Post-Covid syndrome, Myalgic Encephalomyelitis, and the recurring pseudoscience of mass hysteria

The people who want you to think that everything is “all in your mind” are back, their schtick now revised and updated for a COVID-19 world. Here’s the Daily Telegraph:

Some local coronavirus outbreaks could be ‘mass hysteria’, Joint Biosecurity Centre warns

Some local coronavirus outbreaks may just be mass hysteria, the new Government body in charge of Britain’s response has warned, saying that many people could wrongly believe they are infected.

The Joint Biosecurity Centre (JBC), which has taken the lead on co-ordinating the response in place of the Scientific Advisory Group for Emergencies (Sage), said it would be alert to the possibility of “local episodes of mass psychogenic illness” and that they could cause “substantial anxiety, anger and loss of trust in the community” if “poorly handled”.

Mass psychogenic illness – which used to be referred to as mass hysteria – is when people in a community start feeling sick at the same time, even though there is no physical or environmental reason for them to be ill.

These are tough times. It can sometimes seem as if folks are going crazy. So let’s just say that they are. And there you go. Such is the thought process that lies behind the narrative of mass hysteria.

* * *

Claims that COVID-19 outbreaks can result from mass psychogenic illness are especially disturbing, not least because they bring together some interesting, and timely, themes.

One emerging issue relates to the so-called COVID “long-haulers”, people who experience severe after-effects after supposedly “recovering” from COVID-19. Often debilitated for months after their illness, these patients are commonly dismissed with scepticism and disbelief, even by their own doctors.

It is all very reminiscent of the challenges faced in many countries by sufferers of myalgic encephalomyelitis (ME). These patients too have long faced physician scepticism, accusations of malingering, and negative media coverage. For years they have been told that they have caused their own symptoms, through faulty reasoning and consequent counterproductive behaviours. They are accused of exaggerating or misinterpreting their physical symptoms by clinicians wedded to, or duped by, a thoroughly psycho-behavioural worldview.

Most disturbingly, because of the psycho-hegemony, patients get funnelled toward tenuous behavioural therapies that produce little or no curative effects. In many (if not most) cases, the official treatments serve only to worsen their illnesses. (I have written about all this here, here, here, here, here, and here, and have spoken about it here, here, and here.)

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What makes all this eerily relevant right now is the fact that the symptoms of long-haul COVID closely resemble those of ME. Patients in both groups experience persistent muscular pain, regular headaches, post-exertional malaise, respiratory difficulty, and brain fog (in other words, problems with focusing, thinking and remembering). All are left with long-term physical and mental debilitation. The patterns are so similar that no less an authority than Dr Anthony Fauci has drawn attention to the possiblity that the two conditions are, in fact, one and the same. In Fauci’s view, COVID-19 may well produce a lasting post-viral syndrome that amounts to ME in a large subset of so-called “recovered” patients.

* * *

The tradition of ME pseudoscience (one might even say “psychobabble”) has a very long history. In a particularly surreal twist, current claims about mass psychogenic COVID-19 coincide almost exactly with the 65th anniversary of the now infamous outbreak of ME that occurred at London’s Royal Free Hospital back in 1955.

The Royal Free outbreak started in July and continued for four months. Its sheer scale and severity made it a huge media story. (Examples of newspaper articles from the archives are currently being posted to Twitter each day by users @CiaranJ_Farrell and @Needles_Toosay. By drip-feeding updates on the anniversary of their original publication dates, we get to see how the outbreak was first reported by the media, on an “as live” basis.)

Nearly 300 members of hospital staff were hit by sudden-onset symptoms. The vast majority quickly required hospitalisation. People complained of headaches, malaise, muscle cramps, nausea, pain, vomiting, and, in some cases, paralysis. At first the local physicians thought the affected staff members had glandular fever, but eventually they concluded that their conditions were caused by a virus that infects the brain. The ultimate diagnosis they settled on was “benign myalgic encephalomyelitis.”

