Recognising and explaining functional neurological disorder, 2020, Stone et al

One might even say it was old wine in new recycled bottles? Sorry, couldn't resist. "New" bottles is too polite.

 

Right, but you quoted my post, and for criticism, and I originally only wanted to point out, that algorithms and the likes are by far not bound to BSP models and the likes.

Also the interpretation of illnesses which present in a way FND might present themselves, is by far not bound to any BSP approach, instead it could be indeed any dysfunctional algorithms in nerve cells (or whatever).

I find it pretty important that researcher would know this, and would mention this in an effort to think logically. Also for patients it could be very important not too loose recognition on this possibility.


The paper discussed here somehow suggests such an interpretation when it comes to treatment, though doesn´t seem to rely on it theoretically, and this is of course a dangerous mixture. Indeed.

 

Re: Functional neurological disorder - Patients' experience & research

https://www.bmj.com/content/371/bmj.m3745/rapid-responses

 

Thanks for posting, @Sly Saint. I read through the letter, and felt pretty angry at Stone et al. for giving patients the false impression that they believe FND is a neurological disorder ("corruption of the brain-generated predictions and interference from the limbic system and amygdala"). If you strip off the layers, its clear they think the key determinant of who gets FND and who doesn't is personality and psychopathology. These are the characteristics they believe to be the root cause of the "interference from the limbic system and the amygdala" that is at play. The proposed solutions are entirely behavioural (therapy and exercise).

I remember a book that came out in the 70s called "how to lie with statistics", and it struck me that this is the modern equivalent "how to lie with neuroscience".

Stone et al have clearly succeeded, because this group sees hope that their illness will now be taken seriously. And maybe they are partly right, because this new language might prove more acceptable to friends and family (let's face it, its a way more acceptable story than having to tell people you have ME or CFS). But at the end of it is just therapy and retraining and the same old cycles of hope and then self-blame when it all fails. Plus, each iteration of this new model takes us further and further away from actually understanding what's at the bottom of these various movement disorders and how we might actually treat them successfully.

 

The group who wrote the letter are on twitter:
https://twitter.com/recover2renew

interesting discussion and included a retweet of @Carolyn Wilshire

https://twitter.com/user/status/1319770686651465728

 

https://twitter.com/user/status/1306247290798170115


https://twitter.com/user/status/1306250331643351041


https://twitter.com/user/status/1306251884538331139


Thread continues for a few more posts on Twitter.

 

In a funny twist, I don't think the effort will ever work out because no matter how they coat and distort what they mean, other physicians understand very well that this means psychosomatic and thus not medically relevant, so will pay little attention to it.

It may get taken seriously as a psychological thing of nebulous vagueness (yes, it's that fuzzy), but never as a legitimate medical condition, precisely because of their own arguments. I don't think anyone with an MD is fooled by the weird mumbo jumbo, they understand very well it's a BS explanation and still roughly the same as when Freud came up with it.

 

This "change of position" seems very similar to the "change of position" BACME did. As in it changes absolutely nothing, it's simply a reframing/recycling of the same claims with a slightly different emphasis. As is tradition. The emperor has new clothes. Again. This time they're real. Again. This time they're waterproof. Maybe.

 

The brilliant insight of Mark Edwards referred to in the twitter thread -- that insight came at the precise moment that the BPS became aware that their position as it stood was no longer defensible. Because there was a tipping balance of awareness that the theory as previously defined was made of pure conjecture.

Enter (and I'm quoting now) "incorporating neurobiological factors as key drivers". It's laughable and sad NOT brilliant.

Thus rescuing a nonsense theory by making it scientific because they include 'neurobiological factors'. Or so they believe.

The thing is, it may be when the biology is really investigated with actual scientific research the key driver may not be neurobiology at all but something that is affecting neurology whether that be an environmental toxin or a chemical signalling problem or a epigenetic change.

But the BPS continues to be a closed system that has the answers if only the details still need to be tweeked. There is no need for science only the appearance of for the sake of credibility.

 

This is just another "given" with as little association with reality as hysteria or neuroticism and just as firmly rooted in psychology.

 

Would there not need to be a prospective study before one could assert that FMD patients have a body-focused attentional bias? Has there ever been such a study?

 

No, apparently not. And even if the results were negative, this group's appraoch means that they would not see a need to revise the model. There have been a number of recent attempts to link FND with psychological characteristics or adverse life exepriences, and all have failed - - and this group have used that, not to challenge their conceptions, but to argue for using an even looser set of criteria to diagnose it.

 

I haven't followed this thread, but people may or may not be interested in the following rapid response:

https://www.bmj.com/content/371/bmj.m3745/rr-1

 

As Stone et al demonstrate, clinical findings enable the positive diagnosis of FND in tandem with judicious diagnostic testing to exclude relevant pathologies (1). By contrast, many other functional syndromes are identified in a negative sense, only after often extensive physical investigations have excluded demonstrable pathology. This conclusion is generally less satisfying and a frequent source of frustration for both patients and clinicians (4, 5). Doctors thus often find themselves in the difficult position of breaking unwelcome ‘good news’ to patients hungry for a mechanistic explanation of their symptoms. Recognising and skillfully managing patients’ emotional investment in having a physical diagnosis is crucial in avoiding the dual risks of over-investigation and overtreatment (6).

It is not a scientific conclusion to presume that because nothing is found after extensive tests that the problem is FND. There is no scientific proof that a person is experiencing what has been termed and then reassigned a half dozen times at least and is now called FDN. Which is essentially the mind creating illness that the body experiences. The theoretical construct itself is a mere belief on the part of the people who have invested their careers in it.

People are not looking for a materialistic explanation they are experiencing a failure of therapists to understand that their treatment is not working.

And the longer this goes on the more people will die of treatable illnesses that get shunted to FND because of the "judicious" use of what medicine has to offer.

As is mentioned by others in plenty of posts elsewhere -- the system is broken. FDN is not a cure or treatment for anything. It is a symptom of this brokenness.

 

Watch out, NZ, looks like the use of wastebasket pseudopsychological diagnoses might be on the rise here...