key: cord-0774635-41wgp8a7
authors: Mommaerts, Jean-Luc
title: Where is the mind in COVID-19 causality?
date: 2022-03-04
journal: Brain Behav Immun Health
DOI: 10.1016/j.bbih.2022.100434
sha: 4c6971220154718e61cfe47af1ef4e355d0030f6
doc_id: 774635
cord_uid: 41wgp8a7

Two years into the pandemic, hardly any studies have been done regarding the influence of the mind on COVID-19. However, there is much circumstantial evidence. The mind influences the body in ways relevant to COVID-19. Unfortunately, of the scientifically proven mental factors influencing immunology, many have been intensified by lockdowns. Relevant research might help us see COVID-19 not as a disease straightforwardly caused by a virus but by a whirlpool of factors in which the virus and mind play essential roles. Social nocebo (mass psychogenic illness) may be a significant mind-related factor in the whirlpool through heightening the suggestive idea that worse will come. This insight might bring a more profound view of the human social condition, transcending the present disaster. Meanwhile, the whirlpool metaphor may help acute COVID-19 patients and long-haulers, letting them understand that their mind is one element in the whole, no more and no less.

Where is the Mind in COVID-19 Causality?

It is not in the mind of most laypeople, clinicians, and researchers. Two years into the pandemic, hardly any studies have been done regarding the influence of the mind on COVID-19. The domain does not look causally mind-related because no one mentions it; therefore, no one mentions it. However, few researchers deny that the immune system plays a significant role in the complex causal story of individual morbidity and mortality through COVID-19. Also, the mind plays a substantial role in immune reactions and other defense mechanisms. The link is straightforward. This does not mean it is 'all in the mind.' We need research to find out the correct place of the mind in COVID-19 causality.

There is much circumstantial evidence. The mind influences the body in illness and healing in ways relevant to COVID-19. For example, mental stress can lead to acute or chronic inflammation and even provoke instant death, as in the case of 'takotsubo,' an increasingly recognized condition mimicking acute myocardial infarction (1). Mental stress influencing lung tissue inflammation has also been described. Some intriguing quotes:

 "The studies summarized in this review indicate that there are important linkages between anxiety and depression and viral diseases such as influenza A (H1N1) and other influenza viruses, varicella-zoster virus, herpes simplex virus …" (2)

 "The present report meta-analyzes more than 300 empirical articles describing a relationship between psychological stress and parameters of the immune system in human participants." (3)

 "Cortisol also showed a continuous association with duration of viral shedding." (4)

 "Stress-induced immune dysregulation has been shown to be significant enough to result in health consequences, including reducing the immune response to vaccines, slowing wound healing, reactivating latent herpesviruses, such as Epstein-Barr virus (EBV)" (5)  "Stress is an external factor known to be a potent exacerbator of respiratory infections." hysteria'-is common, having been documented for centuries in many cultural settings (7) . One study found 200 published accounts (8), still considerably underappreciated and underreported. No individual nor group is immune (9) . A positive correlation exists with a lifetime history of trauma and depression (10) .

In COVID-19, elements are present that may provoke social nocebo effects, engendering a social whirlpool (social media, news, individuals making each other anxious) and an individual whirlpool (social elements together with symptoms heightening the suggestive idea that worse will come). Of course, the virus is indispensable in a COVID-19 whirlpool. So is, in many cases, an overreaction of the immune system. In acute-upon-chronic stress, the immune system is specifically vulnerable to such.

The SARS-CoV-2 virus has evolved in bat communities, which are societies of mammals subject to a high degree of lifelong stress. In this way, such viruses have ample opportunity to adapt to stressed-out immune systems. Subsequently, they find these in us, humans. Epidemiology shows that human distress and its consequences-burnout and psychosomatic illness-are increasingly rampant, especially in technologically highly developed parts of the world. Distress-adapted micro-organisms can here find a window of opportunity.

So, why isn't the mind more visible in the causal storytelling of COVID-19? To forward the idea is daring because of two culturally underlying premises. Both can be easily tackled, although provoking problematic anxiety and possible backlash:

1. The premise that body and mind are fundamentally separate, whether or not as parts of a bigger whole. So, how could the ephemeral mind influence the material body? Answer: mind and body are just two ways of looking at the same entity. Anxiety-provoking: this means that the mind's survival after the body's death is definitely an illusion.

2. The premise that the mind only exists in conscious awareness. So, how could the conscious mind influence the body? Answer: conscious thoughts, feelings, and motivations result from non-conscious yet meaningful mental processing. Anxiety-provoking: this means that conscious free will is yet another illusion.

Acute stress-induced (takotsubo) cardiomyopathy. Heart Br Card Soc

Anxiety and Depression: Linkages with Viral Diseases

Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry

Basal salivary cortisol secretion and susceptibility to upper respiratory infection

Stress-induced immune dysregulation: implications for wound healing, infectious disease and cancer

Mechanisms of Stress-Mediated Modulation of Upper and Lower Respiratory Tract Infections

Immunization stress-related responses presenting as psychogenic non-epileptic seizures following HPV vaccination in Rio Branco

Mass psychogenic illness following tetanus-diphtheria toxoid vaccination in Jordan

Mass sociogenic illness

Experimental induction of psychogenic illness in the context of a medical event and media exposure