State of Mind: Is Long COVID Linked to Mental Illness?

Sly Saint

Sly Saint

Senior Member (Voting Rights)
Long piece in SLATE by Grace Huckins

Andrea Roberts was getting ready to submit a study for publication, and she was worried. A senior research scientist at the Harvard T. H. Chan School of Public Health, she had just written a paper suggesting that people with high stress levels were more likely to develop long COVID after an acute infection.

Roberts has spent the past decade studying the link between physical health and mental health. She knows that psychology can play a role in almost any illness; a few years ago, she discovered a link between PTSD and ovarian cancer. On paper, the new finding was no different from those in her previous studies, but this time she added a disclaimer to her article. “Our results should not be misinterpreted as supporting a hypothesis that post–COVID-19 conditions are psychosomatic,” she wrote.
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Her worries were not unfounded. The study was published in the Journal of the American Medical Association: Psychiatry on Sep. 7 of last year. A few days later, Jeremy Redfern, a member of Florida Gov. Ron DeSantis’ administration, tweeted out the article and put “long COVID” in scare quotes. In the replies, people referred to long COVID as a “self-fulfilling prophecy” and “symptom of liberalism.”

Roberts had meant to convey with the disclaimer that long COVID is not a fake condition, and that patients experiencing it are not duping doctors or themselves (as Redfern implied they were). In doing so, however, she used the word “psychosomatic” to mean “fake.” But that’s not how “psychosomatic” is used in medicine, and she now has mixed feelings about the disclaimer. “The actual definition of psychosomatic is a connection between your psyche and your soma,” Roberts says—that is, your mind and your body. That connection can look like so-called “hysterical” blindness, where a traumatic experience causes someone to lose their sight without any apparent damage to their visual system, or like the well-known (and uncontroversial) relationship between stress and heart disease. Based on that technical definition, Roberts says what she’s showing in the long COVID study “is actually psychosomatic.”
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Long-haulers are not the first patients to feel gaslit and ignored. For a long time, ME/CFS—which is also known as chronic fatigue syndrome and bears a strong resemblance to some cases of long COVID—was popularly referred to as “yuppie flu.” Some in the medical world also thought that the illness could have a social element: In 1970, two doctors published a paper in the British Medical Journal arguing that the condition, then referred to as “benign myalgic encephalomyelitis,” was really mass hysteria.

In deploying the term “mass hysteria,” the British doctors didn’t mean to suggest that the patients were consciously faking their illness, but rather that their symptoms were purely psychological. But to many readers, the paper nevertheless seemed pejorative, and several clinicians and patients sent letters to the British Medical Journal expressing their indignation. “It is essential to treat this disease seriously,” wrote Betty Scott, a doctor who had worked with myalgic encephalomyelitis patients. “If a diagnosis of ‘hysteria’ is even hinted, the patient experiences a profound loss of confidence in his medical advisers.”

Today, many ME/CFS patients feel similarly about the idea that psychological factors may play a major role in their condition, and scientists have discovered a variety of biological changes in patients. That doesn’t suggest that psychology is irrelevant, however. Patients are the experts on their own symptoms—but without medical examination, it can be impossible for them to tell whether those symptoms are rooted in biology, psychology, or both.
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Long COVID and Mental Illness: How the brain can affect the body (slate.com)
 
Yep, setting the scene for open ended swathes of research on long covid and mental health/psychology/psychiatry. Oh and there are Beard and McEvedy + hysteria, and Adam Gaffney, and ..... FND (how could FND not feature in such an article??)

Groan. It's same old, over and over and over. This article is 'The Debate' - plus the psycho-social researchers say they need lots and lots of funding for mental health studies on LC.



'Funding, too, can be divisive. Scientists won’t be able to clarify the connection between long COVID and mental health with just a few well-designed studies. “There’s not just one thing that is contributing to this, but there’s really a constellation of factors, and many of those factors are all interrelated,” Irwin says. “There’s no straight pathway.” Unknotting this complex tangle of factors will take lots of time and money ........'



