Psychosomatic Illness and Somataform Disorder

[chipmunk1]

from wikipedia:
Somatization is a tendency to experience and communicate psychological distress in the form of somatic symptoms and to seek medical help for them.

that says it all. They are not saying elevated cortisol causes by psychic distress causes symptoms which would be a more credible theory. They are stating that physical symptoms are communication of emotional distress.

Pretty strange if you ask me. Why would they only express distress with doctor seeking behaviour? There would be so many more ways of expression!?

 

[antares4141]

Yes the system is a complete mess. It's a system of fear of failure and somatisation disorders are needed because they can not admit that they don't know what is going on. Not knowing is seen as a sign of incompetence and weakness in medicine.

The truth is that even the instructors are pretty clueless about a lot of things simply because a lot of the human body isn't well understood yet but as long everything is based on their authority they are of course "infallible" and we are just somatizers.

Fundamental "trailer trash 101" turn the argument around and make the victim the villain. Saw the same thing happen to mothers of autistic children 50 years ago: http://en.wikipedia.org/wiki/Refrigerator_mother_theory

 

[antares4141]

It's pretty scary to think the author is a grad student who wants to experiment on people. He thinks the placebo effect is Magic. I understand it to mean, "we don't know what caused the effect".

Placebo effects are generally very subtle and hard to quantify. Never last. It's why we usually do double blind studies so that it doesn't confuse the results. Certainty could fall under the classification of "psychological" Where you run into problems is when you take a small truth and exaggerate it. Or in other words try to use this well understood effect that can be shown to exist through test's and extrapolate it must be true with disabling illnesses like cfs or gws. When there is no way to test for or prove it. The default position should be "we don't know" but without compelling evidence assume it not to be true. (cfs is psychological cause we know placebo effects are) Which is what I understand the default position generally to be in science where their is no compelling evidence you put the theory to rest at least until you find more compelling evidence.

Suppose I were to say mold in a particular building makes me sick. Suppose someone set up a trap for me and painted black stains all over the ceilings to make it look like it had mold in it when it in fact did not. They would say AH HAH! Antares is suffering from a psychogenic illness! If I claimed to react that is. This would be irresponsible position to take cause I could have a underlying condition like celiac disease and confusing this with mold re-activity. Or in other words I went in the building and associated it with my symptoms that originated from a very different cause. I fooled myself! Which is very different from completely imagining symptoms.

This has been done with people who have (or think they have) mcs. Lesson from this? Be careful in how you interpret your results. Also your going to have subtle issues with placebo or in this case it's opposite "nocebo" Which makes the results very difficult to interpret .

Suppose the same test with the phony mold was done to me and I did not have celiac. But suppose I still have symptoms from mold that are in constant flux. You just gave me the expectation my worst fear (reactivity to mold) And don't expect me to react cause you tricked me and I should be able to detect this? It's an unrealistic expectation.

Despite this it is generally accepted by "expert's" if the subject has the expectation of a certain outcome they will have that certain outcome and it's psychological. A over simplified explanation. Which has some truth to it. Nocebo or placebo. But to extrapolate from this that chemical sensitivity or mold reactivty do not exist, is all in the head. That is a fallacious position because of all the nuances mentioned above you have to take into account. And why test's like this need to be double blind. Which causes ethical issues because now they have to expose you to the real substances without your knowledge.

 

[SOC]

'Probably one of the key hints to a possible diagnosis of somatisation is the GP’s emotional reaction to the patient: a combination of anger and frustration at the complexity of symptoms, the frequency of visits and a sense of helplessness may be a cue that the patient may be somatising.'

So if a GP cannot control his or her emotional reaction to being unable to understand the complexity of a patient's symptoms, the patient has a psychological disorder? In what universe does that make any kind of sense whatsoever?

Since when is the GP's emotional reaction a biomarker to a patient's illness? So it's perfectly legitimate for an incompetent, insecure GP to give out large numbers of somatisation diagnoses because s/he frequently feels angry, frustrated, and helpless at the complexity of patient symptoms, while a competent, thinking, emotionally stable GP could legitimately give the same patients a different diagnosis because the s/he does not get easily angry and frustrated? In other words, the patients' diagnoses are not about the patient's condition, but the doctors'?

How can anyone think that makes sense in any way, shape, or form?

 

[alex3619]

How can anyone think that makes sense in any way, shape, or form?

[sarcastic] Of course. Its about getting rid of patients. There, here is a pigeonhole to put you in. Diagnosis given, case closed. Label = valid diagnosis.

 

[chipmunk1]

Since when is the GP's emotional reaction a biomarker to a patient's illness? So it's perfectly legitimate for an incompetent, insecure GP to give out large numbers of somatisation diagnoses because s/he frequently feels angry, frustrated, and helpless at the complexity of patient symptoms,

I think this describes well what happens on a daily basis around the world. In some cases however they are not insecure but just full of themselves and don't think they could ever be wrong.

Let's not forget that some neurologists believe that up to 40% of their patients they see are somatizers and I suspect many of their peers would not disagree with that view.

 

[ahmo]

Let's not forget that some neurologists believe that up to 40% of their patients they see are somatizers

Seriously??

 

[chipmunk1]

Seriously??

yes they are totally insane.

Patient ‘R.’ • 34 yr old male
• Professional Footballer
• Complains of facial and head pain following injury
• Somewhat histrionic but no psychiatric comorbidity
• You are the match doctor…

Feigning / Malingering

• Does occur but extremely hard to detect
• Those malingering for medical care (factitious disorder) often very disturbed
• If they were malingering why do they present such similar stories of bafflement and fear of their symptoms?
• Why do they remain distressed and disabled in the long term?
• Exaggeration to convince or exaggeration to deceive?
• Is detection of malingering a medical or moral issue?

