Andrea Roberts was getting ready to submit a study for publication, and she was worried. A senior research scientist at the Harvard T. H. Chan School of Public Health, she had just written a paper suggesting that people with high stress levels were more likely to develop long COVID after an acute infection.
Roberts has spent the past decade studying the link between physical health and mental health. She knows that psychology can play a role in almost any illness; a few years ago, she discovered a link between PTSD and ovarian cancer. On paper, the new finding was no different from those in her previous studies, but this time she added a disclaimer to her article. “Our results should not be misinterpreted as supporting a hypothesis that post–COVID-19 conditions are psychosomatic,” she wrote.
Her worries were not unfounded. The study was published in the Journal of the American Medical Association: Psychiatry on Sep. 7 of last year. A few days later, Jeremy Redfern, a member of Florida Gov. Ron DeSantis’ administration, tweeted out the article and put “long COVID” in scare quotes. In the replies, people referred to long COVID as a “self-fulfilling prophecy” and “symptom of liberalism.”
Roberts had meant to convey with the disclaimer that long COVID is not a fake condition, and that patients experiencing it are not duping doctors or themselves (as Redfern implied they were). In doing so, however, she used the word “psychosomatic” to mean “fake.” But that’s not how “psychosomatic” is used in medicine, and she now has mixed feelings about the disclaimer. “The actual definition of psychosomatic is a connection between your psyche and your soma,” Roberts says—that is, your mind and your body. That connection can look like so-called “hysterical” blindness, where a traumatic experience causes someone to lose their sight without any apparent damage to their visual system, or like the well-known (and uncontroversial) relationship between stress and heart disease. Based on that technical definition, Roberts says what she’s showing in the long COVID study “is actually psychosomatic.”
No serious doctor would deny that the mind and body are intimately linked—many would even argue that it is meaningless to differentiate between the two, since the mind is really nothing more than the brain. But it wasn’t just the right-wing Floridians looking to minimize long COVID who responded to her results. Pieces by mainstream journalists have suggested that linking depression and long COVID is tantamount to accusing all long COVID sufferers of being malingerers.
As of yet, there is no conclusive proof that stress or mental illness can contribute to long COVID. But since Roberts’ paper, several other studies have found associations between post-COVID symptoms and mental illnesses like depression. None of this research proves that mental illness plays a role in causing long COVID—it might not play any direct role at all—but some experts see the connection as a promising path toward understanding, and treating, the condition. As long as the idea that mental illness is somehow less “real” than physical illness persists, however, investigating that link remains a risky proposition—both for the researchers, who might expose themselves to intense online criticism, and for the patients, who could see such studies weaponized against them.
“Being ‘real’ or not is a very false dichotomy,” says Tracy Vannorsdall, associate professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins. “And it doesn’t do our patients, or our scientific thinking, any good.”
Hellbound and Down 