Dealing with the unknown. Functional neurological disorder (FND) and the conversion of cultural meaning, 2020, Canna and Seligman

Andy

Andy

Senior Member (Voting rights)
Functional Neurological Disorder (FND), otherwise known as Conversion Disorder, is characterized by abnormal sensory or motor symptoms that are determined to be “incompatible” with neurological disease. FND patients are a challenge for contemporary medicine. They experience high levels of distress, disability, and social isolation, yet a large proportion of those treated do not get better. Patients with FNDs are often misdiagnosed and suffer from stigma, dysfunctional medical encounters and scarcity of adequate treatments.

In this paper we argue that an anthropological understanding of these phenomena is needed for improving diagnosis and therapies. We argue that cultural meaning is pivotal in the development of FND on three levels. 1) The embodiment of cultural models, as shared representations and beliefs about illnesses shape the manifestation of symptoms and the meanings of sensations; 2) The socialization of personal trauma and chronic stress, as the way in which individuals are socially primed to cope or to reframe personal trauma and chronic stress affects bodily symptoms; 3) Moral judgment, as stigma and ethical evaluations of symptoms impact coping abilities and resilience. In particular, we focus on the disorder known as PNES (Psychogenic-Non-Epileptic Seizure) to show how cultural meaning co-determines the development of such seizures.

We introduce the notion of interoceptive affordances to account for the cultural scaffolding of patients’ bodily experiences. Finally, we suggest that effective treatments of FND must act upon meaning in all of its aspects, and treatment adequacy must be assessed according to the cultural diversity of patients.
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Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0277953619307208
Sci hub, https://sci-hub.se/10.1016/j.socscimed.2019.112725
 
We argue that cultural models of illness, such as the manifestation of a prototypical epileptic seizure, are stored in patients’ memories, often behind the threshold of awareness. These models can be triggered by particularly impacting stressors (FND are correlated with things like traumatic experience, chronic family stress, and physical injury) and expressed in bodily manifestations that seem to reproduce the model (e.g. an epileptic seizure acts as an embodied model for a PNES)
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There is a simpler possibility that doesn't require speculations about patients subconsciously imitating real illness to communicate their emotional distress.

That current instruments aren't always sensitive enough to pick up the abnormal electric activity associated with epileptic seizure.

It even says on Wikipedia that EEG signals reflect mainly the activity in superficial parts of the brain. The deeper parts don't contribute much if at all to the signal.

https://en.wikipedia.org/wiki/Electroencephalography
 
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This paper by Wilshire and Ward is relevant and it has a section on psychogenic nonepileptic seizures:

https://www.researchgate.net/public...physical_illness_Time_to_examine_the_evidence

The authors also examined how well supported by evidence various psychogenic explanations for this illness are and conclude they are not well supported.

Personally I find it astonishing that medical care for many patients is rigidly based on ideas that lack convincing evidence.
 
They need to look at the doctors' sense-making instead of the patients'. Patients aren't supposed to be able to make sense of diseases, that's why they go to doctors. On the other hand, doctors are failing to honestly and accurately explain the situation to patients with FNDs; this is the problem that should be addressed.
 
Solipsism is one hell of a drug. These people think cultural representations about unexplained illness are relevant because that's what they think about and talk about among themselves. It's exactly the same as the earliest writings that said the exact same things over two centuries ago. They are projecting their own thoughts onto patients with explanations that only make sense given their own personal professional culture.

Good grief it's like this whole field is remedial medicine, the spot where those who get through medical school but can't apply those skills get sent to so they don't cause too much trouble.
 
This manuscript is mostly speculative blather, but they got one thing right - randomised studies of mindfullness tend to have a upper-middle class bias and there is cultural stigma attached to this among certain social classes.

The claim that the somatic illness resulting from the hypothetical conversion of "chronic stress" is shaped due to cultural influences is entirely unconvincing. The reporting of the illness by the patient and the perception of the medical practitioner can certainly be culturally influenced, but it is important not to confuse the finger pointing at the sun with the sun itself. On a meta level, the writers of the manuscript themselves could be suffering from substantial cultural bias in their interpretations.
 
strategist said:
subconsciously imitating real illness to communicate their emotional distress.
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a beautifully succinct description.

I do not see how it is possible to do this. Can the subconscious make a decision like that? The addition of "subconsciously" here seems like a weasel word so they can insist they are not blaming the patient but what they really mean is that the patient is looking for sympathy by pretending to be ill. We have seen that debate in the ME world, malingering or subconscious.

Does illness communicate emotional distress? Society does not look at cancer patients and think they are expressing distress. What they really mean is it is a way of looking for sympathy or to manipulate people or get attention all of which are concepts in the original idea of hysteria and matches the notion that FND should be considered if the patient is a woman who has an attentive husband with her.
 
... (FND), otherwise known as Conversion Disorder, is characterized by abnormal sensory or motor symptoms that are determined to be “incompatible” with neurological disease.
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... we argue that an anthropological understanding of these phenomena ...
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... we focus on the disorder known as PNES (Psychogenic-Non-Epileptic Seizure) to show how cultural meaning co-determines the development of such seizures.
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What are they talking about? About a cultural determination of such seizures? Or about a cultural co-deterimanation of such seizures?

Noteworth is, that the determination of incapabilitiy of these seizures with neurological disease is of course a medical one, so another one - it´s already bad writing in a difficult subject (if admitted). This makes it not very truthworthy already in a formal sense right on from the beginning.

We introduce the notion of interoceptive affordances to account for the cultural scaffolding of patients’ bodily experiences
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Another complicate wording,

"interoceptive affordance" = sense of the internal state the body is in, as it should occur in a selfsuggesting manner

and this now is denied by cultural scaffolding - or "to account for" = denies the cultural scaffolding?? (maybe anyone can explain it to me, a non-native speaker).

