@Friendswithme I am going to take your posts in good faith. I'm genuinely glad that your brain retraining has provided you with relief. I'm hoping that some of my experiences may be able to challenge what you hold to be true, since you are asking the same of us.
PS: I apologize to everyone else with brain fog for what will be an extremely long response!
I am curious as to how people here conceptualise an illness involving PEM where some people can go for a daily walk and not deteriorate with time and others can't sit up or talk without triggering PEM.
In my milder condition I regularly go on walks with my dog. I'm able to participate in a PhD program part time. But if I took the train for an hour and stayed on my feet for another hour, I would start to feel lots of pain and fatigue, which would result in PEM hours later. I never feared exertion, I just became aware of how much activity it takes to trigger negative symptoms after lots of trial and error and decided whether I could afford the consequences of going past them in the moment.
What do you think exists in the literature currently that explains this?
Just off the top of my head, there are findings about
various measurements of ATP production efficiency and
differing levels of cytokines that scale with severity. Meaning the more severe a person rates their illness, the stronger those abnormalities appear in the biology. Lots of biological illnesses vary by degree.
I can see why you think this, but it's not correct. There are certain lightbulb moments in brain retraining that most people seem to have as they recover.
I've been sick with ME/CFS for 6 years and have been in extensive therapy for 5. My therapist echoed much of what you are saying right now. When I first started working with him, he would tell me of other patients with severe fibromyalgia and chronic fatigue who had an "aha" moment and suddenly their symptoms went away.
I've done a huge amount of personal work with that therapist. I've worked through childhood experiences, examined my family dynamics in detail, paid attention to how my body would hold anticipation for a family member's inevitable emotional meltdown that I would have to deal with. I've worked through issues of confidence, why I felt the need to overexplain myself, why on a deeply subconscious level I felt like my perceptions and thoughts were never valued the same as other people.
I've learned to completely reframe my self perception so that other people projecting things onto me no longer makes me feel unsafe and devalued. I know what winds me up, and I even built enough awareness to let myself occasionally indulge in fighting with a difficult person, knowing that they're never going to come around but it's not my job to change their mind. I've even become very skilled at detecting and understanding emotional issues in others. I moved out of my parent's house and felt every bone and muscle in my body relax at the thought that I had full control over what happened in these walls.
I've had lightbulb moment after lightbulb moment after lightbulb moment. And I did notice some very subtle changes in my energy level. Tiny changes that had to do with letting go of anxiety-driven hyperawareness. But crucially, I never became able to be out of the house for more than an hour without pain. My brain fog never went away. I still had to take a reduced courseload at school.
About 3 years in, my therapist started to get incredibly confused. At one point he told me that I had made the most progress out of any other patients in my same age group, including that one whose fibromyalgia went away. He saw me have lightbulb moment after lightbulb moment with no change in my overall physical capacity. I've explained more of the science of ME/CFS to him (I'm pursuing my PhD in computational/systems biology) and finally got him to realize that my fatigue was not correlated with psychological issues. If anything, it correlated most closely with how fast my blood clotted when I got a cut (there's some interesting findings related to platelets in ME/CFS and long COVID that I'm happy to chat about).
You're probably saying to yourself "well if you're still sick then obviously you didn't reach the final lightbulb moment yet." You may be right. Even after several years of successful therapy I still have work to do, as does anyone.
But you know what did make a huge difference? A prescription stimulant and a specific supplement that I hypothesized would work for me after piecing together lots of consistent biological findings in ME/CFS research. I've even done some pretty elaborate placebo blinding to make sure it's not just placebo effect--you can read about my experience
here.
And that might not be an issue for your theory. After all, both SSRIs and talk therapy can lead to substantial improvement in something like depression. Our psychological state and our physical state are not separate.
But even if you could definitively prove that a person's psychological state leads to changes on a cellular level that result in ME/CFS symptoms, that does not mean that those cellular changes are being
maintained by the psychological state. In some people, it might be a permanent shift that cannot be reversed by any of the physiological mechanisms affected by psychological rewiring. It might just be something that gets stuck just beyond the reach of specific neurotransmitter signals, beyond the stress hormones, beyond the neuro-immune axis. That seems to be the case for many illnesses where chronic stress is a risk factor--a triggering factor is sometimes just a trigger.
I actually don't doubt your experience. I think it is entirely possible that a subset of people with ME/CFS may be able to cure their illness using the methods you describe. But not all of us. I'm pretty confident by this point that it's probably not most of us.
If you truly believe that all or even most of us can fix our illness with brain rewiring, you have to ask yourself: what harm am I doing if I'm wrong? Because if you would say what I said above--"well if you're still sick then you didn't reach the final lightbulb moment yet"--your view is unfalsifiable. Even if it is true for you, how would you know if it
wasn'
t true for someone else? If they are still sick and you are convinced that they are sick because of their psychological state, then there is no amount of effort or personal work that will convince you it's
not due to psychological state as long as they are still sick.
If I am a desperate person suffering from an awful illness, and unlike you my illness happens to be the type that simply cannot be treated by brain retraining, what do you think it will do to me if I am continuously told that my failure to reach a lightbulb moment is the reason I am still sick? What if I trust you on that more than I trust myself, because the therapy you're proposing requires me to trust that you are right about the cause of my illness even if my body and mind tell me immediately that it's not? What if I end up spending hundreds or thousands of dollars on these treatments because I have been made to believe that it's entirely possible to cure myself if I just keep going with this same process? What if I am still sick at the end of it, decades down the line, looking back at my life and wondering why I was never strong enough smart enough honest enough to figure out my lightbulb moment?
In order for that to be ethical, you have to be
absolutely certain that someone's illness is the type that can be rewired by brain training. And you just don't have that. Sure, you can say that there is a "need for more research" as much as you want. But you need to be aware that doing this research requires fully convincing desperate study participants that what you say is true when you
don't know if that's true.
If you have done as much healing as you say, I encourage you to notice your immediate emotional reaction to my response, notice your desire to defend yourself, and hold off on immediately responding. Imagine the scenario that I described happening to someone very dear to you. Imagine causing that kind of harm to someone who trusts you and loves you dearly.
If by the end of that you can't understand why many of us seem to not want to hear what you have to say, I don't think further conversation will be productive.