowdrop]

The 'stress produces a biological state (inflammation)' is a really untenable position for Pariante to take. Does he mean all stress? Define stress. And if it's only some stress, which stress? Why?

How can stress produce inflammation some of the time or in some people and not others? Is it because of the way we experience it? So now it's about people who don't cope well with stress.

So we're back to people with psychological infirmity who are not psychologically robust enough to deal with life. Their stress is making them ill. How does one come to know who are the people who don't deal well with stress? And couldn't this form a predictive model?

It does not make sense even on the face of it unless I've completely misunderstood the premise of the argument he's making of his interpretation of research results.

 

[FMMM1]

I think they'd have found that correlation by now if it existed. Pariante's talk at the 2018 CMRC conference included reference to the finding of low cortisol levels in ME/CFS patients and he then compared it with high cortisol found in depressed patients.

I recall some comments by @Snow Leopard basically cortisol studies always find something. If I recall correctly the levels fluctuate naturally throughout the day (high in the morning low at bedtime?) so controlling for this daily cyclic change is difficult.

I wonder if Simon Ponting's GWAS study will provide information which clarifies whether cortisol is implicated/relevant in ME?

 

[MEMarge]

Did Pariante discuss the cancer analogy as he did in his article?

Around 2hrs 27 min there is a passing reference to cancer.
From my notes, not necessarily verbatim:

" ...normalising the fact that the offer of psychosocial supportis part of the package that we offer as we do for all ...... disorders , as we do in cancer, RA, diabetes and Long Covid.
All the clinics being developed in the NHS for LC are multi disciplinary."

There is a fair amount to be disagreed with in his input.

Would a transcript be useful to you @dave30th?

If no-one else has done one/knows good ways of doing this, I could have a go over the w/e.

 

[FMMM1]

Well, that would be drivel - pure psychobabble. Pariente has done some meaningful biological studies but he seems to have no idea in terms of overall theoretical framework. Personalised treatment is bullshit, as we know. I have n'tween the presentation but it is no good being half a scientist.

I was wondering if this undermines the concept of having confidence in peer reviewed science but then I realised it wasn't a peer reviewed publication - it's just a talk at a conference.

 

[dave30th]

Around 2hrs 27 min there is a passing reference to cancer.

How long was the interview??

 

[dave30th]

Would a transcript be useful to you @dave30th?

not if anyone has to go to any trouble, no. but thanks!

 

[Snow Leopard]

He's right that psychological stress isn't good for ME/CFS, as it isn't good for many other conditions. Maybe I'm wrong, but I don't think that anyone has challenged the idea that psychological stress can be bad for ME.

TBH, I feel more energetic and focus on symptoms less when suffering from psychological stress.

Of course I avoid such states as I don't enjoy it mentally, but...

 

[MEMarge]

How long was the interview??

About 20 mins, from 2.19-2.39

The interviewers Mum has had ME for many years, so she asks some good questions.

 

[Woolie]

The 'stress produces a biological state (inflammation)' is a really untenable position for Pariante to take. Does he mean all stress? Define stress. And if it's only some stress, which stress? Why?

How can stress produce inflammation some of the time or in some people and not others? Is it because of the way we experience it? So now it's about people who don't cope well with stress.

So we're back to people with psychological infirmity who are not psychologically robust enough to deal with life. Their stress is making them ill. How does one come to know who are the people who don't deal well with stress? And couldn't this form a predictive model?

It does not make sense even on the face of it unless I've completely misunderstood the premise of the argument he's making of his interpretation of research results.

This.

If you want to claim hope can improve bodily function (or that despair or stress can do the opposite), you must specify the mechanism by which such factors operate, and also specify the conditions under which they do and don't have the predicted effect. Whenever "stress" and "mind-body connections" are mentioned, people think its just fine to draw a big picture of a cloud, mention cortisol and/or endorphins, and just say "then a miracle happens".

And @Snowdrop, you're right. To get around the fact that sheer hope doesn't make everyone better, you end up having to fall back on the psychological characteristics of the person. In the end, you have to say that some people are somehow psychologically more vulnerable than others in some way.

 

[Amw66]

This.

If you want to claim hope can improve bodily function (or that despair or stress can do the opposite), you must specify the mechanism by which such factors operate, and also specify the conditions under which they do and don't have the predicted effect. Whenever "stress" and "mind-body connections" are mentioned, people think its just fine to draw a big picture of a cloud, mention cortisol and/or endorphins, and just say "then a miracle happens".

And @Snowdrop, you're right. To get around the fact that sheer hope doesn't make everyone better, you end up having to fall back on the psychological characteristics of the person. In the end, you have to say that some people are somehow psychologically more vulnerable than others in some way.

I misread this as cortisol and dolphins (!).
Made about the same amount of sense !

 

[Mithriel]

The 'stress produces a biological state (inflammation)' is a really untenable position for Pariante to take. Does he mean all stress? Define stress. And if it's only some stress, which stress? Why?

How can stress produce inflammation some of the time or in some people and not others? Is it because of the way we experience it? So now it's about people who don't cope well with stress.

So we're back to people with psychological infirmity who are not psychologically robust enough to deal with life. Their stress is making them ill. How does one come to know who are the people who don't deal well with stress? And couldn't this form a predictive model?

It does not make sense even on the face of it unless I've completely misunderstood the premise of the argument he's making of his interpretation of research results.

I agree completely. I was thinking about FND too and they all have the same flaw. They say that stress or childhood adversity causes disease and symptoms in the body as if that was an answer, but everyone has the same stress reactions. Everyone trembles or feels nauseous, or has to rush to the toilet under great stress.

They say this means that their theories are correct because it shows stress can cause bodily symptoms but they miss the point. These are the way a healthy stress response works. If your stress response makes you have seizures instead or go blind or become paralysed that response must be broken somehow.
And they offer no explanation for that.

