Long Covid - where is the psychosomatics ?

Full article translation excepting references reproduced below - Fair use, given the context: https://www-dgpm-de.translate.goog/...omatik/?_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=en

German Society for Psychosomatic Medicine and Medical Psychotherapy (DGPM) registered association

Long Covid - where is the psychosomatics?
Created by Peter Henningsen, Munich |11/04/2022 | news

"The debate about what causes the sometimes pronounced symptoms that people suffer from after they have been infected with Covid-19 and which are referred to by terms such as Long and Post Covid is fierce.

Very many of those affected, self-help groups and also physicians represent vehemently one-sided biological conceptions of the cause, combined with sometimes downright scornful rejection of psychosomatic aspects of this symptom syndrome.

There are parallels to the debate about Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), it is also said that many patients with Long Covid also suffer from ME/CFS. Unfortunately, these voices also attract a great deal of media attention, being propagated by Ev Hirschhausen, for example. The whole thing is not a specifically German phenomenon,

As psychosomatic physicians, it is clear to us that in the experience of persistently stressful physical complaints, such as in the case of Long Covid Syndrome, in addition to possible, possibly yet undiscovered biological, e.g Factors, up to current and biographical stressors. In this biopsychosocial understanding, Long Covid can be seen as a functional somatic syndrome.

However, we also know that with our outdated models for the purely psychogenic cause of such physical complaints, we have historically offered a lot of scope for attack for the simply wrong equation of psychosomatic and psychogenic that is often used polemically in today's debate.

But what do we do to not only internally contradict the abridged and falsified, sometimes slandering, anti-psychosomatic statements, but also to oppose something (professionally) publicly? There are different levels here: on the one hand, psychosomatics represent our view of Long Covid in nationwide interdisciplinary research projects and associations, a large multi-centre joint project on Long Covid (PsyLoCo, spokeswoman Dr. C. Allwang, Munich) is coordinated by Psychosomatics .

Groups in Essen and Hamburg have already published interdisciplinary studies with psychosomatic leadership or participation (Fleischer et al. 2022, Engelmann et al. 2022), which show the importance of psychosocial factors for the risk of contracting Long Covid or for the clinical picture itself.

In a large article in the Süddeutsche Zeitung on Long Covid at the beginning of September, psychosomatic experts and perspectives were presented so clearly that the author was exposed to a considerable shitstorm from supporters of purely biological perspectives (Bartens 2022). Members of the Bundestag Health Committee were also contacted and provided with material on the issues.

Since the strongly anti-psychosomatic and also anti-psychotherapeutic attitudes are traditionally particularly pronounced in the group of ME/CFS advocates, it is important that psychosomatics show the flag here as well.

The AWMF-S3 guideline of the German Society for General Medicine on fatigue was so strongly influenced by various patient self-help groups and medical advocates of the biological ME/CFS concept that there, for example, psychotherapy and stepped activation as a form of treatment are actively discouraged in the presence of ME/CFS became.

On the initiative of the DGPM and DKPM, a dissenting opinion was written, which was also supported by the DGPPN and the DGIM (internal medicine), which contradicts these views and is included in the guideline.

Members of the DGPM are also co-authors on an international publication with more than 50 co-authors that exposed serious methodological errors in the guideline on ME/CFS published by the English guideline organization NICE last year and to which many advocates of the biological views refer will.

The DGPM and DKPM also comment on a preliminary report by IQWiG on ME/CFS, which is based heavily on the NICE guidelines, but fortunately draws its own conclusions that are somewhat more favorable for psychotherapy and graded activation, with the aim that in the assessment there the benefit of psychotherapy is emphasized even more clearly. which the English guideline organization NICE published last year and to which many advocates of biological views refer.

The DGPM and DKPM also comment on a preliminary report by IQWiG on ME/CFS, which is based heavily on the NICE guidelines, but fortunately draws its own conclusions that are somewhat more favorable for psychotherapy and graded activation, with the aim that in the assessment there the benefit of psychotherapy is emphasized even more clearly. which the English guideline organization NICE published last year and to which many advocates of biological views refer.

