The Psychologisation Pandemic
Denial of “invisible” suffering is bad science and worse ethics.
They seem to have the idea that millions of people around the world want nothing more in life than to lie in bed and fulfill their “sick role” and that they don’t want to get better. It’s kind of an extraordinary notion.
~public-health journalist David Tuller
I.
In recent years, I’ve grown weary of a certain style of cultural criticism that’s come into vogue, especially online since the onset of the COVID-19 pandemic. It goes something like this:
There is a tendency today for otherwise normal and healthy (and very often privileged) young people to dramatise their pain and problems and pathologies online for attention and sympathy and status. This behaviour is culturally rewarded by peers and parents and prestigious institutions and platforms, thereby exaggerating their weakness and victimhood. People are diagnosing themselves with various mental or physical disorders they may or may not actually have, and defining themselves by their disabilities and diseases in pursuit of a sense of purpose and specialness and belonging, ultimately putting more stock in their vulnerability to life’s forces than their resilience in the face of them. The long-term consequence is that we’re raising a generation that’s uniquely fragile and incapable of dealing with reality. The kids are not all right.
There are many themes at work in that paraphrased summary—political correctness, culture-war imperatives, modern liberalism, the intersection of our collective mental health and the ever-expanding digital space. But the real target of the kids are not all right critique is a popular kind of therapeutic culture found online and in the real world. This culture, we are told, is driven mostly by social-media discourse and risk-averse parenting, and it is characterised by an unrelenting emphasis on emotional safety. Every painful feeling or experience is presumed to be a sign of some larger social or medical issue and difficult realities are rearranged to soothe and affirm the self and alleviate personal agency and responsibility.
But is it actually true that people are genuinely rewarded for their suffering and benefit from victimhood? Is it true that having a disability or illness comes with some sort of social advantage that outweighs the handicap? That weakness and incompetence are more prized in our culture than strength and capability, or that we prefer bleak stories of failure and defeat to uplifting narratives of success and victory?
Well, I am actually sick and disabled and I don’t agree with any of this. There still appears to be a lot of unrewarded suffering in the world and our culture can be pretty cruel and callous toward the vulnerable as a matter of course. I’m stunned by this notion that everyone is super-sensitive to the suffering of strangers these days and that this super-sensitivity has become a serious problem. Do you think anyone is anxious to hear about my complex neurological disease? I would like to ask the people who think that weakness and suffering are everywhere rewarded: Do you reward it?
Samuel Kronen
If anything, our screen-addled, instantly gratifying, digitally intoxicated culture makes people less sensitive to and conscious of suffering in important ways, contributing to a more casual cruelty. Far from rewarding weakness, people seem to be obsessed with power. And it seems that many sick and disabled people are more inclined to hide their conditions and disorders from the world—or drop out of public life entirely—precisely because these things so obviously lack social appeal. Isn’t it more likely that people vent about their conditions online because they so clearly aren’t rewarded in the actual world?
Of course, the goodwill of others can be exploited by those who pathologically crave a certain kind of attention, and we have names for this kind of thing. The overwhelming reality faced by the average disabled person remains that the world is largely indifferent to our pain. Not every problem in the world is related to social media or our alleged “mental-health crisis,” and not every kind of suffering-speak or “medicalisation” can be used to identify some larger or deeper problem with the kids these days.
I worry that we will lose our shared respect for suffering if we cannot distinguish between our general neuroses about the modern world and people struggling with actual diseases and disabilities, often without adequate medical care or social support. You would never know such people existed from the subgenre of media commentary I’m discussing here, and if you do hear something about online advocacy around chronic illness and invisible disability, it would likely be in a rather unflattering light.
Someone will read one of these pieces about how young people overstate their pain for attention and use their diagnoses to escape the burdens of adulthood, and will naturally come away more likely to dismiss complex illness and disability, and more likely to see any suffering they don’t understand as yet another example of how the kids are not all right. If these takes are not about people like me, why does it feel like they are?
II.
The same arguments employed for decades to dismiss my own illness—that it’s psychosomatic or psychogenic, hypochondria squared, psychosis, or social contagion—are now being used to dismiss Long COVID, a disease pathophysiologically similar to my own.
