When your body changes suddenly—and doesn’t change back—your mind has to adjust to a new reality, and there are profound psychological consequences.
Unfortunately, with complex conditions like long COVID, it can be tough to admit, much less process, the psychological impact, for fear of being dismissed. But long COVID isn’t “all in our head,” and we need support.
In February, I was joined by psychiatrist Dr. Samaiya Mushtaq for a Substack Live on this topic. We talked about something many patients feel but struggle to name: Chronic illness is a physical event that can be psychologically damaging.
1. Your reaction is not the problem
One of the most clarifying points from our conversation:
What patients often label as “something wrong with me” is often a response to loss.
Loss of function
Loss of identity
Loss of predictability
Loss of the life you expected
Dr. Mushtaq avoids the word “normal” entirely. Normal—and therefore a change in normal—varies from person to person. Once you stop pathologizing your reaction and accept that you’re impacted, you can start working with it.
Grief, anxiety, rumination are expected when life changes this dramatically.
2. Uncertainty is the real stressor
Dr Mushtaq introduced an important concept: uncertainty tolerance.
Some people can sit in ambiguity more easily. Others cannot—and that difference shapes how illness is experienced.
Chronic illness, especially long COVID, is defined by:
unclear timelines
evolving symptoms
incomplete science
If your baseline tolerance for uncertainty is low, the psychological burden is higher. This is not a character flaw. It’s simply a variable.
Food for thought: What’s your relationship with uncertainty?
3. When does it become “clinical”?
When does “normal” grief become clinical depression? Dr Mushtaq explained that there is no clean line between the two, but offered a practical framework.
Mental health becomes a clinical concern when it starts to affect:
Function (you can’t do what you need to do)
Relationships (strain, withdrawal, conflict)
Quality of life (persistent suffering without relief)
Clinical conditions are determined by severity and timeline.
4. Medications: a reframing
Patients with chronic illness are often wary of psychiatric medications, and some of that skepticism is justified. But some of it might be unnecessary fear.
Medications are not the only way to treat clinical conditions, but left untreated (or under-treated), anxiety and depression have real physiological consequences:
autonomic dysregulation
sleep disruption
cognitive impairment
worsened perception of symptoms
Medications are a tool. And in some cases, they serve a very specific function: They raise your baseline just enough so you can use the other non-pharmacologic tools to improve mood.
Tools like therapy, supportive routines, friendships, and diet can help maintain mental resilience, but they require mental bandwidth—sometimes a lot. Medications can help improve that bandwidth enough to engage with other modalities. Think of it like building a supportive scaffold.
“We ask about the side effects of medications—but not the side effects of untreated mental health conditions.” — Dr Summaya Mushtaq
5. The conversations we avoid
Our mental health isn’t just an internal struggle; it impacts our relationships, too. Care partners might notice their loved one needs help, but may feel helpless and afraid to speak, worried that their concern will be interpreted as denial of physical symptoms.
Dr. Mushtaq reframed this. by pointing out that difficult conversations usually come from a deep investment in the relationship. But that doesn’t mean they’re always handled well.
It can be a tricky line to walk, but the key is giving the conversation time and space. It’s also helpful to remember the love underlying the relationship.
Learn more about the caregiver experience—including burnout— in my conversation with caregiver coach Kim Moy.
Learn more
Thank you to Dr. Samaiya Mushtaq for joining me in this important conversations. Read more from Dr Mushtaq here:
Remember, chronic illness demands more than physical treatment.
It requires:
psychological adaptation
strategic use of tools
and a willingness to work within uncertainty
—Dr Zeest Khan
What has helped you navigate grief?
