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home:alternate:psychosomatic [07.07.2019] – [Historical examples of psychologizing problems with organic causes] sallieqhome:alternate:psychosomatic [09.14.2022] (current) – external edit 127.0.0.1
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 ====== Psychosomatic explanations for disease ====== ====== Psychosomatic explanations for disease ======
  
-Sigmund Freud and Jean-Martin Charcot were born 150 years ago, but their ideas about the effect of the subconscious on disease continue to resonate in the scientific community.(({{pubmed>long:335422}})) Freud and colleagues argued that unconscious mental processes such as sublimated rage could manifest as physical symptoms. However, with the advent of superior technology, one by one, many diseases once supposed to be caused by psychological stress have since been attributed to other factors including infections.+Sigmund Freud and Jean-Martin Charcot were born 150 years ago, but their ideas about the effect of the subconscious on disease continue to resonate in the scientific community.(({{pmid>long:335422}})) Freud and colleagues argued that unconscious mental processes such as sublimated rage could manifest as physical symptoms. However, with the advent of superior technology, one by one, many diseases once supposed to be caused by psychological stress have since been attributed to other factors including infections.
  
-According to the Marshall Pathogenesis, chronic fatigue syndrome, multiple chemical sensitivity and other chronic inflammatory diseases are likely caused by pathogens, yet many physicians consider these diseases to be "medically unexplained." Medically unexplained diseases are widely prevalent(({{pubmed>long:11448704}})) but at the same time have few discernible markers or objectively measurable symptoms. While a lot of Freudian ideas have fallen out of favor, one legacy remains: difficult-to-explain diseases are still routinely attributed to psychological causes. The process by which patients supposedly manifest psychological problems as a disease has been named and renamed, classified and reclassified: hysteria, psychosomatic disorder, somatoform disorder, conversion disorder, functional disorder, etc. In each of these diagnoses, however, the stated origin of disease is unchanged: symptoms that cannot be explained are ultimately "all in a patient's head."+According to the Marshall Pathogenesis, chronic fatigue syndrome, multiple chemical sensitivity and other chronic inflammatory diseases are likely caused by pathogens, yet many physicians consider these diseases to be "medically unexplained." Medically unexplained diseases are widely prevalent(({{pmid>long:11448704}})) but at the same time have few discernible markers or objectively measurable symptoms. While a lot of Freudian ideas have fallen out of favor, one legacy remains: difficult-to-explain diseases are still routinely attributed to psychological causes. The process by which patients supposedly manifest psychological problems as a disease has been named and renamed, classified and reclassified: hysteria, psychosomatic disorder, somatoform disorder, conversion disorder, functional disorder, etc. In each of these diagnoses, however, the stated origin of disease is unchanged: symptoms that cannot be explained are ultimately "all in a patient's head."
  
-While there is no denying the existence of some sort of "mind-body connection," there is minimal compelling evidence that as the 19th century Swiss physician Georg W. Groddeck claimed: "Illness has a purpose; it has to resolve the conflict, to repress it, or to prevent what is already repressed from entering consciousness."((Webster, R. 1996. //Why Freud was wrong: sin, science and psychoanalysis//. London, HarperCollins.)) Despite the stark absence of evidence supporting these views, it is not unusual to read papers describing how patients with long-term so-called psychological illnesses may be subconsciously manifesting them, because it would allow them to have more "care, attention, disengagement, or even financial benefits."(({{pubmed>long:10375340}})) Nor, is it uncommon for new theories to spring up along these lines. In one example, a 2008 [[http://www.cmej.org.za/index.php/cmej/article/view/459/305|continuing medical education]] publication taught physicians that when a celebrity becomes ill, healthy people are suggestible enough to develop long-term illnesses consistent with the celebrity's descriptions of their conditions. Such claims are recklessly speculative, harming patients and stalling needed research.+While there is no denying the existence of some sort of "mind-body connection," there is minimal compelling evidence that as the 19th century Swiss physician Georg W. Groddeck claimed: "Illness has a purpose; it has to resolve the conflict, to repress it, or to prevent what is already repressed from entering consciousness."((Webster, R. 1996. //Why Freud was wrong: sin, science and psychoanalysis//. London, HarperCollins.)) Despite the stark absence of evidence supporting these views, it is not unusual to read papers describing how patients with long-term so-called psychological illnesses may be subconsciously manifesting them, because it would allow them to have more "care, attention, disengagement, or even financial benefits."(({{pmid>long:10375340}})) Nor, is it uncommon for new theories to spring up along these lines. In one example, a 2008 [[https://www.cmej.org.za/index.php/cmej/article/view/459/305|continuing medical education]] publication taught physicians that when a celebrity becomes ill, healthy people are suggestible enough to develop long-term illnesses consistent with the celebrity's descriptions of their conditions. Such claims are recklessly speculative, harming patients and stalling needed research.
  
-Treating patients who complain of so-called medically unexplained symptoms with cognitive behavioral therapy or, in the case of chronic fatigue syndrome, graded exercise therapy, may do more harm than good.(({{pubmed>long:19855350}})) The emergence of metagenomic technologies offers a more sophisticated set of tools for detecting and characterizing microbes in these disease states. Perhaps it is only the use of this technology that will finally relegate the notion of patient as attention-seeking victim to historical relic.+Treating patients who complain of so-called medically unexplained symptoms with cognitive behavioral therapy or, in the case of chronic fatigue syndrome, graded exercise therapy, may do more harm than good.(({{pmid>long:19855350}})) The emergence of metagenomic technologies offers a more sophisticated set of tools for detecting and characterizing microbes in these disease states. Perhaps it is only the use of this technology that will finally relegate the notion of patient as attention-seeking victim to historical relic.
  
  
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 ===== Many patients' complaints are "medically unexplained" ===== ===== Many patients' complaints are "medically unexplained" =====
  
