Editorial: Why the hypothesis of psychological mechanisms in long COVID is worth considering, 2023, Lemogne et al

Andy

Andy

Retired committee member
Many patients infected with SARS-CoV-2 report persistent symptoms that may impair their quality of life for months, even after a mild episode of coronavirus disease 2019 (COVID-19), a situation often referred to as ‘long COVID’. Figures vary between studies but the proportion of patients affected may be around 20% at 6 months post-infection and 10% at 12 months [1], making this a public health issue and a priority for medical research. Although the potential role of psychological mechanisms in long COVID has long been hypothesized, it has been relatively overlooked so far compared to other potential mechanisms [2]. In line with the principles of psychosomatic medicine, we argue that this hypothesis is worth considering to understand long COVID and to relieve patients who suffer from it.

First, there is already substantial evidence suggesting a role for psychological mechanisms in long COVID. For instance, it is now well-established that psychological distress is not only a symptom but also a risk factor of long COVID. Early in the pandemic, a history of psychiatric disorders was shown to be an independent predictor of ‘Post-acute Sequelae of COVID-19’ (PASC) [3,4]. Recently, psychological distress measured at the beginning of the pandemic was associated with the risk of persistent symptoms in individuals later infected with SARS-CoV-2, with a dose-response relationship [5]. It is noteworthy that this association was stronger than those observed for other risk factors of long COVID. However, it remains unknown whether this association is only observed in those infected with SARS-CoV-2. For instance, pandemic-related anxiety in the general population has been associated with physical symptoms that may mimic those of long COVID [6]. In contrast to psychological distress, higher levels of personal resilience have been associated with lower severity of PASC [7]. Beyond psychological distress, a recent observational study linked specific beliefs about COVID-19 – such as one's estimated symptom severity if infected and perception of the body's ability to fight diseases – with the experience of symptoms weeks afterwards [8]. Likewise, a cohort study found that symptom expectations associated with COVID-19 and self-reported history of COVID-19 better predicted the worsening of somatic symptom burden during the COVID-19 pandemic than serology test results [9]. Although these findings do not mean than other mechanisms could not be involved, they suggest that at least some persistent symptoms in some patients may be influenced by psychological factors.

Open access, https://www.sciencedirect.com/science/article/pii/S0022399922004202
 
What can I say? They're arguing a garbage position, citing the same old garbage papers. The good news is that BPS LC researchers are a minority.

I find papers that attribute ME or LC to psychological causes pretty offensive because I've been personally harmed by diagnostic overshadowing. When I first got ME, my symptoms were attributed to my pre-existing mental conditions, resulting in a 3.5-year delay in diagnosis.
 
We have reached the metafailure stage, a stage of failure that has completely lost any ability to even assess failure or success so thoroughly it perceives complete failure as success, and the potential of actual success as failure.

Here you have authors presenting as a hypothesis, 3 years into this, the very treatment model that, by now, at the very least hundreds of thousands have been subjected to, but also millions more who saw the other side of that treatment paradigm in the form of denial, discrimination and gaslighting. Which isn't a separate part of this model, it is in fact the main part. As a construct, this paradigm is economically unviable, only works through mass negligence where less than 10% of patients ever come anywhere close to an actual treatment, the rest are simply discarded.

They present it as a hypothesis. They know it's a mere hypothesis, it has no evidence whatsoever. It's been used on millions of people in the last 3 years, and on us for decades before. There have been countless opportunities to assess it rigorously, all passed, because it was assumed to work from the start, based on past evidence on us that doesn't even support the conclusion.

Because the truth is that this isn't a hypothesis, it's a conclusion. A conclusion that has failed millions for decades. And either the authors don't know, rank ineptitude, or don't care, malicious incompetence. It's complete insanity to be this negligent given the stakes are millions of lives.

They speculate about things we already know, as if those ideas are thought for the very first time. Even though they know those ideas are over a century old, have been forced onto millions already, to widespread failure.

And they love it. Medicine seems to absolutely love it so much it's like an addiction. This ideas is as ridiculous as someone proposing the never-before-thought novel idea that the Sun's activity may be the explanation after all, as a serious proposal. Failure doesn't cover it, this is metafailure, it's failing at even caring whether anything works at all.
 
The standard playbook of pro-psychosomatic arguments.

It's only the third year in for this pandemic. There is unquestionable proof of physical dysfunction at the acute stage, and certainly mounting evidence of physiological dysfunction with long COVID.

Research on other infections has proven long term sequeale.

ETA: changed term
 
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Trial By Error: Double Talk on Mind-Body “Dualism”?

"Proponents of the psychosomatic approach to ME and long Covid–as well as the broader range of so-called “functional” disorders and/or “medically unexplained symptoms”–routinely declare that those who disagree with them are engaging in what they dismissively refer to as mind-body “dualism.” The mind and body are not separate entities, they note, and drawing sharp distinctions between organic and psychological causation is an inherently suspect enterprise.

Ok, then. So why do adherents of this approach keep writing papers that seem fraught with confusion about their own “mind-body dualism” construct? Let’s take one recent example in a prestigious venue: an editorial from a group of French authors in the Journal of Psychosomatic Research called “Why the hypothesis of psychological mechanisms in long COVID is worth considering.” This journal is the official voice of the European Association of Psychosomatic Medicine and is affiliated with the International College of Psychosomatic Medicine. Pretty authoritative stuff."

https://www.virology.ws/2023/01/23/trial-by-error-double-talk-on-mind-body-dualism/
 
I'm sure this has been pointed out on multiple occasions previously, but I assume those holding themselves as experts in the field of psychosomatic medicine could be expert witnesses in civil legal actions against insurance companies: on behalf of the claimant.

If mind-body dualism is held to be both incorrect and that this is foundational to modern medical thinking - that there can be no separation between psychological and biological causation of disease - then insurance companies can not deny claims based on psychological causation. Psychological illnesses are just as valid as biological disease you know.

By these standards it might even be argued that a person was legitimately and permanently disabled, even if that person had simply decided they'd just rather not work (terribly unfortunate of course that our current psychological treatments seem unable to reverse such unhelpful thoughts).
 
Well, they could, but being an expert witness for the insurance companies, testifying on how behavioural treatments can cure almost anything, is highly likely to be better paid, as well as being an opportunity to reinforce the false illness beliefs that they spent their entire careers fabricating.
 
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