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BBC Radio feature on Functional conditions

Messages
15,786
So he doesn't like the term "medically unexplained symptoms", and prefers his "functional" assumptions instead, even though it's based on guesswork? Maybe someone should tell him that doctors don't get fired for saying "I don't know".
 
Messages
13,774
That whatever-you-call-it-sign, to do with testing muscle response depending upon the action being taken, does move some of these diagnoses beyond being simply being: No idea, call it 'functional'.

It seems like this gets mixed in with some narrative building, unreasonable lumping etc, etc. The claims surrounding functional disorders can be quacky, but can have reasonable sections too, so it's best to be cautious and specific in criticisms.

A bit OT, but I didn't think this was worth starting a new thread about. I was just reading this paper on Conversion Disorder: http://apt.rcpsych.org/content/12/2/152.full.pdf

It had this section on hypnosis:

Hypnosis
The similarities between hysteria, hypnosis and
conversion disorder were noted during the 19th
century. There is evidence that people with
conversion disorder have above average levels
of hypnotisability, making hypnosis a potential
intervention in the management of the disorder (Van
Dyck & Hoogduin, 1989). The goals of such hypnosis
include symptom reduction and exploration. Acting
through the evocation of a trance-like state, which
promotes suggestibility, hypnosis may be effective
against symptoms that are influenced by suggestion.
Hypnosis can also be used to evoke memories of
a traumatic event that has a positive link with the
symptoms.
Although there are many anecdotal accounts of
the efficacy of hypnosis in conversion disorder, a
recent randomised controlled trial of the addition of
hypnosis to a comprehensive treatment programme
for in-patients with the disorder found that it had
no additional effect on treatment outcome (Moene
et al, 2002).

Then these were the two cases mentioned:

Case vignette 1: Resolution by hypnosis
A 24-year-old cleaner had an argument with his boss.
Shortly afterwards he developed weakness of his
right arm and an inability to talk. He was brought
to an accident and emergency department. A full
neurological examination, including a number of
blood tests and a lumbar puncture, showed no specific
abnormalities. His computed tomography (CT) and
magnetic resonance imaging (MRI) scans were normal.
His symptoms did not improve after a week in hospital.
Finally, he was offered two sessions of hypnosis. His
symptoms resolved completely at the end of the second
session.

Case vignette 2: Resolution by abreaction
A 30-year-old African woman was the victim of an
assault. She received a severe blow to her head and lost
consciousness for about a minute. She subsequently
developed weakness on the left side of her body, in
both her arm and leg, and loss of vision in her left
eye. She underwent thorough investigation at her
local hospital, including a CT and MRI scan. Nothing
abnormal was found. In several interviews with a
psychiatrist she disclosed that she had been brought up
unable to express anger. During a session of abreaction,
she became very over-aroused and started screaming.
Following this she slowly regained the use of her left
arm and leg. It seemed apparent that her symptoms
were the result of her inability to express anger.

It's so like lots of CFS papers - building narratives out of anecdotes and 'clinical judgement'.

I thought this was a nice and concise write up of the explanation for some of the bullying many patients get:

Learning theory
In a model that emphasises the shaping of behaviour
by the environment, conversion symptoms are seen
as maladaptive operant behaviours that act on the
environment to produce reinforcing consequences
(secondary gains). Conversion disorder is then
sustained by the effects of these behaviours (McHugh
& Slavney, 1998: pp. 223–237). The therapeutic
implications of this theory are that it is important
to alter the patient’s belief by means of countersuggestion
and to take psychosocial measures to
reduce the external benefits associated with the sick
role. The aim of behavioural approaches is to ensure
that the patient gains more from relinquishing
symptoms than from maintaining them.

edit: There was a later bit on whiplash too, and I just stumbled upon this 1997 paper which showed no association between prior personality traits and the onset of whiplash, so thought I'd post a link to it here: http://www.ncbi.nlm.nih.gov/pubmed/9160275
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
Conversion disorder has no objective markers. I am not even sure such a thing exists. The guy who formalized all this was Charcot (hysteria, hypnotism etc), and Freud (conversion disorder) was one of his students. Their theories are largely discredited, yet some of their ideas live on.
 

Firestormm

Senior Member
Messages
5,055
Location
Cornwall England
So he doesn't like the term "medically unexplained symptoms", and prefers his "functional" assumptions instead, even though it's based on guesswork? Maybe someone should tell him that doctors don't get fired for saying "I don't know".

Took me many years to find a consultant immunologist who was willing to say "there is no magic bullet". Kind of wish very much that I'd heard that years before because without it I was constantly blaming myself for not trying hard enough, and then when I failed to get better even by taking and following their advice - that self-blame and guilt only added to the stress of living with it all.

Honesty would be a terrific advance in "modern medicine". Repeated opinions based on not very much other than a hunch does nobody any favours in the long run. My initial belief that a trip to the doctors when I was in desperate need would result in a quick fix; took some time to overcome.

"Modern Medicine" and "Medical Science" are not infallible but I think those that practice either still tend to promote a belief that they are and this is detrimental to anyone with an untreatable/not enough known about it/long term chronic condition.