Wired Magazine: The Painful Truth About Long Covid by Alan Levinovitz, 2026

[Trish]

Gosh, I'd forgotten that thread. It's hair raisingly bad research. Worth reading the discussion.

 

[Lou B Lou]

It's a little more coherent than that, though it's important to add that it's just a hypothesis. I would argue that among PRT advocates the "Fight or Flight" explanation is primarily meant as a way to convey to patients how mind states affect body states in ways that are biochemically measurable. The Fight or Flight response reminds us that *belief* in danger can have dramatic somatic effects. With a sufficient adrenaline surge, you can run on a sprained ankle, and it might save your life. Or your threat assessment may be way off (we're all error prone), and you were never in danger in the first place, but you still ran your ass off on a bad ankle.

You're right that energy surges and the suppression of pain are the opposite of energy disorders and pain syndromes. But the Fight or Flight explanaton doesn't stop at the moment when you have safely fled the real or imagined sabre tooth tiger. The hypothesis is a systemic one, as broadly outlined in the passage you quoted. When threat assessment becomes dysregulated, it can start acting within the space of our own bodies. The medical term for a dysregulated nervous system is central sensitization, which may not be connected to our flight or flight response at all (though it's not entirely implausible that it would be connected.) And there's no proof at present that central sensitization, while predictable and observable in several clinical contexts, is actually the explanation for any given pain syndrome (or fatigue disorder). That part gets overstated by PRT advocates, for what I would hope are largely good-faith reasons.

But the point is, neither is the underlying hypothesis pseudoscience. Dysregulated neurochemical systems are known to give rise to a whole host of somatic symptoms without any underlying local pathology, which puts the hypothesis that some chronic conditions may be dysregulatory phenomena on equal scientific footing with any number of proposed-but-as-yet-unvalidated hypotheses for the same conditions.

Not trying to prosyletize here; I just think some of what gets painted as "woo" in pain science boils down to poor communication by therapy communities who are mostly focused on techniques for which the evidence of effectiveness is stronger that the explanation of the etiology. As a medical hypothesis, it's completely coherent, though of course like all hypotheses it may well completely fail under duress.

@crispscone wrote:

"... it's important to add that it's just a hypothesis. I would argue that among PRT advocates the "Fight or Flight" explanation is primarily meant as a way to convey to patients how mind states affect body states in ways that are biochemically measurable. The Fight or Flight response reminds us that *belief* in danger can have dramatic somatic effects...."


Your sentences about Fight or Flight in ME or LC are as clear as mud.

So are people with ME or LC in a state of permanent Fight or Flight or not?

Or is the 'Fight or Flight explanation' just guff designed to appeal to patients, who appear to have been framed as gullible for the purposes of giving them an enticing, easily repeated, but false 'explanation' for their illness/symptoms.

Because there are tens of thousands (probably more by now) of people with ME or LC who now believe without question that they, and all people with ME or LC, are in a state of permanent Fight or Flight.
Because the patients have been told that repeatedly by sellers of costly commercial Braintraining/Mindbody 'Cure' courses and programs.

Have the patients who now believe that everyone with ME or LC are 'stuck' in permanent Fight or Flight been deceived?

.

 

[Peter T]

It's a little more coherent than that, though it's important to add that it's just a hypothesis.

Isn’t the problem the way the various terms, ‘central sensitisation’, ‘dysregulated threat system’, ‘neuroplasiticity’, etc, are currently used in this field? It is theoretically possible that testable hypotheses could be developed, however I feel that you, @crispscone, are being over generous in describing their current usage as such.

Further I would agree with @Trish that they are generally used because they sound sciencey, but currently this amounts to pseudoscience. Central Sensitisation in particular is a totally circular concept that most use in a way that is completely unfalsifiable. Certainly I see no ground for taking any of this seriously until there are actual hypotheses laid out relating to some form underlying neuro inflammation or neuro over responsiveness that could evaluated scientifically and at least gives the potential for studying something other than questionnaire filling behaviour or clinicians personal beliefs.

 

[Chandelier]

Gosh, I'd forgotten that thread. It's hair raisingly bad research. Worth reading the discussion.