To get around the fact that sheer hope doesn't make everyone better, you end up having to fall back on the psychological characteristics of the person. In the end, you have to say that some people are somehow psychologically more vulnerable than others in some way.

That is obviously what they mean and expect others to know.

 

[Snowdrop]

Well, as always it's never made clear exactly what the BPS cabal mean by anything -- as in it's always vague enough that the reader is led to infer things that are implied.

IMO though I believe they are thinking from the idea that for example people get anxiety from things like speaking in front of a crowd. This type of anxiety (which is I think why they are probably starting from this point -- is amenable to CBT -- because it's really more of a phobia) so this type of anxiety (speaking before a crowd) responds to CBT therefore all anxiety is amenable to CBT therefore people with ME are experiencing physical symptoms due to stress (anxiety is now implied because not everybody who experiences stress gets sick) which is amenable to CBT.

Apologies for the convoluted wording. But I think the BPS line of thinking lends itself to this kind of confused nonsense.

I'd add that I have no idea what the case is for healthy vs unhealthy stress in general. I've not really given it much thought. On the face of it I'd have to disagree that stress response in general is healthy though. I'm not sure I could defend it though.

Perhaps there is a distinction to be made to whether the stress is responding to a physical threat or a psychological one.

 

[Mithriel]

Possibly normal or usual would be a better word than healthy. We live in a world surrounded by stressors like noise

 

[rvallee]

Possibly normal or usual would be a better word than healthy. We live in a world surrounded by stressors like noise

Honestly stress has been so misused because of psychosocial ideology it now means exactly as much as "toxins": diddly squat. It's just a buzzword that can be used to mean anything one wants, almost as flexible as quantum or smurf. You're too smurfed, friend, you gotta reduce your smurf.

Using the same word to mean many different things is a terrible idea. A basic shared vocabulary is critical to communication and we can't even have that because with statutory authority it's far easier to abuse language than do real work.

 

[Woolie]

On the face of it I'd have to disagree that stress response in general is healthy though. I'm not sure I could defend it though.

Like you say, it depends on what you mean by stress. But if you think of stress as some sort of specific challenge or set of challenges that the person/body has to rise to (which I think its a fair definition), and the stress response is the changes people initiate to meet this challenge, then not only is stress part of life, but you are certainly in trouble if you can't mount a stress response.

I see a lot of people in my work who cannot mount the bodily or mental response they need to meet a challenge - usually due to pathology in medial prefrontal cortex. These people do badly on physical tasks that require pushing yourself, like going as a fast as you can on a treadmill, or mental tasks requiring sustained fast responding, focused attention or complicated reasoning.

These people certainly do seem relaxed about things, and contented about their life. Zero anxiety. But when you take a closer look, their lives are very limited. They often just sit in front of the TV all day. Sometimes they don't speak unless spoken to.

Having no stress response in this case means you end up leading half a life.

Again, its all down terminology. But surely the word "stress" has to mean something more than "bad stuff happening to you" or 'thinking bad thoughts/having bad feelings". At a minimum, the word needs to be about the person's reaction to being challenged mentally, emotionally or physically.

 

[Kirsten]

I'm quite a chill person, and really the only time I experience huge amounts of stress is either dealing with the benefits people or when I have to see bps medics or sympathisers.
They seem obsessed with at least offering some treatment, even if it's bad, but imagine how good it would be if the treatment on offer was an end to bps forever! That would certainly bring my stress down!

 

[Arnie Pye]

Again, its all down terminology. But surely the word "stress" has to mean something more than "bad stuff happening to you" or 'thinking bad thoughts/having bad feelings". At a minimum, the word needs to be about the person's reaction to being challenged mentally, emotionally or physically.

I agree that the word stress is overworked to an extreme degree, and I don't think I've ever seen it defined in a medical context.

I'm very dubious about many physical stresses (and the reactions to them) being something that is the province of psychologists, psychiatrists etc. that requires CBT.

Suppose I have a broken leg as a result of an accident which was nobody's fault, get surgery, pins, plates etc and am then left to go away and heal. This will inevitably cause my life to become more stressful than it usually is because just going to the toilet will be hard work, I might not be able to get upstairs to bed, I might find it impossible or very hard to stand and cook or make myself a cup of tea, my leg will hurt - and pain is stressful.

All of these problems will go away as the broken leg heals. But BPS theory seems to suggest that all stress is bad, and not only that but is permanently bad, and must be treated because anyone under stress, from any source, is mentally ill.

As for emotional and mental problems, the stresses that I feel are the ones that go on and on and on - such as being disbelieved by doctors and treated like trash whenever I see them.

 

[Sean]

I agree that the word stress is overworked to an extreme degree

he he

All of these problems will go away as the broken leg heals. But BPS theory seems to suggest that all stress is bad, and not only that but is permanently bad, and must be treated because anyone under stress, from any source, is mentally ill.

Amazing how the human species made it this far without psychs to keep us all from collapsing into a quivering mess at the mere suggestion of a saber tooth cat.

 

[Woolie]

All of these problems will go away as the broken leg heals. But BPS theory seems to suggest that all stress is bad, and not only that but is permanently bad, and must be treated because anyone under stress, from any source, is mentally ill.

Amazing how the human species made it this far without psychs to keep us all from collapsing into a quivering mess at the mere suggestion of a saber tooth cat.

Totally, @Arnie Pye, @Sean!

I've just finished reading about work conditions for domestic workers in Europe 100 years ago. They were up so early and in bed so late, they barely got time to sleep. A lot did heavy physical labour much of the day as well. Plus people commonly died from things that are trivial now, so grief was a pretty regular companion. Now that's what I call stressful.