The DGPM and DKPM also comment on a preliminary report by IQWiG on ME/CFS, which is based heavily on the NICE guidelines, but fortunately draws its own conclusions that are somewhat more favorable for psychotherapy and graded activation, with the aim that in the assessment there the benefit of psychotherapy is emphasized even more clearly.

Even more activity would certainly be desirable, but it comes up against the limits of time and human resources. After all, we wanted to show that psychosomatic medicine raises its voice in various places - and we want to encourage you, dear colleague, to do the same in your environment whenever the opportunity arises. We owe this to our profession, but above all to the patients affected."

 

I guess they wanted to make it very clear that they don't have a damn clue and that the massive harm and suffering they forced on us was not a misunderstanding of any kind, and that they have not learned a single thing out of this.

The answer to the question is simple: it's everywhere, it's literally the current failed model. Which they acknowledge, making the question even more bizarre, as it's basically the whole thing and the reason no progress has been made in decades. Frankly this is like a political party that has had full control of a government for decades and runs on a campaign of fixing the things they broke. They're in charge of everything and take responsibility for nothing, are only in it to impose their will.

They are in this for themselves and simply don't see us. The best recipe for a disaster: the people doing the disaster are oblivious to everything they're doing, and are also the people who decide whether things are good and they think they're doing uh-may-zing.

 

They really do say the quiet bit out loud over there.

 

Also very disappointed, on toggling the translation, that the German for “shitstorm” isn’t scheissesturm, it’s “shitstorm”. Perhaps it loses something in translation.

 

So if the authors believe and then assert without evidence something is ‘psychosomatic’ then it is psychosomatic.

If I believe ‘the moon is made of cheese’ and say ‘the moon is made of cheese’, by this reasoning it is then it is a dairy product formed by coagulation of the milk protein casein.

 

Literally, and I do mean literally literally, this:



That's neat. "Trust us we're experts" is going to a lot of weight in the near future. How can it be trusted that they don't make many small mistakes when they are obsessively committed to major mistakes affecting, by their own claims, a large fraction of all clinical consults?

This is like a filter that should not let through anything bigger than a grain of sand and you basically find a whole trash container's worth of boots and other large pieces of garbage.

 

Anyone know what this refers to?

 

This doesn't seem to have 50 co-authors but might relate:

Eight major errors in the review process and interpretation of the evidence in the NICE guideline for chronic fatigue syndrome and myalgic encephalomyelitis
White, P., Abbey, S., Angus, B., Ball, HA., Buchwald, D., Burness, C., Carson, A., Chalder, T., Clauw, DJ., Coebergh, JA., David, A., Dworetzky, BA., Edwards, MJ., Espay, AJ., Etherington, J. & Fink, P.
2022, (Accepted/In press) In: Journal of Neurology Neurosurgery and Psychiatry.

I can't see it published yet but it's referenced on Per Fink's CV.

 

Something to look forward to. re 'more than 50 co-authors', sounds like there's something else fun coming too?

We should expect more powerful people to speak out now this has become viewed as an example of 'EBM vs the mob'.

 

It feels like these scientists are trying to stay relevant by posting this. The tone of BPS researchers regarding ME was always overconfident superiority. Now the tone is one of being left out, and trying to get back in. "Why is the world ignoring us?" That's a positive sign.

 

I see Alan Carson and who I believe to be Alberto Espay listed as co-authors. Espay is a major player in the FND epistemic land grab, as is Carson, and I have no recollection of him ever being involved in ME before. Disconcerting to see these names anywhere near this condition. The traditional powers aren’t surrendering their hegemony, and I worry whether favorably predisposed clinicians will possess the temerity to respond.

 

Yup.

The world: We might let you back in if you SHOW US THE EVIDENCE.

Also the world: We know you haven't got any.

 

In case Henningsen's appeal disappears someday, I've saved the original link [edit: ] Here:

https://archive.ph/pEki8

[Internet Archive doesn't appear to work

https://web.archive.org/web/20221117152225/https://www.dkpm.de/de/global/news.php?showId=735 ]

And about...

