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Source: (consider it)
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Thread: What do we make of MUS?
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Truman White
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# 17290
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Posted
Nattering to a GP pal last week he mentioned medically unexplained symptoms. No surprise that medics find the odd case hard to diagnose. What got me was the numbers. Looking into this, some research reckons that as many as one in three punters at UK GP surgeries, and one in four at hospital clinics rock up with physical symptoms for which the meds can't find a physical cause.
I expect we've got a few people in the healing and care world on these boards, and maybe some people who've suffered from these conditions. What do you make of it? And what helps?
Posts: 476 | Registered: Aug 2012
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Eutychus
From the edge
# 3081
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Posted
hosting/
General discussion of all this is fine, but everyone please bear in mind that a) this is not a forum for offering medical advice b) sharing extensive personal medical details is not recommended - see for instance Purgatory Guideline 4 and the linked FAQ section.
/hosting
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Let's remember that we are to build the Kingdom of God, not drive people away - pastor Frank Pomeroy
Posts: 17944 | From: 528491 | Registered: Jul 2002
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mr cheesy
Shipmate
# 3330
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Posted
Impossible to answer. By their very nature, unexplainable medical conditions can be caused by many things and what helps in one case may not help in another.
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arse
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itsarumdo
Shipmate
# 18174
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Posted
Truman - Sounds like you think medicine knows everything. Time for a re-think.
[ 21. March 2015, 11:54: Message edited by: itsarumdo ]
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"Iti sapis potanda tinone" Lycophron
Posts: 994 | From: Planet Zog | Registered: Jul 2014
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by Truman White:
Nattering to a GP pal last week he mentioned medically unexplained symptoms. No surprise that medics find the odd case hard to diagnose. What got me was the numbers. Looking into this, some research reckons that as many as one in three punters at UK GP surgeries, and one in four at hospital clinics rock up with physical symptoms for which the meds can't find a physical cause.
I expect we've got a few people in the healing and care world on these boards, and maybe some people who've suffered from these conditions. What do you make of it? And what helps?
I'm not in the medical field, but isn't it rather obvious that what helps is more research? Isn't a MUS just a rare disease/condition (or an unusual symptom of a more common disease/ condition)? One that hasn't been fully understood/ recognized due to it's rare occurrence? So the solution is more research, focused on finding a cure/ treatment. Same as it is with more common conditions. As you knock off the more common illnesses, you're able to devote more time/$$ to the less common ones.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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Truman White
Shipmate
# 17290
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Posted
quote:
Originally posted by itsarumdo:
Truman - Sounds like you think medicine knows everything. Time for a re-think.
Well just so's you know mate, that's not what I think ![[Biased]](wink.gif) . I'll say a bit more when I've seen what others have to say.
What do you reckon by the way? I see our pal Cliff reckons these unexplained phenomena are just down to limits of current knowledge and all will be revealed in time. You sound less convinced.
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by Truman White:
What do you reckon by the way? I see our pal Cliff reckons these unexplained phenomena are just down to limits of current knowledge and all will be revealed in time. You sound less convinced.
Just to clarify-- I don't think all unexplained phenomenon are due to our limited knowledge. I believe there is an "unseen world", that there are forces at work in our world-- forces working for good and forces working for evil. Ultimately, I believe all disease is a result of those unseen forces (see my posts re open theism elsewhere).
But that being said, the way those forces most often play out is in the natural world, subject to the laws of nature. Things outside of that-- supernatural-- are, by definition, extremely rare. So the old "when you hear hoof steps, think horses, not zebras" applies. The most natural and obvious explanation for MUS is simply rare medical conditions or symptoms that have not yet fully be discovered/ explored, so the solution is simply greater research/ scientific discovery.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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itsarumdo
Shipmate
# 18174
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Posted
hmmm I agree in parts.
This could be such a vast field, maybe some description of the kind of MUS you are referring to, Truman?
Wellness in the face of a series of carefully documented and comprehensively negative diagnoses is a MUS. But not one that anyone would object to having.
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"Iti sapis potanda tinone" Lycophron
Posts: 994 | From: Planet Zog | Registered: Jul 2014
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Dal Segno
al Fine
# 14673
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Posted
One of my GP friends says that over half of patients have some form of mental problem, by which she means things like anxiety, stress, and depression. These things going on in the brain can and do affect the body in all sorts of ways. In fact, there is a standard quick test they can set you in the surgery to ascertain whether stress- or anxiety-management might help.
There are also such things as nerves becoming attuned to sending pain signals, so you get chronic pain for no obvious reason. They can give you drugs to modify the pain receptors but they prefer to rule out any other possible cause first.
All-in-all, I find my own GP is remarkably happy when he can actually come up with a simple diagnosis, which implies that the most consultations don't lead to a simple answer.
[Edit: to make the final sentence make sense]
[ 21. March 2015, 16:59: Message edited by: Dal Segno ]
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Yet ever and anon a trumpet sounds
Posts: 1200 | From: Pacific's triple star | Registered: Mar 2009
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no prophet's flag is set so...
Proceed to see sea
# 15560
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Posted
Pain is probably the most common such symptom. The pain is experienced but doesn't line up with medical findings. But the health systems in most countries are really doctor and hospital systems, so we can hardly expect physicians with limited training in psychology and psychotherapy to really understand many problems with nonacute, nonspecific causes.
