Not ALL in Your Head? Think Again

longcovidadvocacy
Jul 25
9 min read

Updated: Sep 13

A Campaign Guide for the Bait and Switch Tactic

Part One - Rhetorical Traps

Audio version in the Substack mobile app

An easy-read guideline is also available - just download above!

It is no accident that rhetoric was one of the three pillars in Roman education. In a world before the algorithm and social media engagement, it was the most powerful tool the ancient world had. Cicero and Quintilian were the Mr Beast and PewDiePie of their day.

How is this relevant to the world of chronic illness and the medical establishment? Well, because rhetoric has been used brilliantly (unfortunately) to sustain and perpetuate myths in society and medicine about the psychosocial or psychosomatic model applied to ME and Long Covid.

The point to understand about rhetoric is that it isn’t about truth - it is the art of persuasion, of how to use language effectively to sway public opinion, and therefore power and control. Simon Wessely is a master of this, and how he has been so successful in maintaining so much falsehood (and knighthood) in ME.

To counter this, we must be aware of the rhetorical traps used and how not to spring them, which is why we have begun this series. It can be used by those engaged with media and by those who hold the line on socials.

'But It’s Not All In Your Head' - Bait and Switch Rhetorical Trap

One of our core problems has been the response behavioural adherents make when they claim their work is not psychosomatic. It’s vital we recognise this trap for the rhetorical smokescreen that it is.

Here’s the rhetorical trap:

It’s not all in our heads

Bait - denies full causation

Of course it’s not all in people’s heads. No one said it was imaginary.

Switch - to partial influence

But psychological factors can influence real physical symptoms. I’m not saying you’re not ill. Your symptoms are real.

The bait and switch is that there are two distinct meanings of ‘All in Your Head,’ and a shift from all to partial.

Bait = Meaning One: It’s imaginary and made up (no illness at all). This is a crude and outdated assumption and is often associated with malingering.

This is the meaning that people usually think they are arguing against, but it’s an opportunity for the bait-and-switch trap.

Switch = Meaning Two: There are psychological factors and influences in origination and sustainment. This is the modern and insidious version. It is framed as compassionate and holistic (danger word) that the person is genuinely suffering, but it is influenced by emotional distress, trauma or unconscious beliefs. The symptoms are seen as real, but are a matter of perception.

The implication is that the patient should be treated with psychological therapies.

This is what proponents of the biopsychosocial model pivot and switch to when challenged.

An example of this can be seen on The Today Program with Prof Chris Ponting and Nick Robinson, June 20th, at 2 min 13 sec.

The Fallacies of The Bait and Switch

First, let’s drill down into the fallacies; we need to be able to spot them. Then we can counter, as it can be seriously tricky to know how to respond.

When people say, ‘Of course, it’s not all in your head, but psychological factors might still be involved,’ the cluster of fallacies is:

False Balance Fallacy: Creating a false equivalence between mind and body influences - implying causality without evidence.
Unfalsifiability: Deploying an unfalsifiable argument that cannot be disproved.
Category Error: Misattributing physical disease processes to psychological mechanisms.

This core problem of ‘Both’ framing it as both body and mind is brilliant rhetoric as it sounds conciliatory and appeals to ‘common sense,’ but it ultimately functions to preserve psychosomatic interpretations without taking responsibility for the harms caused.

Key Talking Points

Now we can recognise the bait and switch ploy, and understand that it's been so effective because it's framed as compassionate. Do edit & adjust according to need!

Strategy One - Expose the False Balance

No one disputes that illness impacts mental health. But that doesn’t mean mental health causes or sustains symptoms in ME/Long Covid (or enter other gaslighted illnesses.)

Strategy Two - Challenge the Category Error

ME is a complex physiological disease. Trying to treat it with psychological methods is disproportionate, and the evidence shows it is ineffective. One doesn’t fix a broken leg with mental health interventions.

Strategy Three - Name the Unfalsifiability

Suggesting psychological influence without evidence is not scientific thinking; it is speculation. Patients deserve better.

