Favourable outcome without psychotherapy in patients with functional neurologic disorder, 2019, Vermeulen and de Haan

Paywall, https://www.jocn-journal.com/article/S0967-5868(19)31448-1/fulltext
Sci hub, not available via.

 

Remarkable. This is exactly Wessely's "the only predictor of outcome is strength of belief" by merely noting that patients who rate themselves as sicker are more likely to be sick long-term, which Occam's razor makes it plain and obvious that what this means is self-reports are actually somewhat reliable, albeit imprecise.

It's amazing how things like "high levels of somatization", a vague concept that cannot be quantified (thus negating even the validity of the words "high levels"), verified or even defined, can be argued with such confidence as if it was the high noon sun. Might as well be talking about levels of karma or feng-shui for all that it is a valid scientific concept. It's not that turtle, it's that other turtle one way down. Or the next one, nobody cares anyway as long as it looks like a turtle if you squint long enough and only use turtle-related terms.

In explaining why PACE had to cheat, Wessely chuckled that some patients get better no matter what, which is obviously explained by the poor selection criteria and the large variability of illness with the few actual patients, any random polling by self-reports will have some having better days and others having worse days. Therapy is evidently entirely useless, but the framing remains stuck in the "necessarily", as if it makes sense that it should be a default explanation, always the god of the gaps.

This is a horse that simply refuses to drink the water it is splashing in its own face. The parallels with cults is stunning, even contradictory evidence reinforces deeply held beliefs. So much confusion.

 

FND is so diverse nowadays we would need to know if they have interstitial cystitis or irritable bowel syndrome, dystonia or pseudoepilepsy! The confusion caused by ME becoming CFS repeating itself.

But assuming FND actually means some sort of neurological problem they have found it can resolve after some time without intervention. Again does that mean it was really a neurological infection or trauma which is being mistaken for FND or is it like MS where the brain diverts function to a working part?

Somatisation is just as diffuse and meaningless as FND so do they mean more sore stomachs or headaches, fatigue or pain?

Something like Myotonic Dystrophy has a weird set of symptoms including gut and bladder dysfunction so they are just finding undiagnosed and untreated diseases which are being dismissed as FND and somatisation by ignorant and ill informed neurologists.

The one good thing they have found is that psychotherapy has no place in treatment.

It frustrates me that the biology of neurological disease is so interesting but they close the door on basic research.