OK they might not be malingering but perhaps I’m best leaving them to their own devices

Aim to make a difference to 1 in 5 severely affected patients
• Can be hard to tell who that‟s going to be at the outset
• Accept they have a chronic illness (like MS) which can be modulated but not cured
• If unsuccessful consider a plan to contain patient and protect from harm by other doctors

60 patients with functional weakness seen 12 years ago in Edinburgh • 83% still symptomatic • Levels of disability similar to Multiple Sclerosis • 29% had taken medical retirement

The ‘Lets do another test approach’….

I‟m not sure. Lets send off some tests for Lyme Disease and get another MRI Scan of your spine

The ‘Psychological Approach’….

You‟re symptoms are caused by psychological stress that you have converted in to a physical symptoms. Really clever doctors call this somatization…. blah blah

The ‘Functional Approach’….

You have functional weakness. Your nervous system is not damaged but it is not functioning properly. Its common and potentially reversible.

http://www.acutemedicine.org.uk/wp-content/uploads/2010/11/neurological_symptoms.pdf

 

[wastwater]

I cant even begin to engage with this psycho-balls

 

[chipmunk1]

So if a GP cannot control his or her emotional reaction to being unable to understand the complexity of a patient's symptoms, the patient has a psychological disorder? In what universe does that make any kind of sense whatsoever?

Since when is the GP's emotional reaction a biomarker to a patient's illness? So it's perfectly legitimate for an incompetent, insecure GP to give out large numbers of somatisation diagnoses because s/he frequently feels angry, frustrated, and helpless at the complexity of patient symptoms, while a competent, thinking, emotionally stable GP could legitimately give the same patients a different diagnosis because the s/he does not get easily angry and frustrated? In other words, the patients' diagnoses are not about the patient's condition, but the doctors'?

How can anyone think that makes sense in any way, shape, or form?

so does that mean if the doctor forgot to take his SSRIs a diagnosis of somatisation is more likely?

 

[ahmo]

@chipmunk1 This is seriously depressing. It's really important that we're aware of it. Thank you. I've opened the pdf, don't know if I can bear to read it.

 

[jimells]

How can anyone think that makes sense in any way, shape, or form?

It makes sense to the zombies that the education factories are manufacturing. Twenty years of enforced conformity and indoctrination seems to be very effective on most people, unfortunately.

What puzzles me is, how come the system failed to work properly on me?

 

[Snowdrop]

For instance what would you call it when someone is worried about something .. and doesn't want to eat/can't sleep/feels all achey and unwell ? These are real physical effects from anxiety.

But why are they experiencing anxiety? If someone else were in the exact same situation they may not experience any anxiety at all.
Is it perhaps because of a physical predisposition to respond that way to certain/particular stimuli?

In other words I'm saying it's the other way round. A physical--either learned or genetic predisposition leads to responding with anxiety to certain stimuli and that manifests as something that looks somatic.

 

[Snowdrop]

@Never Give Up
My take is that the problem should not be looked at from the point of view of these are Dr's/scientists etc. but just of other human beings responding to being confronted with people who are suffering.

In other words, they're response is no different from the average non-medic. It's an inhumane response but it seems quite common.
Unless the suffering is explainable and/or far removed. I think it stems from not being able to deal with it. It's always been this way with some people being exceptional in their compassion. And I don't see that the attitude will likely change although the target will when ME becomes just another illness for which there is an explanation.

This is my peculiar take on the question.

 

[antares4141]

@Never Give Up
In other words, they're response is no different from the average non-medic. It's an inhumane response but it seems quite common..

I think it's inhumane too! Great choice of words! That for a long time the consensus was that we are not sick. It's in our heads. And they acted accordingly. Didn't do any do diligence. Didn't do any substantive research to make sure they were right or wrong. We've suffered horribly as a consequence and continue to do so. And ironically many suffer added stigma that comes with having an illness that is not recognized by science. It's kind of like being raped every day of your life until you die. On many different levels. For many our situations are about as difficult as they could get for someone to endure and not go insane and yet nobody on the outside can even begin to comprehend this.
I know it's probably not fair to blame dr's on an individual level. Except for the one's that promoted the psychological explanation for our symptoms to other dr's. In a field such as this you can't know everything. You have to somewhat rely on information you get from your peer's. If I could criticize the group of people responsible for this I would. It's not that easy. So I focus on the institution as a whole.

 

[ahmo]

@chipmunk @jimells I was seriously wrong about my impression of that article. I see that it was just the opposite of my impression. I only looked at some chapter headings, didn't even load the whole thing when I glanced through. Mea culpa.

Having read it, albeit still cursorily, I see that I got it backasswards. It's actually about teaching how not to label people it's-all-in-your-mind. About accepting that we might not know the cause, but there's something wrong, and we might be able to make things better, and you might have to learn to live with a chronic condition. With appropriate CBT for adjusting to changed circumstances. The rise of Functional Medicine.

 

[Snow Leopard]

http://www.acutemedicine.org.uk/wp-content/uploads/2010/11/neurological_symptoms.pdf

Aim to make a difference to 1 in 5 severely affected patients
•Can be hard to tell who that‟s going to be at the outset
•Accept they have a chronic illness (like MS) which can be modulated but not cured
•If unsuccessful consider a plan to contain patient and protect from harm by other doctors

Wow, these are some really low standards.

 

[chipmunk1]

Wow, these are some really low standards.

these are normal psychobabble standards. the "cure" means that the patients have accepted causing their own symptoms. as long as they have accepted it they can still suffer and have symptoms.