Strategy Four - Point Out the Political Origin

Assuming psychological influence in ME is decades old and has not been shown to be effective in evidence or through patient testimony. This biopsychosocial model has been strongly influential but has been shown to be a failed experiment. It’s time for rigorous science and reality.

Strategy Five - Flip the Burden of Proof

The claim of psychological causation and influence should require evidence. NICE’s evidence review for the ME Guidelines showed us that the evidence for this view was rated very low or low. Now is the time for high-quality science that can make a breakthrough for people’s lives.

Strategy Six - Name the Bait and Switch

There are two versions of ‘all in your head.’ One says it isn’t real and people are faking. The other says they are having symptoms because of psychological factors. Neither has credible scientific evidence, and both block progress. We only have to look at patients’ lives and the lack of care for people with ME - there is no commissioned NHS service for those who are severe.

What Not to Say

Avoid saying, “It’s not all in our heads.” This lessens the chance of the trap being sprung and having to defend the bait and switch.

Instead, you can focus on the lack of care and effective treatments for people with ME. You can bring in the political reason for this, the misattribution of psychological influence in ME.

Avoid saying - “people state that psychological factors wholly cause ME.” This prevents the more nuanced psychological factors push back.

Instead, fall back on psychological influence - as this has been the modern framing.

Media Training Tool - Variations of ‘Not All in Your Head But...’

There are several spin-off scenarios that it is helpful to prepare and watch out for. We've prepped some of them here for you and how to pivot the argument back:

Scenario 1 - Speculation

Well, psychological factors might still be involved.

Pivot

That’s speculative. There’s no robust evidence for psychological factors. We’ve seen this unprovable theory spouted for decades, and it’s time for effective treatments that improve patients’ lives.

Scenario 2 - Mind-Body Disclaimer

I’m not saying it’s imaginary - we just know the mind and body are connected.

Pivot

Yes, mind and body interact. But that doesn’t justify blaming the mind without evidence. If we did that with cancer or MS, it would be recognised as unethical.

3 - Anti-Mental Health Trope

You’re rejecting mental health support.

Pivot

Mental health support is valuable, but not as a substitute for diagnostics and disease-modifying treatments. People with ME have been denied safe mental health support because it has been assumed psychological factors play a role in their illness.

Scenario 4 - Psychology Influences Everything

Surely psychology plays some role in illness.

Pivot

Yes, in how we cope. But not as a cause or sustaining factor. If I break my leg I would not expect to be treated with psychological interventions and for the break to be ignored. This is what happens to people with ME. They deserve our care in treating the break.

Scenario 5 - Difference of Opinion

Isn’t this debate just about perspective?

Pivot

No, it’s about evidence. Psychological theories have been promoted in ME without proof or a history of effectiveness. This has delayed serious medical research. It’s time to apply our resources as a world-leader in medical science for people with ME, just like we do for other serious illnesses.

Clarifying the Core Problem - Anti-Mental Health Trap

The reason this debate has been so pernicious and effective is that if there are justified objections to the biopsychosocial model, they swing back with the “anti-mental-health” trap. In essence, they weaponise mental health, and it becomes a shield for bad science. To be clear, we are not dismissing psychological support for coping with chronic illness - this is vital, but it needs to be disconnected from symptomatology.

Strong Framing for Advocacy - Reframing Strategy

The Side Step

It’s a classic, but don’t answer the question - sidestep the trap. Don’t defend yourself against psychogenic assumptions.

Instead, rely on the reality that ME care and research is poor and under-funded. Shift the conversation to this. Expose the structure and the injustice. Create an emotive response that moves the audience to your side. Clear the smokescreen with reality.

Pivot to Key Facts/Stats:

This psychological explanation for ME has been prevalent for decades, but we just have to look at the reality of the harm to patients this has contributed to and the fact that:

Choose Fact:

There is no commissioned specialist NHS service in England for ME.
ME affects an estimated 400,000 people in the UK. Despite this, ME receives less than £2.48 per patient per year in public research funding. Compare that to:- Multiple sclerosis, £130 per patient- Parkinson’s disease, £75 per patient- HIV/AIDS, £1000 per patient
Action for ME (2017) reported 1 in 5 surveyed families of children with ME had false child protection services initiated.
Many adults with ME report medical disbelief or dismissal in NHS encounters. A 2020 literature review found that up to half of GPs did not accept ME as a genuine clinical entity.
Unlike other complex diseases, ME has no official lead within the Department of Health and Social Care (DHSC).
At least 25% of people with ME are housebound or bedbound, many of them for years and decades.

