Hypothesis Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing, 2023, Joffe

[Andy]

Abstract

This review proposes a model of Long-COVID where the constellation of symptoms are in fact genuinely experienced persistent physical symptoms that are usually functional in nature and therefore potentially reversible, that is, Long-COVID is a somatic symptom disorder.

First, we describe what is currently known about Long-COVID in children and adults. Second, we examine reported "Long-Pandemic" effects that create a risk for similar somatic symptoms to develop in non-COVID-19 patients. Third, we describe what was known about somatization and somatic symptom disorder before the COVID-19 pandemic, and suggest that by analogy, Long-COVID may best be conceptualized as one of these disorders, with similar symptoms and predisposing, precipitating, and perpetuating factors. Fourth, we review the phenomenon of mass sociogenic (functional) illness, and the concept of nocebo effects, and suggest that by analogy, Long-COVID is compatible with these descriptions. Fifth, we describe the current theoretical model of the mechanism underlying functional disorders, the Bayesian predictive coding model for perception. This model accounts for moderators that can make symptom inferences functionally inaccurate and therefore can explain how to understand common predisposing, precipitating, and perpetuating factors. Finally, we discuss the implications of this framework for improved public health messaging during a pandemic, with recommendations for the management of Long-COVID symptoms in healthcare systems.

We argue that the current public health approach has induced fear of Long-COVID in the population, including from constant messaging about disabling symptoms of Long-COVID and theorizing irreversible tissue damage as the cause of Long-COVID. This has created a self-fulfilling prophecy by inducing the very predisposing, precipitating, and perpetuating factors for the syndrome. Finally, we introduce the term "Pandemic-Response Syndrome" to describe what previously was labeled Long-COVID. This alternative perspective aims to stimulate research and serve as a lesson learned to avoid a repeat performance in the future.

Open access, https://journals.sagepub.com/doi/10.1177/20503121231194400

 

[Trish]

Lead author:
Ari R Joffe, University of Alberta Faculty of Medicine & Dentistry, 4-546 Edmonton Clinic Health Academy, 11405 112 Street, Edmonton, Alberta, T6G 1C9, Canada. Email: ajoffe@ualberta.ca

He clearly has no idea just how wrong, insulting and gaslighting this nonsense is. Perhaps someone should tell him.

 

[Jonathan Edwards]

The stupidity of this is remarkable.
The 'Bayesian' theory, which is nothing more than common sense, is that if you expect to feel something and things aren't like that then you feel the opposite. So if you expect blue and it isn't you tend to see yellow.

So if you expect to feel ill (as is suggested it seems) and your body isn't actually ill then you should feel surprisingly well. So the theory is back to front.

 

[Andy]

I wonder how the authors believe they themselves are resistant to "Pandemic-Response Syndrome", especially as in writing this piece of absurd fiction scientific paper they have exposed themselves to far more concepts of and writings about Long Covid than the average member of the public would ever see?

 

[rvallee]

What a "novel" idea. The same old idea from the 19th century, one that is always presented as some new hypothesis.

And "constant messaging about Long Covid"? Good grief why are MDs allowed to just make stuff up like this? You can't do that in most disciplines, it will get you mocked as a clown.

 

[Jaybee00]

Well he is a part of the Canada strong and free network, so there’s that.


https://canadastrongandfree.network/speakers/ari-joffe/

 

[DokaGirl]

Well he is a part of the Canada strong and free network, so there’s that.


https://canadastrongandfree.network/speakers/ari-joffe/

Thank you for this @Jaybee00.

Always amazing how some medical personnel can ignore scientific evidence in favour of weak theories.

 

[Arnie Pye]

Well he is a part of the Canada strong and free network, so there’s that.

https://canadastrongandfree.network/speakers/ari-joffe/

I just checked that link and looked at the "About Us" link - it suggests to me that it is a pressure group promoting right-wing ideology.

The Canada Strong and Free Network was founded in 2005 as the Manning Centre for Building Democracy to support Canada’s conservative movement by networking best practices and ideas pertaining to limited government, free enterprise, individual responsibility and a more robust civil society. The name change took place at the request of the organization’s founder Preston Manning in 2020.

 

[Hoopoe]

You've got to be seriously irrational to believe in this.

 

[DokaGirl]

I just checked that link and looked at the "About Us" link - it suggests to me that it is a pressure group promoting right-wing ideology.

Yep.

 

[DokaGirl]

The dismissal and disdain of society's elders is plain to see in COVID literature that minimizes the general risk, because it's mainly people 70 and older at most risk ("so who cares").

Early in the pandemic we met a fellow with this attitude: who cares if senior citizens, die of COVID. Odd, that his appearance showed he was fairly close to that age range himself.