-Numerous studies have demonstrated that many of the physical complaints presented to physicians are unexplained from a medical perspective.((Nezu AM, Nezu CM, Lombardo ER. Cognitive-behavior therapy for medically unexplained symptoms: A critical review of the treatment literature. Behavior Therapy. 2001;32(3):537-83.)) ((Lombardo ER, Nezu AM. Medically Unexplained Symptoms. In: Freeman A, Felgoise SH, Nezu CM, Nezu AM, Reinecke MA, editors. //Encyclopedia of Cognitive Behavior Therapy// Springer US; 2005. p. 241-4.)) Depending on the setting, between 30 and 66% of patients who seek medical care have unexplained symptoms.(({{pubmed>long:10644789}})) (({{pubmed>long:11448704}})) (({{pubmed>long:14999491}})) According to a 1996 estimate, the eight most common physical complaints (fatigue, backache, headache, dizziness, chest pain, dyspnea, abdominal pain, anxiety) account for more than 80 million physician visits annually in the United States, and only 25% of these symptoms have a demonstrable organic (of the body) cause.(({{pubmed>long:8675547}})) According to the Marshall Pathogenesis and as described elsewhere in the Knowledge Base, many of these "unexplained" symptoms [[home:pathogenesis:evidence_bacteria|are likely due to microbes]].+Numerous studies have demonstrated that many of the physical complaints presented to physicians are unexplained from a medical perspective.((Nezu AM, Nezu CM, Lombardo ER. Cognitive-behavior therapy for medically unexplained symptoms: A critical review of the treatment literature. Behavior Therapy. 2001;32(3):537-83.)) ((Lombardo ER, Nezu AM. Medically Unexplained Symptoms. In: Freeman A, Felgoise SH, Nezu CM, Nezu AM, Reinecke MA, editors. //Encyclopedia of Cognitive Behavior Therapy// Springer US; 2005. p. 241-4.)) Depending on the setting, between 30 and 66% of patients who seek medical care have unexplained symptoms.(({{pmid>long:10644789}})) (({{pmid>long:11448704}})) (({{pmid>long:14999491}})) According to a 1996 estimate, the eight most common physical complaints (fatigue, backache, headache, dizziness, chest pain, dyspnea, abdominal pain, anxiety) account for more than 80 million physician visits annually in the United States, and only 25% of these symptoms have a demonstrable organic (of the body) cause.(({{pmid>long:8675547}})) According to the Marshall Pathogenesis and as described elsewhere in the Knowledge Base, many of these "unexplained" symptoms [[home:pathogenesis:evidence_bacteria|are likely due to microbes]].
  
  
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 The chronic fatigue syndrome and fibromyalgia (probably the same disorder) are characterized by considerable suffering and disability. We must not add to that suffering by trivializing patients with “functional” labels. Marginal care inevitably ensues. The chronic fatigue syndrome and fibromyalgia (probably the same disorder) are characterized by considerable suffering and disability. We must not add to that suffering by trivializing patients with “functional” labels. Marginal care inevitably ensues.
  
-//**Thomas L. English, M.D.**//(({{pubmed>long:10681297}}))</blockquote>+//**Thomas L. English, M.D.**//(({{pmid>long:10681297}}))</blockquote>
  
  
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 ^Disease  ^Early and erroneous claims   ^More valid explanations  ^ ^Disease  ^Early and erroneous claims   ^More valid explanations  ^
-|**cardiac disease**  |Type A behavior – in which people are impatient, time-conscious and controlling – was first described as a substantial risk factor in coronary disease by the cardiologists Meyer Friedman and R. H. Rosenman.((Friedman, M., & Rosenman, R. H. (1974). //Type A behavior and your heart//. New York: Knopf.))  |Research since then has found that Type A behavior is not a good predictor of coronary heart disease.(({{pubmed>long:16934002}})) On the basis of this and other criticisms, Type A theory has been termed obsolete by many researchers in contemporary health psychology and personality psychology.  | +|**cardiac disease**  |Type A behavior – in which people are impatient, time-conscious and controlling – was first described as a substantial risk factor in coronary disease by the cardiologists Meyer Friedman and R. H. Rosenman.((Friedman, M., & Rosenman, R. H. (1974). //Type A behavior and your heart//. New York: Knopf.))  |Research since then has found that Type A behavior is not a good predictor of coronary heart disease.(({{pmid>long:16934002}})) On the basis of this and other criticisms, Type A theory has been termed obsolete by many researchers in contemporary health psychology and personality psychology.  | 
-|**camptocormia** - forced posture with a forward-bent trunk  |supposedly seen in soldiers during World Wars I and II; claimed it could be cured quickly and durably by a "persuasive" electrotherapy(({{pubmed>long:10423797}})) |muscle weakness; an organic comorbidity of Parkinson's and ALS | +|**camptocormia** - forced posture with a forward-bent trunk  |supposedly seen in soldiers during World Wars I and II; claimed it could be cured quickly and durably by a "persuasive" electrotherapy(({{pmid>long:10423797}})) |muscle weakness; an organic comorbidity of Parkinson's and ALS | 
-|**schizophrenia**   |claimed to be caused by cold, distant mothers(({{pubmed>long:10681297}})) (({{pubmed>long:13945453}}))       |communities of microbes have been increasingly implicated. An infection of pregnant woman during critical brain development of foetus is credible.  (({{pubmed>long:22488761}})), (({{pubmed>long:30068405}})), (({{pubmed>long:28463237}})), (({{pubmed>long:    28844435}})), (({{pubmed>long:    25464029}}))      |+|**schizophrenia**   |claimed to be caused by cold, distant mothers(({{pmid>long:10681297}})) (({{pmid>long:13945453}}))       |communities of microbes have been increasingly implicated. An infection of pregnant woman during critical brain development of foetus is credible.  (({{pmid>long:22488761}})), (({{pmid>long:30068405}})), (({{pmid>long:28463237}})), (({{pmid>long:    28844435}})), (({{pmid>long:    25464029}}))      |
 |**stomach ulcers**   |claimed to be cause by stress     |//Helicobacter pylori//                | |**stomach ulcers**   |claimed to be cause by stress     |//Helicobacter pylori//                |
-|**tuberculosis** |in the developed world, claimed to be caused by tubercular personality((Hartz, J. (1944). [[http://www.psychosomaticmedicine.org/cgi/content/abstract/6/1/17|Tuberculosis and personality conflicts]]. //Psychosomatic Medicine// 6(1): 17.)) – romantic, unfulfilled, cosmopolitan people that need change and excitement      |//Mycobacterium tuberculosis//          |+|**tuberculosis** |in the developed world, claimed to be caused by tubercular personality((Hartz, J. (1944). [[https://www.psychosomaticmedicine.org/cgi/content/abstract/6/1/17|Tuberculosis and personality conflicts]]. //Psychosomatic Medicine// 6(1): 17.)) – romantic, unfulfilled, cosmopolitan people that need change and excitement      |//Mycobacterium tuberculosis//          |
 |**ulcerative colitis**  |in children, according to one author's claims, caused by interdependent on relationship between patients, parents, and grandparents((Adams, P. (1968). Childhood Ulcerative Colitis: Outlines of Psychotherapy. //Psychosomatics// 9(2): 75.)) |no widely accepted cause, however, communities of microbes have been increasingly implicated    | |**ulcerative colitis**  |in children, according to one author's claims, caused by interdependent on relationship between patients, parents, and grandparents((Adams, P. (1968). Childhood Ulcerative Colitis: Outlines of Psychotherapy. //Psychosomatics// 9(2): 75.)) |no widely accepted cause, however, communities of microbes have been increasingly implicated    |
  
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 ==== Ancient Greece – origin of hysteria ==== ==== Ancient Greece – origin of hysteria ====
  
