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"Are You Saying She's Mentally Ill Then?" Explaining Medically Unexplained Seizures in Clinical Enco

Dolphin

Senior Member
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17,567
Free full text: http://www.qualitative-research.net/index.php/fqs/article/view/2418/3906

Perhaps of interest to somebody

ROBSON, Catherine M.; LIAN, Olaug S.. "Are You Saying She's Mentally Ill Then?" Explaining Medically Unexplained Seizures in Clinical Encounters. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, [S.l.], v. 17, n. 1, nov. 2015. ISSN 1438-5627. Available at: <http://www.qualitative-research.net/index.php/fqs/article/view/2418/3906>. Date accessed: 05 Dec. 2015.


"Are You Saying She's Mentally Ill Then?" Explaining Medically Unexplained Seizures in Clinical Encounters

Catherine Robson & Olaug S. Lian

Abstract: Bodily phenomena that are difficult to identify, localize, explain and cure with the aid of modern biomedical knowledge and technology leave ample room for cultural influence. That makes them a perfect case for studying the cultural dimension of medical knowledge and practice. Building on this assumption we qualitatively explore the communication between neurologists and women with seizure disorders of uncertain etiology, often labeled psychogenic non-epileptic seizures (PNES), in a specialist clinic in England. Based on an interpretation of film-recordings of eight naturally-occurring clinical consultations we discuss the following questions: How do neurologists explain the name, the cause and the treatment options to these patients? How do patients and their companions respond to these explanations? And finally, what makes these interactions so difficult? Our interpretation of the data is inspired by critical discourse analysis, and framed within a social constructionist perspective on medical knowledge and practice.

We found that the neurologists presented the diagnosis and its cause—inappropriate stress management—through objective language that conveyed a high degree of certainty. Patient-parties often disagreed, and found it hard to believe that these physical symptoms had a psychological origin. Companions often acted as advocates for the patients in negotiations with the doctors. The polarized debate between psychogenic and somatic understandings of the seizures that emerged illuminates how the Cartesian dualism between body and mind complicates clinical encounters—a dualism doctors explicitly reject, but presumably accept. We argue that it is impossible to overcome this polarization without acknowledging the cultural dimension of medical knowledge and practice.

Key words: medical sociology; social construction of illness and disease; health communication; neurology; patient-provider relationships; film recordings; observational study; discourse analysis; critical discourse analysis
 

Jeckylberry

Senior Member
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Location
Queensland, Australia
Thanks, @Dolphin! This is a very interesting paper and one that challenges the current hackneyed method of trying to explain a condition that is clearly not properly understood to patients who can see right through it. I like how they record what is actually said and how it sounds. The docs seem to have little faith in the lines either. I also see how they are infused with 'you have to believe in it in order for it to work' fairytale. How can anyone seriously wondering how to understand this illness possibly start from that sort of premise. It's riddled with flaws. You can't agree to put yourself or a loved one or a patient through something like a psychoanalytical course with something that flimsy to motivate you!

Saying, 'we're not sure what is doing this' is a far better starting point.
 
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... conveyed a high degree of certainty ...
So the neurologists involved were either morons or liars. Psychogenic hypotheses are still very much hypothetical, frequently disproven, and insulting to anyone with a modicum of rationality.

Though no doubt some would conclude that the neurologists simply need more acting classes and/or some better debate skills, to compensate for the complete lack of scientific support. Then maybe they can appropriately persuade the patients to accept their outrageous crap.
 

A.B.

Senior Member
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3,780
Psychogenic medicine is a cult. The goal is always to convert patients to the belief in psychogenic illness, with the promise that they will regain good health.

Cults often claim claim special insight into invisible and unmeasurable powers that influence our lives. In psychogenic medicine this is the power of the mind.

Cults target people in desperate situations because they are more vulnerable: in psychogenic medicine these are patients suffering from chronic unexplained health problems.