'And there’s also a possibility that psychological treatment could alleviate long COVID symptoms more broadly. In a recent trial, around 60 percent of long COVID patients recovered from severe fatigue after a four-month course of cognitive behavioral therapy, compared to about a quarter of those who did not receive CBT. Patients on CBT also saw a significant improvement in their bodily symptoms, like pain and dizziness.

If mental illness can contribute to long COVID, that’s all the more reason to pursue psychological treatments—and understanding exactly how that connection works could help clinicians target those treatments more effectively. “That’s really where we need to start,” Vannorsdall says. “It’s really about getting people back to feeling good with the tools that we have available, and appreciating that if mental health tools are part of that package, it doesn’t invalidate the realness of their experience and of their illness.”
 
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There is essentially one piece on ME/Long Covid being deemed a psychiatric problem, and slightly different iterations are authored over and over again.

Quote Adam Gaffney, don’t mention that the Knoop study is open label/lacks an active control group/relies on subjective outcomes, blame patients for refusing to accept the stigma of mental illness, and lots and lots and lots of FND!

She will get pushback, claim harassment, and then someone else will write an identical piece in a few months.
 
I think this article is deeply problematic.

It seems to me to muddle together into one big mess suggestions that mental illness may credibly be regarded as a predisposing, precipitating and/or perpetuating factor of Long Covid. It also adds to the mix the suggestions that mental disease may be caused by Covid, may result from the stresses of living with LC, or may occur purely coincidentally.

It provides no evidence for any of those propositions and can only give the very dubious CBT study credit as 'proof' that psychological therapy can cure LC, and a single study of cognitive testing as evidence that cognitive problems in LC are a caused by depression or anxiety.

She quotes Jaime Seltzer, David Putrino and Akiko Iwasaki all saying that putting research funding into looking for connections with mental illness or psychological treatments is the wrong way to go for LC and emphasis on these can lead to gaslighting, only in order to dismiss them.

The author seems determined to insist that mental illness is a key factor in Long Covid, that some have FND, and that psychosomatic doesn't mean the symptoms are psychologically induced.

Crossposted with 2 previous posts.
 
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No one ever said that psychology is irrelevant. What's always been said is that it's massively exaggerated and is explicitly used to treat it as a fake illness. No matter how much anyone can insist that it doesn't mean fake illness, in real life when a patient sees a physician in private it plays out exactly this way, and pretending otherwise is dishonest. Once psychology enters, it takes up the whole place and never leaves.

It always ends the same when the quackery takes over. And it has, and so it's happening exactly the same way as before, for the same reasons, with the same pushback.
In doing so, however, she used the word “psychosomatic” to mean “fake.” But that’s not how “psychosomatic” is used in medicine
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It is, at best a distinction without a difference. It is also what most MDs would admit privately if they weren't being careful about saying what they mean. And it makes no difference from the small % who don't, it ends up exactly the same every time.

Again and again they trot out the argument that we say that psychology is irrelevant. Anyone who uses lies as their main argument has no actual argument.

The exact same BS "debate" was happening with the exact same arguments 150 years ago, and nothing's changed ever since except hundreds of millions of lives ruined in the process.
 
Charles B. said:
Is this gaining any traction on social media? I know that other article sparked a firestorm, but it’s my hope that the fervor has somewhat quelled.
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I answered my own question. Responses are expectedly terrible. Everyone naturally regurgitating the tropes the author claims to detest. A lot of grifters in the “Covid was exaggerated/fake” space glomming onto it
 
The introduction to the article is sensical. It's reasonable that LC is correlated with mental health problems, since poor mental health can affect your ability to care for yourself, immune function, and so on. In the proper sense, that's psychosomatic, but researcher, Andrea Roberts, was in the awkward position of having to say her findings don't prove LC is psychosomatic. Unfortunately, the article doesn't address the reason for this: The term "psychosomatic" has been stolen by a bunch of grifters and now means "you're anxious and lazy and need CBT/GET." It's this sense of the word Roberts rightfully objects to.

