Fear of Listening to Patients: Short-sighted on Long Covid

Man staring out window at virus
While at least one psychiatrist considers ‘long Covid’ to be psychosomatic, the vast majority of the medical establishment disagrees. (Image: Gerd Altmann/Pixabay)

It would be mistaken to suppose that disdain for patients is an actual requirement of psychiatric training in North America, but you would have good reason to wonder about it after reading a recent op-ed in the Wall Street Journal by Dr. Jeremy Devine, a psychiatry resident at McMaster University in Canada. According to Devine, the phenomenon known as “long Covid,” in which COVID-19 patients continue to experience perplexing symptoms for weeks or months, is actually nothing more than the “invention of vocal patient activist groups” who, for unexplained reasons, have irrationally chosen to deny their need for psychiatric care.

Devine’s essay shows scant regard for the experience of patients, who are unable, in his opinion, to comprehend their own physical state. Rather, he opines that tens of thousands of people have been misled by a little known organization called the Body Politic COVID-19 Support Group into demanding biomedical research into their condition, when they really should deferentially accept that they are suffering from an “underlying mental-health issue.” After all, Devine explains, “a central feature underlying many psychosomatic-symptom disorders is a fixed belief that one is ill and unlikely to recover.”

Strangely enough, the victims of this remarkably successful disinformation campaign apparently included Dr. Francis Collins, director of the National Institutes of Health, and Dr. Anthony Fauci, chief medical adviser to President Biden, neither of whom agree with Devine’s description of long Covid as produced by “patient denial of mental illness and psychosomatic symptoms.”

The problem, as Devine sees it, is that patient advocacy groups are just too mouthy. Instead of politely acknowledging that long Covid reflects psychologically generated symptoms, the Body Politic has insisted on “cultivating patient led research.” The chauvinistic scare quotes are Devine’s, signifying his horror at the prospect that patient-directed research might pollute psychiatry’s pristine turf.

Nor is the Body Politic Devine’s only bête noire. He is equally ill-disposed toward Solve ME/CFS, a group that seeks to encourage research into the poorly understood condition variously called myalgic encephalomyelitis or chronic fatigue syndrome. Among its other offenses, as Devine sees them, Solve ME/CFS had the temerity to hire “a lobbyist to pressure federal agencies to commit more funds to research.” Lobbyists are a fixture in Washington, D.C., seeking to influence virtually every federal agency. In 2020, according to OpenSecrets.org, at least 2120 organizations employed lobbyists on health issues (behind only expenditure and tax issues). In 2018, the American Psychiatric Association spent $957,300 on lobbying.

Whatever the Solve ME/CFS lobbyist has been able to accomplish in Washington, D.C., the word has evidently failed to reach McMaster University. Devine maintains that his psychiatric theory of ME/CFS is the “prevailing view among medical practitioners,” but that has not been true for many years. In 2015, the U.S. Institute of Medicine (now the National Academy of Medicine) issued a report finding that ME/CFS, is a “serious, chronic, complex, systemic disease”— not a psychiatric or psychological disorder. Key U.S. health agencies, including the Centers for Disease Control and Prevention and the National Institutes of Health, have taken a similar approach. The 2011 PACE trial, a British study of psychologically oriented treatments for ME/CFS – the only source cited or linked by Devine in his oped – has been methodologically discredited. Psychological treatments were also rejected last fall in a new draft of ME/CFS clinical guidelines from the UK’s National Institute for Health and Care Excellence. As a 2017 graduate of the University of Toronto medical school­, Devine has little excuse to be so poorly informed about the current state of ME/CFS research.

Devine worries that “a large group of impressionable patients” has been bamboozled into thinking that “they are helpless victims of an unrelenting sickness,” when in fact they are suffering only psychosomatic symptoms that can be resolved through psychiatry. If so, it would also mean that highly credentialed physicians such as non-psychiatrists Dr. Collins and Dr. Fauci, and even some psychiatrists, have likewise yielded to “pseudoscience” that will “more harm than help patients.”

One would hope for more humility from a new physician in training for a specialty that once diagnosed homosexuality as a mental illness, blamed autism on refrigerator mothers, and attributed asthma to cries for help from a smothering parent. There is much yet to learn about long Covid and ME/CFS. If Jeremy Devine truly wants to be a healer, he ought to stop slighting patients and their advocacy groups and begin listening to them.


Author Steven Lubet was diagnosed with ME/CFS in 2006.

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Steven Lubet

Steven Lubet is Williams Memorial Professor at the Northwestern University Pritzker School of Law and author of Interrogating Ethnography: Why Evidence Matters, and other books such as 2015's The “Colored Hero” Of Harper’s Ferry: John Anthony Copeland And The War Against Slavery and Lawyers' Poker: 52 Lessons That Lawyers Can Learn From Card Players. He is the director of the Fred Bartlit Center for Trial Advocacy.

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Kate

I’m extremely grateful to Mr. Lubert for his article responding on behalf of those of us who have CFS/ME and Long COVID. It is amazing to me that those of us with these syndromes continue to be under attack from people who claim to know better than we do about our health. Dr. Devine seems to be yet another incorrect know-it-all who has become dangerous because he has the power of the pen, and the ability to incorrectly influence those who read his bull$hit. I would never wish this syndrome on anyone, but I do wish he could be fully… Read more »

Paul Fox

As those who already know of Steven Lubet’s work have come to expect from him, this piece is excellent. Aside from Dr Devine’s arrogance and bigotry, failures of logic such as his are so common in psychiatry, and in medicine generally, that I think they are very likely indeed to be, at least implicitly, part of the training. My own experience is, of course, anecdotal, but it accords precisely with the argument advanced, time and time again, in all seriousness, by health”care” academics and policy makers. It boils down simply to the assertion that if a physical cause has not… Read more »

Shelley Waller

Best letter I’ve read this year. The absurdity perpetrated by ppl in these positions adds cruelty to tragedy for so many parents and young ppl who’ve had their lives torn apart by ME. Six years on from a nasty bout of glandular fever, our previously fit, happy & healthy young son remains mostly housebound (not in spite of GET, but largely because of it!). No psych has found him to be anything but an emotionally resilient young man, dealing stoically with the grief of a life-limiting medical illness. Recently, his school provided a bed in the exam room so he… Read more »

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