This is a great post. I’m very interested in your recent articles on long covid!
I continue to think that the distinction between ‘organic’ and ‘psychosomatic’ is not useful. To call someone’s syndrome psychosomatic implies that it is less real than an organic disease, but all it really means is that the biological basis of the condition is not understood well enough to detect it using existing tests. As long as you assume that a person with a psychosomatic condition isn’t lying about their experience, there must be a biological explanation for their fatigue. (There is no other option; the structure and function of your brain is responsible for everything you experience.) You mentioned some potential mechanisms in your previous posts (e.g. the false fatigue alarm), but whatever the cause of the problem, I think that reiterating to patients that their ‘psychosomatic’ chronic fatigue is biological (even if it can’t be detected with available tests) will go a long way to making patients with undiagnosable syndromes feel less stigmatized and demoralized.
I agree that depression is often comorbid with chronic fatigue, and that tackling the depression component might be helpful for many people. It occurs to me that encouraging patients to think of their chronic fatigue in a similar way many patients are encouraged to think about their depression. For example, CBT explicitly uses expressions like “when you’re depressed, your brain tricks you into believing you’re worthless by focusing only on negative types of self-evaluation.” Clearly, it can be helpful to conceptualize depression as a separate agent that you outsmart using strategies like CBT. The fact that the patient might be able to exert some control over their symptoms is considered empowering, and not a reason to discount to reality of their suffering. Conversely, if a patient doesn’t respond to CBT it doesn’t mean that the patient didn’t try hard enough –they are just non-responders to that particular therapy.
I can imagine that this attitude toward depression might be helpful if applied to chronic fatigue. If people were encouraged to think of their fatigue as (at least partially) a false alarm, it would open their minds to the possibility of using psychological strategies to re-train the brain’s fatigue sensor. I agree that CBT is a good basis for such a therapy, and I would love to see an RCT that tested the efficacy of this type of CBT for chronic fatigue and/or Long covid symptoms. :)
I agree although I have to point out that CBT therapy (whether for insomnia, depression, chronic fatigue, or any other condition) always takes work and effort on the part of the patient (usually around implementing new behaviours/habits and tracking things like activities, symptoms, and thought patterns). CBT therapy is different from other forms of therapy in that the therapist often prescribes "homework" for the patient to do. Doing the work is important, and some of the people who don't respond to CBT literally just didn't try hard enough. This is admittedly a problem with CBT and part of the reason response to CBT is highly variable.
I link to a new RCT study on CBT for Long Covid in the post. The CBT methods appear to be fairly similar to methods used in depression (for which fatigue is a major symptom).
It helps to start with the knowledge that SARS-CoV-2 is an engineered virus. The spike protein in particular is the part that shows evidence of having been weaponized. In a natural virus, the spike protein would be evolved simply to bind to a receptor (ACE2) and enter the cell so the virus can reproduce. But in this case, the spike protein was engineered to be toxic in multiple ways, and also to break off (Furin cleavage) so that each virus particle can produce multiple copies of the spike protein that float freely in the bloodstream.
The spike protein induces blood clots, causes neuronal damage, crosses the blood/brain barrier. Of course, there are always some hypochondriacs who induce illness by worrying. But in this case, there are two reasons not to promote this idea. First, there is a known mechanism for neurotoxicity, and second, so many patients are being gaslighted by their doctors and told "it's all in your head" because the toxicity of the spike protein (and therefore of the vaccine) is being politically suppressed and doctors don't know to recognize the symptoms.
I was not aware that the furin cleavage site caused the spike protein to break off -- I'll have to investigate that further. Certainly though free-floating spike protein have been found. In fact one study found them in higher levels in long covid patients (https://academic.oup.com/cid/article/76/3/e487/6686531?login=false). I'm actually not sure if I've seen that study before now, to be honest -- I have seen a bunch of autopsy studies and studies showing virus in fecal matter.
