Mystery illnesses reveal the power of our minds to influence health, New Scientist

Right, because regular people without non-epileptic attacks have no stress or previous experience of trauma, i.e. something outside their control which feels too hard to bear.

 

It's turtlestrauma all the way down. Why can't some people handle trauma while others can? Why, it's trauma, of course! Does it matter that most will not have anything resembling a traumatic experience in their lives? Of course not, they are probably too traumatized to remember it, or whatever.

 

Most psych studies are conducted on bourgeois college students in Western countries. The definition of trauma keeps expanding therefore to include woolly concepts like 'emotional abuse' and hurty words since most such people never experienced any real adversity in their lives.

 

https://www.dailymail.co.uk/health/...ft-18-kayaking-world-champion-wheelchair.html

The crippling brain condition doctors say is all in your mind: Triggered by a bump on the head, it left teenage kayaking world champion in a wheelchair and shattered her Olympics dream

FND.

Also mentions ME.

 

Very interesting to see the confusion again here. It seems that the person in the Mail story relapsed after exercise therapy. We are not told how she is now. Stone seems to make some sensible comments but then says CBT and GET are the treatment, despite, presumably, there being no trials to show these work.

There is this constant - it's not in the head but it's in the head or it's not mental but its psychological, or whatever.

 

ICD-11 and Dissociative neurological symptom disorder:

For DSM-5, the disorder term is "Functional Neurological Symptom Disorder (Conversion Disorder)" and it is listed under the Somatic symptom and Related Disorders disorder category block (the block under which Somatic symptom disorder is also located).


There has been a long-standing tug of war between Dr Jon Stone, Prof Raad Shakir and the WHO over which chapter the WHO's equivalent of FNSD would be located under for ICD-11.

The lead for the revision of the Mental, behavioural or developmental disorders chapter wanted to retain the ICD-11 equivalent of DSM-5's FNSD within the MH chapter.

Prof Raad Shakir was the chair of the ICD-11 Topic Advisory Group for Neurology. Stone and Shakir lobbied WHO for relocating the ICD-11 equivalent of DSM-5's FNSD to the Diseases of the nervous system chapter - not because they consider this diagnosis to be a neurological diagnosis but because, amongst other reasons, neurologists often have these patients referred to them.

They also published a position paper in 2014 [1] setting out their rationales for recommending that this disorder category should be relocated from under the Dissociative disorders and parented under the Diseases of the nervous system chapter or listed in both chapters:

1 Stone, J., Hallett, M., Carson, A., Bergen, D., & Shakir, R. (2014). Functional disorders in the Neurology section of ICD-11: A landmark opportunity. Neurology, 83(24), 2299–2301. doi:10.1212/WNL.0000000000001063
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4277679/


At one point, for the ICD-11 Beta draft, the disorder category was relocated under the Diseases of the nervous system chapter.

Later, the category was dragged back under the MH chapter, but with the concession of secondary parenting under the Diseases of the nervous system.

And that is how it stood for the initial release of the implementation version of ICD-11, last June:

https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1069443471

06 Mental, behavioural or neurodevelopmental disorders

Dissociative disorders
> 6B60 Dissociative neurological symptom disorder
>>6B60.0 Dissociative neurological symptom disorder, with visual disturbance
>>6B60.1 Dissociative neurological symptom disorder, with auditory disturbance
>>6B60.2 Dissociative neurological symptom disorder, with vertigo or dizziness
>>6B60.3 Dissociative neurological symptom disorder, with other sensory disturbance
>>6B60.4 Dissociative neurological symptom disorder, with non-epileptic seizures
>>6B60.5 Dissociative neurological symptom disorder, with speech disturbance
>>6B60.6 Dissociative neurological symptom disorder, with paresis or weakness
>>6B60.7 Dissociative neurological symptom disorder, with gait disturbance
>>6B60.8 Dissociative neurological symptom disorder, with movement disturbance
>>>6B60.80 Dissociative neurological symptom disorder, with chorea
>>>6B60.81 Dissociative neurological symptom disorder, with myoclonus
>>>6B60.82 Dissociative neurological symptom disorder, with tremor
>>>6B60.83 Dissociative neurological symptom disorder, with dystonia
>>>6B60.84 Dissociative neurological symptom disorder, with facial spasm
>>>6B60.85 Dissociative neurological symptom disorder, with Parkinsonism
>>>6B60.8Y Dissociative neurological symptom disorder, with other specified movement disturbance
>>>6B60.8Z Dissociative neurological symptom disorder, with unspecified movement disturbance
>>6B60.9 Dissociative neurological symptom disorder, with cognitive symptoms
>>6B60.Y Dissociative neurological symptom disorder, with other specified symptoms
>>6B60.Z Dissociative neurological symptom disorder, with unspecified symptoms