ETA: edited for clarity (hopefully!)

 

[EndME]

This has created a self-fulfilling prophecy by inducing the very predisposing, precipitating, and perpetuating factors for the syndrome. Finally, we introduce the term "Pandemic-Response Syndrome" to describe what previously was labeled Long-COVID.
Open access, https://journals.sagepub.com/doi/10.1177/20503121231194400

Now that's funny. Didn't patients have to come up with the name Long-Covid because it was a new phenomenon nobody knew of and nobody was writing about, a community of patients meeting on Twitter? Did they believe in a disease that they didn't believe in? Now that news and scientists have started reporting on Long-Covid and creating the "self-fulfilling prophecy" the numbers have actually gone down slightly or have stabilised a bit. Mhhh, what am I missing?

 

[SNT Gatchaman]

Expert groups have emphasized that Long-COVID is a feared and common complication in the population.

Yes expert groups have because that's what experts do.

They fail at their initial point —

What is currently known about Long-COVID
1. Compared to controls, the incidence of Long-COVID is very low in children and also low in adults.

An estimated 10% of those infected, with at least 65 million affected is not low by anyone's definition.

And of course they quote Matta et al, despite the fact that their findings have been debunked and biologically explained.

Several studies of Long-COVID suggest that nocebo effects are occurring. Matta et al. found that belief in having been infected (i.e., self-reported infection) had odds ratio (OR) ranging from 1.39 to 16.37 for persistent symptoms—that is, belief was associated with persistent symptoms to a similar extent among participants with negative and positive serology results.

For example, “[fatigue is] unrelenting exhaustion and a constant state of weariness that reduces a person’s energy, motivation, and concentration,” and “millions of economically active people may be disabled by Long-Covid” stating that fatigue was “a feeling of utter exhaustion, energy drain, or bodily dysfunction that is not necessarily triggered by exertion and is not always relieved by rest.” Another review warned of “an alarming picture of an emerging neurological health crisis.” A recent narrative review of Long-COVID claimed that COVID-19 “can severely damage multiple organs, including the nervous system” and that “COVID-19 has significant long-term effects on the nervous system.” A Scientific American paper asserted that patients have “extreme fatigue,” “add up to millions more people affected—and potentially disabled,” and “[Long-COVID] could last many years.” We believe this exaggeration is counter-productive, as will be discussed later.

This paper is highly political and frankly obnoxious.

As editorialists commented, “when we close schools, we close their lives.”

The COVID-19 mental disorders collaborators identified being female as a risk factor, and commented that this may be due to women being more likely to be affected by the social and economic consequences of the pandemic response (e.g., having additional carer and household responsibilities due to school closures or unwell family; more likely to be financially disadvantaged due to lower salaries, less savings, and less secure employment; more likely to be victims of the increased domestic violence).

In addition, government covert psychological strategies used to induce fear in the population likely contributed, with people being “bombarded with fear-inducing information,” aiming to increase “the perceived level of personal threat” which “ultimately it [sic] backfired because people became too scared.” Taylor has coined the term “COVID Stress Syndrome” that describes this fear, including fear of becoming infected, of coming into contact with fomites or foreigners, and of socioeconomic consequences, often with compulsive checking and reassurance seeking, and traumatic stress symptoms.

It is worth mentioning that, even prepandemic, stress and adverse mental health were associated with inflammation and neuroinflammation, making the direction of causality difficult to determine.

Yes that certainly is worth mentioning. But instead they proceed with —

Reviews have written that if inflammation is found, this is “consistent with decades of psychoneuroimmunology research in patients with anxiety disorders, depression, and traumatic stress-related disorders,” “inflammation and immune dysregulation may link psychological distress with post-COVID-19 conditions [e.g., distress is associated with chronic systemic inflammation, and “mental health disorders are associated with chronic low-grade inflammation and microglia activation” in the central nervous system],” “psychosocial factors are also very important in regulating our immune system [e.g., immune abnormalities are found in chronic fatigue syndrome (CFS), fibromyalgia, chronic pain, depression and other mental health disorders, with increased peripheral inflammation and activation of glial cells with neuroinflammation],” and suggesting that maladaptive behavioral responses are actually causing the abnormal immune findings.

 

[SNT Gatchaman]

Many diverse infections have been associated with so-called unexplained post-acute syndromes with “remarkably consistent” “core symptoms centering on exertion intolerance, disproportionate levels of fatigue, neurocognitive and sensory impairment, flu-like symptoms, unrefreshing sleep, myalgia/arthralgia, and a plethora of nonspecific symptoms.”