After that it goes straight to the crapper. For example:
In deploying the term “mass hysteria,” the British doctors didn’t mean to suggest that the patients were consciously faking their illness, but rather that their symptoms were purely psychological. But to many readers, the paper nevertheless seemed pejorative, and several clinicians and patients sent letters to the British Medical Journal expressing their indignation.
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You can't claim the British doctors were being reasonable. Claiming that a poorly-understood disease is caused by patients' thoughts and behaviors is extremely ableist, resulted in real-world harm, and lacks scientific merit.
But in some patients, cognitive difficulties represent a problem with the brain’s software—the patterns of neuronal activity—rather than its hardware.
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More hardware/software nonsense. Everything in the brain physically exists somewhere, we just don't know how to untangle it.

Then they claim pwLC's cognitive issues might be psychological because they don't score poorly on objective testing, which make no sense, because our cognitive tests weren't designed to pick up post-infectious symptoms.

Then they pull out the old placebo claptrap:
Tell a patient you are giving them a drug and they might start to feel better, even if they’ve only taken a sugar pill; tell them the drug has side effects, and they may experience those, too.
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Long COVID symptoms are real, regardless of whether they derive partly from psychological factors, are connected to a hormonal stress response, or have nothing to do with mental health at all.
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This sentence is a glimmer of hope. We've actually beaten them back a lot. 20 years ago with ME, everyone definitely thought it was 100% anxiety and laziness. Now we're down to LC being maybe partly psychological.

If psychological factors have a considerable role to play in generating and maintaining long COVID symptoms, then psychological treatments should be studied just as rigorously as drugs like Paxlovid.
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The problem is that poor-quality psychological research will be worse than none it all. All the rich ableist doctors with undisclosed conflicts of interest will formulate vague unevidenced nonsense hypotheses, "test" them in studies so poorly designed as to guarantee a positive result, then claim success.

Already, mental health care is central to long COVID care: Living with long COVID can be psychologically taxing, and COVID itself may be able to spark mental illness by infiltrating the brain.
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They keep slapping together sensible quotes like this with subtly flawed reasoning to create an article that overall makes no sense, and pays no mind to the relevant controversies. It's misleading. If you used this article for your reasoning to answer the question "Should we fund drug development or CBT/GET?" you'd say we should fund half and half. If you fully understood the issue you'd say nothing should go to BPS ideologues.
 
and that psychosomatic doesn't mean the symptoms are psychologically induced.
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What else does it mean? This is just Orwellian games with words.
"If psychological factors have a considerable role to play in generating and maintaining long COVID symptoms, then psychological treatments should be studied just as rigorously as drugs like Paxlovid."
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That 'If' is doing a lot of hard lifting. Far more than is legit or safe.
RedFox said:
If you fully understood the issue you'd say nothing should go to BPS ideologues.
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Nothing more. They have hogged the research funding for decades, and have completely failed to establish their case. They had more than their fair chance, and blew it big time. They have no legitimate claim to further funds or authority.
 
Sean said:
What else does it mean? This is just Orwellian games with words.

That 'If' is doing a lot of hard lifting. Far more than is legit or safe.

Nothing more. They have hogged the research funding for decades, and have completely failed to establish their case. They had more than their fair chance, and blew it big time. They have no legitimate claim to further funds or authority.
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Bit of a sidenote but relevant to all of these in as far as another problematic assumption underlying how they think even if their thinking the psychological attribution held water. I don't know the correct term, but we need one for these contexts that is above the deliberate ambiguous melding-terms created by this industry and those at the top of BPS model. I do know that 'psychological warfare', mind games, grinding someone down using unkindness or mobbing are all very true - and that pretending 'the individual's perception' has anything to do with it nonsense, otherwise they wouldn't be things used to manage people out by making their life hard or miserable and bullies wouldn't use them.

We can say that ensuring services aren't accessible to those with a condition, and when said patients try and explain they are given rude replies or behaviour that plays up due to poor information, makes things far worse for anyone. Just like if you took a healthy person and one day stopped taking their bins, made it impossible and really arduous every time they needed to access shopping, prescriptions necessities it would quickly make their life impossible and them more exhausted and 'hurt' because it would be unkind. And no the treatment wouldn't be some nonsense bigotry telling them if they thought differently and motivated themselves - it would be sorting out the nosense being deliberately levelled at them.