This would mean that the interoceptive affordance indirectly causes the bodily experience via cultural scaffolding.

Or are the patients denied to feel themselves in a basal manner by the culture, and therefore they feel and are ill, e.g. with non-neuroligical seizures?

:devilish: Surely, there should be an interaction, an it is by no means clear that the fault doesn´t sit in the machinery of "interoceptive affordance" but in the "bodily experiences".

"bodily experiences" might be better said here as "bodily experiencing". I e.g. felt very ill, and my bodily experiencing was for sure not changeable by any cultural critic (on my parents, or whatever).

So then, in my ME/CFS case, it´s the "interoceptive affordance". I guess that means in their considerations that being ill is somehow nice. So this is on the same side as "bodily experiencing" (my parents or whatever).

-> These people are probably not able to write in a non-betraying manner.


https://en.wikipedia.org/wiki/Interoception (for ME/CFS I think indeed that the thalamus is one key, in a physiological manner though)
 
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Mithriel said:
a beautifully succinct description.

I do not see how it is possible to do this. Can the subconscious make a decision like that? The addition of "subconsciously" here seems like a weasel word so they can insist they are not blaming the patient but what they really mean is that the patient is looking for sympathy by pretending to be ill. We have seen that debate in the ME world, malingering or subconscious.

Does illness communicate emotional distress? Society does not look at cancer patients and think they are expressing distress. What they really mean is it is a way of looking for sympathy or to manipulate people or get attention all of which are concepts in the original idea of hysteria and matches the notion that FND should be considered if the patient is a woman who has an attentive husband with her.
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It's textbook deus ex machina. Zero substance.

What is the cause of this? That. And what is that? The cause of this. Round and round...
 
spinoza577 said:
What are they talking about? About a cultural determination of such seizures? Or about a cultural co-determination of such seizures?
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Co-determination along with their psychogenic conversion of course! They're saying that subjects in a culture that has not heard about epilepsy will not "convert" their psychological distress as PNES, instead manifesting as another set of functional symptoms that mimics another neurological disorder!
 
Snow Leopard said:
Co-determination along with their psychogenic conversion of course! They're saying that subjects in a culture that has not heard about epilepsy will not "convert" their psychological distress as PNES, instead manifesting as another set of functional symptoms that mimics another neurological disorder!
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And I considered myself already as having quite some fantasy! Probably I should apologize for not having digged much into psychiatric theories.

Thank you for clarifying. - On the other side, the title is, "Conversion OF cultural meaning", so first read is, the cultural meaning converts into experienced distress.

In a second read, according to your beguiling interpretation, they say that a kind of mirror (cultural meaning) converts something (psychological distress) into bodily experienced distress. Maybe I will even print out the article, for fun. The abstract is written in an unclear manner. - Thank you again, great hint to this.
 
Sid said:
I wonder how the subconscious brain chooses which symptom to fake. Why do some get non-epileptic seizures, others tremor, yet others functional paralysis or blindness.
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This stands upon the psychiatrist who finally could heal you.
 
Sid said:
I wonder how the subconscious brain chooses which symptom to fake. Why do some get non-epileptic seizures, others tremor, yet others functional paralysis or blindness. So creative. :rolleyes:
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The symptoms probably mirror the deep trauma that people suffered during their childhood? So if you went to a party and played blind mans buff or pin the tail on the donkey the trauma would cause functional blindness?
 
Snow Leopard said:
Co-determination along with their psychogenic conversion of course! They're saying that subjects in a culture that has not heard about epilepsy will not "convert" their psychological distress as PNES, instead manifesting as another set of functional symptoms that mimics another neurological disorder!
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Probably some naive rehashing of findings that schizophrenia affects patients differently between cultures, with some mostly manifesting as bad voices and others as positive ones.

But knowing how non-rigorous psychiatry is, I pretty much assume this was selectively reported and cherry-picked as well anyway. It may be true to some degree, just somewhere between 1/10 and 1/100 of what is claimed.

After all, if it "applies" in one psychiatric illness, surely it applies to all of them. Which is two whole layers of problems, mostly the whole not being able to tell the difference between psychiatric illness and non-psychiatric.
 
Sid said:
I wonder how the subconscious brain chooses which symptom to fake. Why do some get non-epileptic seizures, others tremor, yet others functional paralysis or blindness. So creative. :rolleyes:
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Why obviously it's the ones that lead to getting the most help and sympathy! Which is why it makes so much sense that fatigue happens to be the most common one. This symptom is treated super seriously and leads to sympathy, unending help, support and basically being treated like a minor deity*.

* well, the reverse of that but when you really think about it, the mirror opposite of something is really almost the same thing since all you have to do is a single binary flip, the simplest mathematical operation
 
Adrian said:
The symptoms probably mirror the deep trauma that people suffered during their childhood? So if you went to a party and played blind mans buff or pin the tail on the donkey the trauma would cause functional blindness?
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Woah, if you're not careful with this you'll end up spawning an entire field of study.

Honestly though I am 100% certain this exact point has been made in published literature by at least a dozen people.
 
Adrian said:
The symptoms probably mirror the deep trauma that people suffered during their childhood? So if you went to a party and played blind mans buff or pin the tail on the donkey the trauma would cause functional blindness?
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rvallee said:
Why obviously it's the ones that lead to getting the most help and sympathy! Which is why it makes so much sense that fatigue happens to be the most common one. This symptom is treated super seriously and leads to sympathy, unending help, support and basically being treated like a minor deity*.
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Sounds legit. 100% true fact.
 
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