-The notion of hysteria can be traced to ancient times. In the gynecological treatises of the Hippocratic corpus (5th and 4th centuries BCE), the father of medicine describes an illness in which the uterus dries up and wanders the body in search of moisture. They called this hysteria. Symptoms would then be caused by the uterus pressing on other organs. If it had wandered as far as the cranium, for example, the symptom would be headaches.(({{pubmed>long:18568070}})) Plato's dialogue //Timaeus// tells of the uterus wandering throughout a woman’s body, strangling the victim as it reaches the chest and causing disease. This theory is the source of the name, which stems from the Greek cognate of uterus, //hystera//. Galen, a prominent physician from the second century, wrote that hysteria was a disease caused by sexual deprivation in particularly passionate women. In the 17th century, Sydenham said, "hysteria could simulate any medical disease."((Kallivayalil RA, Punnoose VP. [[http://www.indianjpsychiatry.org/article.asp?issn=0019-5545;year=2010;volume=52;issue=7;spage=240;epage=245;aulast=Kallivayalil|Understanding and managing somatoform disorders: Making sense of non-sense]]. //Indian J Psychiatry// 2010;52:240-5.))+The notion of hysteria can be traced to ancient times. In the gynecological treatises of the Hippocratic corpus (5th and 4th centuries BCE), the father of medicine describes an illness in which the uterus dries up and wanders the body in search of moisture. They called this hysteria. Symptoms would then be caused by the uterus pressing on other organs. If it had wandered as far as the cranium, for example, the symptom would be headaches.(({{pmid>long:18568070}})) Plato's dialogue //Timaeus// tells of the uterus wandering throughout a woman’s body, strangling the victim as it reaches the chest and causing disease. This theory is the source of the name, which stems from the Greek cognate of uterus, //hystera//. Galen, a prominent physician from the second century, wrote that hysteria was a disease caused by sexual deprivation in particularly passionate women. In the 17th century, Sydenham said, "hysteria could simulate any medical disease."((Kallivayalil RA, Punnoose VP. [[https://www.indianjpsychiatry.org/article.asp?issn=0019-5545;year=2010;volume=52;issue=7;spage=240;epage=245;aulast=Kallivayalil|Understanding and managing somatoform disorders: Making sense of non-sense]]. //Indian J Psychiatry// 2010;52:240-5.))
  
  
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 Freud and his contemporaries such as Charcot agreed that hysteria occurred among women, hypothesizing that instead of being a disorder of the womb or anything biological, hysteria was a product of emotional distress, anxiety or some other psychological cause. Extreme psychological stress, they argued, manifested itself in the body as illness, a view which Dr. Henry Maudsley summarized thusly, "Sorrows which find no vent in tears may soon make other organs weep." ((Webster, R. 1996. //Why Freud was wrong: sin, science and psychoanalysis//. London, HarperCollins.)) Uncovering the root psychological trauma, Freud said, would cure illness. This theory that became the basis for his practice of psychoanalysis.  Freud and his contemporaries such as Charcot agreed that hysteria occurred among women, hypothesizing that instead of being a disorder of the womb or anything biological, hysteria was a product of emotional distress, anxiety or some other psychological cause. Extreme psychological stress, they argued, manifested itself in the body as illness, a view which Dr. Henry Maudsley summarized thusly, "Sorrows which find no vent in tears may soon make other organs weep." ((Webster, R. 1996. //Why Freud was wrong: sin, science and psychoanalysis//. London, HarperCollins.)) Uncovering the root psychological trauma, Freud said, would cure illness. This theory that became the basis for his practice of psychoanalysis. 
  
-During the latter half of the nineteenth century, doctors matter-of-factly considered hysteria the most common of the functional nervous disorders among females. One Victorian physician cataloged 75 pages of possible symptoms of hysteria and called the list incomplete.(({{pubmed>long:16858900}})) +During the latter half of the nineteenth century, doctors matter-of-factly considered hysteria the most common of the functional nervous disorders among females. One Victorian physician cataloged 75 pages of possible symptoms of hysteria and called the list incomplete.(({{pmid>long:16858900}})) 
  
  
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 The theory of hysteria has been heavily criticized almost since its reformulation by Freud, Charcot and other 19th century neurologists. The theory of hysteria has been heavily criticized almost since its reformulation by Freud, Charcot and other 19th century neurologists.
   * **1908: Steyerthal** – Armin Steyerthal predicted that, "Within a few years the concept of hysteria will belong to history ... there is no such disease and there never has been. What Charcot called hysteria is a tissue woven of a thousand threads, a cohort of the most varied diseases, with nothing in common but the so-called stigmata, which in fact may accompany any disease."((A. Steyerthal, Was ist Hysterie?, 1908, Halle a S., Marhold. Quoted by Aubrey Lewis, "The Survival of Hysteria" in Alec Roy (ed.), Hysteria, Wiley, 1982, p. 22.))    * **1908: Steyerthal** – Armin Steyerthal predicted that, "Within a few years the concept of hysteria will belong to history ... there is no such disease and there never has been. What Charcot called hysteria is a tissue woven of a thousand threads, a cohort of the most varied diseases, with nothing in common but the so-called stigmata, which in fact may accompany any disease."((A. Steyerthal, Was ist Hysterie?, 1908, Halle a S., Marhold. Quoted by Aubrey Lewis, "The Survival of Hysteria" in Alec Roy (ed.), Hysteria, Wiley, 1982, p. 22.)) 
-  * **1961: Slater** – In his Maudsley lecture and later writings, Eliot Slater, M.D. questioned the concept of hysteria as a valid diagnosis, showing that serious physical illness subsequently emerged in many patients initially labelled hysterical and that the physical illness could often account for their allegedly psychological symptoms. Slater later wrote: "The malady of the wandering womb began as a myth, and as a myth it yet survives. But, like all unwarranted beliefs which still attract credence, it is dangerous. The diagnosis of 'hysteria' is a disguise for ignorance and a fertile source of clinical error. It is, in fact, not only a delusion but also a snare."((Slater, E. [[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2166300/|Diagnosis of "hysteria"]] //BMJ// 1965 May 29; 1(5447): 1395–1399.)) Ultimately, Slater wrote in 1982, "the diagnosis of 'hysteria' applies to a disorder of the doctor–patient relationship."((Slater, Eliot. "What is Hysteria?", in A. Roy (ed.), //Hysteria//, 1982, p. 40.))  +  * **1961: Slater** – In his Maudsley lecture and later writings, Eliot Slater, M.D. questioned the concept of hysteria as a valid diagnosis, showing that serious physical illness subsequently emerged in many patients initially labelled hysterical and that the physical illness could often account for their allegedly psychological symptoms. Slater later wrote: "The malady of the wandering womb began as a myth, and as a myth it yet survives. But, like all unwarranted beliefs which still attract credence, it is dangerous. The diagnosis of 'hysteria' is a disguise for ignorance and a fertile source of clinical error. It is, in fact, not only a delusion but also a snare."((Slater, E. [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2166300/|Diagnosis of "hysteria"]] //BMJ// 1965 May 29; 1(5447): 1395–1399.)) Ultimately, Slater wrote in 1982, "the diagnosis of 'hysteria' applies to a disorder of the doctor–patient relationship."((Slater, Eliot. "What is Hysteria?", in A. Roy (ed.), //Hysteria//, 1982, p. 40.))  
-  * **1963: Popper** – The preeminent scientific philosopher Sir Karl Popper pointed out that Freud's theories of the psyche were ultimately unscientific, because the [[http://en.wikipedia.org/wiki/Null_hypothesis|null hypothesis]] had never been disproven: "As for Freud's epic of the Ego, the Super-ego, and the Id, no substantially stronger claim to scientific status can be made for it than for Homer's collected stories from Olympus. These theories describe some facts, but in the manner of myths. They contain most interesting psychological suggestions, but not in a testable form."((Popper, K. //Conjectures and Refutations//, London: Routledge and Keagan Paul, 1963.))+  * **1963: Popper** – The preeminent scientific philosopher Sir Karl Popper pointed out that Freud's theories of the psyche were ultimately unscientific, because the [[https://en.wikipedia.org/wiki/Null_hypothesis|null hypothesis]] had never been disproven: "As for Freud's epic of the Ego, the Super-ego, and the Id, no substantially stronger claim to scientific status can be made for it than for Homer's collected stories from Olympus. These theories describe some facts, but in the manner of myths. They contain most interesting psychological suggestions, but not in a testable form."((Popper, K. //Conjectures and Refutations//, London: Routledge and Keagan Paul, 1963.))
  