If you look at chapter 08 Diseases of the nervous system you will see Dissociative neurological symptom disorder displaying in black in the Foundation Component with its two parents listed:

https://icd.who.int/dev11/f/en#/http://id.who.int/icd/entity/1069443471

Dissociative neurological symptom disorder

Parent(s)

• Dissociative disorders
• 5-54 Other mental and behavioural disorders
• Diseases of the nervous system

and here in the Mortality and Morbidity Statistic Linearization for the Diseases of the nervous system chapter:

https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1296093776

there is a listing right near the end of the chapter for

6B60 Dissociative neurological symptom disorder

the last term listed directly above what are known as the "residual categories" (in brown in the Linearization)

8E7Y Other specified diseases of the nervous system
8E7Z Diseases of the nervous system, unspecified

If you click on the 6B60 Dissociative neurological symptom disorder category link, it redirects to the category's primary parent location within the MH chapter:

https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1069443471

(this category displays as "Greyed out" in the MMS Linearization for the Diseases of the nervous system chapter indicating that this category is secondary parented in this location and primary parented in another chapter.)



There was also much debate over what terminology would be used for ICD-11. In 2014, the term favoured by Stone, Shakir et al, had been "Functional disorders of the nervous system."

However, the lead for the revision of the MH chapter was keen that for ICD-11, the term should retain the word "Dissociative" within its disorder name.

So for ICD-11, although under Synonyms, the following are listed:

Synonyms

• Functional neurological disorders
• Functional neurological symptom disorder (Ed: this is the DSM-5 term)
• Conversion disorder

​

WHO is going forward with the term, "Dissociative neurological symptom disorder" - though the Beta draft went through various iterations of the term before "Dissociative neurological symptom disorder" was eventually approved by WHO.


Note that in the Stone et al paper referenced above, the authors wrote:

"In ICD-10, functional disorders are commonly found within the parent specialties most likely to see the patients. For example, irritable bowel syndrome is classified in the gastrointestinal section and fibromyalgia within the rheumatology section. Neurology has lagged behind in this respect.
Gastroenterologists, for example, have been refining their understanding and classification of functional gastrointestinal disorders with international consensus since the mid-1970s.5 The Rome Foundation classification for functional gastrointestinal disorders is now in its third revision and has been provisionally adopted on a wholesale basis for ICD-11.

"ICD-11 offers a new, landmark opportunity to bring functional disorders back within the legitimate domain of neurology. We have proposed a category within the Neurologic section in which all of the functional disorders involving motor and sensory function can be listed and coded (including nonepileptic attacks) (table). We suggest that, like other conditions shared between neurologists and psychiatrists, such as Tourette syndrome and dementia, psychiatry retains a code for functional disorders, preferably matching that found in neurology."​

It is the case that for ICD-11, IBS has been retained in the chapter, Diseases of the digestive system, under the Functional gastrointestinal disorders block. However, the IASP/WHO Chronic pain task force had proposed to shift IBS under the new Chronic primary pain disorders block, within the Symptoms, signs chapter, under Chronic primary visceral pain - a proposal which WHO has rejected. (The IASP task force has since requested that IBS is secondary parented to Chronic primary visceral pain.)

In May 2015, Fibromyalgia was relocated from Diseases of the musculoskeletal system or connective tissue and placed under the new Chronic primary pain block, as an inclusion under Chronic widespread pain, from which it takes its code, and it no longer has a discrete code assigned to it, as it had in ICD-10.


So for ICD-11, the term is Dissociative neurological symptom disorder (a term which is being challenged by some FND advocacy orgs) and it remains primary parented in chapter 06 Mental, behavioural or neurodevelopmental disorders under the class: Dissociative disorders, with secondary parenting within chapter 08 Disorders of the nervous system.

In ICD-11 it is the primary parent chapter location that dictates the code, so Dissociative neurological symptom disorder displays with code 6B60 in both locations.

 

Do you think they realise hat these aren't in fact little fiefdoms, but that they are patients, who they are supposed to help?

 

As far as I can tell, what it seems to come down to is the idea that that the conscious/subconscious mind has substantial direct influence over the entirety of the brain (unless there is structural pathology). Therefore you can use your introspection and willpower to produce desired changes in any 'functional' brain disfunction (even if that disfunction is not 'mental').