However, a decade-and-a-half later, the British Medical Journal posted a now infamous retrospective analysis. In it, two psychiatrists dismissed the entire episode as nothing more than a case of “mass hysteria.” They claimed that the Royal Free symptoms were psychological phenomena: there was no infection in people’s brains, just afflictions in their minds. These were psychosocial events, not medical conditions. Unsurprisingly, given this dramatic twist, the new verdict was itself the subject of extensive media coverage:

From the Sunday Times, January 1970 (Pic: @RFH1955 via Twitter)

But despite their diagnostic confidence, the authors of the BMJ paper never actually visited the Royal Free Hospital. Nor did they visit the site of any of the other similar outbreaks that they wrote about. They spoke to no patients or doctors. Instead, they derived all of their verdicts from behind their academic desks.

And it showed. In explaining the causes of such outbreaks, the logic used in their BMJ paper left a lot to be desired:

We believe these epidemiological peculiarities—the prediliction for young women and for institutions containing an undue proportion of them—provide good positive evidence for mass hysteria as an explanation of the illness…

…and on like this it went. In other words, this landmark paper — the first to allege that ME was “all in the mind” — based its mass-hysteria theory largely on the fact that the condition had affected more women than men. The gender difference was the key. As far as these two (male) psychiatrists were concerned, femininity itself was a red flag. It was, ipso facto, evidence of irrationality.

The authors even concluded that the term “myalgic ecephalomyelitis” should be discarded, and offered “myalgia nervosa” in its place. This new label, they suggested, would better echo the term “anorexia nervosa” — and thereby more effectively encapsulate the feminine hysteria that lay at the root of all such outbreaks.

It should go without saying that it would be unlikely for such an assessment to appear in a major medical journal today. However, modern views that these very same conditions are fundamentally psychological and not physical — that they result from mistakes, misperceptions, malingering, and mass hysteria — all remain common, and all owe their existence to this initial vintage framing. These attitudes were spawned by, and are now descendents of, the scientific sexism of the 70s.

* * *

The psychogenic worldview results from ignorance. Literally. The psychological clinicians who suggest that symptoms are caused by psychology do so precisely because they don’t know what is actually going on.

Eminence-based medicine abhorrs a vacuum.

Some psychologists (and I say this as a psychologist myself) believe that everything is fundamentally psychological. In their eyes — whether the problem is crime or happiness or pollution or obesity or HIV or ME or COVID-19 — nothing in the world makes sense, except in light of cognition.

It’s like that old cliché about having a hammer in your hand and then seeing all your problems as nails. But in clinical academia, such DIY-based deduction creates a massive conflict-of-interest problem. The people with the hammers derive their professional standing — and make their living — from nail-related paranoia. They become VIPs (very important psychologists) precisely because they articulate every conceivable social challenge in behavioural terms, thereby positioning themselves in the role of saviour.

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The problem here is one of intellectual overreach. After all, there is absolutely no problem in saying that behaviours and cognitions play important roles in the spread of contagious diseases. There would not be a global pandemic if people with SARS-CoV-2 behaved in ways that limit their exposure to others. And COVID-19 would never be transmitted if these people thought about or perceived their situation in ways that naturally encouraged pro-social behaviour.

However, acknowledging the truism that thoughts and actions play a role in disease transmission does not justify claims that such diseases are caused by those very thoughts and actions. When psychologists claim that ME is “caused by” certain types of attitude or thought process, their interpretation is entirely (and self-servingly) speculative. And when they propose that unexpected symptoms of COVID-19 are likely to be “caused by” hysteria, they are operating way beyond what the available evidence can ever endorse.

* * *

Such conclusions are rooted in correlational thinking. After all, all diseases are accompanied by cognitions and behaviours. But — and this is very simple stuff — when two things happen at the same time, the best we can say is that we are looking at the co-occurence of simultaneous events. We cannot say in any way that we have evidence of cause-and-effect.

To make matters worse, such psychologists regularly compound this elementary error with a form of teleological reasoning similar to the “God-of-the-gaps” fallacy. When faced with an otherwise irresolvible conundrum, they presume that psychology must be the answer. For them, psychology is the “God” that fills the gaps in an incomplete story (a subtle #humblebrag little short of actually claiming to be gods themselves).

The formal term for this type of error is “argument from ignorance.” It is a potent fallacy precisely because, by their nature, humans dislike uncertainty. They are also prone to animistic thinking — all people are liable to attribute psychological dynamics to inert and inanimate processes (as we often do with bingo balls, the weather, or fate itself).

Filling blanks with psychology — in the absence of robust (or any) evidence — is logically flawed. But the practice provides a seductive sense of closure that can be powerfully persuasive. This is exactly why we should only ever do it as a last resort, and only when the highest evidentiary standards have been met.

