The illness is over, now things are looking up: If this expectation is disappointed, it is not uncommon for us to fight the long-term consequences of an infection in our heads. And not only for Covid-19 for a long time. About the psychology of long-term damage.
Physical weakness, fears and depression, a dramatic drop in performance: these are symptoms that can remain as long covid when the actual infection with the coronavirus has long been over. But other viral infections such as flu or shingles can also lead to those affected dividing their life into a before and an after. The psychiatrist and psychotherapist Dr. Monika Vogelgesang works in the Median Klinik Münchwies with long-Covid sufferers and explains what influence the psyche, the struggle with oneself and the impatience of society have on recovery.
BRIGITTE WOMAN: Dr. Birdsong, what surprises you most about people who come to you with long covid symptoms?
Dr. Monika Vogelgesang: The excessive exhaustion. People who were previously very productive are now broken at the slightest stress. But psychologically they are also quickly taken. If you hear or see something that worries you, the tears come faster, you are mentally a flag in the wind. It used to be called irritable weakness, an old medical term. The ability to concentrate is also gone. Multitasking is no longer possible. Another thing that catches the eye: It also catches people who had a rather easier course.
The course of the disease does not tell you how severe the symptoms will be later on?
No, unfortunately not. We still don’t know enough about that. What can be said: people who have been in hospital with Covid-19 suffer from symptoms of trauma. One of our patients was always terribly frightened when he heard a soft knock. Because the intensive care unit always knocked loudly when someone came in. And that never meant anything good for him: The encounters with the masked staff were always brief, which was inevitably not a pleasant human contact. Others have terrible nightmares about what they have experienced. They always revolve around complete helplessness and the fear of dying.
Do these fears later also trigger the great exhaustion?
The body itself plays a major role in exhaustion. It is believed to be a result of the severe inflammation the virus caused. We also know other diseases in which such long-lasting fatigue symptoms occur.
For example with severe influenza or herpes that affects organs.
Exactly. It is about inflammatory processes in the body that drain it for a long time. When we had this violent flu epidemic three years ago, I met affected people who were previously very sporty and who took months to get back to their previous level. There is also such exhaustion with cancer. Nevertheless, it is precisely these physical emergencies that are actually the good news. Because they can regress over time. In the end, it is often the psyche that throws us through our plans. Fears overshadow the recovery process, slowing it down.
Because those affected fear that they will never get out again?
Someone who was previously very productive and strong, who now realizes that I can no longer be as I used to, often reacts very frightened and disappointed. The result can be depression. In such a situation, some people often want to push their heads through the wall with all their might to force them back into their previous form. Unfortunately, that doesn’t work at all.
Why not?
The only thing that helps is to listen carefully to your body. To be very attentive to his deficits and to practice with him very carefully without overexerting him. In physical activity you should find a good, individual balance between sticking your head in the sand and being overwhelmed. This is not easy. Because people know each other very differently and before that they could deal with stress in a much more stable manner. The idea of taking small steps is immensely important. Sporty, motivated people sometimes have an advantage. They often have great stamina and are very tough. They don’t throw the gun in the towel so quickly, they just stick with it.
Does negative expectations worsen the prognosis?
Yes, it can become negative and actually take on depressive traits. Pessimistic beliefs discourage you and rob you of the vital strength you need to recover. Our caregivers play an important role here: If the family understands and helps to get up again, this protects enormously against a mental crash.
Probably one quarrels terribly in such a situation?
It is exactly like that. Those affected put themselves under massive pressure. Don’t understand why they can’t get back on their feet. And then there is also a social component: From the outside you cannot see that someone is suffering from Long Covid or generally from virus-related exhaustion. The external environment therefore reacts with little empathy. We experience this again and again: Patients often feel pushed into an uncomfortable corner. According to the motto: Surely it simulates! Or: is she now shirking work? That is why education is so essential here.
There are certainly people who say: “This fatigue doesn’t exist. It’s all psychological.”
I clearly think that’s wrong. We are dealing with a causally organic disease. That can hit anyone. So I would be careful about pointing the blame: It has nothing to do with willpower or indulgence.
What is the key factor in getting well? Is it the inflammatory processes that are gradually retreating?
On the one hand that. An important hypothesis is that the increased immune defense leads to the great exhaustion. Because it’s still running at full speed or going crazy. The body is drained from these internal processes. It is now obvious that it is going in the completely wrong direction to break it through training. We teach our patients to move very gently. It is also very important that you treat yourself in a friendly manner. In the beginning it may only be possible to go for a walk, to be in nature. We have to give the body a chance to recover.
What role does correct breathing play in recovery? Covid-19 is very often associated with impairment of the lungs.
We know from pulmonary rehabilitation that many people breathe incorrectly. Too superficial. Not in the stomach, not in the flank – which is even more tiring. Even when the lungs have recovered, correct and good breathing is unfortunately far too little practiced. We train that with our patients. Just like being able to sleep well again. Many patients have insomnia and have to learn from scratch how to sleep properly. This includes sleeping as little as possible during the day and stop brooding before going to bed.
How do you work with the emotional lows of those affected?
For example, we offer trauma therapy specifically for nightmares. We treat anxiety and depression psychotherapeutically in groups and one-on-one discussions. Among other things, it is about relief and positive thinking. We have a lot of success with EMDR …
… a technique that redirects processes in the brain via eye movement and is often used in cases of trauma.
It works really well with Long Covid patients who have not been mentally ill before. Of course, if older mental injuries are below that, it’s more difficult. This increases the feeling of helplessness. In such cases, we recommend addressing old trauma that may come to light through Covid in a separate psychotherapy.
If we are only talking about Covid and its long-term consequences, do you dare to predict that this can be dealt with relatively well?
Of course, I may not find my way back to one hundred percent of my old performance. We must therefore make employers and politicians aware of the issue: there must not be any stigmatization here. It can happen, for example, that patients are very sensitive to noise after their recovery or need a lot of rest while working. But I am basically an optimist: if you give it time, it will come back. You may not be able to uproot trees afterwards, but there is a clear improvement. It is very helpful to exchange ideas in self-help groups, to give each other hope. It’s really good when someone says: “It took months, but now it’s actually gotten better.”
You give courage!
In any case. I assume that the psychological impairments will regress over time with the right treatment. One should definitely not give up hope. The Corona virus is completely new to us: Nobody has had anything to do with it before, a lot of people have died from it. The Long Covid patients have experienced great suffering and a threat to their lives. That is why I advocate treating them with the greatest respect.
What is your experience with other viral diseases such as shingles? Are there similar psychological long-term consequences?
I assume. But with shingles there are also neuralgic pain, which is the dreaded complication of this disease, which creates its own problems. That is why one is often treated with it in organ medicine. The patients usually do not come to us at all. But I could well imagine that psychosomatic therapy would also help them a lot. The related Epstein-Barr virus, the causative agent of Pfeiffer’s glandular fever, is also known: it occupies the sick for a long time. This leads to symptoms that we also know after Covid: exhaustion, hopelessness, fears of not recovering. The healing of these viral diseases takes its own pace. And those affected sometimes have a lot of patience.
Dr. Monika Vogelgesang is a specialist in neurology and psychiatry, psychosomatic medicine and psychotherapy. Her specialties include alcohol and drug addiction, anxiety disorders including the consequences of trauma, depression, but also pathological gambling among women. She is the chief physician at Median Klinik Münchwies, where long-covid patients can be treated for about five weeks.