"Abnormal illness behaviour" and the missing citations.

[dreampop]

The only potentially relevant bit of science to come out of all this is the Imboden, Canter Cluff paper on recovery from influenz

At least from the abstract we see they studied Brucellosis and Chronic Brucellosis. There is now evidence from a recent study (2009), of ongoing infection.

In the current study, we evaluated the usefulness of Q-PCR in the diagnosis and follow-up of chronic brucellosis patients. We studied a cohort of 35 subjects with a history of brucellosis diagnosed between 2 and 33 years previously. The most significant characteristic of infection was the long-term persistence of B. melitensis DNA in nonfocal-disease patients complaining of nonspecific symptoms undiagnosable by classical methods. This observation is very important insofar as it offers hope to a not insignificant group of patients who wander from physician to physician, remaining undiagnosed even though their symptoms (weakness, easy fatigability, anxiety, nervousness, and vague aches) persist. In such situations, Q-PCR could help physicians to diagnose chronic infection.

But I bet there are a myriad of things wrong with the paper. I.e. Brucellosis can infect the CNS, probably increasing depression and it is the CNS infection, not the depression that coincides with increased probability of getting the chronic form.

Chronic brucellosis also has clear biological symptoms - from the mayo clinic

Long-term signs and symptoms may include fatigue, recurrent fevers, arthritis, swelling of the heart (endocarditis) and spondylitis — an inflammatory arthritis that affects the spine and adjacent joints.

 

[chrisb]

Wow! At the heart not even a psychological disorder but a doctor-patient disorder!

The plot thickens over the question of the doctor patient disorder.

Perhaps the most fundamental element in the PVFS, and the acrimony that surrounds it, is a disturbance in the doctor-patient relationship.This rests on a number of false assumptions by both parties. Put most starkly, some people believe that: psychological disorder is a sign of moral failure and weakness; while physical illness is an unforeseeable and random event visited upon a person exposed to it. When doctor and patient agree with these views but agree that the current problem pertains to the latter statement (i.e. physical attribution) there is no conflict, though therapeutic nihilism may be a consequence. Conflict arises, not through acceptance that psychological or emotional disturbances are inextricably bound up in physical complaints, but because of the tension created between this truism and the first, judgmental statement, which denigrates mental illness and all that goes with it.

A S David Post-viral fatigue syndrome and psychiatry. British Medical Bulletin (1991) vol 47 no 4 pp966-988 @p 982.

That sounds like AIB to me. the references quoted are the paper PVFS; time for a new approach from 1988 and David A, Pelosi A and Wessely S The chronic fatigue syndrome; signs of a new approach Br J Hosp Med 1991; 45; 158-163.

I think there is a word to describe all this self reference. I shall refrain from using it.

 

[rvallee]

The plot thickens over the question of the doctor patient disorder.

Perhaps the most fundamental element in the PVFS, and the acrimony that surrounds it, is a disturbance in the doctor-patient relationship.This rests on a number of false assumptions by both parties. Put most starkly, some people believe that: psychological disorder is a sign of moral failure and weakness; while physical illness is an unforeseeable and random event visited upon a person exposed to it. When doctor and patient agree with these views but agree that the current problem pertains to the latter statement (i.e. physical attribution) there is no conflict, though therapeutic nihilism may be a consequence. Conflict arises, not through acceptance that psychological or emotional disturbances are inextricably bound up in physical complaints, but because of the tension created between this truism and the first, judgmental statement, which denigrates mental illness and all that goes with it.

A S David Post-viral fatigue syndrome and psychiatry. British Medical Bulletin (1991) vol 47 no 4 pp966-988 @p 982.

That sounds like AIB to me. the references quoted are the paper PVFS; time for a new approach from 1988 and David A, Pelosi A and Wessely S The chronic fatigue syndrome; signs of a new approach Br J Hosp Med 1991; 45; 158-163.

I think there is a word to describe all this self reference. I shall refrain from using it.

I can't help seeing an image of Plato's cave, with strong arguments endlessly going around in a circle to explain the various meanings of the shadows while someone keeps tugging at their sleeves, telling them "will you just turn around and actually look instead of divining meaning about a subject you have no personal insight into?"

Their very basic assumptions about illness are as detached from reality as you'd expect from a panel of Catholic priests producing a book on how to please a woman in bed. The most remarkable thing is how confident they are despite being told they are wrong by the very people they are attempting to describe.

There has to be some corollary to Dunning-Krugger where knowledge, even specialist knowledge, becomes self-defeating because of personal fault. It's not quite professional incompetence, although the outcome is the same, but they have gaps in their judgment so large you could park a supermassive black hole with plenty of room to spare.

If only people understood that failure isn't abstract here. It kills and it inflicts massive suffering. It's disturbing to hear how often misdiagnosis is treated as a minor issue of little consequence. Ironically they'd be absolutely furious if it happened to them, rightfully so.

 

[dreampop]

The plot thickens over the question of the doctor patient disorder.

Perhaps the most fundamental element in the PVFS, and the acrimony that surrounds it, is a disturbance in the doctor-patient relationship.This rests on a number of false assumptions by both parties. Put most starkly, some people believe that: psychological disorder is a sign of moral failure and weakness; while physical illness is an unforeseeable and random event visited upon a person exposed to it. When doctor and patient agree with these views but agree that the current problem pertains to the latter statement (i.e. physical attribution) there is no conflict, though therapeutic nihilism may be a consequence. Conflict arises, not through acceptance that psychological or emotional disturbances are inextricably bound up in physical complaints, but because of the tension created between this truism and the first, judgmental statement, which denigrates mental illness and all that goes with it.

