I shall have to read Unhinged.

The problem is that the vast majority of px never get even a sniff of an MRI etc. Do you have ref for Freud’s prediction? I’m wondering if it’s in a useful paper I failed to read or read properly. Mea culpa, if so.

Freud’s minimally promoted claim notwithstanding, his rather better known blunt-edged tools hold the floor and the reality out here on the ground for px is that there are very few good neurologists in ‘delivery’ and px care terms. And most of them, like the vast majority of GPs, treat ‘functional’ as ‘fruitloop’. Px continuously report encounters with dismissive neurologists.

In a related discussion I was having with a GP the other day, he said he thought the problem was not only the dearth of neuros but also that, traditionally, they’re the brightest of the bright: commensurate arrogance often overrides.

I think the comment of a London neuro, discovered in a ‘Brain’ paper, is very telling:
“… I put them ['functional' px] in a different category because they are not … well, I suppose you have to use the word ‘troublesome’… It’s all about how they make me feel … ” http://brain.oxfordjournals.org/content/early/2009/04/16/brain.awp060.full?ck=nck

The honesty and (hopefully) unconscious ignorance of the neurologists interviewed for this paper is illuminating.

I did not mean to imply that Charcot himself considered MS to be hysterical paralysis, although many did.

My point was more that history and modern medicine make for an interesting juxtaposition.

Many thanks for writing about the new DSM and the opportunity for all of us to comment on their unscientific presumptions (as I have done!)

It’s very worrying that, as you say, the criteria are being widened so that just about any illness can be seen as psychosomatic.

Also the ‘functional’ label. That really is a monumental sleight of doublespeak.

In fact, I’d go so far as to say that the psychiatrists and neurologists themselves are caught up in some massive folie a beaucoups.

The consultation period has been extended to 15th July.

Current proposals for ‘Somatic Symptom Disorders’ are here:

http://www.dsm5.org/ProposedRevision/Pages/SomaticSymptomDisorders.aspx

I am aparticularly concerned with the new category of Complex Symptom Disorder that would seem to make every one a psychiatric patient at some point.

‘Hysteria’ seems to be being relabled ‘Functional Neurological Disorder’ – watch out for the term ‘functional’ to many neurologists it doesn’t simply mean ‘we don’t have the ability to discover what is wrong with you’ but ‘you are suffering from a psychiatric illness even if you show no other signs of it that physical symtoms’.

Once in that basket it is very hard to get other medical help.

The actual incidence of this ‘disorder’ is something like 0.01-2% according to US figures.

Most of the 40% go on to develop florid signs and sx of a physiological neurological disorder in following years.

The medical literature abounds in such misdiagnoses, with sometimes fatal results. This supposed condition’s DSM4 symptomatology is vague and can be diagnosed at whim without any clinical or other tests/scans.

‘Conversion disorder’ is a very convenient, cost-saving dx in a health care system where neurologists are few and far between and where the unaccountable health care institution cuts budgets according to a deeply socialist agenda – or simply where neurologists arrogantly make blind assumptions. Statistically, the majority of these dxs go to women, ethnic minorities, people with lower educational achievement, people from rural communities. Dxs are made on the balance of statistical probability and opinion.

There is no known mechanism for the assumed physical process of ‘converting’ presumed psychological states into long term physical conditions the like of which attract conversion disorder labels. However, sensitive fMRI and other advanced scanning techniques are beginning to pick up more and more subtle physical/neurological changes/abnormalities that show genuine physical causes for what doctors have ever been pleased to call hysterical/somatoform/functional/conversion disorders.

No doubt, these will go the way of MS – that is, newer, more sensitive medical technology will show these DSM4 ‘disorders’ to be actually disorders of thinking which occur largely only in the minds of neurologists and psychiatrists!

I won’t be reading this book. Although I wonder if the author has elaborated on Charcot’s ‘showmanship’: has she detailed the fraudulent performances Charcot co-erced his hapless patients into for the benefit of his audiences and ego? The lucrative business he built on the back of his ‘research’? Has she detailed the hitherto impecunious Freud’s part in repackaging and popularising this ‘disorder’ (he spent all of 19 weeks as a student of Charcot and somehow emerged an expert)? His seminal cases (one of whom he never even met and the other gave him the boot after only 11 weeks because she saw quickly that he was simply wrong)? Is there any mention of his cocaine addiction which may or may not be incidental? (Who in their right minds would willingly consult, still less trust, a doctor who’s off his head on some narcotic or other?!)

Modern day doctors are not taught that the C19th medical establishment was, in fact, deeply sceptical of and resistant to this alleged conversion disorder which was nothing more than the modernisation of a dx first formulated c.4,000 years ago to explain physical signs and sx that were beyond contemporaneous medical knowledge. Spin, PR and the prospect of big money won out. Plus ca change.

The actual evidence and history of the uses and misuses of this ‘disorder’ are tragic, shocking, scandalous. Indeed, I’d go so far as to call it a medical holocaust: millions of people have died as a result, and many millions more have been forced to live painful, attenuated lives.

I’ve engaged in enough academic research on the topic to be convinced that, as Kelly Latta (above) so accurately sums up, “Archaic concepts such as “hysteria” and “neurasthenia” are cultural memes that should probably be abandoned until there is objective scientific evidence that they exist rather than being predicated on a lack of knowledge.”

Multiple Sclerosis was also considered “hysterical paralysis” at least until technological advances allowed objective documentation of the demyelination of the nerve sheaths – aka so-called clear and detectable damage.

Does this mean there was no damage prior to these technological advances or that it was just not clear and detectable and therefore hysteria?

Archaic concepts such as “hysteria” and “neurasthenia” are cultural memes that should probably be abandoned until there is objective scientific evidence that they exist rather than being predicated on a lack of knowledge.