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Out of this nettle, danger, we pluck this flower, safety.
\_(ツ)_/
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itsarumdo
Shipmate
# 18174
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Posted
I've seen a lot of pain reported along acupuncture meridians rather than nerve tracts, and so I guess they are MUS unless the medicine in question embraces either acupuncture or the strong persistence of embryological growth layers in the adult (and the ability of that embryological patterning to dominate pain, which is usually considered to be neurological in origin).
But really, all this is rather moot - a spiritual belief system should be capable of being independent of the current state of knowledge of (e.g.) medical science.... or of any theory of medical "reality" You just don't know how good (or not, more to the point) any health/illness/medical/treatment paradigm is at grasping the essence of this soul and its vehicle.
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"Iti sapis potanda tinone" Lycophron
Posts: 994 | From: Planet Zog | Registered: Jul 2014
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Lamb Chopped
Ship's kebab
# 5528
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Posted
What pisses me off about the article linked to is that it assumes that, because no physical cause can be found, therefore no physical cause exists. Which is bullshit.
There may be in fact no physical cause. But there may also be a physical cause which is a) unrecognized, overlooked or misunderstood by the practitioner, b) unrecognized yet by the current state of medical science, c) noticed but being confused with something else.
There are, of course, psychological conditions that lead to physical symptoms. There are also physical conditions that lead to psychological conditions. Decent doctors take their time and don't jump to conclusions before weighing all the available evidence.
I mean, seriously. Within my own lifetime we have had new diseases (AIDS, anyone?) and surprising new explanations of old ones (h. pylori infection and ulcers). I would be very much surprised if in 100 years we haven't made a great deal more progress, and things that are presently being labeled as psychological in origin turn out to have all too physical causes. (Heck, when did we discover the mitochondrial diseases?)
So as a catch-all category, MUS is fine. But the implied explanation ("there's nothing physically wrong, it's got to be something social or psychological") is dangerous.
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Er, this is what I've been up to (book).
Oh, that you would rend the heavens and come down!
Posts: 20059 | From: off in left field somewhere | Registered: Feb 2004
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no prophet's flag is set so...
Proceed to see sea
# 15560
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Posted
fMRI - functional MRI can show the nervous system in action. I've been involved with a project re CRPS - complex regional pain syndrome which does not make anatomical sense but show disordered nerve and connective tissue. CRPS was previously called RSD - reflex sympathetic dystrophy. There is some really fascinating work with a "mirror box" where fooling perception to think the uninjured limb is the injured one. We are seeing perceptual tasks altering basic brain representations of body parts. The people who have this condition were, in the past, thought to be have Conversion Disorder or be otherwise psychiatrically diagnosable.
Re accupuncture. We are seeing deep tissue needling being supported by public and private health plans. Chinese accupuncture not. I think there is merit in it, but the evidence base isn't there and the traditional theory is probably wrong.
(I work in behavioural medicine about 50% of my consulting.)
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Out of this nettle, danger, we pluck this flower, safety.
\_(ツ)_/
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mdijon
Shipmate
# 8520
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Posted
quote:
Originally posted by Lamb Chopped:
Within my own lifetime we have had new diseases (AIDS, anyone?) and surprising new explanations of old ones (h. pylori infection and ulcers). I would be very much surprised if in 100 years we haven't made a great deal more progress, and things that are presently being labeled as psychological in origin turn out to have all too physical causes. (Heck, when did we discover the mitochondrial diseases?)
I don't disagree at all with your main point that new causes are always turning up and the psychological turns into the medical overnight - but I want to add a few points.
First there are some diseases where although the important causing factor is unknown, it is crystal clear that there is going to be a physical cause. For instance H.pylori - stomach ulcers were not dismissed as "in your mind" even though we didn't know what bacteria caused them. If someone is admitted and dies of overwhelming infection we might not know that HIV weakened their immunity as the ultimate cause but we weren't ever going to think that a spot of counselling might hit the spot.
On the other hand if someone says "my arm hurts" but there is nothing to see on a scan, a blood test, an endoscopy or any other objective test then it is felt to be in the balance until someone turns up with an fMRI scan that shows that a bunch of neurons are not doing what they should.
Second that the dividing line between psychiatry and neurology is coming down. Schizophrenia is now a very well characterized biochemical disorder, as well characterized as Parkinson's or as epilepsy. All three can be treated with drugs. It just happens that the primary manifestation of the first is to make you appear mad, the latter two have manifestations that make you see a neurologist. It perhaps makes sense to maintain different skill sets (one kind of doctor good at understanding descriptions of delusions, another good at understanding descriptions and appearances of problems with movement) but there is no fundamental difference in the kind of illness.
It won't take long before depression is more thoroughly understood than it is at present, and anxiety, regional pain syndromes (see above) and many other illnesses thought to be "in the mind" will have more medical explanations.
