It’s Not All in Their Heads

In an op-ed in the Wall Street Journal Yochai Re-em responds, presumably to the same op-ed I commented on last week:

The lack of a positive Covid test doesn’t mean a patient never had Covid or doesn’t have long Covid. There is significant research both establishing the presence of prolonged Covid symptoms and laying out possible explanations for these symptoms. A literature review published this month in Nature Medicine, a leading scientific journal, posits that organ damage from infection, immune issues and inflammation can partly explain long Covid. These explanations are supported by the data significantly better than the psychosocial argument.

Medicine has been burned in the past by misattributing physical symptoms to psychological issues. Think of lobotomies used to treat ulcerative colitis and Freud’s attribution of physical symptoms to repressed thoughts. That some repressed thoughts can be transformed to physical symptoms doesn’t mean that all unexplained physical symptoms are caused by psychological processes.

Many healthcare providers seem to assume a psychological link when traditional medical work-ups don’t turn up an immediate cause. That medicine doesn’t have all the answers seems too readily forgotten in favor of a simple explanation: “It’s all in your head.” We know that medical science is always evolving. So why is the default approach doubting patients instead of believing them?

I think I can provide one answer to his concluding question although certainly not the only one. Blaming the patient obviates the physician from the unpleasant chore of confessing the limitations of his or her and, indeed, the entire profession’s knowledge.

I think that some of the long-term effects are, indeed, psychological in origin but probably not all of them.