What do medical students think about functional neurological disorders? 2023 Escribano-Paredes et al

Functional neurological disorders (FND) are a frequent reason for visits in neurology. However, specific training on these disorders during undergraduate and residency training is limited. This study assesses the knowledge, attitude and exposure of medical students to FNDs before completing their medical degree.

We conducted a 15-item survey to explore understanding, exposure and attitudes towards FNDs among sixth-year medical students at four Spanish universities.A total of 118 students (mean age 23.6 ± 1.2 years; 71.2% female) returned the survey. Of these, 88 (74.6%) were aware of the concept of FNDs and 78 (66.1%) had studied them in psychiatry classes. The term 'psychosomatic' was chosen by 54.1% of the students as the most appropriate term to refer to these disorders, and 111 (94.1%) believed that a history of sexual or physical abuse was common among FND patients. Fifty-seven students (48.3%) assumed that the diagnosis of FND was mostly a clinical diagnosis of exclusion and 63 (53.4%) indicated that it is managed only by psychiatry. One hundred and one students (85.6%) considered that adequate training on FNDs is an important aspect of their medical training.

Medical students are aware of the existence of FNDs, but their preferred terminology, as well as the perceived aetiological factors, reflect that the historical view of these disorders is still deeply rooted. Medical students feel that they should receive adequate education on FNDs from specialists in neurology and psychiatry as part of their training.

PubMEd English abstract only available at time of posting, https://pubmed.ncbi.nlm.nih.gov/37046395/

 

Useful study. To me, these findings suggest that medical students aren’t fooled by the attempted rebranding of FND. Most of them are aware that it’s all just psychosomatic old wine in new bottles.

 

I don't think that fooling MDs was ever a goal. They always knew what was in the bottle and among themselves they have no shame admitting those stories are just that: stories invented precisely to sound pseudoscientific, so that the patients won't know what they're consenting to. Frankly, this is basically equivalent to medicine with roofies, and a disturbing comfort with playing hand puppet with the patient's mouth as if they really said yes. The ethics are the same anyway.

What this study says more than anything is that most MDs are OK with the same old, as long as it keeps getting rebranded in a way that hides the true intent and meaning. So this means that most MDs are perfectly comfortable with lying to patients as long as it makes their job easier, consequences be damned, they make sure never to find out anyway.

Altria was Philip Morris. Functional disorder was conversion disorder. Same thing. Same intent.

 

Fooling no, but there has been a definite attempt by leading proponents of FND to increase mainstream legitimacy of this diagnostic category by appearing distance themselves from Freudian “conversion” narratives, by emphasising positive diagnostic signs (as opposed to being a diagnosis of exclusion) and by using neurobabble about “software versus hardware problem”, fMRI, predictive coding. The thing is, healthcare workers just aren’t buying it. You see a lot of mockery/rejection of these explanations by doctors and nurses on social media, esp Twitter.

 

This is really playing out exactly the same way as the "chemical imbalance", that somehow many MDs pretend was never asserted, even though it's aggressively defended and is ready to spring back at the slightest hint of a possible maybe. Chemical imbalance is dead, long live network imbalance. Two terms equally devoid of any actual meaning, now that's how you cook up quality pseudoscience.

It's the new ritual of absolution, giving blessing to be negligent, but the fact that pretty much everyone understands that it's BS, and is ready to go for round 2, identical to round 1 in all but a few labels and mantras, is a really disgusting look into the culture of medical negligence.

I guess that's what they mean by how it's so easy to ignore us. It really is, it only takes a few blatant lies and all sins have been washed away by bureaucratic checkboxing. In the end, it's all about the here and now, the daily routine, colleagues, bosses and the like. We are out of sight, they make sure of that, and out of mind the whole time, even while we're right there in front of them.

But, hey, they have cultural permission, and I guess that washes away all moral issues, even so-called "duties" and human rights. No one actually has the right to healthcare, it's all dependent on terms and conditions.

 

Has anyone actually done prope experimental trials looking at the harms of treating people with any condition (and I’d suggest adding in a mental health to be balanced eg ‘health anxiety’ and physical health one and ‘healthy control’ as well as then having controls where they don’t get ‘treated’) with placebos and gaslighting - with a focus on all the forms of harm, how they interact (ie not limit ‘how bad they could be’ by doing a survey that limits to just ‘feeling fooled rather than how it screwed relationships or decisions made) over a longitudinal period.

so that as the people don’t get better they are shouted at criticised and forced to hide that decline just to try and minimise the abuse. And what that does to them across all of the potential areas for harm and injury.

if the only reason for this not having been done is ethics ‘as that would like bad 1960s harmful psych experimentation’ then that tells us all we need to know about how not only does the profession but most laypersons know it’s just a weapon.

But it seems a major gap and given this is the main treatment mode/only ‘health service’ allowed to access for being in a certain demographic and getting ill with something that isn’t such an obvious red flag they are scared of getting sued should it really be looked shouldn’t it being oversighted independently and have been researched.

confirmation of safety of CBT was never going to be done by not studying safety so where did the sector get the idea repeating the same dodgy design of leading questions along the lines of ‘do you feel the service you got from Sarah today was satisfactory’ as ‘proof of cure’ was ‘it’.