  
 ==== Feminist criticism ==== ==== Feminist criticism ====
  
-In her 2000 analysis,(({{pubmed>long:16858900}})) Briggs says that scholars of women and gender have long argued that hysteria participated in powerful narratives of cultural crisis, which goes a long way toward explaining the logical glue that held together an apparently endless catalogue of symptoms as a singular syndrome. She goes on to say hysteria was the "provenance almost exclusively of Anglo-American, native-born whites, specifically, white women of a certain class." "The primary symptoms of hysteria in women were gynecologic and reproductive—prolapsed uterus, diseased ovaries, long and difficult childbirths—maladies that made it difficult for these hysterical (white) women to have children."+In her 2000 analysis,(({{pmid>long:16858900}})) Briggs says that scholars of women and gender have long argued that hysteria participated in powerful narratives of cultural crisis, which goes a long way toward explaining the logical glue that held together an apparently endless catalogue of symptoms as a singular syndrome. She goes on to say hysteria was the "provenance almost exclusively of Anglo-American, native-born whites, specifically, white women of a certain class." "The primary symptoms of hysteria in women were gynecologic and reproductive—prolapsed uterus, diseased ovaries, long and difficult childbirths—maladies that made it difficult for these hysterical (white) women to have children."
  
-Barbara Ehrenreich and Deirdre English, for example, have concluded hysteria is virtually a diagnostic fiction, arguing that nineteenth century physicians called upon narratives of nervous illness to denounce women’s agitation for expanded social roles. They cite the now classic example of Harvard president Edward Clarke arguing against women’s education in 1873 by claiming that the blood demanded by the brain would prevent the reproductive system from developing properly.(({{pubmed>long:16858900}})) +Barbara Ehrenreich and Deirdre English, for example, have concluded hysteria is virtually a diagnostic fiction, arguing that nineteenth century physicians called upon narratives of nervous illness to denounce women’s agitation for expanded social roles. They cite the now classic example of Harvard president Edward Clarke arguing against women’s education in 1873 by claiming that the blood demanded by the brain would prevent the reproductive system from developing properly.(({{pmid>long:16858900}})) 
  
  
 ===== Criticism of conversion disorder ===== ===== Criticism of conversion disorder =====
  
-The impetus for renaming Freud's notion of hysteria in 1980 was to put the theory (with its transparently sexist origin(({{pubmed>long:16858900}})) and pejorative overtones) on supposedly more scientific ground. Different sub-types were reassigned to other categories and several other small changes were made. For example, in the interests of diagnostic specificity, patients who are feigning (faking) illness are excluded from the diagnosis, however, feigning is "very difficult to either disprove or prove."(({{pubmed>long:21036784}})) +The impetus for renaming Freud's notion of hysteria in 1980 was to put the theory (with its transparently sexist origin(({{pmid>long:16858900}})) and pejorative overtones) on supposedly more scientific ground. Different sub-types were reassigned to other categories and several other small changes were made. For example, in the interests of diagnostic specificity, patients who are feigning (faking) illness are excluded from the diagnosis, however, feigning is "very difficult to either disprove or prove."(({{pmid>long:21036784}})) 
  
 As Peter Halligan comments, however, the greatest liability is a more fundamental one: conversion still has "the doubtful distinction among psychiatric diagnoses of still invoking Freudian mechanisms."((Harold I. Kaplan and Benjamin J. Sadock, //Comprehensive Textbook of Psychiatry V//, 5th edition, Baltimore: Williams and Wilkins, 1989, p. 375.)) According to Richard Webster's excellent analysis, "the only strict criterion is that the patient's symptoms were medically inexplicable." As Peter Halligan comments, however, the greatest liability is a more fundamental one: conversion still has "the doubtful distinction among psychiatric diagnoses of still invoking Freudian mechanisms."((Harold I. Kaplan and Benjamin J. Sadock, //Comprehensive Textbook of Psychiatry V//, 5th edition, Baltimore: Williams and Wilkins, 1989, p. 375.)) According to Richard Webster's excellent analysis, "the only strict criterion is that the patient's symptoms were medically inexplicable."
  
-A 2010 psychiatrist-written paper on somatoform disorders could not be more aptly titled: "Understanding and managing somatoform disorders: Making sense of non-sense."((Kallivayalil RA, Punnoose VP. [[http://www.indianjpsychiatry.org/article.asp?issn=0019-5545;year=2010;volume=52;issue=7;spage=240;epage=245;aulast=Kallivayalil|Understanding and managing somatoform disorders: Making sense of non-sense]]. //Indian J Psychiatry// 2010;52:240-5.)) +A 2010 psychiatrist-written paper on somatoform disorders could not be more aptly titled: "Understanding and managing somatoform disorders: Making sense of non-sense."((Kallivayalil RA, Punnoose VP. [[https://www.indianjpsychiatry.org/article.asp?issn=0019-5545;year=2010;volume=52;issue=7;spage=240;epage=245;aulast=Kallivayalil|Understanding and managing somatoform disorders: Making sense of non-sense]]. //Indian J Psychiatry// 2010;52:240-5.)) 
  