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
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itsarumdo
Shipmate
# 18174
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Posted
Schzophrenia, Bipolar, PTSD, Depression and probably most "psychological" "disorders" are currently being shown to all be on the same causal spectrum. They are body-mind conditions where the physiology (i.e. hindbrain) has become jammed in a survival response. You cannot treat just body because mental activity feeds back into the body, so the mental end of the loop has to be properly addressed - and you certainly can't treat them as psychological because the hindbrain/RAS and ANS (and spinal nerve roots) are NOT the domain of psychology. However, it IS possible (and this IS being done now - e.g. look at the work of Onno Van der Haart, Allan Schore, Bessel van der Kolk, Peter Levine, Pat Ogden) to engage the body AND mind to reverse these. Interesting results - where there are before and after brain MRIs we see e.g. a 30% recovery in volume of parts of the midbrain (e,optional system) which have atrophied, and other signs that the brain is physically, morphologically plastic according to use, and the use can be changed positively by engaging humanely and intelligently with primitive survival and socialisation reflexes. With medication as necessary if this is needed to provide temporary stabilisation.
Imo, you can probably add Parkinsons, quite a few cases of tinnitus and migraine, and most forms of dyspraxia, dystonia and a range of developmental disorders in there for good measure, though that is a bit more complex. Personally I'd even go so far as to say that pretty well every physical pathology, pain syndrome, identified or unidentified symptom one way or another begins with this dislocation. And the subsequent incorrect relationship between mind and body also creates fertile ground for disease. But without a few years exposure to how paragraph 1 really works in practice, it's unlikely what I've just said here in paragraph 2 will really mean anything.
If you're professional and want to get a quick practical insight into this, the trainings by PODS or other First Person Plural educational material is as good a start as any.
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"Iti sapis potanda tinone" Lycophron
Posts: 994 | From: Planet Zog | Registered: Jul 2014
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itsarumdo
Shipmate
# 18174
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Posted
quote:
Originally posted by no prophet's flag is set so...:
...
Re accupuncture. We are seeing deep tissue needling being supported by public and private health plans. Chinese accupuncture not. I think there is merit in it, but the evidence base isn't there and the traditional theory is probably wrong.
Public health plans (you can get Chinese Acup on Private plans).
It's not that there is no evidence - take a look at the Research links page at the Acupuncture Society
WRt theory, there's a western trained doctor just written a book (spark in the machine) pointing out the huge similarities between the morphology and functional relationships of the embryological neural crest, the embryological origins of abdominal compartments and the acupuncture meridien system. Worth a read. He shows that the traditional Chinese theory is 90% symbolically coded embryological detail - symbolic because they were looking at what was connected to what in an adult rather than understanding intricate details of its embryogenesis.
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"Iti sapis potanda tinone" Lycophron
Posts: 994 | From: Planet Zog | Registered: Jul 2014
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mdijon
Shipmate
# 8520
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Posted
quote:
Originally posted by itsarumdo:
They are body-mind conditions where the physiology (i.e. hindbrain) has become jammed in a survival response. You cannot treat just body because mental activity feeds back into the body, so the mental end of the loop has to be properly addressed - and you certainly can't treat them as psychological because the hindbrain/RAS and ANS (and spinal nerve roots) are NOT the domain of psychology.... Interesting results - where there are before and after brain MRIs we see e.g. a 30% recovery in volume of parts of the midbrain (e,optional system) which have atrophied, and other signs that the brain is physically, morphologically plastic according to use, and the use can be changed positively by engaging humanely and intelligently with primitive survival and socialisation reflexes. With medication as necessary if this is needed to provide temporary stabilisation.
What utter and complete fetid nonsense.
Which reminds me of this thread where you spouted unevidenced nonsense without links. As I said then;
quote:
I'm not going to play whack-a-mole argument with more daft assertions of yours when you won't admit that you were demonstrably wrong on the previous daft assertions that I took the effort to reply to and show you evidence.
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
Posts: 12277 | From: UK | Registered: Sep 2004
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Eutychus
From the edge
# 3081
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Posted
hosting/
Cool it, guys, or take it to Hell.
/hosting
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Let's remember that we are to build the Kingdom of God, not drive people away - pastor Frank Pomeroy
Posts: 17944 | From: 528491 | Registered: Jul 2002
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Dave W.
Shipmate
# 8765
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Posted
quote:
Originally posted by Lamb Chopped:
What pisses me off about the article linked to is that it assumes that, because no physical cause can be found, therefore no physical cause exists. Which is bullshit.
That's not how I read the article. In fact, the first paragraph denies this ("The terms used to describe such symptoms - medically unexplained symptoms or functional somatic symptoms - are purely descriptive and do not imply psychogenesis.")
Maybe it would seem less objectionable if it were interpreted as advice to GPs who have looked for all the physical causes they can think of and have run out of ideas. Even pain with a clearly identified physical cause has psychological aspects; in cases where they can't identify a physical cause, attempting to deal with those aspects could still be worthwhile.
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Curiosity killed ...
Ship's Mug
# 11770
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Posted
The linked article seems to have missed that IBS has been linked to gut bacteria - a bit like H. pylori and stomach ulcers. That's been known for a few years now.
Secondly, the underlying condition that is written off as something somatic can end up killing the person. A friend died last year in her early 40s from the effects of a genetic mitochondrial disease that wasn't diagnosed until she was already very ill. Her son has inherited the same condition. What they were both diagnosed with was CFIDS / CFS/ME, and offered CBT to:
quote:
challenge the patient's beliefs and maladaptive behaviours, in a caring manner
rather than further investigations.
There are quite a few cases like that one.
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Mugs - Keep the Ship afloat
Posts: 13794 | From: outiside the outer ring road | Registered: Aug 2006
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mdijon
Shipmate
# 8520
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Posted
quote:
Originally posted by Curiosity killed ...:
There are quite a few cases like that one.
