PRESSS: A New Patient-Centered Name for an Old Problem, 2021, Ventres

Andy

Andy

Retired committee member
Abstract

There are many words for what physicians commonly refer to as Somatoform Disorder. However, none is particularly patient-centered; to greater or lesser extent, they are all framed by medical jargon. Based on his experience as a seasoned clinician, the author suggests family physicians consider adopting the word PRESSS—an acronym for “Physical Reaction to Emotional Stress of Some Sort”—when describing and explaining to patients with Somatoform Disorder the cause of their suffering. Using examples from practice, the author notes how PRESSS combines simplicity, ambiguity, and directness in one non-stigmatizing, patient-focused word. Combined with a patient-centered manner of communication, the use of PRESSS can help create the kind of shared therapeutic presence that is so important when attending to patients who experience the bothersome, unrelenting symptoms these conditions suggest.

Open access, https://www.jabfm.org/content/34/5/1030
 
I tried to find what they mean by "patient-centered manner of communication" and it's left to the imagination. I can only assume it means using tortured acronyms. As best as I can tell the author suggests this is patient-centered because the author thinks it is, which makes the point better than anything that "patient-centered" is a buzzword with no actual meaning. Especially as obviously no patient input influenced any of this junk.

And of course there is always the issue that they can't even imagine that we can read, that when they admit to this:
It is a diagnosis we as family physicians frequently encounter in our work1: Somatoform Disorder or Functional Disease. These were the names I learned years ago in medical school, both having replaced the previously used pejorative terms “neurasthenia” and “hysteria.”2 Later, generalists in the United States introduced the less stigmatizing monikers Medically Unexplained Symptoms and Multisomatiform Disorder into the literature.3,4 Clinician scholars in Europe suggested alternative expressions: Functional Somatic Disorders, Persistent Physical Symptoms, and Bodily Distress Syndrome.5⇓–7 Much more recently, the DSM-V recommended as the “umbrella” diagnostic label Somatic Symptom Disorders, with 4 accompanying subclassifications: Somatization Disorder, Undifferentiated Somatoform Disorder, Pain Disorder, and Hypochondriasis.8
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We know what they mean, because they freely admit to it when they think only other physicians are listening. So when they pretend they don't mean "hysteria" or "conversion disorder" it's easy to know they're lying, which is the entire problem to begin with, that they literally can't imagine actually listening to the patient, even as they write nonsensical tripe on which they slap a "you can fit so many patient-centered nonsense in this baby" and give it a few taps.

This is what happens when toxic garbage is gift-wrapped with a bow and unaccountable people think the problem is with presentation, even after decades of total failure, oblivious to the possibility that what is inside the packaging actually matters, simply because it does not matter to them and they can't manage to think outside of their frame of reference.

And underneath that new sticker is the same old junk as always, endlessly stacked with new stickers that are completely transparent because they genuinely seem to think we are that stupid.
 
It's darkly hilarious how they keep recycling through the same moves. The name for giving people an unjust psychiatric diagnosis becomes a problem, so they invent a new one to placate patients while they're being misdiagnosed so the psychiatrist can keep doing what he does. Only "new" thing is the lame acronyms.

(Mann & Rosenblatt, 1979): people get mad when we use the term mass hysteria, so we propose "Collective Stress Syndrome"instead.
 
A good example of how completely detached from reality they are. Different person but clearly like-minded. This appears to be about a dramatization of some of the horrors of early psychiatric institutions, before they had to be regulated, and the problem of mass misdiagnosis, especially with concepts like hysteria and conversion disorder. It's clear that for dudes like Carson, the only horror resulting from those psychiatric facilities is that they were stopped.

I genuinely have no idea what point he is trying to make as he can't seem to consider any other perspective than his own, and how it shows his work for the horror that it really is. It's clear they'd rather all this happen behind closed doors with even less accountability, they basically want free rein to do what they want with us, it's so bizarre, so obviously misguided.

There's even a bonus FND evangelist confused that a FND "specialist" accidentally says what he means and that it really does mean the same as the old concept of hysteria.

 
rvallee said:
There's even a bonus FND evangelist confused that a FND "specialist" accidentally says what he means and that it really does mean the same as the old concept of hysteria.
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Never understood what was wrong with "wandering womb" meself. It precisely reflects of their level of understanding, and serves as a useful signal to any woman hearing it to set off the fire alarm and escape amid the confusion.
 
a couple of papers and a couple of books [for those gathering references]. there are probably a lot more but were in my notes and seemed linguistically/rhetorically related:


One advantage of =91functional=92 may thus be as a simplifying euphemism, allowing neurologists to use the same term to mean one thing to colleagues and another to patients. It may be precisely this ambiguity which has allowed the construct to survive despite the uncertainty and conflicts underpinning its meaning at any point in time.
--- http://jnnp.bmj.com/content/early/2012/01/15/jnnp-2011-300992.full


another paper:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1820749/


a book [re reduction of resistance]:

"Such usage occurred, moreover, ... not only in communications issued to the Jewish public when
the intention of those issuing the communications was to
deceive the Jews in order to minimize the likelihood of
resistance, but also in addresses to the outside world and,
perhaps more significantly, in internal communications as
well, among officials who unquestionably knew (who were
themselves sometimes responsible for) the linguistic
substitutions stipulated by the language rules."
--- Act and Idea in the Nazi Genocide, by Berel Lang
http://books.google.se/books?id=g1y0sE1qmNUC&pg=PA93&lpg=PA93


another book [re cooption of terms]:

"And what happens if the cultivated language is made up of poisonous elements or has been made the bearer of poisons? Words can be like tiny doses of arsenic: they are swallowed unnoticed, appear to have no effect, and then after a little time the toxic reaction sets in after all.

The Third Reich coined only a very small number of the words in its language.... But it changes the value of words and the frequency of their occurrence, it makes common property out of what was previously the preserve of an individual or a tiny group, it commandeers for the party that which was previously common property and in the process steeps words and groups of words and sentence structures with its poison. \\
--- The Language of the Third Reich: A Philologist's Notebook
 
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I commonly use PRESSS in my practice with patients, as in this example situation: “Ms. Doe, we have investigated what is going on, and while I will continue to explore other causes for your problems, I suspect what you have is a condition called PRESSS—you are experiencing is a ‘Physical Reaction to Emotional Stress of Some Sort.’” “I wonder,” I continue after a moment of silence to gauge my patient's reaction, “whether have experienced any stress in your life? Or whether you may be experiencing any now?” Or, using a characteristic pause and probe style13: “Might that explain your problems?” Or, simply: “Does that ring true to you?”
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I especially liked the questions about stress. Because, even if the patient has had the extraordinary good fortune to have had no stress in their life, the current situation of reporting their physical symptoms to this patronising doctor and being told it's a stress reaction must certainly elicit a 'yes'. Job done, aetiology satisfactorily sorted. Pay on your way out.

Surely, surely this is parody. Complete with a typo in the 'whether have experienced'.
 
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