An essay by Gurwinder Bhogal—republished last year in the British postliberal magazine UnHerd (after it was originally posted on Substack)—complains that “liberal society is making us ill.” It exemplifies this denialist brand of cultural-medical commentary around emerging or complex disease. In an effort to say something about the importance of agency, the author begins by asking: “Given that Covid tends to affect men more than women, why would long Covid affect women more than men?” He continues:
And given that Covid complications are extremely rare in the young, why would teenage girls be disproportionately affected by long Covid? Finally, why would long Covid affect transgender people most? The answer lies in the fact that long Covid is not a strictly physical phenomenon.
False premises lead to false conclusions. Long COVID is actually quite prevalent among young people and children, according to recent data. A large longitudinal study of thousands of kids and adolescents has uncovered long-term complications in every organ system—a finding that helps to explain the ongoing school absentee crisis. Up to 5.8 million children in the US have some form of Long COVID, according to an estimate in the American Academy of Pediatrics. And this type of post-viral condition has been far more common in women for decades (a discrepancy that should not be entirely surprising to those who accept than men and women are biologically different).
Bhogal misuses the fact that many people with Long COVID didn’t initially have a positive COVID test. Many of these cases date back to early in the pandemic before testing kits were widely available. Besides which, the absence of a positive test does not mean a person definitively has not had COVID (especially considering how widespread it has become since). “In fact, long COVID correlates about as much with mood disorders as with Covid itself,” the author claims.
Just because a disease is associated with stress or mental illness and more commonly affects women or some other demographic group, that doesn’t mean it’s not a real physical condition. Still, the author summons these tropes and ultimately employs the same backwards psychosomatic logic once used to attribute cancer to emotional repression or Parkinson’s tremors to “the moralistic man’s suppressed desire to masturbate” or HIV/AIDS to homosexual stress or birthing pains to female hysteria.
No disease is “strictly physical” in a narrow sense because all diseases can affect and be affected by our emotions. But Bhogal’s essay is really about an alleged explosion of fake illness after the pandemic and how everyone now wants to be sick online because it’s super-rewarding and satisfying. This hypothesis has little to do with the aetiology of any particular affliction. “The tendency for people to misdiagnose their despair as a medical disorder can be observed far beyond reports of long Covid,” Bhogal declares. “Young people are reporting despair and distress at an unprecedented rate, and this mental health crisis is a symptom of a malfunctioning society—a society that is making people sick, by teaching them to feel sick.”
It really shouldn’t be this difficult to distinguish a cultural sickness or “mental-health crisis” from the reality of a biological disease, yet Bhogal’s essay moves from Long COVID to gender dysphoria and racial victimhood politics because, apparently, these things are all the same. The idea, it seems, is to cast doubt on any medical diagnosis or claim of suffering subject to uncertainty or novelty or unfamiliarity, guided by the conviction that the real problem is people making too much of their suffering rather than the suffering itself.
But Long COVID is a physical phenomenon in the same sense as cancer. Unless you believe that mice can suffer from psychosomatic illness or therapy culture, you will have to acknowledge this is a physical disorder and not an attitude problem or a byproduct of some generalised despair. COVID has now been linked to all sorts of long-term health issues, from brain damage to autoimmune disorders and diabetes. There is in fact an extensive historical precedent for this phenomenon, dating back at least to the Spanish Flu and the 1889–90 pandemics. A minority of the population really does develop complex chronic symptoms following various infections, both in sporadic and epidemic form.
In my case, it was mononucleosis (aka glandular fever), caused by the Epstein-Barr virus, but the same phenomenon can result from a COVID infection (in fact, these viruses are linked). Pathogenic chronic illness exists and matters and has been overlooked for decades in medicine and society at an outrageous human and economic cost. Around 400 million people worldwide report long-term COVID complications, at the cost of around a trillion US dollars. Even if you divide that number by eight or sixteen, it would still be absurd to dismiss that amount of suffering.
Given the historical record of post-viral health conditions, is it not possible that the apparent uptick in illness-related disability during the pandemic, and the more general visibility of diagnosis online, is due to people getting sick from new and worse viruses that spread more easily in our globalised modern world?
III.