  
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 //**Richard Webster**// ((Webster, R. 1996. //Why Freud was wrong: sin, science and psychoanalysis//. London, HarperCollins.))</blockquote>  //**Richard Webster**// ((Webster, R. 1996. //Why Freud was wrong: sin, science and psychoanalysis//. London, HarperCollins.))</blockquote> 
  
-Even more than 100 years after this idea was first proposed, researchers remain at a loss to find any compelling scientific evidence for somatoform disorders.  Psychology, physiology and functional brain imaging technology (e.g. EEG, fMRI, PET, or SPECT) have failed to elucidate the neurobiology of conversion disorder.(({{pubmed>long:21036784}})) Methodologic problems of such studies "abound."(({{pubmed>long:20083794}})) Even in cases where psychological stress can be measured in patients with the diagnosis of somatoform disorders, these reactions to stress are "similar to the severity of psychological stress in non-psychosomatic neurological disorders."(({{pubmed>long:19733363}})) +Even more than 100 years after this idea was first proposed, researchers remain at a loss to find any compelling scientific evidence for somatoform disorders.  Psychology, physiology and functional brain imaging technology (e.g. EEG, fMRI, PET, or SPECT) have failed to elucidate the neurobiology of conversion disorder.(({{pmid>long:21036784}})) Methodologic problems of such studies "abound."(({{pmid>long:20083794}})) Even in cases where psychological stress can be measured in patients with the diagnosis of somatoform disorders, these reactions to stress are "similar to the severity of psychological stress in non-psychosomatic neurological disorders."(({{pmid>long:19733363}})) 
  
  
  
  
-Today conversion disorder does not connotate the full measure of diagnostic stigma that hysteria does, but that may change as patients learn what conversion disorder means. Some commentators report that the term "conversion disorder" has not been accepted by patients.(({{pubmed>long:19425106}})) (({{pubmed>long:20558396}})) Indeed, papers about conversion disorder also discuss the challenge of dealing with patients who feel insulted by implications they are engaging in "elaborate self-deception."((Lombardo ER, Nezu AM. Medically Unexplained Symptoms. In: Freeman A, Felgoise SH, Nezu CM, Nezu AM, Reinecke MA, editors. //Encyclopedia of Cognitive Behavior Therapy//: Springer US; 2005. p. 241-4.)) +Today conversion disorder does not connotate the full measure of diagnostic stigma that hysteria does, but that may change as patients learn what conversion disorder means. Some commentators report that the term "conversion disorder" has not been accepted by patients.(({{pmid>long:19425106}})) (({{pmid>long:20558396}})) Indeed, papers about conversion disorder also discuss the challenge of dealing with patients who feel insulted by implications they are engaging in "elaborate self-deception."((Lombardo ER, Nezu AM. Medically Unexplained Symptoms. In: Freeman A, Felgoise SH, Nezu CM, Nezu AM, Reinecke MA, editors. //Encyclopedia of Cognitive Behavior Therapy//: Springer US; 2005. p. 241-4.)) 
  
-Conversion disorder is the subject of criticism even among those responsible for rewriting the //Diagnostic and Statistical Manual of Mental Disorders.//  A 2010 letter to the editor of //American journal of psychiatry// criticizes the name and criteria for conversion disorder, suggesting alternatives.(({{pubmed>long:20516161}})) In the letter, Stone //et al.// eschew "conversion disorder" in favor of the term "functional neurological disorder." The absurd criterion that the symptoms must be medically unexplained remains, which they euphemize as "diagnostic features" that "provide evidence of internal inconsistency or incongruity with recognized neurological or medical disorder." This proposed change in terminology (and [[http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=8#|others]]) would do nothing to remedy this fatal flaw of any psychosomatic diagnosis. +Conversion disorder is the subject of criticism even among those responsible for rewriting the //Diagnostic and Statistical Manual of Mental Disorders.//  A 2010 letter to the editor of //American journal of psychiatry// criticizes the name and criteria for conversion disorder, suggesting alternatives.(({{pmid>long:20516161}})) In the letter, Stone //et al.// eschew "conversion disorder" in favor of the term "functional neurological disorder." The absurd criterion that the symptoms must be medically unexplained remains, which they euphemize as "diagnostic features" that "provide evidence of internal inconsistency or incongruity with recognized neurological or medical disorder." This proposed change in terminology (and [[https://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=8#|others]]) would do nothing to remedy this fatal flaw of any psychosomatic diagnosis. 
  
 Whatever their official designations, somatoform and conversion disorders are not substantively different than hysteria. The existence of such conditions is not supported by scientific evidence. In practice, these terms, no matter which is used, will remain a "diagnostic dustbin."((Webster, R. 1996. //Why Freud was wrong: sin, science and psychoanalysis//. London, HarperCollins.)) Whatever their official designations, somatoform and conversion disorders are not substantively different than hysteria. The existence of such conditions is not supported by scientific evidence. In practice, these terms, no matter which is used, will remain a "diagnostic dustbin."((Webster, R. 1996. //Why Freud was wrong: sin, science and psychoanalysis//. London, HarperCollins.))
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   * irritable bowel syndrome   * irritable bowel syndrome
   * multiple chemical sensitivities   * multiple chemical sensitivities
-  * nonepileptic seizures – Seizures in the absence of abnormal EEG-video monitoring readings are widely believed to be caused by sexual abuse.(({{pubmed>long:18410361}})) This is in spite of the fact that an EEG only measures electrical activity on the first few millimeters of the skull, with even skull and scalp thickness producing variations in readings.(({{pubmed>long:14755596}})) +  * nonepileptic seizures – Seizures in the absence of abnormal EEG-video monitoring readings are widely believed to be caused by sexual abuse.(({{pmid>long:18410361}})) This is in spite of the fact that an EEG only measures electrical activity on the first few millimeters of the skull, with even skull and scalp thickness producing variations in readings.(({{pmid>long:14755596}})) 
   * migraine as well as a variety of types of pain in the back, chest, abdomen, limbs and face    * migraine as well as a variety of types of pain in the back, chest, abdomen, limbs and face 
-  * vulvodynia (vaginal pain)(({{pubmed>long:18664054}}))+  * vulvodynia (vaginal pain)(({{pmid>long:18664054}}))
  
  
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 ==== Prevalence ==== ==== Prevalence ====
  
-It is fairly obvious that the actual prevalence of conversion disorder probably approaches zero, but some researchers continue to debate how common it is. Estimates of "disease" prevalence have differed by several orders of magnitude. For some researchers, conversion disorder is as common as ever. Carson //et al.// imply that over 15% of new attendees at neurology outpatient clinics had conversion disorder.(({{pubmed>long:12810775}})) On the other hand, Singh and Lee surveyed primary care physicians and identified 18 patients (out of a catchment population of 37,000) with conversion symptoms.(({{pubmed>long:9330242}})) Akagi and House call the disorder "vanishingly rare."(({{pubmed>long:11866315}})) +It is fairly obvious that the actual prevalence of conversion disorder probably approaches zero, but some researchers continue to debate how common it is. Estimates of "disease" prevalence have differed by several orders of magnitude. For some researchers, conversion disorder is as common as ever. Carson //et al.// imply that over 15% of new attendees at neurology outpatient clinics had conversion disorder.(({{pmid>long:12810775}})) On the other hand, Singh and Lee surveyed primary care physicians and identified 18 patients (out of a catchment population of 37,000) with conversion symptoms.(({{pmid>long:9330242}})) Akagi and House call the disorder "vanishingly rare."(({{pmid>long:11866315}})) 
  
