Thread by @PutrinoLab

Ok. Another request, another 🧵. Today, we address the strained relationship between psychology, psychiatry and #LongCovid. Much of this may also apply to #pwME and other infection-associated chronic illnesses (h/t again @microbeminded2) and other “invisible” illnesses (1/n)

Psychology and psychiatry have a complex history with syndromic illnesses. Why? When illnesses are diagnosed on the basis of symptoms rather than “objective” tests, some clinicians will doubt the reality of the condition. Let’s start by psychoanalyzing them, shall we? (2/n)

This behavior is not justifiable, scientific or ethical. But it is also is not new: in the 1800s, tuberculosis was regarded by most physicians as the “disease of the sensitive” before tubercule bacillum was discovered, the “cancer personality” was touted for decades (3/n)

in “modern medicine”, before being famously called out by Susan Sontag in her book “AIDS and its metaphors” as she brilliantly concluded that we ‘metaphorize conditions that we do not understand’. Unfortunately this “clinical fragility” has continued into the present day (4/n)

Ask @Dysautonomia how many people with #POTS/#dysautonomia are diagnosed with anxiety prior to receiving an actual diagnosis of dysautonomia (years later)? Or how many #pwME in the #MECFS community have been actively harmed by the now-discredited-but-not-discredited enough (5/n)

“PACE trial”, which led to the famous statement that all people with #MECFS need to recover is “exercise and positive thinking”. We could go on, but suffice to say, there has been a legacy of horrific damage associated with the tendency to psychologize illnesses that are (6/n)

poorly understood on a physiological level. This is hard to recover from, and I think that #medtwitter treating #LongCovid and other infection-associated chronic illnesses need to be aware of the emotional labor they are asking of a patient when they refer to psych services (7/n)

as well as the rationale behind the referral to psych so that the person does not feel they are being “abandoned to psych” with no other treatment options being presented. With all of that said, what are some roles for psych services in #LongCovid?
1. Working through the (8/n)

emotions associated with the diagnosis of a chronic condition. FACT: #LongCovid is a highly debilitating chronic condition with (as yet) no cure. People with LC are likely to feel grief and other strongly negative emotions around this fact. Psychologists can be helpful in (9/n)

working through these emotions, assisting them with strategies for regulating these emotions (more on this later) and helping them with associated feelings of depression and anxiety that may develop in response to their diagnosis (psychiatry may be looped in here in cases (10/n)

where meds are indicated).
2. Helping people with #LongCovid navigate changes in relationships due to their diagnosis. One of the cruelest facets of #LongCovid is its ability to isolate those who live with it. Those with LC may look (mostly) like the same person, but (11/n)

they are not. One of the first things to go is socializing. For those without #LongCovid, let’s take a moment to acknowledge how stressful/draining it must be to manage 15+ intermittent, terrifying and uncontrolled symptoms whilst trying to engage in social interaction (12/n)

we can’t really ever understand, but suffice to say, most people with #LongCovid learn to avoid it right quick. There is a reason that those with #MECFS have championed the hashtag #MillionsMissing - because that is what these illnesses do: they put you on the missing list (13/n)

Families, friends, work colleagues, etc don’t understand: “you don’t *look* sick”, and this leads to near constant gaslighting. An important part of self-care in these situations is understanding that being equipped with emotion-regulation techniques in these moments can (14/n)

save you from experiencing a flare or crash as a result of the stress and emotional exertion that a negative interpersonal interaction that can bring about, which leads me over to 3) regulation, regulation, regulation: #LongCovid is indeed a condition of consequence. (15/n)

Exertion harms people with #LongCovid and exertion can take different forms: physical, cognitive and emotional, for instance. Pacing and regulation are *just as important* for your emotional labor as it is for physical and cognitive. A good psychologist can help you with (16/n)

emotion regulation strategies to help with stressors that you are hitting in your daily life that are causing setbacks for your health. Beyond these 3 main points on the role of psych services in #LongCovid care, I want to acknowledge that in very rare cases we have seen (17/n)

severe psychosis related to (we think) immune-mediated encephalitis which has required immediate and aggressive medical management, and that neuropsychologists can have an important role (re: my last thread) in assisting with #LongCovid-related cognitive dysfunction (18/n)

I also want to restate clearly that if a healthcare provider is psychologizing your #LongCovid rather than recommending psych services as *supportive care* to deal with issues that have been caused by LC, not the other way around, find a new provider ASAP. (19/n)

Finally, we must acknowledge that many cannot afford or access the psych services that they need and that is a shameful fact. To these individuals, I say embrace your community: the psychological benefits of peer support are incredibly robust and powerful. Every single day (20/n)

I feel grateful knowing that there are groups like @itsbodypolitic (and so many others!) out there who create safe and responsible spaces for people with #LongCovid to share their experiences and support one another through challenges. Please take advantage of peer (21/n)

support groups in the #LongCovid community, as there are few things more additionally damaging to a person with a chronic illness than social isolation. As always - apologies if I have left something obvious or non-obvious out of the thread. I hope this has been helpful 🙏🏻 (end)