Psychogenesis claims are extraordinary. They require extraordinary evidence.

* * *

Conditions like ME and long-haul COVID-19 are vastly complex. We have a long way to go before we can explain exactly how they happen. Their clinical details are still taking shape, as investigators around the world pursue thousands of research strands. For now, we will just have to accept the many gaps that remain in our understanding.

Science will need to put in many more hard yards gathering data to complete the picture. But there is nothing wrong with that. There is nothing wrong with not knowing everything.

People with ME have been waiting decades for their dignity. It is a tantalising but poignant reality that COVID-19, in creating a cohort of post-viral long-haulers, may now be the event that finally brings attention to their plight. The resources and attention of global science might at last uncover the true physiology of their symptoms, and in so doing consign the psychogenic worldview (and its related treament approaches) to the annals of academic history.

Gaps in understanding are what make science worth doing in the first place. We should not presume to fill them with clinical lore, academic intuition, or outdated theoretical tropes.

14 Comments

  1. Well written and timely. Thank you.
    > “Filling blanks with psychology — in the absence of robust (or any) evidence — is logically flawed. But the practice provides a seductive sense of closure that can be powerfully persuasive. This is exactly why we should only ever do it as a last resort, and only when the highest evidentiary standards have been met.”
    The evidence and arguments of which one should be most skeptical are those that appear to support one’s existing narrative.
    > “There is nothing wrong with not knowing everything. ”
    Indeed, the simple but profound understanding and admission that ‘I don’t know’, is the starting point of all knowledge and wisdom.
    Arguably the most distinguishing characteristic of psychogenic advocates is their utter certainty about their ‘knowledge’. Their work on ME is a stark testament to that phenomenon, and its tragic consequences.

  2. Linda Gray Gibbons

    From someone who was active until a “Post Viral Meningitis” diagnosis lost the ability to hear head pain beyond explanation barely able to move for three years.. suffer PEM in Consistent Pain Twenty Years Now
    Engaged in all Precribed Medications/Treatments (CBT) (GET) housebound mostly bedbound- daily temperatures
    unexplained Pathological other than possible [Neuropathic Messaging]
    “The body still believes it is fighting a Virus consistently” Damage to the Central Nervous System.
    You only get it..
    When you get it..!

  3. Jane Waters

    UK published alleged episodes of ‘mass hysteria’ were found to have a physical cause. Others were of very small populations mainly associated with religious fanaticism. Kombolcha, in North West Ethiopia, was one of a few published with any due consideration. It is therefore modelled in the paper against the ME cluster outbreaks, including the Royal Free and found to have no mathematical similarity
    in transmission. httpss://www.tandfonline.com/doi/full/10.1080/21641846.2020.1793058?scroll=top&needAccess=true

    • A comparison with MS would be as enlightening.
      Notably also classed as ” hysteria” if female and considered a Male dominant disease until CT scanning provided an objective route to diagnosis.
      Female to Male ratio found to be approx 2:1. CT scanning instigated but not widely available in mid / late 1970s .
      CT scans are not infallible and MRI now provides a more comprehensive picture of the disease.
      History seems to be on an ever repeating loop.

  4. gildedcell

    Thank you for this… you argue from erudition, not ignorance.
    I would however warn (as a person with very long term ME) not to conflate Post Covid Syndrome (or its synonyms) with ME per se. The two should be treated a being distinct, especially at this early venture, no matter what Fauci might say. He is not the oracle on this disease given he has spent many productive years ensuring that people with ME do not get proper evaluation or investigation of their disease (as world renowned author Hillary Johnson observes in this tweet: “Clueless New Yorker valentine to Fauci describes how he led U.S. through AIDS, Ebola, Zika, etc. The mother of them all–ME–doesn’t even make the list, because Fauci disappeared ME so deftly from 1980s on starting with rename “chronic fatigue syndrome.” )

    The principle wrt psychogenic disease is however the same and you make it well. My observation would be to ask whether there is such as thing as a somatising disease/ conversion disorder, yada yada, yada, at all? Doesn’t it *always* take the place of the vacuum where biomedical disease has been misdiagnosed and re-labelled to suit those who deem it necessary to make such claims (and ‘those’, from Gov’ts to individuals, might have different reasons for this re-framing, from saving money to earning knighthoods and providing their children with a private education….for example 😉 ). In other words as it’s impossible to prove the hypothesis of psychogenic disease at all (given we aren’t in possession of all knowledge at this point in time, back in 1970, nor ever will be) shouldn’t the notion of psychogenic disease simply be put to bed..or better still 6 feet under (where too many people with ME already ‘rest’ after a life of suffering without help or compassion)?