 For its part, the //Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)// offers strikingly imprecise estimates for its prevalence: "Reported rates of Conversion Disorder have varied widely, ranging from 11/100,000 to 500/100,000 in general population samples. It has been reported in up to 3% of outpatient referrals to mental health clinics. Studies of general medical/surgical inpatients have identified conversion symptom rates ranging between 1% and 14%."((American Psychiatric Association. //Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision//. Washington, DC: American Psychiatric Association; 2000.)) For its part, the //Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)// offers strikingly imprecise estimates for its prevalence: "Reported rates of Conversion Disorder have varied widely, ranging from 11/100,000 to 500/100,000 in general population samples. It has been reported in up to 3% of outpatient referrals to mental health clinics. Studies of general medical/surgical inpatients have identified conversion symptom rates ranging between 1% and 14%."((American Psychiatric Association. //Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision//. Washington, DC: American Psychiatric Association; 2000.))
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 For interest, here is a list of certain groups thought to be more susceptible to psychosomatic illnesses: For interest, here is a list of certain groups thought to be more susceptible to psychosomatic illnesses:
-  * **women** – There is no solid evidence of conversion disorder in women, but it is routinely assumed they are more likely to have it. According to a 2010 [[http://emedicine.medscape.com/article/917864-overview|eMedicine article]], the prevalence of conversion disorder "is higher in women than in men, with a female-to-male ratio of 2-10:1. Approximately 25% of emotionally normal postpartum and medically ill women report conversion symptoms sometime during their lives." A study of Turkish women in the general population reports that 48.7% of participants had a lifetime history of a conversion symptom.(({{pubmed>long:19213973}})) +  * **women** – There is no solid evidence of conversion disorder in women, but it is routinely assumed they are more likely to have it. According to a 2010 [[https://emedicine.medscape.com/article/917864-overview|eMedicine article]], the prevalence of conversion disorder "is higher in women than in men, with a female-to-male ratio of 2-10:1. Approximately 25% of emotionally normal postpartum and medically ill women report conversion symptoms sometime during their lives." A study of Turkish women in the general population reports that 48.7% of participants had a lifetime history of a conversion symptom.(({{pmid>long:19213973}})) 
-  * **victims of sexual abuse**(({{pubmed>long:12411227}})) – The association between history of sexual abuse and conversion disorder is a transparent example of diagnostic bias. A diagnosis of conversion disorder cannot be made until a patient history is taken.(({{pubmed>long:18568070}})) If a patient history discloses sexual abuse, the person is more likely to have conversion disorder. Therefore, victims of sexual abuse are more likely to suffer from conversion disorder – or, so the logic goes. +  * **victims of sexual abuse**(({{pmid>long:12411227}})) – The association between history of sexual abuse and conversion disorder is a transparent example of diagnostic bias. A diagnosis of conversion disorder cannot be made until a patient history is taken.(({{pmid>long:18568070}})) If a patient history discloses sexual abuse, the person is more likely to have conversion disorder. Therefore, victims of sexual abuse are more likely to suffer from conversion disorder – or, so the logic goes. 
-  * **rural residents and other patients who may be naive about medical and psychological issues** – In one study, high rates of conversion disorder were thought to be seen in Appalachian males. In another study, this 2003 one is from Turkey,  lower education level and socioeconomic and sociocultural problems were supposed to play a role in the "disease."(({{pubmed>long:12563551}})) +  * **rural residents and other patients who may be naive about medical and psychological issues** – In one study, high rates of conversion disorder were thought to be seen in Appalachian males. In another study, this 2003 one is from Turkey,  lower education level and socioeconomic and sociocultural problems were supposed to play a role in the "disease."(({{pmid>long:12563551}})) 
-  * **wealthy and overworked people** – Poor people (see above) are more likely to get conversion disorder, but so are rich people. CFS was once called the "the yuppie flu." This characterization has a 19th century equivalent, neurasthenia, which was also thought to be a disease of affluent people with "unflagging devotion to work."(({{pubmed>long:2181519}})) In their 2001 paper, Van Houdenhove //et al.// employ the euphemism "high action-proneness" for saying CFS patients tend to be "hyperactive" prior to disease onset.(({{pubmed>long:11595245}})) (({{pubmed>long:7490698}})) This folklore is analogous to claiming patients with obstructive lung diseases contract those illnesses by excessive breathing. According to this impenetrable logic, unlike so many other diseases, patients' dissatisfaction with being sick is responsible for them remaining sick. +  * **wealthy and overworked people** – Poor people (see above) are more likely to get conversion disorder, but so are rich people. CFS was once called the "the yuppie flu." This characterization has a 19th century equivalent, neurasthenia, which was also thought to be a disease of affluent people with "unflagging devotion to work."(({{pmid>long:2181519}})) In their 2001 paper, Van Houdenhove //et al.// employ the euphemism "high action-proneness" for saying CFS patients tend to be "hyperactive" prior to disease onset.(({{pmid>long:11595245}})) (({{pmid>long:7490698}})) This folklore is analogous to claiming patients with obstructive lung diseases contract those illnesses by excessive breathing. According to this impenetrable logic, unlike so many other diseases, patients' dissatisfaction with being sick is responsible for them remaining sick. 
-  * **military personnel**(({{pubmed>long:8487965}}))  – Gulf War syndrome has been widely labelled an example of conversion disorder. As discussed in the section [[home:social:stress#war_a_crucible_for_chronic_disease|War - a crucible for disease]], it's clear war contributes to higher rates of disease among veterans, but, as the higher rates of cancer, hypertension, and obesity illustrate, these illnesses are certainly not psychological. In one 2004 paper, Jones //et al.// claimed that servicemen and women were more likely to "somatize" a disease when it becomes more popular in the medical world.(({{pubmed>long:15094027}})) There is no evidence for this.+  * **military personnel**(({{pmid>long:8487965}}))  – Gulf War syndrome has been widely labelled an example of conversion disorder. As discussed in the section [[home:social:stress#war_a_crucible_for_chronic_disease|War - a crucible for disease]], it's clear war contributes to higher rates of disease among veterans, but, as the higher rates of cancer, hypertension, and obesity illustrate, these illnesses are certainly not psychological. In one 2004 paper, Jones //et al.// claimed that servicemen and women were more likely to "somatize" a disease when it becomes more popular in the medical world.(({{pmid>long:15094027}})) There is no evidence for this.
   * **not physicians and not researchers** – It may be worth noting that we have yet to see anyone claim that researchers or physicians are more prone to conversion disorder. Edward Jenner, the discoverer of the smallpox vaccine, complained of hysterical-type symptoms, an exquisite sensitivity to sound, in his final years alive. "Were I female," Jenner wrote, "I would call it Hysterical – but in myself I know not what to call it...."((Jenner, E., & Miller, G. (1983). //Letters of Edward Jenner, and other documents concerning the early history of vaccination//. The Henry E. Sigerist supplements to the Bulletin of the history of medicine, new ser., no. 8. Baltimore: Johns Hopkins University Press.))    * **not physicians and not researchers** – It may be worth noting that we have yet to see anyone claim that researchers or physicians are more prone to conversion disorder. Edward Jenner, the discoverer of the smallpox vaccine, complained of hysterical-type symptoms, an exquisite sensitivity to sound, in his final years alive. "Were I female," Jenner wrote, "I would call it Hysterical – but in myself I know not what to call it...."((Jenner, E., & Miller, G. (1983). //Letters of Edward Jenner, and other documents concerning the early history of vaccination//. The Henry E. Sigerist supplements to the Bulletin of the history of medicine, new ser., no. 8. Baltimore: Johns Hopkins University Press.)) 
  