That was always supposed to be about what mental health being acknowledged was about and instead those in charged used that to manipulate saying those who were made miserable by 'reactive' ie appropriate and predictable responses to untenable and inappropriate behaviour of others stuff were acknowledged properly. Instead those in charged used it to do the opposie and undermine those being bullied or put in terrible situations never getting said situations acknowledged and sorted - which isn't psychology but is anti-psychology, and then labelling them as it being internal to them rather than those doing it to them (who could be treated if it is that they have attitude issues that e.g equate to bigotry, disability-ism, personality issues and so on). We have this weird dystopian reverse-world created now where anti-psychology is claimed to be psychology thanks to the people in charge getting it all the wrong way around, who knows if it was deliberate initially or just continued deliberate ignoring.

But just because you can make someone with RAs health worse by bullying them at an intiminate level with access to essential needs and being horrid to them, wouldn't be proof that there is a psychogenic or psychosomatic component - just what everyone, particularly society should know already, which is that you should bully and aim to hurt those with disability in order to make them worse (because why else do people do it, alongside 'just to take their own liberties because they are selfish and it is easier to do so from someone either more ill or whose reputation is undermined, or who is too tired to tell on them and be heard well').

And this stuff needs to be begun to be written in response to this lot: it isn't 'all or nothing' just like an unsafe job at work causing 'stress' doesn't mean that person has any internal issue that needs CBT, just that the workplace needs to stop giving them 4 people's jobs or treating them badly or having them in an uncomfrtable set-up or allowing colleagues to be unkind and so on. Said people getting drained by that is normal, not pathologic and the employer is responsible for stopping the sutation and behaviour causing it'.

Translate that to what is happenning with the medical and indirect from the medical adjustment and attitude and access to services based stuff out there in the world and such articles should be more about self-effacing 'is it us, is it something we aren't doing right' as much as this weird jump to assume if the situation grinds these people down psychologically it isn't because they've made the situation inappropriate? And that it and their attitude needs to change, not shove people off to another dept as if there is some nonsense about 'you should cope with this crap by laughing at it whilst your bins stack up with uncollected waste, and you go without on things you need'. I just don't get the cloth-earedness of it, at the same time as such people cite 'holistic' and actually quote these 'its the surrounding factors too'. Yes it is, but they've got it 100% in reversal of how they understand it and I don't see how anyone can and did given the real literature that was there with real science before the BPS model farce with non-evidence just manifesto.
 
RedFox said:
It's reasonable that LC is correlated with mental health problems, since poor mental health can affect your ability to care for yourself, immune function, and so on.
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Direction of causality may well be inverted. Pre-existing abnormalities of immune function may be responsible for much of mental illness; and predispose to deterioration in mental health post Covid (well described), and new chronic diseases already considered biological. As you point out, social circumstances, inability to optimise health, drug side effects etc may all compound impairments to health. The hypocritical "anti-dualists" really did a number on the world and in particular the people they claim to be championing.

(agree with everything in your comment)
 
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Shame the article author was not so rigorous in her (everything but the) kitchen sink article.

Slate's tweet of the article shows 36.4K views, 26 'Likes', 14 Retweets, 14 quote Tweets, and 12 Bookmarks. Hardly a twitter storm. The Comments directly on the article site are the predictable mess of cluelessness, eager gaslighting anecdote and imaginative but uninformed opinion.
 
I have no doubt that mental disorders are closely related to ME/CFS and possibly LongCOVID. However, I do not believe that it is all in our mind. The perspective of what we think about "mental" disorders changes drastically if we would consider that that these disorders may be attributed to specific metabolic, mitochondrial and redox problems.

https://pubmed.ncbi.nlm.nih.gov/30585734/
 
Charlos (@loscharolos) is doing a heroic job of trying to reason with Grace Hucking from every possible angle. Grace digs her heels in, continues accusing us of stigmatising people with mental health conditions, and dismisses pretty much every argument made by informed ME and LC patients. She wildly misses the points made by the patients - in nearly all of her tweet responses to them. She appears to be oblivious of the stigmatisation of LC and ME that her article is causing.
 
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