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Medically Unexplained Symptoms: A Treacherous Foundation for Somatoform Disorders?

Discussion in 'Other Health News and Research' started by Dolphin, Feb 19, 2017.

  1. Dolphin

    Dolphin Senior Member

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    I thought this short article makes some good points about the problems of the Medically Unexplained Symptoms diagnosis.

     
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  2. alex3619

    alex3619 Senior Member

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    Pretty well. Here I am responding to the excerpt, I need to read the full article.

    It left out logical fallacies in the thinking, though did point out the main foci of such fallacies. It also does not discuss the pseudoscientific methodologies used in this research.

    The thing I find annoying about unjustified mind-body dualism is that, not only are the mind and body treated as separate, they want to describe them as the same. Mind is just another part of body, but its a special (satirical accent on special) kind.

    The time to focus on "mind" is over. Its an obsolete term, like ether, phlogiston, etc. Using it keeps us in the age of ignorance.
     
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  3. trishrhymes

    trishrhymes Senior Member

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    Looks promising. It's behind a paywall - I'd like to see the rest...
     
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  4. AndyPR

    AndyPR Senior Member

  5. DeceptivelySlow

    DeceptivelySlow

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    Looks to me the quoted material raises some good points. Research and symptoms I have come across suggest the body-mind neural connection plays a significant role in emotions which I find fascinating. That is there is a very direct connection from the body generating what is in the mind (or at least that feed back loop is necessary to generate what is in the mind). To me this further validates that the conversion disorder concept is complete bullocks.

    For example doctors are successfully treating PTSD with a sympathetic neural block. A psychological issue being treated with something as "electrical/mechanical" as a neural block. I think there are some significant implications there.
     
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  6. trishrhymes

    trishrhymes Senior Member

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    Hmm, not sure about this. It makes some good points about not assuming that because a patient has had an MUS label put on them, it doesn't mean all future symptoms should be ignored, and that MUS simply means the cause hasn't yet been found.

    However, he seems to conclude that there is a role for psychiatry in dealing with physical symptoms because there is influence by the mind on how we perceive the severity of our symptoms, whether explained or unexplained.

    Personally, I find physical symptoms such as pain hardest to live with when I am frightened that there is something sinister going on that I don't understand. The thing that makes this pain more manageable is good scientific investigation and understanding of what is wrong, and, if necessary, pain relieving medication, not some psych messing in my head, thank you.
     
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  7. xrayspex

    xrayspex Senior Member

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    yes this is fascinating to me....firstly because I have chronic pain and fatigue. but I am curious about chicken/ egg with physical and cognitive ----it seems like it can't be just one way or the other. there are clearly a lot of people without chronic physical pain and fatigue who have been mightily helped by the work of people like David Burns a cognitive therapist who has written many books instructing people how to change their outlook and feelings by deconstructing and restructuring their thoughts and it can be very effective. To a degree it can also help some other physically chronically ill folks deal with tough situations....I find it difficult territory to navigate in my own understanding of what it is all about as well as trying to have conversations with those that don't understand the nuances, maybe because they have been pleased with their results of navigating "mind over matter" and I can tell they sometimes can't help but think maybe you just need to try harder.

    so how do you figure that out, determine which people can start at the point of thought-- catching their thought, changing it and having a more positive outcome vs those that won't work for? Some things it seems clear that you are going to have pain right away before any thoughts such as putting hand on a hot stove accidentally or something (or is that clear? can Tony Robbins and some gurus living in the mountains prevent that pain with their minds? I dunno)....but when you get into something like spinal pain it seems so tricky, or inflammatory pain.....I am trying to do what I can thru nutrition, rest, pacing and my mind etc to deal because there are no better tools I can tolerate available to me at this point in history that I am aware of so I am interested in understanding how far I can work with my thoughts emotions and behaviors but trust me I get really frustrated if a friend or medical person tries to play judge or director of that.......I know when something is beyond my control and have done the best i can.......

    its a quandary that can cause me great frustration and anger if I don't do a bunch of CBT on myself lol
     
  8. xrayspex

    xrayspex Senior Member

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    yes this sort of thing like the neural block is really of interest to me and relates to my quandary of how to figure out when something needs a physical approach like a block or meds or if you can make good headway with working mostly on thoughts and emotions. I feel very empathetic to people who have "only" a known psychological diagnosis, who don't actually present with a physical complaint but they can't get better with psych therapy--I bet people sometimes are the hardest on them thinking they aren't trying hard enough--the neural block for ptsd a psych diagnosis is great example of how the realm of what is considered "mind"/psych is not fully understood and sometimes responds best to physical intervention and not something like CBT. and like Alex was saying, talking about mind/body in that old way is sort of passe....but I want to find better language and concepts that I can easily use to help myself and others..........what is a working paradigm that can allow for the group of people with severe chronic pain or other "real" illnesses making progress with mindfulness and thought-work but others that need a neural block or other meds to make any progress?
     
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  9. Snowdrop

    Snowdrop Rebel without a biscuit

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    Some good points.

    Is there a link to this that I can tweet?

    Re: mind-body unity/dualism

    Is there not a case to be made for separating (for the purpose of understanding functioning) the brain from mind?
    The way I see it brain is just another organ of the body. Biochemistry happens in the brain as elsewhere. It can get sick whether with cancer or chemicals out of balance can cause depression or the electrical system can malfunction causing seizures.

