BPS attempts at psychologizing Long Covid

I wonder what happens to the patients it doesn't work for?

 

"We can't find anything, so it must be anxiety." ¯\_(ツ)_/¯

It looks like the NIH is about to throw long covid patients under the bus. This has eerie similarities with the events following Incline Village.

 

She has given several interviews on how she recovered from ME with mindfulness at psychiatrist Bjarte Stubhaug. here is an interview with the Journal of the Norwegian Medical Association. Google translation here

 

VeryWell Health: How to Cope With Post-COVID Brain Fog

"Jackson said that psychological causes of brain fog should not be ruled out because anxiety can cause many of the symptoms. That said, he also acknowledges that "a lot of COVID survivors are a little cautious and uncomfortable when they hear from a provider say you may have a problem with anxiety because the message received is that it is all in your head.”


Still, Jackson said that a person with long-haul COVID might be unable to engage in meaningful activities, may have lost a job, or be worrying about the future. In this case, “it would be quite normal to develop anxiety, and in that context, that's what I would expect," Jackson added.


According to Jackson, "we need to thoughtfully explore whether the psychological dynamics are contributing to worsening cognitive problems" but ultimately, identifying a single cause for COVID-19 brain fog “may be a bit of a fool's errand because there could be a lot of pathways by which people with COVID developed cognitive impairment."


Budson said that for some people, "almost certainly the brain fog will be temporary because there's been no permanent damage to the brain." In these cases, the brain fog might be like the disruption of thinking and memory that comes with a bad cold or the flu and will go away gradually with time."

(...)

"Practicing mindfulness can also help people learn to pay attention better, and Budson said that he is "a big believer that people can improve their ability to pay attention.”​

 

"a lot of COVID survivors are a little cautious and uncomfortable when they hear from a provider say you may have a problem with anxiety because the message received is that it is all in your head.”

The reason for this anxiety is glaringly obvious. Being told your problem is caused by anxiety is the first warning flag that you won't be taken seriously and you won't be treated with honesty. Also, once anxiety is mentioned the doctor's sincerity level drops to the floor in many cases. There are a lot of doctors who just can't fake sincerity.

Still, Jackson said that a person with long-haul COVID might be unable to engage in meaningful activities, may have lost a job, or be worrying about the future. In this case, "it would be quite normal to develop anxiety, and in that context, that's what I would expect,"

That's kind of him (sarcasm) to accept that ordinary people suffer anxiety without it being a sign of an entrenched mental illness. It would also be nice if such doctors/therapists/psychologists accepted that anti-depressants don't help people to get a job, or help them to get money when they have run out and face hunger and/or being evicted.

According to Jackson, "we need to thoughtfully explore whether the psychological dynamics are contributing to worsening cognitive problems" but ultimately, identifying a single cause for COVID-19 brain fog “may be a bit of a fool's errand because there could be a lot of pathways by which people with COVID developed cognitive impairment."

I have gone to see doctors in the past where the doctor decides that my problem is X. So they test for X. They always choose X to be the condition that is cheapest to test. If the doctor is wrong they always go for the psychological causes next. Getting someone to test for Y or Z is impossible. It's anti-depressants all the way. In actual fact, in my case, they often won't even test for X they will almost always go for the psychological first if my problem is invisible.

"Practicing mindfulness can also help people learn to pay attention better, and Budson said that he is "a big believer that people can improve their ability to pay attention.”

The majority of people who get Long Covid will have had no problems "paying attention" to their lives and the world around them before they got Long Covid. But apparently Covid can cause lack of focus and since lack of focus is assumed to be psychological it must be the patient's fault?

 

"identifying a single cause for COVID-19 brain fog “may be a bit of a fool's errand because there could be a lot of pathways by which people with COVID developed cognitive impairment."

If a patient is in a hospital in another city does that mean it's pointless trying to see them, as there are so many routes to that hospital, some of which may well be via California, or Mars, so it's impossible to know which way to go?

Or.....making a stew may well be impossible because there are so many carrots, all of different shapes, sizes, etc, in so many different places, that being able to determine which ones go in a stew is impossible, or effectively so due to all the testing (work needed to assess which is the correct carrot for the job).

 

Same here. I've lost count of the number of times I've been told my symptoms are due to stress, depression or anxiety and offered anti-depressants. (Doctors are so hasty and willing to hand out anti-depressants you'd almost think they were earning a commission ).

Yet I've never once been assessed against the diagnostic criteria for depression.

 

They may do that on the sly, my medical ones contain references to them doing so stating that I was not depressed according to some assessment they performed, without my knowledge, or consent.

 

True, I have caught them asking the "what would you do if you were suddenly healthy?" question. I always reply with a long list of places I'd like to travel to and how I'd love to return to my career.

One specialist actually admitted that my answer to this question meant that I wasn't depressed so instead of anti-depressants, he suggested hypnotherapy.

 

I wasn't aware that hypnotherapy worked for physical illness.

