Suzanne O’Sullivan’s new book ‘The Age of Diagnosis’ and her curious characterisation of Long Covid as a psychosomatic condition

[SNT Gatchaman]

https://bjgplife.com/suzanne-osulli...n-of-long-covid-as-a-psychosomatic-condition/

by Dr Elke Hausmann (Bluesky)

Listening closely to the episode on Long Covid in her book presentation on BBC Radio 4 […] her language is a give-away. She talks about ‘patient activists’, rather than ‘advocates’. ‘Activists’ conjures up the image of agitators, disruptors that need to be brought back into line. ‘Advocates’ are simply people who stand up for people who have no voice.

She argues that ‘science must take precedence’ and ignores the huge research literature that makes the case for Long Covid most definitely not being a psychosomatic condition, cherry picking some research that seems to support her view.

She makes much of the fact that for most Long Covid patients, tests are coming back as normal, and that this demonstrates that the condition must be psychosomatic. Curiously, she is actually contradicting herself when she talks about epilepsy, which is her field of expertise, when she states that negative tests are no obstacle to giving a diagnosis of epilepsy, as long as the patient describes their seizures as typical, since a good doctor takes into account the clinical presentation and does not put too much store on negative test results alone.

O’Sullivan suggests that people don’t like to be told that their physical symptoms might have an underlying psychological explanation. Her idea is that we simply ignore this possibility because mental health conditions are still stigmatised in society, and we don’t want to be seen through the lens of that stigma. Proponents of the psychosomatic explanation of Long Covid (and the same goes for ME), always make out as if we were really the ones stigmatising patients with mental health disorders, by inferring that mental health conditions are somehow lesser, when we represent our illness as ‘physical’.

O’Sullivan and others fail to recognise the likelyhood that most Long Covid patients will have already tried to improve their condition through psychological and behavioural approaches (pacing, breathing exercises, mindfulness and meditation, counselling and therapy), because in a situation where medicine is not able to give you any treatment that will cure your disease, the idea that there might be some underlying psychological or behavioural issues that, if addressed, could cure you, is the only thing we have left. So we try everything, only to find that none of it cures us. It might make us feel a bit better in ourselves and it might make it a bit easier to manage our condition, but we are still ill.

When she talks about Long Covid, she is talking about me. She characterises Long Covid as an invented and socially contagious condition, putting doubt into the minds of her readers and listeners about any patient who has Long Covid. As to whether their condition might not really be of psychosomatic origin, and yes, in our society that is still stigmatised (no matter how much she says that it should not be, and insinuates that we are just misunderstanding what psychosomatic conditions are).

Some GP and psychiatrist comments follow the article.

 

[Utsikt]

The article mostly consists of good points. There are a few inaccuracies, especially with regards to PEM and pacing.

even if I am still left with the (maybe even more) disabling exercise intolerance, which is driving the relapsing and remitting symptom complex described as post-exertional malaise, for which there are currently no treatments.

The terminology is a bit confused here.

O’Sullivan and others fail to recognise the likelyhood that most Long Covid patients will have already tried to improve their condition through psychological and behavioural approaches (pacing, breathing exercises, mindfulness and meditation, counselling and therapy), because in a situation where medicine is not able to give you any treatment that will cure your disease, the idea that there might be some underlying psychological or behavioural issues that, if addressed, could cure you, is the only thing we have left. So we try everything, only to find that none of it cures us. It might make us feel a bit better in ourselves and it might make it a bit easier to manage our condition, but we are still ill.

This section makes it seem like pacing is a treatment.

 

[Utsikt]

Snippets from some of the comments:

Dr Selina Shaw:

Patients with Long Covid are sick because a virus has damaged their bodies, they are not making it up. It’s the arrogance of our profession to assume that because we, the physicians, do not recognise a new pattern of symptoms, the patient must be anxious or somatising. I thought that kind of attitude was defunct in medicine, paternalism seems to be alive and quite well in some quarters.