As I say in my other post on psychosomatic contributors (in the appendix), I do think persistent virus is a likely explanation for a lot of Long COVID symptomology. The other likely "biological"/"organic" explanation, I think, is Epstein-Barr reactivation. My own feeling is that I was most likely effected by Epstein-Barr reactivation (a booster covid vaccine did not help me -- although it helps a small subset possibly by flushing out persistent virus). Furthermore, I was under a lot of stress about a month after getting covid, and stress is associated with EBV reactivation.
I'm glad you acknowledge that for some patients with Long Covid their illness may be primarily psychosomatic in nature. However, I disagree that its not a good idea to discuss psychosomatic aspects. In my view, the exploration of such effects is often shunned online (for instance when I posted my earlier posts on the Covid Long Haulers Reddit they were removed).
I think the reason patients are "gaslighted" is not that the illness is not recognized as a serious and very real syndrome, but rather that doctors do not have any established way of treating Long Covid other than telling patients to reduce stress and try to ease back into exercise. This is actually good advice regardless of how big you think the organic effects are (ie from spike protein, etc), but many patients react very negatively too it and ignore it.
The purpose of this article wasn't to push the idea that Long Covid is all psychosomatic - I have never said that -- I have always acknowledged organic causes (in particular Epstein-Barr reactivation). I personally found the techniques here useful, as have others, but I have never proposed these techniques will help everyone with Long Covid or even the majority of sufferers.
The main impetus for writing this particular article was that a friend asked me too and I realized I have not seen any article dedicated to techniques for treating the psychosomatic aspects. There are dozens of articles on potentially dangerous and/or expensive unproven treatment methods for Long Covid, however, such as powerful psychotropic drugs, stem cell therapy, hyperbaric oxygen, etc etc. The main methods I discuss here (CBT, GET, fixing sleep, etc) have loads of peer-reviewed RCT evidence to support them in the treatment of ME/CFS and there is emerging literature showing CBT and GET help with Long Covid. This is all very important information which is not being communicated elsewhere or is being wrongly disparaged elsewhere online. None of the techniques discussed here are not being proposed as cures, merely as cheap and safe things for people to try that may help them to some extent. Maybe I should have been more clear about that.
FLCCC has effective treatment protocols for long covid and has doctors who know how to individualize treatment. https://covid19criticalcare.com/ Nattokinase not only breaks up blood clots but also binds to the spike protein.
Thanks, I will add Nattokinase to the appendix of the post.
I looked at the long covid treatment protocol from covid19criticalcare.com -- some of the blood tests are good but they don't really offer anything in the way of treatments. They talk about treating pulminary fibrosis and blood clots but both are very rare in long covid.
The same website says to follow the same treatments as for "post vaccine syndrome". That is not an established condition. Serious side effects from the vaccine (ie that are life-threatening or don't resolve in a few days) are very rare (about 1 in 10,000). Furthermore, the treatments they recommend are just a hodgepodge of supplements that don't do a whole lot (in my estimation). For instance they recommend elderberry syrup and vitamin C to help prevent infection, there's been many studies on vitamin C that show it doesn't prevent colds. They also recommend ivermectin which is a useless quack therapy for covid all around (see https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted )
Overall it strikes me as not a reputable medical site containing unscientific treatments based on unscientific anti-vax ideology.
Dan, you and I live in different COVID realities. I believe I have done my homework, reading the mainstream literature, which I see as consistently biased or fraudulent, and also the alternative literature where there is some reality to be found. I have analyzed some fraudulent ivermectin studies that were "designed to fail". I have looked at different estimates of the disabilities and deaths from mRNA vaccines, and wrote up an estimate that several hundred thousand Americans have died from prompt effects of COVID vaccination. For a start reading the alternative literature, I suggest (1) VAERS data report 35,000 deaths and 1.5 million injuries from the COVID vaccines https://openvaers.com/ (2) My review estimating American deaths from COVID vaccines as of a year ago https://mitteldorf.substack.com/p/how-many-people-have-covid-vaccines and (3) A meta-analysis of 98 IVM studies https://c19ivm.org/ .
If you're open to a discussion of major deception in the medical literature of COVID, we can exchange emails or schedule a video call.