For sure. But as a doctor what does one do with that information? A little humility and recognition of the possibility of being wrong in declaring something not a physical or treatable illness is certainly called for. An ability to reassess new information, and not making a mess of it in the first place is also good.
But then what? Doctors will continue to make mistakes - either because there was no way of knowing at the time, or because there was a way but no-one is perfect all the time. Would it make the world a happier place to increase the threshold for referring to cognitive behavioural therapy and reduce the threshold for more investigations and second opinions? I'm not sure, but I am sure that there are going to need to be thresholds and they will continue to be imperfectly applied.
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
Posts: 12277 | From: UK | Registered: Sep 2004
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Curiosity killed ...
Ship's Mug
# 11770
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Posted
It's difficult. I spent too long in the CFS/ME world, not for me, for someone else, and realise that many people have unrealistic expectations of cures and will not accept that most people aren't living lives of being 100% well, but are getting on with conditions that do affect their lives. But it's taken some of those people with that level of determination to fund and run ME Research UK and Invest in ME. Invest in ME was set up and run by parents of a sufferer, ME Research by a scientist who contracted CFS/ME and was convinced what he had wasn't somatic.
That world made me aware of many, many misdiagnoses when diagnostic tests were skimped or not followed through, and something treatable like thyroid problems or pernicious anaemia was given a CFS/ME diagnosis and the GET (graded exercise therapy) and CBT treatment.
When Professor John Gow started researching into CFS/ME he took all the patients on various hospital books and retested them. For a third he found an identifiable condition that hadn't been picked up, a third he found something he identified as CFS/ME and a third he couldn't identify anything.
CFS/ME / CFIDS is known to be a range of conditions* that come under MUS. It's a diagnosis of elimination - if the GP can't find anything that's the resulting diagnosis.
* Dr Jonathan Kerr and Dr Esther Crawley both identified several different forms - 7 and 5 respectively.
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Mugs - Keep the Ship afloat
Posts: 13794 | From: outiside the outer ring road | Registered: Aug 2006
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orfeo
Ship's Musical Counterpoint
# 13878
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Posted
quote:
Originally posted by mdijon:
For instance H.pylori - stomach ulcers were not dismissed as "in your mind" even though we didn't know what bacteria caused them.
Eh? They were attributed to stress. It wasn't a case of not knowing which bacterium caused it, no-one thought it was a bacterium at all.
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Technology has brought us all closer together. Turns out a lot of the people you meet as a result are complete idiots.
Posts: 18173 | From: Under | Registered: Jul 2008
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itsarumdo
Shipmate
# 18174
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Posted
quote:
Originally posted by mdijon:
quote:
Originally posted by itsarumdo:
They are body-mind conditions where ... dah de dah .....
What utter and complete fetid nonsense.
Which reminds me of this thread where you spouted unevidenced nonsense without links. As I said then;
quote:
I'm not going to play whack-a-mole argument with more daft assertions of yours when you won't admit that you were demonstrably wrong on the previous daft assertions that I took the effort to reply to and show you evidence.
Just following on Google scholar the names I supplied...
2010 review of plasticity
van der Kolk's homepage (yes - I know it's obviously a quack site with the use of green pastel colours...)
NICABM discussion on polyvagal theory
... and this is a relevant discussion ... see bottom 50% of discussion for the professional comments another NICABM seminar
The consensus in this field is that PTSD + attachment deficit can produce more or less the whole range of mental disorders that do not have a primary neuropathological basis, and even some of the ones that DO apparently have a neurological basis, the neurology has changed due to a trauma/attachment precondition. OK - it's not provable to that extent so you won't hear all those dots being put together in publications. But there it is. And the high incidence of MUS in this group is - lets say an interesting coincidence.
And, as is commented on in some of the above articles, if we consider these things to be trauma + attachment, they are potentially treatable. Unlike the diagnoses bipolar, schizophrenia, adhd, et etc etc whic are effectively just basket cases requiring lifelong controlled medication "because it's organic".
[ 22. March 2015, 13:26: Message edited by: itsarumdo ]
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"Iti sapis potanda tinone" Lycophron
Posts: 994 | From: Planet Zog | Registered: Jul 2014
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itsarumdo
Shipmate
# 18174
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Posted
quote:
Originally posted by Curiosity killed ...:
The linked article seems to have missed that IBS has been linked to gut bacteria - a bit like H. pylori and stomach ulcers. That's been known for a few years now.
Secondly, the underlying condition that is written off as something somatic can end up killing the person. A friend died last year in her early 40s from the effects of a genetic mitochondrial disease that wasn't diagnosed until she was already very ill. Her son has inherited the same condition. What they were both diagnosed with was CFIDS / CFS/ME, and offered CBT to:
quote:
challenge the patient's beliefs and maladaptive behaviours, in a caring manner
rather than further investigations.
There are quite a few cases like that one.
Yes - note that the gut contains rather more bacterial DNA than the human body contains human DNA (so who's running this show anyway? and what is a human being?) , and also produces and stores neurotransmitters - e.g. about 3x more serotonin than the brain produces and stores
and it responds to mental-emotional states.
"stomach churning, butterflies, gut-wrenching, I shat myself, queasy, liverish, to have a lot of guts, etc etc"
all of which aforementioned abdominal-emotional sensations are also MUS.