I suggest O’Sullivan removes her chapter on Long Covid until she has done some more homework on the subject. 2 million people in the UK have long covid, of which 110,000 are children and 10,000 are NHS staff who are still sick, and none of them are making it up. They are disabled, have lost their jobs , homes and life to this illness and O’Sullivan trivialises all of their suffering with her thoughtless comments.

Dr Sheri Winder:

For a lot of clinicians I suspect, even those who are well read on the subject, the term post exertional malaise will not conjure an image that comes close to the reality of living with such a debilitating condition. Brain fog and fatigue likewise sound far less significant than they are.

 

[rvallee]

This section makes it seem like pacing is a treatment.

It's a behavioral adjustment approach, so it's a fine characterization. The rest of the list aren't really treatments either, they're more generic support with the intent of supporting behavioral adjustments, little of which can fix specific problems.

And it's still a fact that pacing is the most effective thing to do, the fact that medical science is still unable to determine it either way is more of an indictment of how poor their methods and instruments are, than a judgment on what pacing is or does. It should not be considered a treatment, but medicine doesn't really seem to have the language or skills to integrate it with a more accurate meaning. It can't be called an intervention either, because that involves an external actor, and the whole point is precisely that no one can direct it with useful knowledge.

I thought that kind of attitude was defunct in medicine, paternalism seems to be alive and quite well in some quarters.

Yikes. Shows how distorted the training in medicine is. How can anyone be so ignorant that psychosomatic ideology has never been more influential and used than today? It's baffling. They are completely unaware of the big picture, which makes the entire premise of this ideology being 'holistic' so completely ridiculous.

Good comment from Winder on the problems with language, and how they so poorly convey what's going on. Not a surprise, that aside from fatigue, which medicine doesn't understand either, brain fog and PEM are colloquial terms that we have to use because the medical profession is negligent, and hasn't come up with ones they can use and understand. Not our fault, though, just like Long Covid the idea was that professionals would take it from there.

 

[Utsikt]

The rest of the list aren't really treatments either, they're more generic support with the intent of supporting behavioral adjustments, little of which can fix specific problems.

There’s this later on in the paragraph. So I still believe that pacing is portrayed as an attempted cure in this instance.

the idea that there might be some underlying psychological or behavioural issues that, if addressed, could cure you, is the only thing we have left.

Yikes. Shows how distorted the training in medicine is. How can anyone be so ignorant that psychosomatic ideology has never been more influential and used than today? It's baffling. They are completely unaware of the big picture

I think it’s mostly understandable. GPs primarily work alone and rarely get opportunities to interact with peers outside of their office. Although they should probably have been able to catch on by reading the news.

 

[rvallee]

I think it’s mostly understandable. GPs primarily work alone and rarely get opportunities to interact with peers outside of their office. Although they should probably have been able to catch on by reading the news.

That's really it, though. Basic and updated training is inadequate for them to know some very basic things. It depends entirely on rare circumstances. It's like looking at official professional resources for ME/CFS or Long Covid, and how utterly inadequate they are, how a physician who relies only on those official sources is basically no better informed than a random person who has read a few magazine articles.

In itself this isn't unusual, training to become a programmer requires significant personal time practicing and reading about things outside of curriculum, forever. Hell, many programs don't even feature basic things like version control, people are expected to learn on the job.

But with the medical profession it becomes massively problematic because most physicians don't do that, they work too much, and in circumstances like dealing with ME/CFS, they accept the unreasoning that if it's not covered by basic or ongoing training, and especially if it's very popular, then it doesn't exist, and their knowledge remains static.

It's really all the damage done by psychosomatic ideology. It's doing exactly the role that the Catholic church did in opposite Galileo. Even what appears to be the recent weird trend about the "power of explanation" is exactly the same as the old "you have a divine explanation of God's work in the beauty of nature, why would you seek a lesser explanation when there is one that involves a perfect creator?". It's not similar, it's exactly the same: beliefs are overruling the entire purpose of science, of trying to know better.