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

Probably

 

I must say I'm a bit surprised that depression has been left out of the FND debate, or as far as I'm aware it has.

The hypothesis of neurotransmitters, although not actually validated, seems to generally fit the idea of there not being any observable physiological damage, rather the system functioning improperly. And it can't be tested for, which is basically about the only requirement for FND (and the whole acronym-based community).

It basically fits all the criteria, yet is somehow arbitrarily not part of targeted conditions. I don't think it should, I just find it absurd how yet again things are arbitrarily decided in this school of thought.

 

I have started posts here over and over, but I soon get caught in a morass trying to describe what is wrong with FND. It is like trying to summarise what is wrong with the PACE trial, where do you start?

The problem is they mix in sensible enough things, like signalling problems with dubious things like adverse childhood reactions which takes us right back to Freud. So biology is mixed up with old fashioned hysteria. It must be about twenty years since I first read about functional neurological disorders and even then there was disagreement about whether they were to do with the "functioning" of the brain or served a "function" for the patient by relieving some aspect of their life.

The terminology may have moved on from the pseudocoma and pseudoepilepsy but giving something a new name makes no difference if the treatment is the same.

I could easily be rediagnosed as having FND so it frightens me on the one hand but I have had to be my own doctor since I have never been treated or tested for ME (the consultant who diagnosed me died a few months later and that was that) so I am always willing to consider any paper to see if I can pick out some aspect that might help.

But I can make no sense of the FND literature and information. It is like a politician's speech - it sounds good while you listen but as soon as you try to find a meaning it melts away.

 

Has this new paper by Stone et al been mentioned yet?

Indrit Bègue, Caitlin Adams, Jon Stone, David L. Perez (2019) Structural alterations in functional neurological disorder and related conditions: A software and hardware problem? , NeuroImage: Clinical, In Press, Accepted Manuscript, Available online 28 March 2019

https://www.sciencedirect.com/science/article/pii/S2213158219301482

(Not able to read this at the moment -- the abstract and "Limitations" don't look promising IMO though, rather even more muddled regarding FND and "somatic symptom disorders"?)

 

You're presumably British, the correct thing to say is "Would you like a cup of tea?". It's our answer to everything.

 

A clarification:




The assertion

"....The paper you cite was a request for dual coding*, but that request was denied."

is a misstatement.

*The authors of the 2014 paper:

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

had recommended: "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."

The WHO's Project lead for the revision of the Mental, behavioural or neurodevelopmental disorders submitted a proposal on 28 May 2018. Those with access to the Proposal Mechanism can view that proposal at:

https://icd.who.int/dev11/proposals...lGroupId=ac78765d-8c45-49f5-894e-1b57f09e48f7

In that proposal (one of several submitted by Dr Reed, that day, on behalf of TAG Mental Health), Dr Reed requests:

After making the changes in title and definition, adding new child categories, and deleting two categories in thiis grouping, the categories in this grouping should appear in the following order:

(...)

Also, please secondary parent entire grouping in Diseases of the Nervous System chapter.

Rationale
Per external review and interaction with the Diseases of the Nervous System TAG​

The submission of the proposal for secondary parenting of "Dissociative neurological symptom disorder" and its sub classes group under the Diseases of the nervous system chapter had been approved and marked as "Implemented" on 28 May 2018. By the following day, this change could be viewed in the public version of the Beta draft.

The "Dissociative neurological symptom disorder" category and sub classes group remain secondary parented under Diseases of the nervous system in the Blue "Implementation version" in the versions as released for June 2018, December 2018 and April 2019, and in the Orange Maintenance Platform, in both the Foundation Component and the Mortality and Morbidity Statistics Linearization.

MMS Linearization:

https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/1069443471


Orange Maintenance Platform, Foundation View:

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

 

There have been two letters published in New Scientist this week about "Functional disorders may still have physical causes".

https://www.newscientist.com/letter...l-disorders-may-still-have-physical-causes-1/

https://www.newscientist.com/letter...l-disorders-may-still-have-physical-causes-2/

 

I cannot see the full letters but the openings sound quite sensible.

What the 'experts' like Stone and Edwards still seem not to connect to is that if there is a malfunction of the central nervous system software there is no reason to think any neo-Freudian or other teleological story (such as predictive coding) provides any insight.

When a computer crashes what you usually get does not suggest that the computer is reacting to previous trauma or trying to mount a defence response. It is usually complete gobbledygook. My screen goes magenta every now and again - how does one account for that in emotional terms?

