Thread by @LongCovidAdvoc

1/ 🧵 New perspective: Maybe all those yoga classes aren’t fixing fatigue… turns out, in ME/CFS & Long COVID, we may not be stuck in fight/flight at all. 🧘‍♀️

Cort Johnson summarises a new model suggesting low brain norepinephrine (NE) is central to symptoms.

2/ In this view by David Goldstein & Lilian Aregawi: The sympathetic nervous system isn’t overactive - it’s struggling. Low NE vesicle levels in the locus coeruleus → high neural “firing” but low output → “wired but tired”. 😵‍💫

3/ Symptoms line up: alertness and anxiety (“wired”) yet low energy, poor recovery, orthostatic intolerance - exactly the “high noise / low gain” scenario described. 🛌
healthrising.org/blog/2025/11/1…

4/ Treatment implications: This suggests we shouldn’t just suppress sympathetic activity or boost parasympathetic tone. Instead, supporting sympathetic reserve / NE production might be key. 🧠

5/ The new model in short:
• Trigger: infection / injury → locus coeruleus over-drive → metabolic stress → NE vesicle depletion
• Chronic phase: sympathetic “noise” remains but effective signalling falls → parasympathetic system lies low
• Outcome: ME/CFS / Long COVID 🛌

6/ Looking back: Early psychosomatic models of 'CFS/ME' painted a very different picture - a “stuck in fight/flight” narrative.

As do the brain retraining models such as The Lightning Process & The Gupta Program. ⚡

7/ Simon Wessely, Trudie Chalder, and colleagues framed fatigue syndromes as functional somatic syndromes: initial illness triggers stress/arousal, then behaviour & beliefs maintain a chronic autonomic over‑arousal.
ncbi.nlm.nih.gov/pmc/articles/P…

8/ Their 1998 book Chronic Fatigue and its Syndromes describes patients in a persistent fight/flight state perpetuated by behaviour and beliefs. 🏃🏼
simonwessely.com/Downloads/Publ…

9/ Under that model: sympathetic dominance → fatigue, disrupted sleep, hypervigilance; parasympathetic “rest/digest” suppressed. This rationale underpinned CBT and graded exercise therapy (PACE trial).
en.wikipedia.org/wiki/Graded_ex…

10/ But there’s an even earlier precursor: John Sarno’s Tension Myositis Syndrome (TMS). His work (~1980s) suggested repressed fear & emotions trigger autonomic responses as a “safety mechanism” - chronic pain is the body’s distraction. See our article:👇
open.substack.com/pub/longcovida…

12/ Critiques of Wessely’s framing: Autonomic research shows measurable dysautonomia, orthostatic intolerance, hypovolemia - evidence that symptoms are physiological, not just “maladaptive arousal”.
ncbi.nlm.nih.gov/pmc/articles/P…

13/ So today: the paradigm is shifting. From overactive fight/flight (psychosomatic) → to impaired fight/flight reserve (neuroenergetic/autonomic dysfunction). 🧠

14/ Why it matters: Conceptualising the mechanism correctly shapes therapy, research, & how patients understand their bodies

It's why we have fought so hard to counter the fight n flight model as portrayed in brain retraining. We know it's rooted in flawed psychosomatic theory