It's Not All In Your Head

This has happened over and over. Multiple Sclerosis was a psychological disease until we found the cause. Medically unexplained simply means we don't know the cause and a lot of conditions are very hard to diagnose, especially since doctors tend to stop after their first test for the problem fails and they then try the depression route. I am convinced depression will become a physical biological condition that is treatable once we investigate its causes.

There has been a flurry of papers around long covid, ME/CFS and Fibromylgia (and maybe chronic Lyme and Gulf War Syndrome) over the past 2 months. They show a core dysfunction in oxygenation of tissue caused by micro-clots and capillary narrowing, the red blood cells can't adjust their shape properly among other aspects. This came after a German researcher found that H.E.L.P. Apheresis helped long covid patients, now everyone is testing the various aspects and finding real problems in all these patients. It is the sort of breakthrough that I think in a few months will lead to treatments and eventually cures after 80 years of the condition being considered and treated psychologically.

This month NICE in the UK changed its guidelines to remove the psychological explanation and remove the treatments patients said were harming, they were removed after the evidence was reviewed and found to be of low quality. This is happening the world over since covid has proven post viral conditions that lead to long covid and other conditions are obviously very real and debilitating. It looks like 2% of our population will become severely disabled by covid unless we solve it. But there is finally a test that is showing microclots in these patients and not in controls. So we might finally have a good diagnostic test and a treatment all in the space of months.

So I think its badly timed that this articles suggest at the end this is maybe psychological condition given the enormous progress made in the past couple of months, that come about because of just how many millions of long covid patients there are suffering badly with the conditions.

Medicine has a problem, it leaves people to suffer without researching at all the cause and misses diagnoses. It has consistently failed to research conditions that we have known about for 100s of years. If a patient says they are ill odds are they are right and its not just in their head given just how often medicine has proved to be wrong and how many millions it continues to leave in suffering for issues that are already treatable.

Psychology in time is going to disappear, none of its results in time has proven repeatable, none of its treatments seem to work very well and its diagnoses are not consistent. It is the place where bad medicine goes when it doesn't have an answer, which is fine we don't know the causes but we ought not waste yet more money into the pit of something proven to be wrong and not work. We can do something about these conditions if we reallocate that funding.

> [if] they know my body, symptoms, and experience better than I do.

> It's Not All In Your Head (firstthings.com)

I was certain that this was going to be an essay from Ross Douthat about his struggles with chronic Lyme. "All in your head"? The premier Catholic public intellectual magazine? What else could it possibly be? But I was wrong.

It's a review of Ross Douthat's book about his struggles with chronic Lyme. A review that begins with several paragraphs of trashing Freud, including compelling and little-known historical detail of Freud's horrific diagnostic mistakes rooted in his turn-of-the-century scientific sexism. Followed by a flash-forward to the 1980s satanic ritual child abuse panic, concluding with a Scott Alexander-tier bit of jerking the reader around: "what if Freud was right after all?"

Alright. Alright. I'm here for this.

I think it's too much to ask that every doctor (or any professional in any field, really) make an accurate individual judgement on who of their clients are able to do their own research or not. That's a luxury you might be able to afford if you're offering high-end (and thus expensive) services, but not when serving a large amount of customers.

Maybe that is the question (doubt it). Think about it. Its brilliant. You say 'I always ask this one question to my doctors' then ramble off on some other tangent. See if they come back to that question. It means they are paying attention and are inquisitive.