Cults are impervious to reason and criticism. In psychogenic medicine, they're unwilling to debate whether psychogenic illness even exists. When therapies don't work, patients are blamed for not doing it right.

Cults like to have total control over their members. In psychogenic medicine, patients are told that everything they feel and believe is wrong and that they must do everything they're told. Mental and emotional manipulation is used. Patients that disagree are sometimes imprisoned by force (theHansen or Pelletier to name two examples).
 
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Cheshire

Senior Member
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1,129
The authors point the supposedly false mind-body dichotomy that doctors reject while it's the basis of their explanations.

Contrary to what they say, however, they do seem to assume a Cartesian dualism where the immaterial mind and the material body are conceptually separated into two contrasted aspects. Their explanations are in line with a current general trend: The brain has become increasingly emphasized in medical approaches to the mind-body problem: "the connection between the mind and body is the brain. The brain is the organ of the mind ... body events are brain events are mind events" (GISLASON, 2011, pp.61-62). The doctors stressed that the brain is both a physical organ and the locus of the psyche: psychological triggers cause physical reactions in the brain. However, whether this "resolves" the "mind-body problem" or simply transforms a Cartesian psyche-soma dualism to a tripartite interpretation consisting of mind, body and brain, remains to be seen.

They can add the brain to the equation, the conclusion is always the same: MUS are caused by bad emotional coping. (and not matter that this has never been scientifically proven...)
 

Jeckylberry

Senior Member
Messages
127
Location
Queensland, Australia
The importance of this paper is that it catches the exact words and shows just how crappy the reasoning is. I've heard similar every time I go to hospital or went to my neuro 'team' but unfortunately with much more zeal - just like 'cult' proselytisers @A.B. mentions. But to average doctors this pseudo medicine makes no real sense. They anticipate it being rejected before they open their mouths because they have no faith in it and it shows.
 

Snow Leopard

Hibernating
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5,902
Location
South Australia
The polarized debate between psychogenic and somatic understandings of the seizures that emerged illuminates how the Cartesian dualism between body and mind complicates clinical encounters—a dualism doctors explicitly reject, but presumably accept.

If someone claims a disorder has both biological and psychological aspects, but the doctor only uses psychological explanations and pushes psychological treatments, it is no wonder patients are going to suspect their doctor believes in mind-body dualism.

Also, their logic seems to be a non-sequitur:
If not an epileptic seizure, therefore psychogenic.

Quite a logical leap there.
 
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Jeckylberry

Senior Member
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127
Location
Queensland, Australia
In my experience of being on the receiving end of this 'cult', I don't think it's very helpful for neurologists to head into this fusion of mind and body. They are not trained in eastern or new age philosophy and most of their patients aren't either. Western medicine is fundamentally dualist! therefore if someone is behaving atypically for whatever reason it remains the neuro's job to find something that can be correlated to a known disease. If they can't find anything then they should say so. They shouldn't meddle with a persons psyche in an attempt to find potted answers. Any psycosomatic or psychogenic conclusion just makes the switch from body to the area of the mind, or flip flops back and forth between each one which is uncomfortable for all but the true converts (who demand blind faith). I would rather have fought to get a diagnosis from a neurologist that shrugged me off than where I am now, fighting to get rid of a psychogenic label.
 

jimells

Senior Member
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2,009
Location
northern Maine
Though no doubt some would conclude that the neurologists simply need more acting classes and/or some better debate skills, to compensate for the complete lack of scientific support. Then maybe they can appropriately persuade the patients to accept their outrageous crap.

Maybe they need some personal training from Sir Simon on how to be a con man (or woman). He'll need to do some moonlighting soon in order to pay the lawyers.
 

jimells

Senior Member
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2,009
Location
northern Maine
But to average doctors this pseudo medicine makes no real sense. They anticipate it being rejected before they open their mouths because they have no faith in it and it shows.

But that doesn't stop them from abusing patients by promoting this rubbish, which says much about their personal integrity and ethics.