Much of this has to do with the misconception that suffering is always obvious. But many forms of suffering are not. There’s no direct connection between suffering and moral outrage, I’m afraid, and very often that relationship needs to be corrected by drawing specific attention to an otherwise neglected issue. On the other hand, it’s human to be sceptical of suffering we don’t understand or that morally challenges us, from racism to AIDS, so there will always be a tendency to blame the sufferer for their plight to assuage our sense of moral responsibility.
When I was healthy, I studied mixed martial arts full time, trained hard all day, every day, and worked as a stonemason for two years before that. I was a tough and strong young man. But when I got really sick, life became about working within limits and accepting things I couldn’t change—how to forgo pride to ask for help, how to relate to others despite how different their problems are, how not to hate those people, how to reconcile myself with smallness and keep growing in smaller and humbler ways, how to routinely absorb unbelievably harsh experiences while resisting the urge to kill myself or harm others or have some other kind of breakdown.
Yes, the emphasis among the young on emotional vulnerability and therapeutic self-expression can clearly go too far and overshadow the essential human value of resilience in the face of adversity. But somewhere between limitation and possibility sits reality and that’s the only place where anything can be resolved or changed.
Humans’ fragile bodies are vulnerable to all sorts of damage and disease. Whoever came up with the comforting idea that what doesn’t kill you makes you stronger had clearly never heard of an affliction like Myalgic Encephalomyelitis. The much darker truth is that endless suffering can almost make a person less human. Some people do manage to become, in a sense, more human through the experience of pain, but that doesn’t mean everyone can at all times. What’s lost on self-help gurus is that things can always get worse, and are probably already worse than outsiders imagine.
IV.
Socialist writer Freddie deBoer offers an example of an otherwise careful analyst whose focus on online-identity trends around illness and disability sloppily conflates broad cultural pathologies with specific pathologies of the body and brain. “People hate when I talk as though there are personal benefits to identifying with these disorders,” he announces, “but there plainly are, or diagnoses would not decorate so many Instagram bios, would not make it onto so many scholarship applications, appear in so many gauzy celebrity profiles.” Well okay, but the idea that some people benefit from their afflictions is almost always accompanied by scepticism about the very existence of medically neglected diseases from which millions do suffer. In this way, deBoer’s writing ventures well beyond cultural analysis and into the realm of scientific truth claims.
DeBoer doesn’t believe Chronic Lyme disease exists, he attributes Fibromyalgia—a condition of severe neurological pain—to everyday human tiredness, and he calls my own illness (ME/CFS) a “boutique diagnosis.” That last description is a longstanding stereotype about a horrifically crippling disease with almost no research funding that uninformed people call “yuppie flu” because it is supposed to be somehow fashionable and desirable and cool. As far as I know, deBoer has never discussed Long COVID and only wrote about COVID fairly recently to say that anyone still concerned about the virus is basically a nut. He has only ever brought up pathogenic chronic illness to say that it’s probably bullshit and what we really need to talk about is the new wave of hypochondria and Munchausen syndrome and psychosomatic illness in the digital age, which are causing people to believe that they’re sick when they’re really not. These topics are never addressed separately—one is always used to discount the other.
DeBoer is apparently inclined to believe that anyone who claims to suffer from a complex or “mysterious” chronic illness is just mentally unsound in some way. These patients are not sick in the same medical sense that deBoer suffers from bipolar, they are sick in some vague and unreal sense that can be dismissed by armchair diagnosticians. I cannot imagine a person finishing deBoer’s aggressively sceptical review of New York Times columnist Ross Douthat’s memoir and feeling anything but doubt about the existence of Chronic Lyme disease and the idea of anyone living with it. Is anyone who reads an outrageously one-sided piece in the Free Press—scornfully titled “Hurts So Good”—likely to be sympathetic to sufferers of invisible illnesses and disabilities? Or are they simply going to dismiss them as attention-craving neurotics who need to somehow lighten and toughen up?
Naturally, deBoer will deny some or all of this or put it in different words. He will say that no individual should live under an unnecessary cloud of suspicion about their illness, but he will then proceed to cast doubt on the existence of an entire illness and by extension every patient suffering from it. He will say (and has said), “You just need to acknowledge that some people can believe they are sick when they aren’t.” In deBoer’s own words:
I don’t know how we confront the spiraling number of people claiming to have illnesses for which there are no objective tests without being frank about the existence of hypochondria, Munchausen’s, and psychosomatic illness—particularly when people insist on deepening the social incentives by giving the sick more and more attention.