 

"Practicing mindfulness can also help people learn to pay attention better, and Budson said that he is "a big believer that people can improve their ability to pay attention.”

According to Wessely people with ME pay too much attention to their inner workings so they think that normal bodily processes are signs of disease. They should make their minds up!

Brain fog is one of those terms that ME has been squeezed into but normal people think they have. They talk about MS brain and pregnancy brain too but I have never seen anyone describe the cognitive problems we get in ME.

Years ago an ME doctor said it was similar to the dementia in AIDS patients which was nearer the mark.

 

https://www.s4me.info/threads/bps-attempts-at-psychologizing-long-covid.16013/page-25#post-322703

 

There are a lot of “big beliefs” in psychiatry on the worth of mindfulness and neuroplasticity, rewiring stress pathways from trauma. Of course the real evidence is still lacking, it is an emerging science. I see Mindfulness Based Stress Reduction courses are being offered at some ME/CFS clinics in UK so I gather new “evidence” from the BPS crowd will arise from that…. which is also trumpeted by the wellness industry - you will be cured by mindfulness….a good fob off.

 

We've seen how some people have previously made exaggerated claims about anxiety, post-viral symptoms, etc, but I think that there's some reason to be cautious about viewing Long Covid from only that perspective. The global pandemic, lockdowns, reduced access to psychological care for those who might benefit from it, isolation, etc are all going to be additional psychological strains on people and we don't know how that will have affected some. If there's a lack of caution in claims about psychosocial factors maintaining symptoms then it would be fair to criticise that, but we should also be cautious in our criticism. There's a lot we don't know here, and to me it always seemed like this could be a situation where the importance of psychosocial factors might be greater than in many other instances of post-viral symptoms.

 

I have been having a conversation with a GP strongly in favour of a BPS approach and we got on to the question of describing causes as mental or physical or psychological or biological or whatever.

The GP suggested that if we were dealing with fear causing an increased heart rate then it was more useful to use the psychological concept of fear as a cause rather than some neurophysiology.

I had a think about that. It might make sense but then we hit the problem that we have no way of ascertaining that what we call fear - indicated by a subjective sensation - actually causes the increase in heart rate. Although BF Skinner has gone out of fashion he was still in a sense right that all we can do in terms of science is to link some input like seeing a tiger, with an apparently neurophysiologically mediated tachycardia.

You might say that we know from experience that the sense of fear plays a reliably predictable role in this but actually it doesn't. I have on several occasions been moved to tears by sensory inputs without feeling any emotion at all.

What I realised was the bottom line is that despite all the academic units of psychology throughout the world Karl Popper's remarks remain true that when it comes to linking thoughts to actions theories are so vague and contingent that they do not make useful predictions. And then there is the fact that for things like ME we know that 99.9% of the time stimuli that cause emotions and thoughts do not produce the symptoms.

So although I agree that we cannot exclude 'psychosocial factors' in the genesis of all sorts of things the important fact is that we do not know enough ever to usefully invoke these factors. Anyone who claims that it is evident that they contribute is bullshitting.

For sure we can invoke grief as a cause of misery in a recent widow and stuff like that but fear causing fatigue? Where is the evidence for a mechanism that provides a consistent causal link? Even if we all think we feel tend to tired if we are miserable that isn't enough to explain il health. It in no way compares with a low thyroid level leading to sleepiness and a slow heart rate.

So where I think I would agree is in that maybe the discussion should move from saying how could psychosocial factors possibly be relevant to how could anyone be sufficiently sure they are to claim it is likely? And I don't think there need be any timidity about that. I have come to learn from this ME business just how messianic so many of my colleagues are about their beliefs in these factors. It is a cult, for sure. It has the epidemiology of a cult!

 

@Esther12 I agree, but only up to a point.

Certainly there will be those who have been very badly affected by the pandemic. So the number of people experiencing psychological stressors is going to be high.

Getting covid, then “recovering” but not actually recovering to full health, is another major psychological stressor, especially if there is blame attached by society.

I can also see how various pre-existing psychological conditions could be exacerbated by the pandemic.

However, I can see no logic to the idea that being psychologically stressed can lead to physical ailments.

 

In terms of “psychosocial factors”, the only usefulness to this might be in putting in place better social help for those in need. (Whether that need is psychological, or physical).

 

It all goes back to Freud I suspect... these days most people don't build their explanations around the oedipus complex and repressed memories of unpleasant events but the belief that there are two kinds of illnesses, one being caused by emotions and the other by physical factors is still there. Whenever they see an illness that can't be explained by physical factors the believers feel like it's a job for them to explain that it's caused by emotions, and that they just need to figure out the details. They don't question the underlying assumptions even if they have never been adequately proven.

Freud's psychoanalysis was more an esoteric cult than the medical treatment it aspired to be. Freud was a physician and people came to see him for illness and physical symptoms, not anxieties and relationship advice.