If you are living with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or long COVID, you are likely dealing with a range of persistent symptoms, which may include fatigue, brain fog, pain, nausea, poor sleep, and digestion problems, among others. In the face of this litany of symptoms, you would be forgiven for concluding that your body is somehow broken.
However, it may be more accurate to consider your body as being dysregulated. Despite confusion and contestation surrounding ME/CFS and long COVID, research arguably points to these health conditions as signaling a body out of balance — an idea I introduced in a previous post.
But what gives rise to this state of imbalance in the entire organism? One logical answer, borrowed from physician and author of The Myth of Normal, Gabor Maté, is an imbalanced environment. To understand how this might be the case, a useful starting point may be to consider that balance is what your body fundamentally needs to run smoothly.
Your body needs balance
Your brain and body are engaged in a constant process of keeping different biological resources balanced, from oxygen and carbon dioxide levels, to glucose and insulin. This ongoing balancing act, called homeostasis, is what health psychologist Vincent Deary describes as the “largely automatic work we do every day just to stay the same”.
If we were to live our lives in a perfectly stable environment, homeostasis would be a wonderfully straightforward process. However, as Greek philosopher Heraclitus observed, the only constant in life is change. But even in the face of ever-changing circumstances, our brains and bodies are incredibly effective at adapting to new demands. This process, which Deary summarises as “the work of maintaining stability in the face of change” is called allostasis.
The brain is the body’s conductor: it orchestrates allostasis. It is responsible for balancing our “body budget”, in the words of neuroscientist, Lisa Feldman Barret. Staying within budget means that we are not using more biological resources than we have.
The calculating brain
In order to maintain this balance, the brain enlists our senses to scan our environments for cues of safety and danger. This is known as exteroception. Here, the brain is trying to answer the question: What threats are out there?
The brain also makes sense of signals coming from inside the body. This is called interception. Here, the brain is trying to answer the question: Do we have the necessary resources to respond to the challenges out there?
The brain integrates information coming from the outside world and from inside the body, along with its prior knowledge about what has happened in similar situations in the past. It uses all of this information to make predictions about whether or not it will be worthwhile for us to expend energy on a particular activity.
Escaping potentially threatening situations is generally prioritised as an essential expenditure of energy. Fighting off infections — ditto. Moving towards rewards like food or sex are usually calculated as worthwhile, so long as the costs of doing so don’t outweigh the benefits.
Neuroscientist Lisa Feldman Barret summarised this dynamic when she noted that at a certain point in the evolution of living beings, “the most critical question in existence became “Is that blob in the distance good to eat, or will it eat me?”
Based on these unconscious predictions and calculations, the brain sends instructions to various bodily systems through neural pathways, especially via the hypothalamic pituitary adrenal (HPA) axis and the autonomic nervous system. In turn, this allows the brain to regulate the immune system’s inflammation response, along with the gut and each of the organs in the body. This “homeostatic network” helps direct our body’s resources to best respond to the particular situations in which we find ourselves.
When the turbulence is too much
At this point, you may be wondering what any of this has to do with chronic health conditions like ME/CFS and long COVID. Well — and thanks for bearing with me — what I am hoping to explore with you here is that we humans are generally pretty impressive in our ability to balance our body’s resources, even in the face of stress. However, what is crucial, is that our ability to navigate change and handle stress is not infinite. In order to keep on meeting the next challenge on the horizon, eventually we need downtime to rest, restore, and rebalance our body’s resources.
When we lived as hunter-gatherers, our lives were probably quite conducive to this balance. We might spend a few hours on a hunting expedition, but then we could come back to camp, snooze, eat, and chat. At some point, we might run across a predator and need to enlist our body’s stress response to escape it. But again, we could be sure that, assuming we survived the encounter, we could rest afterwards.
But what happens in the bodies of humans living in the twenty-first century — for whom stress is more likely to come in the shape of social media than saber-toothed cats? What happens when our lives become completely unmanageable? What is the end result when our brains come to conclude that the cumulative demands being placed on our bodies are so relentlessly overwhelming as to be insurmountable?
Vincent Deary summarises this predicament as follows:
“Our hearts, minds and wills — our emotional, cognitive and biological resources — are altered and drained when too much is demanded of them for too long, or when the demands don’t stop coming. This is what is known as allostatic load, the wear and tear that happens when the turbulence is too much.”
Chronic stress, ME/CFS and long COVID
Such situations of chronic stress are what I routinely see in my clinical work with people who have ME/CFS and long COVID. Typically, in the period before they become unwell, people with these conditions had been doing their best to muddle through months and often years of stressful life events.
Everyone’s story is different, and yet there are common themes. People have been navigating ongoing stress in one or multiple forms: relationship difficulties, unforgiving jobs, caring responsibilities, financial strains, discrimination, being neurodivergent in a neurotypical world, bereavement, the weight of past trauma and exposure to harmful toxins, along with physical injury and medical procedures. Then there are the wider impacts of living through an age of unprecedented change, the global pandemic, and the moral injury of twenty-first century life.
In many cases, people have not had the opportunity to process the psychological impacts of these stressors. Commonly, on the back of such stressors, there comes a final insult to the body such as a viral infection. This appears to act as the straw that breaks the camel’s back.
Research is still emerging, but psychosocial stress has been shown to be associated with conditions like ME/CFS and long COVID. One study found that a low baseline level of cortisol, which has itself been associated with chronic stress, was the strongest predictive biomarker for long COVID. Another study suggested that psychological distress made people more likely to develop long covid.
Observing that many people are chronically stressed before becoming unwell with fatigue-related health conditions is not to say that stress is a single “cause” of these illnesses. In future posts, I look forward to exploring with you how chronic stress may help create a set of conditions in which the brain eventually comes to learn that the body is fundamentally unable to meet the challenges facing it. This in turn may prompt the immune system to unleash a seemingly unending “sickness response” in the form of persistent symptoms like those seen in ME/CFS and long COVID.