I don’t know either, but somebody should probably tell deBoer that his own disease lacks objective and reliable testing, as do many other undisputed conditions from appendicitis to every form of mental illness. There can be reasonable disagreements about the nature of a given affliction, but why is mine the only disease in the world that it’s acceptable to regard as an attitude problem I could simply snap out of?
Yes, human beings sometimes incorrectly believe that they are sick when they’re healthy. And yes, that can include conditions like mine that are hardest to identify and treat. But the far more obvious and overwhelming reality is that most people don’t want to be sick and disabled for the rest of their lives—they want to do and be things and invest a lot in how much they do and are. Most people seem to have a very hard time sitting still and doing nothing!
It really comes down to different ways of looking at the general public. Are people usually excuse-makers and malingerers, forever on the prowl for handouts and sympathy? Or do they mostly want to be productive members of society, trying to act in their own self-interest while maintaining some semblance of pride? The modern world seems to place a great deal of value on not being a total loser, and I’m sorry to report that disabled people are not somehow exempt from insecurities and may well be more prone to them for obvious reasons!
There is a long-held and incredibly harmful tendency in medicine to psychologise anything it can’t yet explain, which led first to the belief that multiple sclerosis is a form of hysteria-induced paralysis, and later, to the idea that it only occurs in men—because women were disbelieved until the invention of the MRI scan was able to identify brain lesions in patients. We now know that it’s much more common in women. The problem is not psychology but the incursion of psychology into areas where it doesn’t belong. It’s one thing to say, in a clinical setting, that a given individual doesn’t have the illness they believe they have or that their physical symptoms are caused by underlying psychological problems. But it’s simply a fallacy to presume the entire global and historical phenomenon of pathogenic chronic illness is not real simply because it’s difficult to screen.
Not every medical issue or disease has been understood or resolved—medicine isn’t free of the blindspots and incentives that disfigure larger society, and medical personnel are as biased and egocentric as people in any other profession. Medicine isn’t just a science; it’s an applied science, in which all sorts of preventable human blunders can potentially arise. That’s why I’m in favour of bringing the patient experience to bear in medical settings. This is really the whole point of medicine—to correct the interplay between suffering and medical support that in many cases has been interrupted by institutional inertia and backward attitudes. If the customer is always right, the patient is right at least some of the time.
Advocates of greater awareness about my condition don’t want to reinvent the wheel. We simply want people to know that diseases like mine exist and that they need to be better understood and treated by medicine and society. I have a very hard time seeing the scientific or ethical value of opposing this position.
V.
The human tendency to turn away from any unrelatable suffering reflects a more serious blindspot in media and culture around marginal or unseen conditions. These diseases are barely ever covered, and when they are, coverage is often sceptical. Why do journalists, especially, feel so comfortable dismissing entire kinds and clusters of disease when the biological evidence for their existence is overwhelming?
UnHerd has published numerous articles casting doubt on the reality of Long COVID with titles like “Has Long Covid Been Exaggerated,” “Do Two Million Brits Really Have Long Covid,” “Weaponising Long Covid Damaged Public Trust,” and “Does Long Covid Really Exist?” (Although when science writer Tom Chivers was still a contributor, he did write a great piece about my own disease for them.) The reason the magazine has been so eager to publish this material seems to be related to their opposition to lockdowns and non-pharmaceutical interventions during the 2020 pandemic (framed as opposition to government tyranny), and an entire media apparatus has subsequently been constructed to downplay the effects of the virus.
But there haven’t been any lockdowns or mandates in nearly half a decade. That argument has been over since the arrival of the COVID vaccines. Governments are now actually banning face-masks in some places (what was that about government tyranny?), and the new social taboo against wearing them was illustrated by an incident in June in which a cancer patient was heckled on the street for wearing one. The tide has turned, recapitulating a common historical cycle of panic-and-neglect around infectious disease—people initially freak out about the danger and then do anything not to think about it anymore. And those hurt most by this will naturally be the most vulnerable—the sick, the old, the immunocompromised, and the disabled.