A S David Post-viral fatigue syndrome and psychiatry. British Medical Bulletin (1991) vol 47 no 4 pp966-988 @p 982.

That sounds like AIB to me. the references quoted are the paper PVFS; time for a new approach from 1988 and David A, Pelosi A and Wessely S The chronic fatigue syndrome; signs of a new approach Br J Hosp Med 1991; 45; 158-163.

I think there is a word to describe all this self reference. I shall refrain from using it.

Yes, although this adds in "those w/ hysteria deny it because they see mental illness as a moral failure", which is of course a blatant lie.

 

[rvallee]

Yes, although this adds in "those w/ hysteria deny it because they see mental illness as a moral failure", which is of course a blatant lie.

Is there even data supporting this assertion at all? I doubt it.

Mental health patients likely resent but do not reject their diagnosis. What would be the purpose in that?

It's infuriating that words are being put into our mouths even through decades of denial and evidence that this is a blatant mischaracterization.

 

[chrisb]

I have discovered where Wessely made use of the concept of Abnormal Illness Behaviour, which the 1988 indicated was the replacement for Hysteria

Mass hysteria will be regarded as a phenomenon with certain characteristics. First, it is an outbreak of abnormal illness behaviour that cannot be explained by physical disease. Secondly, it affects people who would not normally behave in this fashion. Thirdly, it excludes symptoms deliberately provoked in groups gathered for that purpose, as occurs in many charismatic sects (Douglass, 1944; Massey et al. 1981; Sargant, 1948). Fourthly, it excludes collective manifestations used to obtain a state of satisfaction unavailable singly, such as fads, crazes and riots. Finally, the link between the participants must not be coincidental (Watson, 1982).

This concept is an attempt to limit the scope of mass hysteria. By emphasizing the role of abnormal illness behaviour it excludes episodes of false group rumours, such as the reports of a madman engaged in blood sacrifice (Jacobs,1965) or the epidemic of windscreen pitting blamed on the 'H-bomb' that affected Seattle (Medalia & Larsen, 1958). In these episodes the abnormality was a belief, not a behaviour, and the participants neither regarded themselves as ill nor sought medical attention

Psychological Medicine, 1987, 17, 109-120
Printed in Great Britain
Mass hysteria: two syndromes?
SIMON WESSELY1

It would appear then that AIB is a constituent part of Hysteria, but that there is little difficulty in establishing the other parts.

 

[chrisb]

It is interesting to note SW's explanation of the Royal Free as described in that paper

The common feature of the stressors underlying outbreaks of mass motor hysteria is an inability on the part of the subjects either to comprehend the true nature of the threat facing them or to avoid it. On Tristan da Cunha, 'a monotonous, isolated island' (Rawnsley & Loudon, 1964), stress could not be relieved, while nurses at the Royal Free would have been failing in their professional duties if they had refused to treat the victims of the real poliomyelitis epidemic, and thus avoid exposure. Stress is also reinforced by the frequent finding of a lack of channels of protest, as occurs with repressive headmasters (Knight et al. 1965; Tan,1963; Teoh et al. 1975), employers (Colligan et al. 1982; Kerchkoff & Back, 1965; Stahl & Lebedun, 1974) or a matron (Ikeda, 1966).


It isn't clear how this fits the evidence.

 

[Sean]

Don't you just love his utter certainty.

...that cannot be explained by physical disease.

That cannot is doing an awful lot of lifting in that sentence.

Just one word missing: known. Add that, and everything changes:

...that cannot be explained by known physical disease.

But if he conceded that then his argument would disappear up its own fundament.

 

[Cheshire]

It isn't clear how this fits the evidence.

I'm wondering what scientific device/measurement could evaluate the degree of unconscious willingness to abandon one's task while refusing to admit it because one fears an epidemic, specially retrospectivelly. So I guess it can only be "wild speculation" on the part of SW.

 

[chrisb]

There has always been some difficulty in understanding what SW et al mean by the term "maladaptive behaviour" which, along with the dysfunctional cognitions, forms part of our illness....apparently. This section from the Hysteria paper gives a clue as to its usage.

This concept is an attempt to limit the scope of mass hysteria. By emphasizing the role of abnormal illness behaviour it excludes episodes
of false group rumours, such as the reports of a madman engaged in blood sacrifice (Jacobs,1965) or the epidemic of windscreen pitting
blamed on the 'H-bomb' that affected Seattle (Medalia & Larsen, 1958). In these episodes the abnormality was a belief, not a behaviour, and
the participants neither regarded themselves as ill nor sought medical attention.

A further consequence of the proposed definition of mass hysteria is the support it gives to the view that such behaviour is maladaptive.
Many authors consider all forms of collective behaviour to be successful ways of coping with stress (Asch, 1956). The loss of internal restraints
permits the release of previously suppressed behaviours (Festinger et al. 1952), and contagion leads to fear reduction (Wheeler, 1966

 

[rvallee]

The common feature of the stressors underlying outbreaks of mass motor hysteria is an inability on the part of the subjects either to comprehend the true nature of the threat facing them or to avoid it

Yes, because if there's one known fact about people presenting to the emergency room everywhere is that they know precisely what's happening to them and feel perfectly calm and confident about the whole thing. They basically come with a chart pointing exactly where and why along with a list of tests and procedures to order around.

People with COVID everywhere echo that very smart fact, they all say, without fail, "oh, I got the COVID so everything is fine and I feel very reassured right now". That is definitely what is happening right now. Everywhere. Universally. They present to the emergency room barely able to breath and calmly and confidently proclaim that they feel great about fully comprehending what is happening.

Absolutely. Makes perfect sense. This is smart. SMART.