This is a great post. I’m very interested in your recent articles on long covid!
I continue to think that the distinction between ‘organic’ and ‘psychosomatic’ is not useful. To call someone’s syndrome psychosomatic implies that it is less real than an organic disease, but all it really means is that the biological basis of the condition is not understood well enough to detect it using existing tests. As long as you assume that a person with a psychosomatic condition isn’t lying about their experience, there must be a biological explanation for their fatigue. (There is no other option; the structure and function of your brain is responsible for everything you experience.) You mentioned some potential mechanisms in your previous posts (e.g. the false fatigue alarm), but whatever the cause of the problem, I think that reiterating to patients that their ‘psychosomatic’ chronic fatigue is biological (even if it can’t be detected with available tests) will go a long way to making patients with undiagnosable syndromes feel less stigmatized and demoralized.
I agree that depression is often comorbid with chronic fatigue, and that tackling the depression component might be helpful for many people. It occurs to me that encouraging patients to think of their chronic fatigue in a similar way many patients are encouraged to think about their depression. For example, CBT explicitly uses expressions like “when you’re depressed, your brain tricks you into believing you’re worthless by focusing only on negative types of self-evaluation.” Clearly, it can be helpful to conceptualize depression as a separate agent that you outsmart using strategies like CBT. The fact that the patient might be able to exert some control over their symptoms is considered empowering, and not a reason to discount to reality of their suffering. Conversely, if a patient doesn’t respond to CBT it doesn’t mean that the patient didn’t try hard enough –they are just non-responders to that particular therapy.
I can imagine that this attitude toward depression might be helpful if applied to chronic fatigue. If people were encouraged to think of their fatigue as (at least partially) a false alarm, it would open their minds to the possibility of using psychological strategies to re-train the brain’s fatigue sensor. I agree that CBT is a good basis for such a therapy, and I would love to see an RCT that tested the efficacy of this type of CBT for chronic fatigue and/or Long covid symptoms. :)
I agree although I have to point out that CBT therapy (whether for insomnia, depression, chronic fatigue, or any other condition) always takes work and effort on the part of the patient (usually around implementing new behaviours/habits and tracking things like activities, symptoms, and thought patterns). CBT therapy is different from other forms of therapy in that the therapist often prescribes "homework" for the patient to do. Doing the work is important, and some of the people who don't respond to CBT literally just didn't try hard enough. This is admittedly a problem with CBT and part of the reason response to CBT is highly variable.
I link to a new RCT study on CBT for Long Covid in the post. The CBT methods appear to be fairly similar to methods used in depression (for which fatigue is a major symptom).
It helps to start with the knowledge that SARS-CoV-2 is an engineered virus. The spike protein in particular is the part that shows evidence of having been weaponized. In a natural virus, the spike protein would be evolved simply to bind to a receptor (ACE2) and enter the cell so the virus can reproduce. But in this case, the spike protein was engineered to be toxic in multiple ways, and also to break off (Furin cleavage) so that each virus particle can produce multiple copies of the spike protein that float freely in the bloodstream.
The spike protein induces blood clots, causes neuronal damage, crosses the blood/brain barrier. Of course, there are always some hypochondriacs who induce illness by worrying. But in this case, there are two reasons not to promote this idea. First, there is a known mechanism for neurotoxicity, and second, so many patients are being gaslighted by their doctors and told "it's all in your head" because the toxicity of the spike protein (and therefore of the vaccine) is being politically suppressed and doctors don't know to recognize the symptoms.
I was not aware that the furin cleavage site caused the spike protein to break off -- I'll have to investigate that further. Certainly though free-floating spike protein have been found. In fact one study found them in higher levels in long covid patients (https://academic.oup.com/cid/article/76/3/e487/6686531?login=false). I'm actually not sure if I've seen that study before now, to be honest -- I have seen a bunch of autopsy studies and studies showing virus in fecal matter.
