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

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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.

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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.

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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.

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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.

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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.

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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.