And why on Earth does it think foolish taxpayers and patients don’t get to call and say hang on is this [checking it is actually safe and doesn't harm, by monitoring for harm independently] not the basic ‘trial’ element for any new treatment, nevermind one based on deciding to redesign treatment for a demographic merely based on a model of misogyny and hysteria (Beard and McEvedy ‘we re attribute this disease as hysteria because the victims were mostly women’ but many more ‘ass hysteria as they are women ones’ after that fed into it)

isn’t it time we just outed precisely what is behind all this crap and inside those who choose to believe it and such it up. And yes I’ve noticed it being pushed like propaganda through popular culture in the most insidious way it is creepy - so blatant you wonder how anyone watches it and doesn’t realise they are being brainwashed into bigotry [or more accurately being taught to stand by and do nothing when they witness such misogyny happenning blatantly to someone else in front of them].

But shockingly some laypersons do think they’ve ‘been educated’ by 2mins if a storyline where yet again the teenage girls who try hard at football turn out to be cured from their tics by the ‘wise psych’ giving them a placebo. Rather than realising they’ve watched ignorant paternalism portrayed in their screens. And deny that exists despite having just watched it in full glory

- so it being common and bold enough it is at the point of being sewn as an accepted line of 'and of course these girls are 'dealt with' in this way and this is just a side story of the real medicine that is going on that they have to deal with and all that just assume they've lost their mind is OK and acceptable and not for any layperson to question is a cultural bigotry/ogyny they should be calling out when they see'.

Certainly beliefs do die very hard in certain people who want to maintain their values whilst telling themselves who they want to think/believe they are (and these not adding up without some delusion to bridge that dissonance) - something has to give and this is like hopium to those who need to bury themselves in excuses to think they are good intelligent people yet kind of deep down think the world is right and should work where everyone assumes any young girl just needs a bit of headshrinking and can never be emotional due to your rude behaviour and lack of mood control etc. ie sexist. And yes so many women do this other women.

There is a heck of a lot they could have pulled out of these minds and this really terrifying point in time (kids who've had it all go right to get to medical school, then surrounded by others who are similar to them, and in the same position at university and who have the same future prospects of never being poor or disabled or de-statused etc but before they have met or been educated in any of these realities of what the world and 'others' actually is) where minds are taken from ‘potential for’ to ‘no going back without a heck of a lot of reprogramming’ on this mass delusion journey for them . It is such important stuff for someone to be starting to look at this programme of ‘education’ what it is and its impact etc.

 

Sad isn’t it - there isn’t even the benefit that at least it attracts out the dark personalities who don’t want to do real science into the pseudo area of medicine where only those unlucky enough to have got dumped under the dregs have their lives ruined and personality etc attacked.

I mean at least if it stopped early on and just said if this is who you are then go into that discipline we’d know them. But they want to be so accepted as if they are the normal ones/not deluded they do all this. Spend days writing manifestos in sophism. And inventing pretend techniques they think other medics won’t be familiar with the term enough to know it’s BS like ‘Bayesian’ - why not Boolean or Fibonacci whilst they are blagging in the hope most switch off and assume if there’s detail it couldn’t be tosh.

Talk about using every social psychology trick in the book just to have your instinctive behaviours ‘accepted as not abormal’ but to claim the instinct to assume what they do has some strange convoluted new science based on storytelling - I find the whole phenomena so fascinating but not because of the poor patients who are sadly just objects and goodness knows what terrible condition they actually have that might have been treatable or possible to progress research on.

 

I've interacted with dozens of neurologists over the years and i haven't met a single one who thought FND was a legitimate illness that required research or figuring out how to treat. It's always a "send the patient straight to the psychologist and it's done" kind of deal. In some cases, the neurologists are marketing themselves as FND specialists because it's an easy way to pocket money without having to do anything, just talk to the patient a bit. But they would never consider that the patients might actually be ill.

It's funny because a couple of times I've been referred to FND specialists, and when i described my severe ME symptoms via email they straight up told me they don't deal with this kind of illness and not to see them. But on their website it says clearly they deal with chronic fatigue and FND... They probably figured my symptoms are too severe and i would be a troublesome patient. Mild patients are easier prey as you can convince them they don't really have a problem, which is what the FND "treatment" consists of anyway.

 

One question that would have been interesting is whether they thought the diagnosis came first THEN the history ‘scavenged for’ .

just like the old days of calling a woman mad and someone not listening to her but assuming it’s her mother and just writing that down.

Any condition that puts as the headlines if it’s abstracts ‘orders’ based on quotas they want filled to prime people to think 10% of those they’ll see have it, and that they must have suffered abuse and pretty much writes the description as female is basically saying ‘assume most females you see who don’t have a red flag are secretly this then seek out justification’ aren’t they?

And that doesn’t just change medical treatment did them but horrifically is about their whole view of them in society - ill women are just ‘damaged’ (I hate that term but use it to denote the attitude and pseudo words used by those I think are anti-mental health , which is seeing people in bad situations are ‘the problem’ ‘to be fixed who cares what the cause is’ and people harmed by others behaviours not as someone who should be protected and have a bystander step in to stop it but as ‘weak fir allowing it’ and now ‘damaged’ to be treated not by resolving justice and getting apologies but because of the idea these people have ‘demons’ etc). It’s not a nice way of thinking even in the world of psychology it’s just a ‘bad osychology’ certain people have that is warped.

I find the last paras pretty frightening therefore as it really does seem to get drilled into these people at a young impressionable age before they had enough adversity and diversity of people they’ve met to see the nonsense of it. It’s a very arms length view of certain patients ‘you will encounter’ and reminiscent of the Chalder video ‘how to deal with these wild animals with faux care’

 

Yup. The “treatment” often consists of a scribbled piece of paper with a weblink to Stone’s ghastly website. But it’s ok because the grifter doctor says he believes the patient!