I think there is an important distinction between calling something psychiatric and calling it psychological. Neither may be very helpful but psychiatric covers a number of illnesses for which nobody has a clue what is going on and that is admitted. Psychiatric side effects of drugs in general make no sense at all.

But 'psychological' seems to imply that the problem has a causation of the sort that psychologists understand. And the problem is that it is becoming ever clearer that they don't.

Moreover, if various illnesses are indeed due to software problems it looks as if it is a mistake to assume that there is anything much in common between them. Parkinson's disease and narcolepsy may prove to involve hardware defects with cell loss but they are currently understood in terms of software malfunction. They seem to have pretty little in common with non-epileptic seizures.

The 'experts' need to have the courage to admit that so far they have absolutely no idea how to base treatment on an understanding of mechanism and they should stop trying until they have a workable theory.

 

Most illnesses at some point in history had an unknown mechanism that probably made little sense to anyone. "They are converting psychological distress into physical symptoms" is the modern equivalent of "They are sinners and the illness is God's punishment".

People with unpleasant health problems of a certain severity are probably distressed at least initially, just as people with chronic illness probably don't go to church as often or neglect their responsibilities. It's easy to construct narratives that seem to fit, but it's not possible to show that these explanations are correct. Nobody knows how the emotional conversion step is even supposed to work and it cannot be observed or measured, just like it's not possible to observe God.

 

It's a terrible analogy. Electronic hardware is fixed, immutable and designed top-down for a specific purpose. Biological "hardware" changes itself constantly, it's literally how it creates the "software". It isn't just philosophically poor, it's technologically illiterate.

Even more so that the entire point of software is to instruct the hardware in precise steps (move this here, add those registers, interrupt that), so even there the separation is superficial.

 

If you add in firmware the analogy works better, if you start from the assumption that our consciousness is just another task, a tool for generalised, and very limited problem solving.

but yeah, it's not great.

People have the whole thing the wrong way around, we, us, I am, are not the ones in charge, we do not issue instructions, we take them, from the animal, to give another string to it's bow in problem solving. We then, if we've noticed something anomalous, spend time trying to figure out/justify the reason we made a decision, when we didn't, the animal did, all we do is rationalise it.

We is just jumped up little spreadsheets under the illusion we are in charge, an illusion we are allowed to maintain most of the time because most of the time it doesn't matter.

When it matters it becomes apparent what/who is in charge - try not breathing for a while and see what happens.

It's not us.

ETA - That's my opinion anyway

 

Absolutely.

I think the software analogy works as long as it is clear that actual instances of software always involve some slight rearrangement of the hardware - as in firmware. The old plug-in software chips in BBCB computers were sort of hardware in themselves.

For me the distinction is that a software problem does not break the basic structural rules of the system - it makes use of them to create havoc. Immunological diseases are a good example of rogue cells working within the structural rules. That means that you cannot find anything apparently wrong with these cells - but they screw up the system by sending out inappropriate signals.

 

Is DNA hardware or firmware using the definitions you are using? Coz it could easily be seen as both.

You seem to be taking a gross simplification and trying to interpret it literally.

That's probably not going to work out well, for several reasons, biology is not computer science, but some analogies can be drawn, mainly coz the entities looking superficially at both are the same, so think the same way, broadly speaking, about each when trying to understand them.

But that's true of everything in the universe, until it's not.

 

Slight OT, but presumably that's the same M Hallet who is also working on the NIH's post-viral study: https://me-pedia.org/wiki/Mark_Hallett

 

Neither.

Biology is a process. You can't put human DNA in a test tube with all the essential nutrients for life and grow a baby.

 

Me either. This is just the latest in a long line of analogies psychiatry has used to try and understand the brain. As technology has evolved, so have these analogies. If you go back 100 years to Freudian psychoanalysis times, it was a hydraulic or steam valve model of the brain purporting to explain repressed emotional content converting itself into functional neurological symptoms (hysteria). Then the behaviourists came along and you had the black box with inputs and outputs and no one cared about what was inside the box itself. According to this radical environmentalist model, you could just condition people to behave in various ways via rewards and punishments. Then, with the rise of computers and cognitive psychology, all these daft hardware-software analogies came in. More recently, quantum woo woo is making inroads in theories of consciousness.

Analogies are nice for explaining things to students but they only go so far and ultimately they constrain your thinking in a straightjacket if you take them too literally.