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-  * **misallocation of research funding** – In 1998 it became known almost 13 million dollars for CFS research – more than half(({{pubmed>long:10681292}})) – had been [[http://web.archive.org/web/19991009092250/www.hhs.gov/progorg/oas/reports/region4/49804226.htm|redirected or improperly accounted]] for by the United States CDC. The agency stated the need to respond to other public health emergencies. The director of a U.S. national patient advocacy group charged the CDC had a bias against studying the disease.(({{pubmed>long:10932206}})) In cases where money is spent directly on research for medically unexplained conditions, funds are often used to study ineffective approaches such as cognitive behavioral therapy. +  * **misallocation of research funding** – In 1998 it became known almost 13 million dollars for CFS research – more than half(({{pmid>long:10681292}})) – had been [[https://web.archive.org/web/19991009092250/www.hhs.gov/progorg/oas/reports/region4/49804226.htm|redirected or improperly accounted]] for by the United States CDC. The agency stated the need to respond to other public health emergencies. The director of a U.S. national patient advocacy group charged the CDC had a bias against studying the disease.(({{pmid>long:10932206}})) In cases where money is spent directly on research for medically unexplained conditions, funds are often used to study ineffective approaches such as cognitive behavioral therapy. 
-  * **ineffective/harmful therapies** – Because patients suffering from CFS/ME suffer from an organic cause, these interventions are unsettling, if not sadistic. It is tragic or humorous to think cognitive behavioral therapy (CBT) or graded exercise therapy (GET) would ever be considered a first-line therapy for illnesses such as AIDS, leprosy or other diseases for which the infectious causes of which are less disputed. In a 2009 study, F.N. Twisk //et al.// concluded, "it is unethical to treat patients with ME/CFS with ineffective, non-evidence-based and potentially harmful "rehabilitation therapies", such as CBT/GET."(({{pubmed>long:19855350}})) Nevertheless, as of November 2010, the top three treatments for CFS on the [[http://www.cdc.gov/cfs/general/treatment/index.html|Centers for Disease Control website]] remain, respectively: professional counseling, CBT and GET.any+  * **ineffective/harmful therapies** – Because patients suffering from CFS/ME suffer from an organic cause, these interventions are unsettling, if not sadistic. It is tragic or humorous to think cognitive behavioral therapy (CBT) or graded exercise therapy (GET) would ever be considered a first-line therapy for illnesses such as AIDS, leprosy or other diseases for which the infectious causes of which are less disputed. In a 2009 study, F.N. Twisk //et al.// concluded, "it is unethical to treat patients with ME/CFS with ineffective, non-evidence-based and potentially harmful "rehabilitation therapies", such as CBT/GET."(({{pmid>long:19855350}})) Nevertheless, as of November 2010, the top three treatments for CFS on the [[https://www.cdc.gov/cfs/general/treatment/index.html|Centers for Disease Control website]] remain, respectively: professional counseling, CBT and GET.any
   * **stress caused by denial** – Social stress impacts an immune system already burdened in any patient struggling with CFS and so at risk of increased microbe induced symptoms and chronic disease.   * **stress caused by denial** – Social stress impacts an immune system already burdened in any patient struggling with CFS and so at risk of increased microbe induced symptoms and chronic disease.
   * **added insult to injury** – On top of receiving care for which no effective first-line therapies exist, patients must contend with dubious physicians who assume that these patients are somehow responsible for their illnesses and subconsciously trying to trick themselves and their physician. As ludicrous as it may sound, some say CFS/ME patients benefit from illness:   * **added insult to injury** – On top of receiving care for which no effective first-line therapies exist, patients must contend with dubious physicians who assume that these patients are somehow responsible for their illnesses and subconsciously trying to trick themselves and their physician. As ludicrous as it may sound, some say CFS/ME patients benefit from illness:
  
-<blockquote>Apart from the many disadvantages, long-lasting illness can also have more desirable consequences, such as care, attention, disengagement, or even financial benefits, which might also be considered perpetuating factors.(({{pubmed>long:10845358}})) (({{pubmed>long:10375340}}))+<blockquote>Apart from the many disadvantages, long-lasting illness can also have more desirable consequences, such as care, attention, disengagement, or even financial benefits, which might also be considered perpetuating factors.(({{pmid>long:10845358}})) (({{pmid>long:10375340}}))
  
-//**A.J. Barsky** et al.//(({{pubmed>long:10375340}}))</blockquote>+//**A.J. Barsky** et al.//(({{pmid>long:10375340}}))</blockquote>
  
  
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 ==== Misdiagnosis ==== ==== Misdiagnosis ====
  
-One of the most damaging effects of the term "hysteria" is that it has encouraged doctors to think they have arrived at a diagnosis of symptoms which, in reality, remain mysterious. This in turn means that it is much easier for doctors to miss real but obscure organic illnesses.((Webster, R. 1996. //Why Freud was wrong: sin, science and psychoanalysis//. London, HarperCollins.)) Ever since renaming hysteria, the day-to-day practice of diagnosing conversion disorder remains no less questionable due to its inherent subjectivity(({{pubmed>long:19321463}})) and a lack of a credible scientific basis.+One of the most damaging effects of the term "hysteria" is that it has encouraged doctors to think they have arrived at a diagnosis of symptoms which, in reality, remain mysterious. This in turn means that it is much easier for doctors to miss real but obscure organic illnesses.((Webster, R. 1996. //Why Freud was wrong: sin, science and psychoanalysis//. London, HarperCollins.)) Ever since renaming hysteria, the day-to-day practice of diagnosing conversion disorder remains no less questionable due to its inherent subjectivity(({{pmid>long:19321463}})) and a lack of a credible scientific basis.
  