When the pandemic is over—and for many of us it simply isn’t—there is going to be a final accounting of the damage—which will include not just the millions of dead but also the many millions more who developed long-term health complications from repeated COVID infections. At which point, I am willing to bet that the story is not going to be that the pandemic turned everyone into a crazed hypochondriac or made them give way to some generalised social anxiety disorder. It is—and always was—the virus, stupid. As a recent paper on the ongoing threat of Long COVID summarised, “The narrative that we’re back to normal … is not based in reality.”
The pandemic inflamed the culture war. After the rise of therapeutic liberalism in the 2010s, we’re now seeing the ascendance of the opposite tendency, much of it in reaction to early COVID policies and online youth and mental-health cultures. The fact that Donald Trump could be president of the United States again speaks for itself. Otherwise apparently normal people seem to hold pretty extreme views these days, and the unhinged insanity of the average citizen is being exposed on social media daily.
Perhaps we are losing our shared sense of what’s normal in life. Perhaps the tendencies to normalise pathological things and pathologise normal things both stem from the fact that the normal itself has become pathological in certain ways. Is it really that young people today are suffering less and complaining more, or is it that they are just suffering in different ways? Is it that people are making too much of their suffering or are we just seeing more of it now online?
Perhaps some of this has to do with how weird we are about suffering in modern life, the games we play around it, and the meaning we try to draw or avoid drawing from it. Have you noticed that a majority of both the political Left and Right seem to be obsessed with defining marginal experience and using the alleged suffering of their favoured groups to gain moral authority and political power? Perhaps there is something everyday people need from the suffering of others, and perhaps we are not wrong to want to give meaning to pain.
We need a worldview that can use our collective and individual suffering for the good of all; that can say “your suffering matters” but “other people have it worse” in a way that allows those truths to coexist. Because a culture that cannot accept or acknowledge vulnerability, disability, and misfortune is not healthy, it is sick. A world that can stand to face the most profound forms of suffering is a much healthier and, in a way, more beautiful one. Indeed, there may be nothing more human than to make meaning of suffering.
Samuel Kronen
At present, few of us are anxious to hear a story of disability or illness that doesn’t have some kind of uplifting spin. This toxic positivity is part of why people don’t know more about my disease—because it simply sucks and only sucks and people don’t generally like to hear about things that simply and only suck, even when more awareness might make it suck a little less. For every inspiring story of disability, there are thousands more stories of people who languish in obscurity or worse and would love nothing more than to simply be average and okay.
Disabled people offer an unwanted reminder of how vulnerable we really are and how little control we have over our own lives and bodies. And those who get upset when they find some weird “disability is cool” thing online seem to be far less concerned by the much more common and casual cruelty that sees handicapped people as burdens whose interests are best ignored.
VI.
There’s definitely been a generational shift, and I don’t entirely disagree with the people I’m criticising here about the problems exacerbated by social media. I’m profoundly disturbed by TikTok culture and its effect on human attention, the way our digital migration detaches us from real life and other people and our own bodies and humanity, and the general numbness and nihilism and narcissism that seems to be everywhere at the moment. People need connection and community and direction that they are clearly not getting online, and that void is being felt across generations.
In this overcomplicated, disconnected, and fast-moving world, where people destroy each other less through outright malice than through cold and calculated indifference, what we need is a balanced message that compels us to look within and without, to examine and come to terms with ourselves and our lives and our flaws, even as we recognise our responsibility to the world and to others. To understand that all those other people out there, who can seem so strange and hostile and frightening, are actually like us; to recognise that what’s happening inside of us is also happening out there, too, and to deal with that somehow. What I’m really talking about is a kind of love, built from our shared loneliness.
Yet having a permanent, disabling, and largely invisible disease that medicine cannot yet treat and that most people don’t know about is not a normal part of growing up or being human. I hope the journalists who wave this kind of thing away never know what it feels like to be this vulnerable. It doesn’t hurt so good. It hurts really badly, constantly, and forever. It’s not a rite of passage; it’s a human tragedy and it’s my nightmare. If I vent about the pain, I’m complaining and victimising myself. If I try to cope with it publicly in any way, I’m accused of glorifying and glamourising it. And if I conceal it, my suffering will never be seen or helped and I will only suffer more for it.
Sometimes, we need to hear that bellow from the deep to remind ourselves that we’re still part of this world. You don’t have to understand or help people like me. But for the love of God, please stop using us as a way to complain about the kids these days.