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"Iti sapis potanda tinone" Lycophron
Posts: 994 | From: Planet Zog | Registered: Jul 2014
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no prophet's flag is set so...
Proceed to see sea
# 15560
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Posted
quote:
Originally posted by mdijon:
quote:
Originally posted by itsarumdo:
They are body-mind conditions where the physiology (i.e. hindbrain) has become jammed in a survival response. You cannot treat just body because mental activity feeds back into the body, so the mental end of the loop has to be properly addressed - and you certainly can't treat them as psychological because the hindbrain/RAS and ANS (and spinal nerve roots) are NOT the domain of psychology.... Interesting results - where there are before and after brain MRIs we see e.g. a 30% recovery in volume of parts of the midbrain (e,optional system) which have atrophied, and other signs that the brain is physically, morphologically plastic according to use, and the use can be changed positively by engaging humanely and intelligently with primitive survival and socialisation reflexes. With medication as necessary if this is needed to provide temporary stabilisation.
What utter and complete fetid nonsense.
Actually it is not nonsense, but the post did over simplify very complex interactions. There are interactions between the cortex (thinking parts of brain) with various regulatory parts of brain and other organs. Thus, for example, some forms of anxiety can be treated with drugs to control heart rate, pain can be treated with drugs to stabilize mood.
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Out of this nettle, danger, we pluck this flower, safety.
\_(ツ)_/
Posts: 11498 | From: Treaty 6 territory in the nonexistant Province of Buffalo, Canada ↄ⃝' | Registered: Mar 2010
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mdijon
Shipmate
# 8520
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Posted
quote:
Originally posted by mdijon:
For instance H.pylori - stomach ulcers were not dismissed as "in your mind" even though we didn't know what bacteria caused them.
quote:
Originally posted by orfeo:
Eh? They were attributed to stress. It wasn't a case of not knowing which bacterium caused it, no-one thought it was a bacterium at all.
A proximate cause related to a psychological cause isn't quite what is usually meant by "in your mind". Stress is still considered an important cause of a number of physical illnesses but they aren't dismissed in quite the same way as illnesses where the symptoms themselves are a manifestation of stress.
For instance abdominal pain with no demonstrable ulcer or other cause might be dismissed as "in the mind" whereas a stomach ulcer thought to be caused by stress (not all of them are caused by H pylori by the way) won't be dismissed in the same way.
I must hurry to add that I don't consider "in the mind" to be a very useful label, but that's how it was used.
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
Posts: 12277 | From: UK | Registered: Sep 2004
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mdijon
Shipmate
# 8520
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Posted
quote:
Originally posted by no prophet's flag is set so...:
Thus, for example, some forms of anxiety can be treated with drugs to control heart rate, pain can be treated with drugs to stabilize mood.
Agreed, a simple enough statement which can be made and tested without loading it with pseudoscience like;
quote:
They are body-mind conditions where the physiology (i.e. hindbrain) has become jammed in a survival response.
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
Posts: 12277 | From: UK | Registered: Sep 2004
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itsarumdo
Shipmate
# 18174
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Posted
waddyawant, a PhD thesis?
Go read Porges
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"Iti sapis potanda tinone" Lycophron
Posts: 994 | From: Planet Zog | Registered: Jul 2014
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mdijon
Shipmate
# 8520
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Posted
quote:
Originally posted by itsarumdo:
waddyawant, a PhD thesis?
Got one thanks.
quote:
Originally posted by itsarumdo:
Go read Porges
I didn't find it very convincing. He doesn't seem to have done many experiments, and none that I could find that allow one to make statements about the physiology of the hind-brain.
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
Posts: 12277 | From: UK | Registered: Sep 2004
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no prophet's flag is set so...
Proceed to see sea
# 15560
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Posted
quote:
Originally posted by mdijon:
quote:
Originally posted by no prophet's flag is set so...:
Thus, for example, some forms of anxiety can be treated with drugs to control heart rate, pain can be treated with drugs to stabilize mood.
Agreed, a simple enough statement which can be made and tested without loading it with pseudoscience like;
quote:
They are body-mind conditions where the physiology (i.e. hindbrain) has become jammed in a survival response.
I'm on a computer versus no-so-smart phone so I type a little more.
This is the excessive simplification to which I commented. "Hindbrain" is not really a term I'd use when we mean the hypothalmus, hippocampus, and various interactions with the pituitary, thyroid, adrenals, thymus.
The field of psychoimmunology was given a boost with the HIV/AIDs demographic promoting research. The cardiovascular research showing that hostility and bitterness are more toxic than simple stresses. Functional approaches to orthopaedic and soft tissue injuries have shown the subjective nature of pain perception. Marital conflict and tension delaying skin lesion healing.
The psychological influence on perception and coping is rather strong, and often underappreciated. A personal story: after being hit by a car I was briefly patched up from abrasions and the bicycle also repaired. About a month later I had increasing symptoms of numbness in the 4th and 5th fingers on one side. So I requested X-rays which showed compression fractures of 2 thoracic vertebrae (roughly between the shoulder blades). The news that they were cracked created about 2 weeks of more intense pain and a great reduction in my physical activity. This fascinated me in part because I knew this was a matter of perception: that I was no more injured that prior to knowing of the fractures. Yet I was as susceptible to the perception and its emotional consequences like someone lacking the academic knowledge.