The Journal of Neurology Neurosurgery and Psychiatry is published by the BMJ group and Alan Carson is one of the Journal's Associate Editors.


See also here:
https://www.s4me.info/threads/uk-ni...lication-discussion.22996/page-51#post-447147

Edit:

I would like to add that personally, I had as part of my now 25 years of medical care for ME/CFS a few good and helpful encounters with one general physician with a psychosomatic qualification in a psychosomatic clinic, a psychiatrist (in a neurological rehab clinic), a psychologist, a neuropsychologist, a couple of exercise therapists/ physical therapists and also one general physician with a psychosomatic qualification in a psychosomatic clinic.

Those were the rare exceptions though who took my illness-related limitations and my experiences with trying to gradually extend them seriously. They also disagreed with the psychological diagnoses (aka Neurasthenie, personality disorder and the like) the other, unhelpful psychocomatic doctors and psychotherapists had ascribed to me.

Yet, for most of my 25 years with the illness, the latter diagnoses had been preventing decent medical care, including a lack of acknowledgment of my severe disability and reduced capacity (later complete incapacity) to work to work. Only recently this was acknowledged, thanks to a reasonable general physician and a neurologist (who's by the way also a psychiatrist) both 'ordinary' SHI-accredited/ NHS- doctors without expertise in ME/CFS, just a willingness to listen and read some papers on the evidence of what ME/CFS might be and how it cannot be treated.

 

Yeah, frankly it looks like the next few months could be especially ugly and disrespectful. The only effect it seemed to have had is to get a more aggressive counter-reaction. There's just too much at stake, too many careers, billions wasted and millions of lives ruined.

Admitting this is clearly too big. The whole nightmare has to keep going like the bus in Speed or it just blows up and no one wants to deal with that, no one even has to.

If anything, Long Covid seems to have given massive fuel for psychosomatics. I wouldn't be surprised if we see 10x more efforts and resources towards psychosomatics than real research. Which will make an inevitable breakthrough, although it could still be years away, especially damning with all of this so fully blatant and documented.

Making it all really loud and clear that none of this was accidental, that they still have complete domination over us and that it's their show, they own us.

 

To me, that feels like a positive interpretation of a negative sign.

I think that we're facing a long and drawn out conflict that's going to end up making life worse for patients for many more years. And any mistakes from patients could make things worse, with there being no mechanisms to help prevent mistakes from patients.

 

The Journal of Neurology Neurosurgery and Psychiatry has a Patient Editorial Board: https://jnnp.bmj.com/pages/editorial-board/

Sara Riggare, Stockholm, Sweden. Sharon Roman, Canada. Rick Thurbon, Sydney, Australia.

Sara Riggare https://www.riggare.se/

Sharon Roman https://blogs.bmj.com/bmj/2019/08/02/sharon-roman-because-empathy-matters/

Patient Editorial Board for JNNP https://www.semanticscholar.org/pap...rbon/d0084927658386b9b150e8d7069b7b1d6514c6f8

full pdf = https://jnnp.bmj.com/content/jnnp/early/2020/09/01/jnnp-2020-324675.full.pdf

"At a recent BMJ Editor’s retreat, as formal proceedings ended and the dinner began, a late arrival and the need to squeeze in one more seat at the table resulted in the new direction you see, with the launch of a Patient Editorial Board. Following wide ranging discussions about patient involvement across all aspects of clinical research, a commitment was made to address ways to improve patient engagement in the studies that we publish. Establishment of an Editorial Board comprised solely of patients to help guide the journal, is part of a growing trend for greater consumer involvement across all walks of life in an attempt to refine and drive more meaningful exchanges and outcomes. Of relevance to neurology practice, a number of patient support groups have reacted to a perceived lack of progress in relation to discovery of new treatments and investigation of rare neurological diseases. To date, rare diseases seem to have been left in the wake of the more prominent conditions. This has become increasingly apparent in the realm of neurodegenerative disease where patient groups have broadly questioned the direction of research. Specifically, questions have arisen about the suitability of clinical trial models particularly for conditions where there is significant heterogeneity, even if … "

 

"Psychosomatic physician" means they only think they're doctors