  5. Guido Den Broeder

    Of course, as a psychologist, you still make the same mistakes as the ones you describe. They’re a different type of nails but the hammer remains the same.

    ME and ‘Longcovid’ are not alike at all. For instance, respiratory difficulty is not a characteristic of ME, and many ME symptoms don’t occur in Longcovid. There are furthermore a thousand other distinctly different chronic diseases that have some symptoms in common with Longcovid, some with ME, but not others, and that are often facing the same problems of finding recognition.

    Also, the cause of ME is well known and has been since the beginning. The disease was first described in medical literature by Wickman in 1905, calling it superior polio.

  6. This “mass hysteria” explanation sounds so familiar…hmmm, can I extract the name from the cobwebs…

    Ah ha: CAMELFORD WATER POISONING

    The short version is that the Camelford water supply was accidently poisoned with twenty tonnes of aluminium sulphate. About 20,000 people were exposed to “a highly acidic cocktail of metals” [1] with devastating effects. The government’s immediate reaction was to deny and coverup the incident. Fortunately for the government, our old friend Regius Professor Sir Simon Wessely eagerly sacrificed himself and stepped into the breach:

    “We suggest that the most likely explanation of the Camelford findings is that the perception of normal and benign somatic symptoms (physical or mental) by both subjects and health professionals was heightened and subsequently attributed to an external, physical cause, such as poisoning …

    … there can be no doubting the substantial effect that the prospect of litigation has on distress, particularly of the ill-defined sort present at Camelford…” [2]

    The UK government has already decided that “Long Covid” is “psychosomatic” and will be treated with magic CBT and forced exercise. The rest of the “western world” will be close behind. It’s very depressing to think of the additional thousands of people about to be severely harmed by Sir Simon’s psychobabble.

    [1] “Britain’s worst mass water poisoning happened 30 years ago in Cornwall and victims want answers”; https://www.cornwalllive.com/news/cornwall-news/britains-worst-mass-water-poisoning-1760990

    [2] “The Legend of Camelford”; https://pubmed.ncbi.nlm.nih.gov/7760298/

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  8. And so this is where medicine ends up – https://www.youtube.com/watch?v=DqDTAHUMnq4 – with disease being relegated to a minor consideration? Truly frightening.

  9. Pingback: July 2020 Facebook Blog. – DGMEFM Network

  10. Stephen Lawrence

    Hysteria: ETYMOLOGY: 19c: from Greek hystera womb, from the former belief that disturbances in the womb caused emotional imbalance. NB 19th cent.

  11. Pingback: Post-Covid Syndrome, Myalgic Encephalomyelitis, And The Recurring Pseudoscience Of Mass Hysteria – The York ME Community

  12. Lazy scientists and doctors. Feel like not doing your job today? Psychologist it!

  13. William Weir

    Long Covid is beginning to look more and more like ME/CFS. I speak with the experience of seeing > 2000 patients with the latter, and have seen and spoken to an increasing number of Long Covid sufferers. Breathlessness is a feature of ME/CFS because of the abnormally low anaerobic threshold which is so characteristic. ME/CFS is also triggered by a wide range of immunological challenges from Salmonellas (bacteria) to Giardia (protozoa), EBV (virus) also some vaccines. Long Covid is ME/CFS triggered by Covid19 (also a virus). The only difference is the presentation in pandemic numbers, as opposed to the sporadic presentation of pre-Covid19 ME/CFS. No doubt that many unfortunate Long Covid sufferers will (or already have) been told that they are anxious and/or need to go to the gym. If they do the latter they will suffer a brutal collision with post exertional malaise. Worse, they then might be told to “push through” the muscle pain and discomfort by well intentioned medical professionals with no understanding of the true nature of the problem. The most intransigent psychological adherents then apply a different diagnostic label to the collapse which follows; in teenagers the term “pervasive refusal syndrome” is fashionable in some quarters. Scandal isn’t a powerful enough term to describe this.

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