When another car hit me and fractured 3 ribs some years later, I was more prepared by the earlier experience to not be so psychologically influenced by perception.
There many stories of disease response, and recovery from specific things like heart attack. It is not pseudo-science, but it is very easy to slip into that with hopeful and probably nonsensical ideas like imagining immune cells killing cancers. But should we throw that idea out completely? probably not, because if the person is a believer in this, they might influence via their cortical thought processes hormones that actually do something via the connections we know that exist between the brain and bodily organs. Thus, the theory may be wrong but the effect real. For these ideas to receive attention by professionals they have to be repeated and proved via studies: testimonials and one person's recovery not being evidence, though might motivate someone to do a study.
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Out of this nettle, danger, we pluck this flower, safety.
\_(ツ)_/
Posts: 11498 | From: Treaty 6 territory in the nonexistant Province of Buffalo, Canada ↄ⃝' | Registered: Mar 2010
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itsarumdo
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# 18174
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Posted
quote:
Originally posted by mdijon:
quote:
Originally posted by itsarumdo:
waddyawant, a PhD thesis?
Got one thanks.
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Originally posted by itsarumdo:
Go read Porges
I didn't find it very convincing. He doesn't seem to have done many experiments, and none that I could find that allow one to make statements about the physiology of the hind-brain.
in one of the NICABM transcripts he describes how Polyvagal theory predicts the auditory function will alter if the RAS is hyperaroused... which includes a lot of stuff that points to Autistic behaviour. (I miss out quite a bit of detail here ) e.g. the RAS is not interested in "safe" vocal range frequencies, and filters them out so that the frequency range of interest is the low f that you would associate with big predator sounds. This includes neutralisation of facial expression to prevent the middle ear chamber being squeezed by the TMJ.
This in itself is totally consistent with human behaviour and sensory activation patterns in stressful situations and in PTSD. Then he worked out a frequency modulation schema that would renormalise the auditory NS and get it to be more interested in vocal range f again. Autistic kids so far exposed to this for 3x1 hour sessions have permanently regained "normal" socialisation skills(!) "though they are often still a bit quirky in other ways". i think that constitutes some kind of rather spectacular proof. A few people have been successfully treating autism for maybe 20 years now, but up to this breakthrough it was always an expensive slog taking from a year or so up to a decade of treatment. afaik he's still in the evaluation phase before general release.
[ 22. March 2015, 18:51: Message edited by: itsarumdo ]
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"Iti sapis potanda tinone" Lycophron
Posts: 994 | From: Planet Zog | Registered: Jul 2014
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itsarumdo
Shipmate
# 18174
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Posted
thanks No Prophet - nice post
"Primitive brain" might have been a better choice - all this is based on interpretations of evolutionary biology (or more preccisely, Evo-Devo).
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"Iti sapis potanda tinone" Lycophron
Posts: 994 | From: Planet Zog | Registered: Jul 2014
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Lamb Chopped
Ship's kebab
# 5528
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Posted
The original article (from OP) seemed slippery to me--it started out all right, but by the middle seemed to be segueing into "here's how you gently ease your perfectly physically healthy but mentally perturbed patient into considering seeing a shrink." Which is damned impertinent.
As was said by somebody up thread, a strong dose of humility is a good thing in a doctor. We don't know everything. We don't even know what we don't know. There's nothing wrong with seeing a shrink, or seeing a physician, or seeing both; but whoever I see had better accept that there are limits to their skills and occasionally They May Be Wrong.
(Yes, I'm touchy about this (though not to anybody on this thread)). I've had fucking righteous lectures about my bad choices and screwed up psychology from a physician/asshole who refused to believe hypothyroidism was a Thing™ with my lab results right there in his lap. I ditched him and found somebody who knew something about body chemistry.
Similarly, I had a very well-meaning nurse (a family member) who diagnosed my E.coli infection as nervous stomach and an attempt to get out of seeing my in-laws. And my own stupid-ass self took her word for it and went off to visit an in-law with cancer (!), exposing the poor guy to a bug that causes projectile vomiting and diarrhea. (Thank God he didn't get it.)
There are still so many things we don't know, and so much room for humility.
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Er, this is what I've been up to (book).
Oh, that you would rend the heavens and come down!
Posts: 20059 | From: off in left field somewhere | Registered: Feb 2004
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no prophet's flag is set so...
Proceed to see sea
# 15560
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Posted
Training to work with people often seems to take second seat to the specific content knowledge. People tell me about physicians who will deal with one issue only in an appt and want every appt to be only one thing. Thus, the person with a headache must avoid talking about the GI problem that goes along with it or doctor gets mad. I think the near future of medical care lies with nurse practitioners.
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Out of this nettle, danger, we pluck this flower, safety.
\_(ツ)_/
Posts: 11498 | From: Treaty 6 territory in the nonexistant Province of Buffalo, Canada ↄ⃝' | Registered: Mar 2010
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itsarumdo
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# 18174
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Posted
Apparently - it will be an inflatable nurse practitioner with a shipload of AI/Prolog coding
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"Iti sapis potanda tinone" Lycophron
Posts: 994 | From: Planet Zog | Registered: Jul 2014
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Ethne Alba
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# 5804
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Posted
Which is all very well and it's been ever so interesting reading this.....