As I say in my other post on psychosomatic contributors (in the appendix), I do think persistent virus is a likely explanation for a lot of Long COVID symptomology. The other likely "biological"/"organic" explanation, I think, is Epstein-Barr reactivation. My own feeling is that I was most likely effected by Epstein-Barr reactivation (a booster covid vaccine did not help me -- although it helps a small subset possibly by flushing out persistent virus). Furthermore, I was under a lot of stress about a month after getting covid, and stress is associated with EBV reactivation.
I'm glad you acknowledge that for some patients with Long Covid their illness may be primarily psychosomatic in nature. However, I disagree that its not a good idea to discuss psychosomatic aspects. In my view, the exploration of such effects is often shunned online (for instance when I posted my earlier posts on the Covid Long Haulers Reddit they were removed).
I think the reason patients are "gaslighted" is not that the illness is not recognized as a serious and very real syndrome, but rather that doctors do not have any established way of treating Long Covid other than telling patients to reduce stress and try to ease back into exercise. This is actually good advice regardless of how big you think the organic effects are (ie from spike protein, etc), but many patients react very negatively too it and ignore it.
The purpose of this article wasn't to push the idea that Long Covid is all psychosomatic - I have never said that -- I have always acknowledged organic causes (in particular Epstein-Barr reactivation). I personally found the techniques here useful, as have others, but I have never proposed these techniques will help everyone with Long Covid or even the majority of sufferers.
The main impetus for writing this particular article was that a friend asked me too and I realized I have not seen any article dedicated to techniques for treating the psychosomatic aspects. There are dozens of articles on potentially dangerous and/or expensive unproven treatment methods for Long Covid, however, such as powerful psychotropic drugs, stem cell therapy, hyperbaric oxygen, etc etc. The main methods I discuss here (CBT, GET, fixing sleep, etc) have loads of peer-reviewed RCT evidence to support them in the treatment of ME/CFS and there is emerging literature showing CBT and GET help with Long Covid. This is all very important information which is not being communicated elsewhere or is being wrongly disparaged elsewhere online. None of the techniques discussed here are not being proposed as cures, merely as cheap and safe things for people to try that may help them to some extent. Maybe I should have been more clear about that.
FLCCC has effective treatment protocols for long covid and has doctors who know how to individualize treatment. https://covid19criticalcare.com/ Nattokinase not only breaks up blood clots but also binds to the spike protein.
Thanks, I will add Nattokinase to the appendix of the post.
I looked at the long covid treatment protocol from covid19criticalcare.com -- some of the blood tests are good but they don't really offer anything in the way of treatments. They talk about treating pulminary fibrosis and blood clots but both are very rare in long covid.
The same website says to follow the same treatments as for "post vaccine syndrome". That is not an established condition. Serious side effects from the vaccine (ie that are life-threatening or don't resolve in a few days) are very rare (about 1 in 10,000). Furthermore, the treatments they recommend are just a hodgepodge of supplements that don't do a whole lot (in my estimation). For instance they recommend elderberry syrup and vitamin C to help prevent infection, there's been many studies on vitamin C that show it doesn't prevent colds. They also recommend ivermectin which is a useless quack therapy for covid all around (see https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted )
Overall it strikes me as not a reputable medical site containing unscientific treatments based on unscientific anti-vax ideology.
Dan, you and I live in different COVID realities. I believe I have done my homework, reading the mainstream literature, which I see as consistently biased or fraudulent, and also the alternative literature where there is some reality to be found. I have analyzed some fraudulent ivermectin studies that were "designed to fail". I have looked at different estimates of the disabilities and deaths from mRNA vaccines, and wrote up an estimate that several hundred thousand Americans have died from prompt effects of COVID vaccination. For a start reading the alternative literature, I suggest (1) VAERS data report 35,000 deaths and 1.5 million injuries from the COVID vaccines https://openvaers.com/ (2) My review estimating American deaths from COVID vaccines as of a year ago https://mitteldorf.substack.com/p/how-many-people-have-covid-vaccines and (3) A meta-analysis of 98 IVM studies https://c19ivm.org/ .
If you're open to a discussion of major deception in the medical literature of COVID, we can exchange emails or schedule a video call.