Conclude with an empathetic link that connects to patients, i.e.

Imagine a neurological disease affecting hundreds of thousands without a properly funded NHS treatment pathway.

Imagine your child being ill and being subject to a safeguarding intervention from a system that doesn’t understand the illness? This is what families with ME have to go through.

People with ME are treated like a disappearing population - unrecorded, under-resourced and unrecognised.

The Socratic Tactic

The goal here is to avoid defending your position directly. Socrates was the master of discovering knowledge and fallacies through questions. This is a slightly riskier tactic, as it doesn’t shut the dialogue down. But in a pinch, it can work.

Question

But couldn’t it be influenced psychologically?

Evidence Clarification Response

What specific evidence are you referring to that psychological factors cause ME?

Would you apply the same standard of evidence to diseases like Parkinson’s or diabetes?

Burden of Proof Response

What would it take to falsify your theory of psychological influence?

Shouldn’t the burden of proof be on those making this psychological claim, not the patient disproving it?

Category Error/ Misattribution Response

If a person with cancer feels anxious, would you say their anxiety is influencing the tumour?

How would you distinguish between psychological causes and psychological consequences of a debilitating disease?

Double Standards and Selective Application Response

Why is ME so often singled out for psychological speculation when other better-understood diseases are not?

Do you think this focus on psychological factors reflects scientific reasoning, or social stigma?

Trauma Link Test Response

If you think trauma and psychological factors influence ME, how do you explain the cluster outbreaks and post-acute viral onset patterns?

Policy Consequences Response

What do you think happens when we treat a biological illness as if it’s heavily influenced by psychological factors?

Are you aware that assuming psychological influence has caused documented harm and injustice to patients?

Do you think we should be cautious about assigning psychological explanations, given the historical and present-day harm they have caused?

Final Reframe Response

Why are you so invested in the idea that the mind must be influencing ME, when the biology is pointing elsewhere?

If we treated this as a biological disease until proven otherwise, what would change?

This approach can make the listeners question the deeper applications and shifts the burden of proof back onto them. It also allows one to stay calm and maintain an authoritative and reasonable impression. Yet, it can also extend the discussion into further territory and open one up to more convolutions. If backed against the ropes again, ask another question!

Naming the Traps, Shifting the Power

We hope you find this guide useful and informative. The idea is to offer the community clarity and energy-saving tools to deal with the harmful rhetorical traps often touted. It isn’t perfect, and it can’t guarantee success, as genuinely who admits to changing their mind or being wrong?!

Ultimately, it is only irrefutable biological proof that will stop the speculation that ME is psychologically influenced. Fingers crossed, the emerging findings of Decode ME (we're rooting for you Chris and all) will help, especially if genetic signals can be pinned down.

Hopefully, what it can do is scaffold likely ways out and take the audience with you.

With Decode ME coming out and the Delivery Plan finally seeing the light of day (yes, it’s not good enough), this is a key opportunity to shift public perception and the narrative to truly see the injustice and awful situation the community is in.

If you have any other suggestions for ways out of the ‘it’s not all in your head’ bait and switch or ideas of other rhetorical traps you’d like us to cover, then please let us know below in the comments. Traps on the drawing board are:

It’s Multifactual Trap
The Gaslight Reversal Trap
The Anecdotal Trap

Remember we also have our easy-to-read jazzy campaign guide. Please download and use! If there is anyone you would like us to send it too, again just let us know!

*A quick note to say thank you for supporting LCA's articles this year. We hope they can positively add to the shifting discourse around Long Covid and ME. To keep ourselves fresh, we are just about to take an advocacy break in August - but will be back in September! Stay safe! (And yes, our fully fledged Media Guidelines are nearly done.)