But, had i read this whilst off work ( for four years)....receiving no benefits what so ever...unable to function properly.....i would be gutted.
What helps?
What helped me (and it could be different with other folk) was:
* doctors who said it like it was, i.e. we just don't know
* doctors who said they would be there for me (and were)
* The medics finally realising after about a year that something was very wrong and doing something about it. In my case supporting me and encouraging me to believe that one day this would indeed pass and i would be in another place, not the same place, but somewhere where i might be able to function normally again.
What didn't help?
(you didn't ask but hey this comes gratis...)
* Medical staff lying and especially in print.
* Suggesting that hopi candles might help with my lack of taste.....still working that one out.
[ 22. March 2015, 20:56: Message edited by: Ethne Alba ]
Posts: 3126 | Registered: Apr 2004
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itsarumdo
Shipmate
# 18174
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Posted
quote:
Originally posted by Ethne Alba:
...
What helps?
What helped me (and it could be different with other folk) was:
* doctors who said it like it was, i.e. we just don't know
* doctors who said they would be there for me (and were)
* The medics finally realising after about a year that something was very wrong and doing something about it. In my case supporting me and encouraging me to believe that one day this would indeed pass and i would be in another place, not the same place, but somewhere where i might be able to function normally again.
What didn't help?
(you didn't ask but hey this comes gratis...)
* Medical staff lying and especially in print.
* Suggesting that hopi candles might help with my lack of taste.....still working that one out.
You were very lucky - I've been helping someone stay alive for the past 2 years who is still more or less doing it herself. The few hospital stays so far - whilst providing a bed and some monitoring - ended up with the condition becoming worse because nobody knew what to do and very few people appeared to be bothered. Any one of your three positives would be very welcome. The other not-so-positive stuff is - familiar.
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"Iti sapis potanda tinone" Lycophron
Posts: 994 | From: Planet Zog | Registered: Jul 2014
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mdijon
Shipmate
# 8520
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Posted
quote:
Originally posted by itsarumdo:
Autistic kids so far exposed to this for 3x1 hour sessions have permanently regained "normal" socialisation skills(!) "though they are often still a bit quirky in other ways". i think that constitutes some kind of rather spectacular proof.
Hallelujah. Evidence?
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
Posts: 12277 | From: UK | Registered: Sep 2004
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itsarumdo
Shipmate
# 18174
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Posted
When you provide proof that what you thought you ate last Sunday was exactly what you thought it was, I'll have a think about it.
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"Iti sapis potanda tinone" Lycophron
Posts: 994 | From: Planet Zog | Registered: Jul 2014
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Ethne Alba
Shipmate
# 5804
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Posted
At the end of the day we are all wonderfully and marvellously made; goodness knows how on earth our bodies work normally for most of the time. But what makes us think that we can always understand these bodies? How can medics possibly know all that there is to know? We can't and they can't.
I finally came to some understanding after four long years, that i will never know what happened to me. That's cool.
But tell you what, i never never never want to go back there again.
+
I find myself avoiding doctors like the plague (sad but true)
Posts: 3126 | Registered: Apr 2004
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mdijon
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# 8520
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Posted
quote:
Originally posted by itsarumdo:
When you provide proof that what you thought you ate last Sunday was exactly what you thought it was, I'll have a think about it.
I'm not advocating what I ate last Sunday as a treatment for a serious condition with massive implications for millions of people. Many of whom have been seriously mislead by miracle cures touted by quacks without evidence.
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
Posts: 12277 | From: UK | Registered: Sep 2004
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Curiosity killed ...
Ship's Mug
# 11770
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Posted
I was just highlighting the CFS/ME issue as that is one I am aware of, but we have a long and inglorious history of attributing any illness that we don't understand as psychosocial rather than biomedical (or biopsychosocial). Examples include hysteria and all that jazz as described by Maudesly, Multiple Sclerosis as psychosomatic, stomach ulcers and stress. Many, many illnesses we once saw as psychosomatic are now understood far more and the physical nature of those illnesses have been identified.
Although I did, when in the CFS/ME world, point out the links between emotional state and effects on the hypothalmic-pituitary-adrenal axis, mostly as a way to suggest being positive and making sure life is as enjoyable as possible, I do think we need to be wary of of blithely attributing all illnesses we do not understand to psychosomatic causes.
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Mugs - Keep the Ship afloat
Posts: 13794 | From: outiside the outer ring road | Registered: Aug 2006
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mdijon
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# 8520
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Posted
quote:
Originally posted by Curiosity killed ...:
Many, many illnesses we once saw as psychosomatic are now understood far more and the physical nature of those illnesses have been identified.
I also wonder about the distinction between psychological, psychiatric and physical. Parkinson's manifests with problems of movement, it relates to not having enough dopamine in a particular spot of the brain. Schizophrenia manifests with delusions, it relates to having too much dopamine in a particular spot. Both can be treated with medication. Depression likely relates, at least in part, to having a lack of serotonin. But can be treated with psychological treatments as well as medication.
Which of these illnesses is psychological, psychiatric or physical and how does the distinction help us? I'm not sure anymore.
