http://www.bmj.com/cgi/content/full/bmjusa.03020004v1
From BMJ USA 2003;Feb:90
RAPID RESPONSES FROM BMJ.COM Following are edited excerpts from Rapid Responses generated by this article, which can be read in their entirety at
http://bmj.com/cgi/eletters/325/7378/1449.Editor
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Can't we deal with uncertainty?
EDITOR
Why can't we just say, "I'm terribly sorry but at the moment I don't know what's wrong with you"? Why can't we be honest and declare that the cause of the symptoms isn't clear? Honesty will not offend half as much as using terms with meanings likely to be misinterpretedand which stop us from looking, or send us in the wrong direction. Some of my fellow mental health professionals find it hard to deal with uncertainty. It's actually quite a primitive response and something which deserves further attention. In essence, we can either admit to not knowing, or guess. To rely on words like `functional' generally says more about us than about the patient's problems. It's better that we learn to deal with feelings of inadequacy and not give our patients misleading labels and inappropriate advice.
Ellen Goudsmit, psychologist.
Teddington, UK
ellengoudsmit@hotmail.com
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Perpetuating ignorance
EDITOR
When a label applied to an individual or group we don't like causes offense, we invent a euphemism to replace it. This will serve us until the euphemism itself becomes offensive, whereupon we must invent the next euphemism, and so on. However it's not the euphemistic term itself that is offensive, it is the murky concept continuing to lurk behind it.
In this article the authors seek to re-euphemize "hysteria" with "functional," but the shabby concept remains, and in time the term "functional" will cause just as much offense. Witness how their most recent version, "medically unexplained symptoms" failed to stick and became offensive in record time.
They say that one way to reduce your prejudices against a group or individual you dislike is to become thoroughly familiar with your subject. In most instances you will then discover that they do not conform to the stereotype and that your concept of them was just plain wrong. No doubt many can bring to mind at least one acquaintance who has received a psychiatric label, and who has wasted valuable time before finding an accurate diagnosis.
Seeking to persuade physicians to accept your latest euphemism will mean that even fewer stones are turned for individuals who are up against chronic and badly researched illnesses. Thus, ignorance about these diseases will persist, and when your latest euphemism in time becomes transparent, doctor-patient relationships will be further damaged by the deceit involved.
Douglas T Fraser, freelance musician.
London, UK
doug@dtfraser.freeserve.co.uk
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The need for history (and epistemology) lessons
EDITOR
I think if the BMJ 's going to publish papers like this, it should also publish information about the history of "medically unexplained symptoms" and how patients of many currently recognized diseases would have bee told in the past that their symptoms were "medically unexplained" or "hysterical" (eg, patients with multiple sclerosis, formerly known as "hysterical paralysis" up to a few decades ago). Overconfidence in medical professionals of the day meant that many patients suffering from diseases we recognize today were exposed to inappropriate psychiatric treatment and lack of support from families, the medical profession and society in general.
The history of currently recognized condfit6ions and how they were characterized in the past, often based on psychological speculations, should remind people not to be overconfident that "modern medicine" (as each generation calls its medical knowledge) can easily distinguish between diseases and "non-diseases." Sometimes medical technology of the time can pick up physical abnormalities in patients and groups of patients, but the (psychological) speculation of doctors can be more influential.
Information about the changes in medical views over the years could also be given to medical students so that future generations are not left as overconfident about the ability to "know" things as some of the current medical profession. Lessons in epistemology might also be useful. Then, some doctors might be more willing to think that it is acceptable to think (and say): "I don't know what is wrong with this patient" rather than feel that their medical training encourages them to conclude that "this patient's symptoms are functional/hysterical/all in the mind" (or whatever euphemism is in fashion at the time.
Tom P Kinlon, unavailable for work due to ill health.
Dublin, Republic of Ireland
tkindlon@maths.tcd.ie