Suggested treatment is multidisciplinary and includes explaining the diagnosis of a somatic symptoms disorder through education of the patient and caregivers (including the disorder of brain function explanation to be discussed later), graded physical therapy/ rehabilitation, and cognitive behavioral therapy, with an emphasis changed from cure to care and coping, focusing on perpetuating factors that affect overall functioning.

Apparently the cure for this paradigm of abnormal illness beliefs doesn't actually work. We're still promoting it as the only therapy though...

Willis and Chalder explicitly suggested that Long-COVID may be an SSD. They suggested that pandemic effects “create a ‘perfect storm’ for the development of persistent physical symptoms,” contributing to predisposing (e.g., psychological distress, stress, anxiety, depression, inactivity, social isolation, adverse media exposure), precipitating (e.g., acute COVID-19 symptoms), and perpetuating (e.g., beliefs of a serious prolonged illness conveyed by the term “longhauler” and medical and media portrayal of serious consequences and prolonged recovery) factors.

Several studies have documented a marked increase during the pandemic in functional tick-like behaviors (a form of FND) in children and adolescents, especially females, often associated with other somatic symptoms. This functional disorder is believed to have occurred with the pandemic-associated surge in social media and digital technology use (i.e., viewing of social media content involving tic-like attacks) combined with increased stress and isolation associated with imposed pandemic restrictions (i.e., lockdowns and mental health deterioration).

Nope, it can be shown to be caused by specific neuro-autoimmunity.

Explanation should avoid problematic statements such as “all the tests were normal, so there is no disease,” “this is a psychiatric condition,” or “this is all in the mind”; these are not only inaccurate but also reduce trust and increase problematic cognitions. [...] Follow-up is important to prevent the patient from feeling abandoned or ignored. Cognitive behavioral therapy aims to change maladaptive thoughts (e.g., symptom focusing, believing symptoms are a sign of damage, catastrophizing) and behaviors (e.g., avoidance of social interaction or physical activity).

our hypothesis avoids the accusation of “medical gaslighting,” by attempting to maintain epistemic humility and avoid ontological politics.

Don't think you've succeeded.

we offered a physiological explanation for the syndrome, that is, the brain’s Bayesian perceptual processing. Accordingly, it would be a mistake to think we suggest that Long-COVID is “only a psychological problem”; this would be a belief that mistakenly perpetuates mind–body dualism, and misunderstands the mechanisms of brain functioning and perception.

I think this paper exemplifies the mistakes and misunderstandings of our era. I guess it's good in a way to see this nonsense laid out so "clearly".

this was not a systematic review, and we may have missed important studies contrary to our hypothesis.

You (literally) have no idea.

Ethics approval: Not applicable

Indeed.

 

[Sean]

predisposing, precipitating, and perpetuating factors

Spot the tired old provenance.

 

[bobbler]

Apparently the cure for this paradigm of abnormal illness beliefs doesn't actually work. We're still promoting it as the only therapy though...





Nope, it can be shown to be caused by specific neuro-autoimmunity.





Don't think you've succeeded.



I think this paper exemplifies the mistakes and misunderstandings of our era. I guess it's good in a way to see this nonsense laid out so "clearly".



You (literally) have no idea.



Indeed.

Willis and Chalder explicitly suggested that Long-COVID may be an SSD. They suggested that pandemic effects “create a ‘perfect storm’ for the development of persistent physical symptoms,” contributing to predisposing (e.g., psychological distress, stress, anxiety, depression, inactivity, social isolation, adverse media exposure), precipitating (e.g., acute COVID-19 symptoms), and perpetuating (e.g., beliefs of a serious prolonged illness conveyed by the term “longhauler” and medical and media portrayal of serious consequences and prolonged recovery) factors.

I'm so bored of this pretend job area existing explicitly to allow individuals to basically troll vulnerable people with bigotry - which is what this is - and then pretend it is 'Ok'd' rather than just hatred and rumour-mongering to do harm of the worst kind. There is nothing logical or medical or psychological about what is said there it just as common language would call it 'talking smack about those who you think are smaller than you so you can pick on' which is the most disgusting thing like those who choose to rob old people rather than at least being even-handed

I saw the whole SSD thing being pushed by Sharpe into the DSM V and it made no sense as a condition and was clearly just intended as a no-win whereby noone could ever prove it wasn't if they were rude enough to upset or indeed just lied about 'perceiving upset' because it was a manifesto to say there was no longer any exclusion from having a genuine condition causing your symptoms. The power that provided those who are far from responsible individuals over anyone unfortunate enough to cross their path could never be justified really - and seeing it quoted by certain individuals now in this way just confirms what I predicted.

