🧵Long COVID, this tweet and these kinds of psychological approaches:

Long COVID is a multi-system condition with microvascular damage, immune dysregulation, clotting abnormalities and neuronal damage being amongst the mechanisms implicated.
Sadly but unsurprisingly, it took too long for it to be taken it seriously and it still isn't being taken seriously enough. And like with everything else in COVID, there are plenty of prominent scientists who dismiss it as just a post-viral syndrome or 'psychosomatic'.
There are clearly neuropsychiatric aspects to Long COVID (neurological, psychiatric and cognitive symptoms) and important psychological aspects (dealing with severe, chronic, disabling, life-altering illness). Both will require psychological research and treatment.
On the other hand, any approaches that consider the causes of and risk factors for Long COVID as being primarily or largely psychological, are very problematic, as the primary assumptions and models are very poor/wrong.
The information on this Campaign is very sparse but it seems to fall into this category.
This is from their information sheet:
And this is what the expected outputs are. Based on these the assumptions seem to be that a certain set of psychological factors predict long COVID (no mention of severity of biological damage). These can be screened for and CBT approaches can be used to treat long COVID.
Then there is:
'An information campaign to promote a biopsychosocial approach to long COVID to avoid the inevitable distress that can result from dualistic, biomedical reductionism.'

I think there are at least 3 far more important causes of inevitable distress.
These are:
1. Suffering with a major multi-system condition with potential long-term consequences
2. People not believing/minimising point 1.
3. People not investigating, treating and researching the condition because it is thought to be psychological.
Btw in the video Patrick Hill says that biomedical dualism would say that it's all psychological.

I think the biomedical view (isn't necessarily dualistic) would think of it as a complex multi-system disease.
It is troubling that we have a new condition that is still being understood and people are already trying old treatments based on little mechanistic understanding.
And I would be very wary of applying the Surawy model (CBT for chronic fatigue, which has been criticised) to Long COVID. There are several aspects of the syndrome that would be difficult to align with such a CB approach e.g. loss of sense of smell.
I think there will be a major role for psychological approaches & treatments in helping people recover from Long COVID.
But I don't think these simplistic approaches will be helpful & worry they are dismissive and will be used to dismiss/minimise by govt, insurers, etc.

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More from @HZiauddeen

12 Sep
🧵COVID-19 and the corruption of systems and values:
(Mainly UK-centric but aspects relevant to other countries)
This is about various troubling aspects of govt and society that have become more pronounced over the last 18+ months and make me really fear for the future.
Corruption, in its different meanings, seems like a good term to describe these phenomena but I'm open to suggestions.

Let's start with the simple and straightforward stuff: corruption in our political systems, and I'll stick to a few highlights.
-In the immediate background (and increasingly in the foreground) is Brexit and complete hash that is was and is.
-There is the horrendous pandemic response and how it has been shaped by lobby groups (HART, AIER) and other vested interests

Read 30 tweets
10 Sep
Making treatment decisions in the psychiatric clinic 🧵

So this is a thread about how we think about someone's treatment in the clinic and it is partly about addressing some misconceptions about what we do.

(It contains a fictional case story)
This was occasioned by a recent tutorial I did with some medical students that reminded me of how we are failing on some aspects of clinical education.

To be v. clear, this thread is not criticising medical students, it's criticising us who are teaching them (incl me)
Also because this is a psychiatry thread, I ought to make clear that this will be about psychiatric illnesses and will include some discussion about medication and so may not be for people who are not keen on either of those areas.
Read 51 tweets
9 Sep
This study is looking at health anxiety specifically about COVID and seeing if CBT can help with it.

My psychologist and therapist colleagues, you think you've done exposure work with people?

You haven't.


I've been through the infosheet (couldn't find a study website) and it is difficult to tell what exactly the methodology is.

I do find it troubling though that this is being examined through a health anxiety lens when we are in a worsening pandemic with an uncaring govt.

Best case scenario: it is looking at how to help people cope if they are forced to get on with life in the midst of a raging pandemic because the govt has decided it's not going to do anything more as 'the pandemic is over'.

That is a seriously grim best case scenario.
Read 5 tweets
5 Sep
'They are acting in good faith.'
'It was not my intention to hurt them'

This is the privilege of intentionality, where someone's intentions are given more moral weight than their actual harmful actions and the impact of those actions.
(More details in QT below)
This is one of the benefits of power i.e. those in power are granted this, those who are not, are not.
This operates across multiple levels.
E.g. a man who harasses a women expects to be given a pass because it was not his intention to hurt her.
This is operating at the level of the power imbalance in their interaction.
When the woman takes the matter to HR, they too take the view that it was not his intention to hurt her and any hurt caused was inadvertent.
This is operating at the level of the institution.
Read 12 tweets
4 Sep
'I've known him for many years & I know he is a good person.'

Are you:
-of the gender or age group he harasses & assaults?
-in one of the subordinate positions he bullies?
-from the racial/other groups he discriminates against?
If no to all, your opinion is irrelevant.
But what you are doing (whether you are aware of it or not) is using your privilege to protect another privileged person and discredit a victim who is at a lower position in the power hierarchy.

What if the answer to one or more of the questions is yes?
Well, in that case, remember that we only ever see or know parts of people. Just because what you have heard from a victim does not fit with your experience or your idea of a person, it does not mean that it is not possible.

Basically, believe victims.
Read 8 tweets

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