    The mind is more than the sum of it's parts so to speak. It is not brain. It is the interplay between our body (including brain) and the world we experience. Because we have self-awareness there is more to our functioning than the biochemical actions taking place in the brain. All animals respond to their environment we respond 'thoughtfully' or 'reflectively' giving rise to a more nuanced way of responding to our environment.

    As a result of this kind of thinking we can also feel moods that are functionally problematic. So we feel depressed. Perhaps brain chemistry responds? This means that not everyone with depression (as an eg) will not have major life issues that need resolving since some have as primary brain malfunction in the context of a more or less normally satisfying life.

    We can't have mind without the body but we can't have mind without something outside ourselves either.

    To me this is the problem with the new mind-body speak. I's vague and it really signifies nothing. It's not science. And it allows for non-science interpretations of physical symptoms/illness. People tend to like this mind-body unification without really parsing what is meant by it--it just appeals to the concept of unity and wholeness. It is superficial. And harmful. It needs to be examined more closely as to it's meaning or any MUS can be mental phenomena because the mind and the body are one.
     
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  10. DeceptivelySlow

    DeceptivelySlow

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    I tend to get angry along with many others when some sort of psychological causality and ME/CFS get mentioned together. The articles points out some problems with that line of thinking which is good. I firmly convinced any psychological issue associated with ME/CFS is a side affect and has zero causality other than possibly aggravating symptoms. Anxiety is something that jumps out at me as possibly side affect from a malfunctioning ANS but mental stress can certainly aggravate this issue.
     
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  11. xrayspex

    xrayspex Senior Member

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    snowdrop, good points about distinction and intersections of mind/brain

    your last paragraph tho is part of the quandary, I want to find legitimate way thru it to make sense and make most of it.....Norman Doidge who has written a couple of books (I have both) about brain research around the world that is promising for chronic health problems I think navigates the territory pretty respectfully and intelligently
     
  12. alex3619

    alex3619 Senior Member

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    When I read "mind" I interpret that as "brain function". The idea of mind as an entity, a thing, something separate, is from an age in which we believed that life could spontaneously arise, that miasma caused disease, and that women had wandering wombs.

    To me the brain is the physical thing, what the brain is, and what we call mind, and a lot of other aspects of brain, are what the brain does. Labeling this "entity" "mind", as separate from brain and brain function, remains an unproven hypothetical construct, and leads to errors in reasoning. Its useful in everyday discussion, but does not have any scientific validity at all. Its just accepted as such far too often.

    Think of it this way. Any machine is just a stack of parts put together in a particular way. What it does is a separate idea from what it is. How we use it is often a different type of idea as well. If you know enough about how a machine works you can describe the function of the parts toward any specific action it makes, such as with a car engine. If you consider a situation in which you know nothing about car engines, never open the hood, and make guesses about what is going on, then you have about summed up our understanding of mind. I am deliberately not using a computer analogy as I think that is also flawed, maybe even more flawed.

    There are learning loops for the brain that include internal and external stimuli, including what we call information, language, experience, etc. This can deeply complicate any consideration of brain function. However what and how the brain learns is implicit in its physical structure and molecular function. It cannot learn things it has no capacity to learn. A lot of psychogenic claims are outrageous claims about what the "mind" (brain) can do.
     
    Last edited: Feb 19, 2017
  13. A.B.

    A.B. Senior Member

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    Why psychosomatic diagnoses are disliked: it's fairly obvious they are pseudoscience, and of no value to the patient (but of some value to those promoting the concept).

    I have never seen a clear and detailed explanation for how these illness are even supposed to work! The entire idea is based on magical thinking.
     
    Last edited: Feb 19, 2017
  14. alex3619

    alex3619 Senior Member

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    Cite that some time where they have an opportunity to reply and watch the psychobabble fly. I have said that in response to media article comments. :whistle:
     
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  15. anciendaze

    anciendaze Senior Member

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    It might be amusing to ask proponents of this approach how they do differential diagnosis to diagnose the following known medical conditions: pituitary hypophysitis, damage to vagus nerve, damage to dorsal root ganglia, diffuse (e.g. diabetic) neuropathy. I'm just assuming it would be a waste of time to ask if they have read this well-known reference on autonomic failure. Questions about the enteric nervous system would also be likely to draw blanks. All these things are "somebody else's problem". You might then wonder what medical problems are actually within their specialization. The answer may be none. Like inquisitors of old, they are more interested in identifying a patient's moral failings.

    All the named conditions are more likely to be apparent to patients before they produce clinical signs. Rare exceptions like herpes zoster show that persistent infectious disease in, e.g. dorsal root ganglia, does take place. This is detected by convenient clinical signs which other infections or causes need not produce.

    Added: In the above I left out a problem with a definite organic cause that can be verified through objective tests, but may produce a bewildering range of somatic symptoms: cervical spinal stenosis. (This cervix is the neck, not the uterine cervix.) Naively, one might guess that this had a 50/50 chance of producing signs in motor nerves a physician might confirm, since about half the nerves through these vertebra are afferent nerves. Since you might also assume that some impairment of afferent nerves would result in definite paresthesias, which could be mapped to isolate the location of the damage, you might even guess that most such problems are caught by doctors. Clinical reports are much less reassuring. I can't really estimate what percentage of problems due to this are currently being caught by ordinary medical doctors and referred to appropriate specialists. There is no lack of reports of problems caught only after years of ineffective treatment based on assumptions of MUS.
     
    Last edited: Feb 20, 2017

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