Basically - anything bad-'brain' = implicitly caused by bad-'mind' and can be helped by good-'mind'

(And then once you have to make sense of things like depression it gets even more fuzzy...)

In any case it creates a nice slippage where you can say 'brain/neurological' and really mean 'mind/mental' in the instances that it suits you.

 

They definitely do not see the lives they ruin in the pursuit of carving out a career. Out of sight, out of mind. It's a flaw in medicine that still needs to be plugged, and likely won't be until medical care changes from a privilege that can be arbitrarily denied to a right that requires due process.

 

There is another thread on this 'crippling brain condition' article which might be best re-merged in here.

https://www.s4me.info/threads/news-...ors-say-is-all-in-your-mind.9097/#post-160328

 

The ICD story is interesting.

I looked up dissociative disorder. Some definitions just seem to describe it as meaning some form of disconnect between thoughts and environment etc which could mean all sorts of things. But Wikipedia gives an idea of where the concept is really rooted I think. It includes:

"People with dissociative disorders use dissociation as a defense mechanism, pathologically and involuntarily."

For me this is a no-no approach because there is no such thing as a 'person' that can 'use' the function of a brain. The suggestion reveals the truly Cartesian nature of the biopsychosocial approach, or indeed the approach of the psychotherapeutic arm of psychiatry as a whole. There is a belief that there is a separate sort of mental causation that interacts with the physical causation of the brain and of course we have no reason to think they are different.

I don't like the sound of the politics in this. However, functional neurological disorder does seem to me a much better term than dissociative or conversion or hysteria. Much of what Stone says sounds legitimate.

The case in the article clearly suffers from something wrong in her central nervous system. It is not in her immune system or gut or muscle metabolism, so things are much simpler than for ME. There is no structural change, and the brain is like a computer so saying there is a software problem rather than a hardware problem sounds very appropriate. There seems little doubt that the episodes of paralysis are due to patterns of signalling in the brain getting blocked without any tissue damage, much as a computer application can crash and then function again when re-booted.

And that makes 'functional neurological disorder' to me an honest and appropriate category. It would be the same for 'functional bowel disorder' if the meaning was some malfunction of the bowel without structural change. But of course functional bowel disorder is not used to mean that. It is used to mean bowel symptoms presumed to be driven by unhelpful thoughts.

I guess that if Stone has a political desire to grab conditions for neurology then he is faced with having to provide care for the patients and so is under pressure to maintain that psychotherapy or exercise is good because that is all they have. It may be that his team can actually provide an environment in which functional neurological disorders are most likely to improve. But:
1. We need some evidence
2. It is hard to see why therapies derived from defunct biopsychosocial theorising should be the best sort of approach.
It seems to me much more likely that if the team members help the FND patients it is despite the CBT or GET aspects rather than because of them.

 

I read about a man who had fatigue every day between about 15:00 and 19:00. At some point the fatigue turned into paralysis, almost every day. He saw 80 doctors and of course heard all the usual things about these symptoms being caused by stress and psychological factors. He actually had a potassium channel defect. The clue was that he felt worse on a healthy diet of fruit and vegetables, and better with heavy meals like sausage and fries.

https://ng.neurology.org/content/4/5/e274

 

And/ or moving to a yet to be created subforum on MUS and FND on the "Other News and Research" forum?

 

For completeness: in ICD-10 and ICD-11 there are a number of other categories under the Dissociative disorder class, in addition to 6B60 Dissociative neurological symptom disorder and its 20 sub categories:

ICD-11 for Mortality and Morbidity Statistics
(Version : 04 / 2019)
Version for preparing implementation

https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/108180424

Dissociative disorders
>6B60 Dissociative neurological symptom disorder
>> [child and grandchildren categories 6B60.0 to 6B60.Z]
>6B61 Dissociative amnesia
>6B62 Trance disorder
>6B63 Possession trance disorder
>6B64 Dissociative identity disorder
>6B65 Partial dissociative identity disorder
>6B66 Depersonalization-derealization disorder
>6E65 Secondary dissociative syndrome
>6B6Y Other specified dissociative disorders
>6B6Z Dissociative disorders, unspecified

-------------------

For all of these terms, a brief Description text has been included which will be expanded in the not yet released, ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders companion publication (the ICD-11 equivalent of ICD-10's "Blue Book").

(There have been no proposals that any of these additional categories should be relocated under the Neurology chapter or secondary parented under Neurology.)