I get so offended that these people are paid for the work they do particularly by taxpayers as it is nothing more than some grumpsromp going around spending their life ranting about how women are hyserics and don't listen to them because they are just a bunch of mad whingers. Hidden by nothing. From someone who in Chalder as CBT professor isn't qualified in anything other than brainwashing techniques, rather than actual psychology or the wider idea of 'mental health' or 'health' or anything like that, ie her culmination of 'expertise' focuses only on the 'how to make the 'mode of delivery' seem efficient in producing changed answers on a questionnaire' and not in anything that covers whether what is being delivered is healthy rather than harm. Her area doesn't require her to check whether what might have been embedded 'effectively' actually was healthy rather than harmful. Or to diagnose, nevermind speak to someone's personality. So why is she allowed to speak on these things in such a way and not just seen as a layperson should which is just a woman saying stuff that is unpleasant about other people? who happen to mostly be women and all are vulnerable and should be being safeguarded from those who have irrational discrimination against them

 

[rvallee]

Not really surprised, but one of the authors is a pandemic minimizer who seems to think that public health shouldn't control infections and promoted their belief that they are good for our health. Or maybe some infections. Hard to tell anymore. The premier of Alberta is strongly opposed to any such measures, and generally antiscience, and has cited Joffe as one of the only medical experts she listens to.

When you peel back the later of Long Covid denial, you will find people who have and continue to promote the idea that everyone should be infected as much as possible, because it's good for our health. Somehow. Of course they can't accept that LC is real, it shows them wrong. So it has to be something else. In a real sense this is a huge conflict of interest, but a very subtle one.

 

[rvallee]

Ah, it seems that others found out about Joffe's extracurricular activities. Good.

The dismissal and disdain of society's elders is plain to see in COVID literature that minimizes the general risk, because it's mainly people 70 and older at most risk ("so who cares").

Early in the pandemic we met a fellow with this attitude: who cares if senior citizens, die of COVID. Odd, that his appearance showed he was fairly close to that age range himself.

ETA: edited for clarity (hopefully!)

Honestly, it really has to be said and understood that those attitudes are not fringe in medicine, but fundamental to it. I'm not shocked anymore, but I was still surprised by what Fauci said:

Fauci to BBC: "Even though you'll find the vulnerable will will fall by the wayside, they'll get infected, they'll get hospitalized, and some will die. It's not going to be this tsunami of cases that we've seen."

I find this to be a psychopathic attitude, because nothing is being done anymore to help the vulnerable. Medical facilities are now some of the most dangerous places to be when it comes to airborne infections. Not only are vulnerable people being openly sacrificed, but previously healthy people are made disabled because of those attitudes. So many healthy people are being sacrificed, all out in the open. Not much different from death squads run by the government.

There's a strong conviction of "can't help everyone, so don't bother". But that's exactly the premise of the system, the fiction under which we all live, where medicine decides who is ill and who isn't, and determines who gets help and who doesn't. And it turns out that a lot of those things are decided by feelings, and whether they can actually do something to help or not, which somehow influences the definition of who is actually ill. Even worse, a lot of what they can do to help is determined by those attitudes, so it all loops back, failure causing more failure, justifying it endlessly.

Medicine is openly eugenicist, and sees nothing wrong with it. It's taught at medical school and never questioned, always justified. It's shocking but it's true. I guess we can go there and say "not all doctors", but when you have to go there, the premise of a just and fair system is already lost. It really is a human system like any other.

 

[rvallee]

Now that's funny. Didn't patients have to come up with the name Long-Covid because it was a new phenomenon nobody knew of and nobody was writing about, a community of patients meeting on Twitter? Did they believe in a disease that they didn't believe in? Now that news and scientists have started reporting on Long-Covid and creating the "self-fulfilling prophecy" the numbers have actually gone down slightly or have stabilised a bit. Mhhh, what am I missing?

It's been a main frustration to most long haulers that they never heard about it from the start, and is now pretty much the main one. At first it was somewhat justified by being "new", but that doesn't work anymore.

This makes it a completely delusional position, it's obviously and blatantly false and it's a popular one. Might as well blame it on all those headlines about alien abductions that every single newspaper runs every day. And hardly any MD will openly object to this, maybe hundreds in total, precisely because those beliefs are so fundamental to what they do.

 

[rvallee]

Paul Garner tweeted this yesterday.

I got puzzled wondering if it's the new research coming out he mentioned recently. It's described exactly the same way as this, the new obsession is clearly 'predictive coding'.

But that's not what's notable. The hypothesis presented here is of the impact of messaging about Long Covid. Which is minimal. But more importantly, did not exist at the time of Garner's tall tales timeline. In fact he did some of that messaging himself. Because there was basically none.

Ah well, this is like deconditioning without evidence of deconditioning, because "they're active enough". Not making sense is mandatory.