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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon
Posts: 12277 | From: UK | Registered: Sep 2004
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Golden Key
Shipmate
# 1468
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Posted
quote:
Originally posted by Curiosity killed ...:
CFS/ME / CFIDS is known to be a range of conditions* that come under MUS. It's a diagnosis of elimination - if the GP can't find anything that's the resulting diagnosis.
* Dr Jonathan Kerr and Dr Esther Crawley both identified several different forms - 7 and 5 respectively.
I have CFIDS/CFS/ME. There are other ways of approaching it. For instance, as being a virus or having a viral component. Google "Dr. Jose Montoya Stanford Chronic Fatigue". He has a special clinic in the Infectious Disease clinic, and is doing good work with anti-viral medicines, and testing for a variety of viruses. I understand he has some very good explanations on You Tube.
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Blessed Gator, pray for us!
--"Oh bat bladders, do you have to bring common sense into this?" (Dragon, "Jane & the Dragon")
--"Oh, Peace Train, save this country!" (Yusuf/Cat Stevens, "Peace Train")
Posts: 18601 | From: Chilling out in an undisclosed, sincere pumpkin patch. | Registered: Oct 2001
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
I feel I should point out that psychological disorders, are not imaginary and they can be severe and life threatening - they can ruin your physical health and have catastrophic effects on your well being. And sometimes we can mitigate that, and sometimes we can cure it - sometimes we can't.
Considering a psychological / psychiatric cause should not be a dismissal or denial of the seriousness of the problem.
Also, living with a chronic health problem is hard, sometimes talking therapies can help with that - they offer talking treatments to people with life limiting physical health conditions too.
(Which is not to say that things are not mis-diagnosed sometimes - I am just not sure it is worse to be misdiagnosed with a mental health condition and given the wrong treatment than it is to be treated for the wrong physical health condition and given the wrong treatment.)
[ 24. March 2015, 16:54: Message edited by: Doublethink. ]
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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no prophet's flag is set so...
Proceed to see sea
# 15560
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Posted
quote:
Originally posted by mdijon:
quote:
Originally posted by Curiosity killed ...:
Many, many illnesses we once saw as psychosomatic are now understood far more and the physical nature of those illnesses have been identified.
I also wonder about the distinction between psychological, psychiatric and physical. Parkinson's manifests with problems of movement, it relates to not having enough dopamine in a particular spot of the brain. Schizophrenia manifests with delusions, it relates to having too much dopamine in a particular spot. Both can be treated with medication. Depression likely relates, at least in part, to having a lack of serotonin. But can be treated with psychological treatments as well as medication.
Which of these illnesses is psychological, psychiatric or physical and how does the distinction help us? I'm not sure anymore.
The distinction is useful only insofar as there is a specific identifiable treatment for the diagnosis. Depression, for example, might be due to errant neurochemicals, chronic pain, malfunctioning thyroid, bereavement or other life circumstances etc. Symptoms are often very similar. None of it is helped by saying it is one of physical (honourable) or psychological (disparaged). A past project was to understand the demographics of the patient and doc, and to see what conclusions about etiology were. Young women were seen more frequently as having psychogenic disorders than educated older, but not elderly men (this was the strongest contrast)
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Out of this nettle, danger, we pluck this flower, safety.
\_(ツ)_/
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itsarumdo
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# 18174
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Posted
ah yes - hysteria
people used to be locked up in mental institutions for life just because their relatives were not comfortable with their range of emotional expression. It's chilling.
Pierre Janet is interesting - a lot of modern body psychotherapy arises from his (unusually for the time) very humane and compassionate observations. Freud from the same era identified sexual abuse and incest as the main cause of hysteria in young women, but he was given such a sound shot off the bows by the rich families this happened in that he changed his public presentation to the projective neuroses (e.g. penis envy) that he's much more famnous for now.
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"Iti sapis potanda tinone" Lycophron
Posts: 994 | From: Planet Zog | Registered: Jul 2014
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Curiosity killed ...
Ship's Mug
# 11770
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Posted
quote:
Originally posted by mdijon:
Which of these illnesses is psychological, psychiatric or physical and how does the distinction help us? I'm not sure anymore.
From the patient's point of view, the distinction helps when the recommended CBT treatment that:
quote:
begins to challenge the patient's beliefs and maladaptive behaviours, in a caring manner.
is not applied to something like the deterioration of the myelin sheath of the nerves disrupting the motor nervous system. Which did happen in the past.
Interestingly digging to check I was being accurate there, the MS Society page on causes of MS lists the Epstein Barr Virus as a possible cause for MS. EBV is implicated in a good percentage of CFS/ME cases - so much so that it's a standard test.
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Mugs - Keep the Ship afloat
Posts: 13794 | From: outiside the outer ring road | Registered: Aug 2006
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
Surely, the distinction should be about correct diagnosis, it would be fuck all use to be diagnosed with a different neurological condition and prescribed an acetacholine agonist in those circumstances either.
[Tangent]What CBT would offer nowadays for someone ith CFS would be help with adjustment to disability, self-esteem and activity pacing. So if offered nowadays it would not be about convincing someone they are not ill, but helping them cope with their illness. It is likely these elements would always have been present in treatment, regardless of whether the therapist and client the same view of the symptom causation.
Example of a maladaptive belief, "I was flat out on Wednesday, I feel a bit more energic today, so I must catch up by doing as much as possible today". [/Tangent]
[ 26. March 2015, 07:48: Message edited by: Doublethink. ]
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
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