[Earw0rm]

Not necessarily fake. Mind/body homeostasis is WAY more complicated than that.

To use a computing analogy, which doesn't map perfectly onto the body, if consciousness awareness is userland, you can have things go wrong which are localised in ring 0 - brain drugs will be to some degree effective on those, that doesn't mean it's fake or made up.

In reality there are fuzzy boundaries and feedback loops everywhere. SSRIs treating this isn't any more mysterious than NSAID painkillers being somewhat effective for acute depression.

It's probably a whole set of feedback processes that get screwed up, hence the panoply of symptoms, inserting a hard stop into one part of the loop can be enough to kick the system back into a better functioning state.

[colordrops]

Thank you, these overly simplistic first-order-only analysis of extremely complex phenomena drive me nuts.

[Gibbon1]

I think there are strong links between the immune system, the autonomic system, and the brain. A dysregulation immune system can seriously mess with you.

The classic psychological explanation is the patient only thinks they are sick. But the reality is their body is behaving like they are sick. Worse the classic explanation why you feel sick is 'toxins' from an infection and that is wrong. It's your reaction to feedback from your immune system.

[Earw0rm]

Yep - people wonder why we can't treat ME/CFS, we don't even have decent biochemical markers for "fatigue" vs "energy", beyond trivial stuff like blood oxygenation and lactic acid. Nor are there much in the way of markers which will determine whether a competing athlete is going to have a good or a bad day.

For example, we have a concept of "energy" for which calories is a rough proxy, but there's no particular reason why fighting an infection should draw on the same reserves that running either endurance or peak muscle does, especially as most people operate in a state of calorie surplus, and their respiratory system is more than capable of supplying a bit of extra O2 unless they're severely ill. And yet clearly the immune/autonomic system forces people into a "rest" state in case of infection.

Or another one, there's no particular biological reason for older people to have less "energy". Like yes there's loss in muscle mass and some small drop-offs in the efficiency of various systems, but it doesn't seem like directly compensating for those makes all that much difference.

[MrBuddyCasino]

> we don't even have decent biochemical markers for "fatigue" vs "energy", beyond trivial stuff like blood oxygenation and lactic acid

We do have devices that can measure mitochondrial energy production. There are two I think, forgot their names.

[Earw0rm]

Yep, we can measure ATP and so on at the cellular level, but we don't have much of a picture of how that maps onto the physical/psychological sensation of "energy".

Like we know at a crude physical level, we can give someone a bit of a boost with glucose and sympathomimetic stimulants, but sometimes it works a lot better than others. And it's ineffective for fatigue syndromes, but they can't be the other mechanical things commonly associated with fatigue either. (lactic acid, micro-tears and so on).

[MrBuddyCasino]

I really hope we figure that one out soonish. There are so many people affected by these syndromes.