By David Tuller, DrPH
My friend and colleague Steven Lubet is a professor of law at Northwestern University. He and I have collaborated on a number of articles, including a response to Professor Michael Sharpe’s views on so-called “medically unexplained symptoms” in the journal Medical Humanities and a piece on links between ME/CFS and Long COVID for STAT. This spring, along with Professor Brian Hughes, a psychologist at the National University of Ireland, Galway, we wrote an essay for Health Affairs, a public health journal, about the ongoing paradigm shift in this medical domain.
Some recent high-profile commentary has dismissed Long COVID as a psychogenic phenomenon requiring psychological intervention. Below is Professor Lubet’s response to the misogynistic and homophobic slant of the current debate.
By Steven Lubet
As numerous studies continue to document the distressing sequelae of Covid-19 infections, the various â€œLong COVIDâ€ deniers in the medical profession are looking increasingly misguided. Among the most foolish of all has been Jeremy Devine, a psychiatry resident at Canadaâ€™s McMaster University. Devine somehow obtained space on a prestigious platform–the Wall Street Journalâ€™s oped page–to advance a theory that Long COVID is â€œpsychologically generatedâ€ and is actually a â€œpsychosomatic-symptom disorderâ€ invented by â€œvocal patient activist groups.â€ In June, Devine opined in an interview with Londonâ€™s Sunday Times that Long COVID stems “from a subconscious desire to be sickâ€ that may be â€œrooted in depression and anxiety,” for which he blamed what he called â€œthe chronic fatigue lobby.â€
Unfortunately, Devine has not been alone in attributing patientsâ€™ continuing symptoms to depression or anxiety. This response is all too common when doctors confront a confounding condition, as is the case with Long COVIDâ€”and especially when the patients are predominantly female. In Unwell Women, a recently published examination of the medical establishmentâ€™s mistreatment of female patients, the author Elinor Cleghorn observed that womenâ€™s â€œmysterious chronic diseasesâ€ are often â€œcontested within the medical community.â€ Furthermore, she added, â€œthose seeking diagnoses continue to be haunted by the . . . perception that the only place womenâ€™s pain and fatigue really exist is in their minds.â€ The prize-winning novelist Hilary Mantel related her painfully familiar experience with psychiatry in her memoir, Giving up the Ghost: â€œThe more I said that I had a physical illness, the more they said I had a mental illness. The more I questioned the nature, the reality of the mental illness, the more I was found to be in denial, deluded.â€
There is an unmistakable vestige of the same misogyny, amplified by a general mistrust of patients, in Devineâ€™s dismissal of Long COVID. As a bonus, he managed to add a bit of not-so-subtle homophobia. Informing his readers that the first organization to demand research on Long COVID was the Body Politic COVID-19 Support Group, he made a point of noting that the group â€œdescribes itself atop its websiteâ€™s homepage as â€˜a queer feminist wellness collective merging the personal and the political.â€™â€ It makes sense, of course, that a wellness collective would be among the first to notice the lingering effects of a COVID-19 infection, and that feminists would be among the first to realize that the extended illness mostly affects women, many of whom were being shrugged off by their doctors.
But the sexuality of the Body Politic members is no more relevant to the etiology of Long COVID than is their race, ethnicity, or religion. Devine never bothered to explain why he brought up sexuality in an article about medical diagnosis, but it certainly looks like an attempt to discredit the Body Politicâ€™s â€œpatient led research.â€ It was not so long ago that gay men and lesbians were routinely disparaged in the mainstream press, and there is a regrettable whiff of that in Devineâ€™s oped.
The Body Politic collective does not hesitate to describe itself as queer, nor should it, but that is not a reason for Devine to insert their sexuality into circumstances where it has no bearing. That is roughly the equivalent of vaccine deniers mentioning that Pfizer CEO Albert Bourla is Jewish, or that the head of Operation Warp Speed, Moncef Mohamed Slaoui, is a Muslim. Both men are likewise proud of their backgrounds, but that would not keep conspiracy-minded anti-vaxxers from exploiting religious biases to sow doubts about their work.
And perhaps there is an even more damaging aspect to Devineâ€™s superfluous reference to sexuality. His main theme, after all, is that Long COVID is a psychiatric disorder, which he then appears to reinforce by stressing its inferred origin with a â€œqueer feministâ€ collective. Whether or not it was Devineâ€™s conscious intention, some readers of the very conservative Wall Street Journal will inevitably draw a connection between mental illness and homosexuality, assuming that gayness is at the root of a psychosomatic condition.
Bill Colley, a commentator on a Fox News Radio affiliate, quoted Devineâ€™s description of the Body Politic as a reason to worry that tax dollars will be spent to â€œstudy â€˜long covidâ€™ among lesbians.â€ Because the Body Politic serves women, Colley also suggested that â€œmany have some of their symptoms on a monthly basis,â€ adding that perhaps â€œPamprin would relieve some of the symptoms of â€˜Long COVID.â€™â€ Jonathan Kay, an editor of the conservative website Quillette, likewise quoted Devineâ€™s claim that Long COVID had been â€œpsychologically generated.â€ Referring to the Body Politic as part of a â€œpseudo-scientific movement,â€ he called Long COVID an aspect of a new â€œgender ideologyâ€ embraced by â€œa whole population of rich, pampered students looking for some kind of ideological framework that will help them weave a meaningful narrative out of the necessarily wrenching emotions associated with growing up.â€
I know nothing of Devineâ€™s background other than his current employment at McMaster and his 2017 graduation from the University of Toronto Medical School. Perhaps he is a person of great good will without a bigoted bone in his body. Perhaps he is an extreme progressive, outwardly devoted to equality and respect for all persons. Even if so, he is now in training for a profession with a sorry history of misogyny and homophobia. Psychiatry has attributed autism to â€œrefrigerator mothers,â€ and once classified homosexuality as a mental illness and attempted to â€œcureâ€ it through psychotherapy. Devine should therefore know better than even to hint â€“ especially in a hostile and dismissive tone â€“ that sexuality may play a role in what he calls an â€œunderlying mental-health issue.â€
We are fortunate to live in a time when LGBT+ people have at last achieved basic civil rights and no longer need to conceal their identities. It is good that the Body Politic can announce itself as a â€œqueer feminist wellness collectiveâ€ without (too much) fear of reprisals. Sadly, however, it is evident that implicit gay baiting has not gone away, even among the most well-educated professionals.
Extensive biomedical research on Long COVID has been well funded by the National Institutes of Health. Progress is now being made at multiple laboratories, though the mysteries have not yet been solved. So letâ€™s be clear: Long COVID is real; it is not a manifestation of mental illness; and it has nothing to do with anyoneâ€™s sexuality.