At least it’s research.
Recent articles in Swiss newspapers aren’t shy to mention websites like cfs-hilfe.ch where the domain owner picks ‘n mixes his own theories on what keeps us ill (Google Translate):

ME/CFS & Long Covid: Ursachen & Stand der Forschung

Warum bist du erkrankt? Erfahre mehr über die biologischen Ursachen von ME/CFS und Long Covid. Ich ordne den aktuellen Forschungsstand für dich sachlich ein.

translate.google.com

 

[Utsikt]

I would argue that among PRT advocates the "Fight or Flight" explanation is primarily meant as a way to convey to patients how mind states affect body states in ways that are biochemically measurable.

There is no such thing as «mind states». Everything is biological, or biochemical if you want. The concept of a «mind» is an illusion, and is impossible if you want to adhere to what we know about physics.

When threat assessment becomes dysregulated, it can start acting within the space of our own bodies.

Again, this assumes some kind of «mind» that is separate from the body. It’s the very dualism that the biopsychosocial proponents claim to oppose.

And this statement is too general. We know there are limits to how one thing can affect another. No matter how much you believe (if you’ll allow me to use the unscientific everyday phrasing) that you can turn your skin green, you will not be able to do it.

And there's no proof at present that central sensitization, while predictable and observable in several clinical contexts, is actually the explanation for any given pain syndrome (or fatigue disorder).

Can you provide any sources for the claim that CS is «predictable» or «observable» in «clinical contexts»?

That part gets overstated by PRT advocates, for what I would hope are largely good-faith reasons.

Why would we assume good faith on their behalf? They have a very long track record of exaggeration and lying about everything from their own data to threats and needing protection from the police.

 

[EndME]

It's a little more coherent than that, though it's important to add that it's just a hypothesis. I would argue that among PRT advocates the "Fight or Flight" explanation is primarily meant as a way to convey to patients how mind states affect body states in ways that are biochemically measurable. The Fight or Flight response reminds us that *belief* in danger can have dramatic somatic effects. With a sufficient adrenaline surge, you can run on a sprained ankle, and it might save your life. Or your threat assessment may be way off (we're all error prone), and you were never in danger in the first place, but you still ran your ass off on a bad ankle.

You're right that energy surges and the suppression of pain are the opposite of energy disorders and pain syndromes. But the Fight or Flight explanaton doesn't stop at the moment when you have safely fled the real or imagined sabre tooth tiger. The hypothesis is a systemic one, as broadly outlined in the passage you quoted. When threat assessment becomes dysregulated, it can start acting within the space of our own bodies. The medical term for a dysregulated nervous system is central sensitization, which may not be connected to our flight or flight response at all (though it's not entirely implausible that it would be connected.) And there's no proof at present that central sensitization, while predictable and observable in several clinical contexts, is actually the explanation for any given pain syndrome (or fatigue disorder). That part gets overstated by PRT advocates, for what I would hope are largely good-faith reasons.

But the point is, neither is the underlying hypothesis pseudoscience. Dysregulated neurochemical systems are known to give rise to a whole host of somatic symptoms without any underlying local pathology, which puts the hypothesis that some chronic conditions may be dysregulatory phenomena on equal scientific footing with any number of proposed-but-as-yet-unvalidated hypotheses for the same conditions.

Not trying to prosyletize here; I just think some of what gets painted as "woo" in pain science boils down to poor communication by therapy communities who are mostly focused on techniques for which the evidence of effectiveness is stronger that the explanation of the etiology. As a medical hypothesis, it's completely coherent, though of course like all hypotheses it may well completely fail under duress.

Hi @crispscone! Thanks for joining the discussion. I can sympathise with some of the things you say and I don't think anybody has problems with hypotheses, as long as they are also treated as such, which all to often does not seem to be the case. Unfortunately, it seems to me that this "woo" often impacts the lives of people quite directly.

Moreover, I'm usually left wondering about the following

I just think some of what gets painted as "woo" in pain science boils down to poor communication by therapy communities who are mostly focused on techniques for which the evidence of effectiveness is stronger that the explanation of the etiology.

