Letter in BMJ: Long COVID-19, persistent somatic symptoms and social stigmatisation, Ballering, Rosmalen et al, 2021

Andy

Andy

Senior Member (Voting rights)
Long COVID-19 bears a resemblance to functional somatic syndromes characterised by persistent somatic symptoms of unclear aetiology. Such syndromes often develop after an eliciting trigger, such as a viral infection. However, at the moment of symptom reporting, no clear somatic abnormalities can be found despite sound history taking and diagnostic investigation. The absence of detectable bodily abnormalities in people affected by persistent somatic symptoms facilitates stigmatisation. This stems from dualistic thinking, that is, the body-versus-the-mind idea, which allows others, including healthcare professionals, to assume patients should ‘toughen up’ as apparently nothing is physically wrong.3 Thus, in persistent somatic symptoms social stigmatisation stems from the psychosomatic connotation of symptoms: the blame projected towards people affected by persistent somatic symptoms refers to the perceived inability of people to waver their symptoms.4 These negative attitudes are likely to negatively impact help-seeking behaviour for these symptoms as is commonly seen in other (infectious) diseases.
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https://jech.bmj.com/content/early/2021/02/22/jech-2021-216643
 
I like how they're engaging in the usual tactics of rerouting discourse towards Cartesian dualism, relabelling patients with their own ill-begotten construct, and ascribing causality to self-blame (since the symptoms obviously would resolve if they sought help for them), but also framing it in this altruistic, cordial manner, that'll probably throw off all the people who aren't intimately familiar with all the weasel words. Just look at that disgustingly saccharine graphic. Is there a name for this sort of tactic? Because I think there should be.
At least they're warning not to automatically assume a psychological cause. Not that it matters, because that is the implied next step, since if you follow through on "educating yourself on PSS from trustworthy sources", guess what you will find?
 
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Ah, that's so sweet. They seem to really care so much. Now they are co-opting our narrative of being stigmatised turning it around and using it to drum up business for somatic illness clinics.

Give them another thirty / fifty / hundred years and buckets of cash and I'm really really sure they will have this all sorted. -- NOT.

What I really want to see (not sarcasm) is a letter signed by multitudes of professionals that digs into how this pandemic clearly shows that the people in charge are incompetent and completely unable and unwilling to do the right thing. How the system is broken and why that might be and how to go about repairing the problem.

The one thing that has worked is the capacity of the system to get people finding a vaccine. Because that was a political win. As for everything else including future epidemic prepared-ness it's all uninteresting and no fun. Why throw money where there is no benefit to cronies. Where's the fun in that.
 
Both Rosmalen and Olde Hartman were part of the Dutch Health Council. I really believe that they have the best intentions but as long as they still promote CBT as a potential cure for conditions like "post" infectious ME and start labeling Long Covid as MUS, FSS, PPS etc. they are part of increasing stigma!
 
Michiel Tack said:
I like the sentence: "Do not automatically assume a psychological cause for persistent somatic symptoms in the absence of detectable pathological abnormalities."
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Right, but notice how that is in the graphic--they don't actually say that in the article itself. The stigmatization certainly has something to do with the standard presumption of these people that in fact the absence of detectable pathology does indeed indicate a psychological cause, or at least one amenable to recovery through CBT or other multi-disciplinary rehabilitation. To say you're against stigmatization without explicitly acknowledging that your formulations have helped lead to the stigmatization shows a distinct lack of awareness or a distinct lack of something, anyway.
 
dave30th said:
To say you're against stigmatization without explicitly acknowledging that your formulations have helped lead to the stigmatization shows a distinct lack of awareness or a distinct lack of something, anyway.
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Exactly. Right on the money!!

I always get super annoyed with Rosmalen on Twitter when she pretends to be the researcher that actually gets the patients but keeps promoting this harmful form of CBT anyways. She ended up muting me on Twitter! :)

The sad part is that most doctors and researchers will consider this a helpful letter and the authors will receive scientific browny points for it...
 
Even if it doesn't come across as entirely honest, that they have to take this position shows I think how much ground the psychosomatic brigade have lost. Someone that is trying to treat unexplained illness with CBT in a systematic manner is 100% in the psychosomatic camp no matter what they say.

I'll believe them the day they say psychotherapy or similar has no special role to play in medically unexplained illness, but can be considered in individual cases.
 
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