Opinion What is the Role of “the Psyche”? Long COVID and ME/CFS as Test Cases for Evidence-Based and Patient-Centered Psychiatry and Psych..., 2026, Schomerus

rvallee

rvallee

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What is the Role of “the Psyche”? Long COVID and ME/CFS as Test Cases for Evidence-Based and Patient-Centered Psychiatry and Psychotherapy
Only available in German: https://www.thieme-connect.com/products/ejournals/pdf/10.1055/a-2866-9127.pdf

Posted in the psychosomatic forum but is sympathetic and argues about its harms.


Abstract

The role of psychological factors in the development and course of Long Covid (LC) and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) remains a subject of controversial debate. We argue that psychologizing LC and ME/CFS carries significant risks: it leads to potentially harmful therapies, invalidates the patients' experience of illness, hinders effective interventions such as pacing, diverts focus from necessary physical diagnostics and treatment, disadvantages patients in
medical assessments, and places a considerable additional burden on the families of affected children or other relatives.

We show that many of the arguments presented for a psychological contribution are nonspecific or insufficiently supported by empirical evidence. Our essay therefore advocates for extreme caution in attributing psychological factors to these conditions, in the interest of a specific, evidence-based, and patient-centered psychiatry and psychotherapy
 
What I find damning is that I perceive these narratives about psychological factors as an invasion of my life by zealots who are unable to respond positively to a difficult situation, don't understand it and aren't interested in learning more. This perception is the result of interaction with this ideology.

It has a flavour of a witch hunt and a moral panic, of an ignorant mob wanting to punish the deviant for the sins they imagine he has committed.

If you don't understand an illness, the behaviour adopted by the patient can seem nonsensical, immoral, self-defeating. This could be overcome by curiosity and willingness to listen and listen.
 
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Lead author is Georg Schomerus who presented so empathically at the UniteToFight 2024 conference.

SNT Gatchaman said:
Psychiatrist Prof. Georg Schomerus - what an absolute star :trophy@ He's like Chat-GPT 5000 trained on S4ME, brought to life.
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A couple of translated passages:

For example, it is argued that psychological involvement cannot be meaningfully excluded because psychological factors are relevant in every chronic illness. In reality, however, the proportion and nature of psychological factors can only be determined if the "non-psychological" component is known—as is the case with multiple sclerosis, cancer, and chronic heart disease. As long as there are no valid biomarkers for individual disease courses, the relevance of psychological factors in individual cases, as well as at the group level, remains speculative. This also applies when the biopsychosocial model is cited as evidence that there are almost always psychological factors that must be considered. As long as little is known about the pathophysiology of the disease, and the "biological" component of the model cannot be precisely determined, the model tempts one to overestimate the psychosocial components without the possibility of external validation. In fact, the model itself makes no statements about the direction and intensity of specific influences; in our view, it should be understood more as a matrix upon which hypotheses could be formulated and empirically tested.
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The assumption of psychological factors for the development or maintenance of LC and ME/CFS appears to us not only insufficiently substantiated, but above all risky, with the potential to cause significant harm to those affected. It makes no sense to impose such a disease model with questionable benefits and considerable risks against the experiences of those affected.
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