Is that really the case though? I have not come across such strong evidence, perhaps this exists in other fields outside of the ME/CFS realm, could you perhaps provide some evidence that would be useful to this discussion?

 

[rvallee]

I would argue that among PRT advocates the "Fight or Flight" explanation is primarily meant as a way to convey to patients how mind states affect body states in ways that are biochemically measurable. The Fight or Flight response reminds us that *belief* in danger can have dramatic somatic effects.

It's a possible interpretation of this model. And it is a model, not a hypothesis. It's not very convincing, as it seeks to explain symptoms, rather than coming out of real observations. It's a retro-explanation, it mostly takes things that happen after, and reattributes them as their own cause. Grandfather paradox in a model does not make for good science.

The main problem with this interpretation is that it does exactly the same thing as "lie detectors", aka polygraphs. Polygraphs do detect a physiological response. It has nothing to do with lying, or honesty, or any combination of that. It's, in fact, entirely useless at "detecting lies". Where there is a physiological response of sorts, there is nothing actually making any connection to a model that attributes it to a preferred explanation, it's purely circular interpretation based on asking about symptoms, and finding that a model based on fear, for some reason, can explain anything.

To people who pretty much have no fear, this is especially silly. All those people making up narratives about what we think and believe, when we do none of those things, and meet none of the requirements they speculate about. I don't have a clue what this model goes on about fear and threats, it's not even something I ever experienced once in my life. Same with trauma. They might as well be talking endlessly about my fifth arm.

The celestial spheres model was very compelling for millennia. It was believable, yet completely wrong. It modelled circular orbits, which are actually parabolic. Close enough to the naked eye, does not stand up to any scrutiny. Still stood strong for millennia, because we could not do the required scrutiny. The odds of anything in those models being close to reality is so far-fetched it's not even worth considering, but for sure they will definitely claim the equivalent of "well, a circle is sort of an ellipse", which, while true, is entirely irrelevant.

 

[skronen]

I know this thread has gone on way too long but a couple things: I find the fight-or-flight brain loop theory plausible, I think Jonathan hypothesized something similar sounding, some faulty danger threat signal switching off full metabolic capacity. But even if it is that, there's no reason to think we can consciously change our deep neurological processes through brain rewiring or whatever else.

Also these people tend to think any immune system issue is downstream from the neurological issue, but it could easily be the other way around or some kind of interaction. They need to think that to hold up their theory. There's also way too much conflation of "brain" with "mind" to make the theory sound more technical when they usually mean the latter.

Since the Wired article came out, I've been talking to all these mind body brain retraining people, including Alan, pretty extensively, genuinely seeing what they had to offer and what they thought, and I'm absolutely convinced they are all 100% bad faith. I was told that Maeve wouldn't have died had she addressed her underlying stress. This wasn't some rando but a fairly well known x account in this space.

That is actually insane, and so unbelievably cruel, and it flows very directly from the idea that the illness is not entirely physical or can be cured with mind-body interventions. Night follows day. I'm pretty sure they know how cruel it is in practice but pretend not to.

As has been pointed out, I think all this stuff is just a rebranding of the same harmful nonsense that's plagued us for decades, old wine new bottles. Because long covid is yet unresolved they think oh maybe the whole biomedical approach is flawed and we need to try something new, even though what they're pushing is not new or interesting at all and is actually very counterintuitive and strange. Where's the evidence!?

Why is it so hard to understand that some illnesses just haven't been resolved yet and that doesn't make it some weird psychologically-tinged phenomena? Why is this stuff always framed as an alternative to actual medical treatment, and why are patients always the villains in the story?

 

[MrMagoo]

It’s BSP they’ve said it elsewhere, AL must be feeling pretty silly now!

 

[Trish]

BSP?

 

[Axel]

I was told that Maeve wouldn't have died had she addressed her underlying stress.

These people really know a thing or two about stress. That sentence alone is stressful.

 

[MrMagoo]

It’s BSP they’ve said it elsewhere, AL must be feeling pretty silly now!

BPS
I don’t know why my iPad always autocorrects it?!