In general, the WHO does not like the term "functional" in classification system nomenclature because of the several different ways in which it is used e.g. in the context of assessment of level of functioning [the WHO publishes the International Classification of Functioning, Disability and Health (ICF)]; in the sense of malfunction with no evident structural cause; in the sense of driven or maintained by maladaptive behaviours or cognitions.

Edited to add:

https://dxrevisionwatch.com/2015/01...nervous-system-under-neurological-conditions/

Extract:

"...The Mental Health TAG is aware that there is a vocal group of advocates for this terminology among neurologists. In fact, this terminology was included as alternate terminology in DSM-5. However, in DSM-5, these are still very clearly classified as Mental disorders.

Similarly, these terms can be added as inclusion terms to the equivalent categories in the Mental and behavioural disorders chapter.

In spite of its popularity among at least some neurologists, this terminology is currently viewed in psychiatry as obsolete, and based on a mind-body split (division between ‘organic’ and ‘non-organic’) we are elsewhere attempting to remove from the ICD-11. The implied contrast is between a ‘real’ (medical) disorder and a ‘functional’ (psychiatric) disorder.

A further problem with this terminology is its inconsistency with WHO’s official policy use of terminology related to ‘functioning’ (function, functional), as defined in the ICF.

In some instances of the use of the term ‘functional’ in other parts of proposals for ICD-11, it is not clear that the proposals use the term ‘functional’ in this same sense, or if they mean something close to ‘idiopathic’. However, it is quite clear that what is meant in this group of proposals is ‘without neurological explanation or plausible or demonstrable etiology’.

However, this terminology is in any case problematic. In addition to requesting that this group of categories be deleted from the classification and instead integrated appropriately as inclusion terms in the chapter on Mental and Behavioural Disorders, the Mental Health TAG requests that the Classifications Team examine other uses of the term ‘functional’ in proposals for ICD-11 and consider either appropriate parenting in Mental and behavioural disorders or alternative terminology."

The Mental Health TAG also requests that this issue be revised by the Revision Steering Group (and or Small Executive Group) in order to arrive at an ICD-wide solution as efficiently as possible. The Mental Health TAG requests that this issue not simply be arbitrated by the same TAGs that have made these proposals."

–On behalf of Mental Health TAG
January 2015

 

Question: does a lack of structural change or tissue damage always suggest a signaling problem in the brain? Or there other examples of diseases that are chronic but cause no observable changes in organs and tissue, or a degenerative pathology (thinking of mitochondrial disorders for example)?

 

When you get down to the biochemistry of the cell, signalling problems have to be due to some damage to the way the cell should work. Whether we can detect those problems with the technology available is another question.

Diabetes takes a long time to cause observable tissue damage as does high blood pressure.

They acknowledge that FND often comes after an injury. A few years ago I read a paper about the nerves leading to the eye. It was difficult to understand but it seemed to say that signals travel strongly from the eye to the brain but not the other way, After an injury to the nerve the processes of healing mean that afterwards the nerve signals are equal in both directions. (There has been a lot of money put into eye research because LASIK surgery is very profitable so they are researching side effects vigorously. he nerves are cut during the surgery so this is one of the areas they are concerned about).

That sort of thing may be the answer to some FND but I do not think they are considering it.

We know with ME that they say that it is medically unexplained but they do not consider all diseases first just the common ones. (Someone who was rediagnosed as having bechet's disease (treatable) after many years of being told he had ME asked SW if he tested for it and was told he did not) I doubt if they look comprehensively with FND and all the research money will be going to psychological treatments.

 

This is a response to posts on the other thread that has been closed.

There are useful ways to distinguish the meaning of illness and disease. Disease implies some sort of reference to a causal category that illness need not, although it is subtle and context dependent.

However, Stone's claim that people with FND do not have a disease seems tome to be confused and unhelpful. It is the same confusion as with medically unexplained symptoms that are then explained. Stone understands that there is a problem in explaining what he thinks FND is to patients. But the real problem is that Stone has not quite worked out in his own mind what he does think FND is because he is still stuck in the Cartesian dualist mind influencing body paradigm.

The irony is that there is considerable merit in what Descartes said but it does not work the way modern neuropsychiatry seems to want it to.

 

That does not actually have to be the case. In autoimmunity B cells that produce autoantibodies are allowed to survive despite their being disadvantageous to the rest of the body. However, these B cells are not in any sense damaged or abnormal in their biochemistry. They use normal physiological mechanisms to produce unwanted signals. You could consider an analogy with machine delivered with the wrong instruction manual. You cannot get the machine to work but neither the machine nor the manual are damaged. The problem is at a higher level of organisation.