Mind and Body in the Guardian again

But also it's very, very bad philosophy. The kind that can serve as a how-to of what philosophy isn't. If at least it were any good, but instead philosophy is used here with the same intent and purpose as they use science: as a cover for what are just a bunch of personal opinions.

 

Everyone wants to know why things happen, even though we can’t. Some make educated guesses, others just make thing up. We’ve always done that.

We also like to know how to fix things.

 

Yes, it is pretty weird to see better with glasses upside down, although it might occur if there is different astigmatism in each eye. (I am not that convinced of the AI story.)

And this would definitely be structural, not functional. The shape of the lenses - either the ones in the eyes or the ones the optician didn't quite get right in his test frames!

 

So, it sounds like you are saying there is no legit functional disorder. Is that right? I'll have to differ in that case. There indeed are cases that brain is trained (or mis-trained) to respond abnormally to inputs or generate abnormal outputs, and threated by various means of retraining.

To me a disease is legit if the disorder can be diagnosed and treated/prognosticated. And there are FND cases can be diagnosed and treated. Aside from accepted medical practices, I've read a few poignant accounts by FND patients how they were freed from vision loss or mobility problems.

We all agree that there are just too many misuses and abuses of "functional disorder" label. But we shouldn't throw out the baby with the bath water. My personal experiences are no more than annoyances, but there indeed are people who suffered greatly for years and then found relief through non-somatic modifications.

 

How did we ever live without AI for so long? Thanks for digging that out, that thought also occurred to me. It still doesn't explain why my vision automatically worsens when I put the glasses on. Only difference between the measuring machine and the glasses that I could think of was the lack of the arms, so I tried it upside down with arms over my ears rather than behind. I'll have to admit though, it's not scientific and there could be other factors like misalignment of lenses.

 

That still doesn't explain why my vision automatically worsens when I put on the glasses. Consider this functional possibility: I had been wearing prescription that was slightly off for years. My eyes compensated for years by "squinting" and got trained to do so whenever I put on the glasses. When I finally got the correct prescription, it still compensated and therefore threw off the prescription.

Also consider the known experiment with glasses that switches left and right. Subjects live with the switch for a week, their brains get rewired, and they get severely disoriented when they are finally off the glasses. Now imagine such rewiring happening for whatever reason and brain getting stuck in that state. Wouldn't you call that a functional disorder?

[edit: added the last paragraph]

 

Even if an intervention helps some, there is no guarantee that it does so in the way those undertaking the intervention think. That is the point of an active control condition and objective outcome measures.

 

I think the term "functional" was useful in the sense that it also means "having to do with function," so on its face it comes across as neutral and would be neutral if that's how it were used by clinicians. As Jo says, that's not how it's generally understood. "Functional" has more or less replaced "MUS." So the main "functional" syndromes are said to be IBS, ME (they often still prefer CFS), and fibromyalgia. Any other symptoms not parts of syndromes are "functional" if they're "uexplained" by which is meant "unexplainable in perpetuity because it's 'functional.'"

FND is somewhat different and more specific, because they have given it actual diagnostic criteria. It is the current name for what was conversion disorder. And conversion disorder in 20th century generally fell into three categories--motor, sensory, and seizures. Leg paralysis, "hysterical" blindness/deafness, and "psychogenic non-epileptic seizures," for example. In the 2010 Stone et al study of neurology diagnoses, these were the conversion disorder categories and they constituted 5.5% of visits to the neurology clinics they examined. (That doesn't mean the diagnoses were accurate!!--that's just what the diagnoses were.)

In 2013, the DSM added "functional neurological symptom disorder" to the conversion disorder category, and changed the criteria. It no longer required a psychological trauma to be identified as the cause, but there had to be a positive clinical "rule-in" sign indicating a mismatch between neurological disease and the symptoms. Since then, FND has been in expansion mode, with the experts laying claim to cases of "dizziness" (many likely from orthostatic intolerance of some kind) and cognitive impairment as sub-groups of FND. Given the pandemic, FND is in a state of "diagnosis creep" but the creep has been quite rapid.

ADDED: This is all as I understand it. I don't pretend to be an expert here.

 

Fibromyalgia was termed Fibromyalgia Syndrome (FMS) back decades. Why it's bumped down in the pecking order to functional is beyond me.

Another instantly assumed meaning of functional is something that works, functions.

In FMS, the opposite happens. Pain being a huge inhibition of normal F.

Generational categorization games per the academies.

 

That is still structural. You would be changing the shape of your lens or eye muscles.
I also think it fairly unlikely that this would occur. When one is reading the eye charts with different lenses the optometrist relies on very rapid optimisation by your brain to a better selection.

Accommodation and focal plane can change for other reasons relating to hydration etc. - something that happens in diabetes. Again a structural problem. I have recently had such a change probably relating to lens stiffening with early cataract formation.

I am not sure that any of this has much to do with the diagnosis of functional neurological disorder.

 

Yes, that's why some people get dizzy when they put on a new pair of glasses. Worse-than-expected vision is not one of them, I don't think. Practitioners wouldn't get surprised by that if that were the case.

Would you agree that it's enough evidence if the (non-somatic) FND treatments are effective? A quick search for FVL turned up this: "A 2016 systematic review of the prognosis of functional visual loss included 5 studies (between 1966 and 1989) with 132 patients, mostly adults, with a follow up over several years. Between 46 and 78% of patients had improved or remitted at follow up [4]. A further study of 8 cases in children showed that 25% had recovered in 1 month [5]." Or, this: "In addition, although not a DSM criteria, any demonstration of reversibility of a deficit is characteristic of FND". I'm not an expert on FND by any means, nor is it a particular interest of mine; I'll have to rely on Google.

Absolutely. I don't think anybody here is arguing that FND applied to ME/CFS is valid in any shape or form. I'm simply saying FND diagnosis may be valid in some other cases, and we shouldn't be against FND as whole.

 

The point is though, that "structural" change is happening without somatic modification or intention, hence it is functional.

The problem occurs not during the measurement, but when I put on the glasses. The lenses are the same; the delta here the machine vs the frame on the face.

I'm just using my experience as an example of possible FND, albeit a minor one. If my eyes are trained to contract eye muscles as soon as I put on glasses, that would be a functional, not somatic, problem.

 

That tells us sweet FA. These are not controlled trial data. Of course people will improve with time. It is hard to credit just how bad the research I this field is but it is. This is worse than the Cochrane exercise review.

 

Where does that come from. What is somatic modification if not strudel change? Or by somatic are you meaning psychosomatic? Structural change in cancer occurs without intention and isn't functional so what has intention got to do with it?

 

I suspect you need a better optician. I have had similar problems in the past.