 <blockquote>The diagnosis of "hysteria" is all too often a way of avoiding a confrontation with our own ignorance. This is especially dangerous when there is an underlying organic pathology, not yet recognised. In this penumbra we find patients who know themselves to be ill but, coming up against the blank faces of doctors who refuse to believe in the reality of their illness, proceed by way of emotional lability, overstatement and demands for attention ... Here is an area where catastrophic errors can be made. In fact it is often possible to recognise the presence though not the nature of the unrecognisable, to know that a man must be ill or in pain when all the tests are negative. But it is only possible to those who come to their task in a spirit of humility. <blockquote>The diagnosis of "hysteria" is all too often a way of avoiding a confrontation with our own ignorance. This is especially dangerous when there is an underlying organic pathology, not yet recognised. In this penumbra we find patients who know themselves to be ill but, coming up against the blank faces of doctors who refuse to believe in the reality of their illness, proceed by way of emotional lability, overstatement and demands for attention ... Here is an area where catastrophic errors can be made. In fact it is often possible to recognise the presence though not the nature of the unrecognisable, to know that a man must be ill or in pain when all the tests are negative. But it is only possible to those who come to their task in a spirit of humility.
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 <relatedarticle> [[home:social:stress|Stress]]</article> <relatedarticle> [[home:social:stress|Stress]]</article>
  
-If the mind has the power to cause illness, wouldn't the mind also have the power to reverse it? One of the popular implications of Freudian notions of the mind-body connection is that positive thinking both protects against disease and cures those patients who are already ill. Indeed, researchers have shown psychological stress appears to have a certain effect on immune function.(({{pubmed>long:18279846}})) The extreme version of the "mind over matter" theory is that illness though is a manifest failure to be positive: +If the mind has the power to cause illness, wouldn't the mind also have the power to reverse it? One of the popular implications of Freudian notions of the mind-body connection is that positive thinking both protects against disease and cures those patients who are already ill. Indeed, researchers have shown psychological stress appears to have a certain effect on immune function.(({{pmid>long:18279846}})) The extreme version of the "mind over matter" theory is that illness though is a manifest failure to be positive: 
  
 <blockquote>There are no incurable diseases, only incurable people. <blockquote>There are no incurable diseases, only incurable people.
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 //**Bernie S. Siegel, M.D.,** 1986//((Siegel BS. 1986. //Love, medicine and miracles: lessons learned about self-healing from a surgeon's experience with exceptional patients//. Harper & Row, New York.))</blockquote> //**Bernie S. Siegel, M.D.,** 1986//((Siegel BS. 1986. //Love, medicine and miracles: lessons learned about self-healing from a surgeon's experience with exceptional patients//. Harper & Row, New York.))</blockquote>
  
-Some studies suggest that positive thinking is helpful to a certain extent, but it is always a problem inferring causation from these types of observational studies. Sick people may be more likely to be pessimistic, but it could just be that people are happy because they are healthy. Positive affect (mood) may be //marginally// associated with lower rates of AIDS mortality,(({{pubmed>long:12883113}})) but what is to say that AIDS patients who are depressed aren't sicker than their more optimistic counterparts – and that this effect cannot be adequately controlled for using multivariate analysis (which attempts to control for such differences)?+Some studies suggest that positive thinking is helpful to a certain extent, but it is always a problem inferring causation from these types of observational studies. Sick people may be more likely to be pessimistic, but it could just be that people are happy because they are healthy. Positive affect (mood) may be //marginally// associated with lower rates of AIDS mortality,(({{pmid>long:12883113}})) but what is to say that AIDS patients who are depressed aren't sicker than their more optimistic counterparts – and that this effect cannot be adequately controlled for using multivariate analysis (which attempts to control for such differences)?
  
  
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-It has become conventional wisdom that a positive attitude improves a cancer patient's survival duration. According to Rittenberg //et al.//,(({{pubmed>long:7697301}})) while many studies and articles have been published claiming that various psychological parameters influence the course of cancer, their results have been contradictory and methodologically impaired.(({{pubmed>long:3183705}})) (({{pubmed>long:3572466}})) (({{pubmed>long:1960562}})) Other studies have supported this conclusion:+It has become conventional wisdom that a positive attitude improves a cancer patient's survival duration. According to Rittenberg //et al.//,(({{pmid>long:7697301}})) while many studies and articles have been published claiming that various psychological parameters influence the course of cancer, their results have been contradictory and methodologically impaired.(({{pmid>long:3183705}})) (({{pmid>long:3572466}})) (({{pmid>long:1960562}})) Other studies have supported this conclusion:
   * A 10-year follow-up study of 136 breast cancer patients looked at how patients who participated in a psychosocial program compared to those who did not. The program consisted of weekly cancer peer support and family therapy, individual counseling, and use of positive mental imagery. The study showed no positive impact on survival. Ironically, the senior author of this study (who disputed his study's methodology) was the same person who claimed there are no incurable diseases, only incurable people.   * A 10-year follow-up study of 136 breast cancer patients looked at how patients who participated in a psychosocial program compared to those who did not. The program consisted of weekly cancer peer support and family therapy, individual counseling, and use of positive mental imagery. The study showed no positive impact on survival. Ironically, the senior author of this study (who disputed his study's methodology) was the same person who claimed there are no incurable diseases, only incurable people.
-  * A 2001 //New England Journal of Medicine// study found that supportive-expressive group therapy does not prolong survival in women with metastatic breast cancer, but instead only improved mood and the perception of pain, particularly in women who are initially more distressed.(({{pubmed>long:11742045}})) +  * A 2001 //New England Journal of Medicine// study found that supportive-expressive group therapy does not prolong survival in women with metastatic breast cancer, but instead only improved mood and the perception of pain, particularly in women who are initially more distressed.(({{pmid>long:11742045}})) 
-  * Cunningham //et al.// showed in a randomized controlled trial that psychological intervention had no significant effect on patients with metastatic breast cancer.(({{pubmed>long:9885092}}))+  * Cunningham //et al.// showed in a randomized controlled trial that psychological intervention had no significant effect on patients with metastatic breast cancer.(({{pmid>long:9885092}}))
  
-Positive thinking may be appropriate as one of many successful coping strategies. To attribute more to it or, worse, to insist that patients believe in its power to cure, positive thinking can be stigmatizing, adding an extra burden to an already devastated patient.(({{pubmed>long:7697301}})) If patients fail to become healthy, they are to blame as they are not trying hard enough to be positive. Chronic diseases are traumatizing life events. Sometimes crying, anger, or any of the other signs of negative attitude may be useful for effectively coping with the challenges of being sick. Norem //et al.// argue convincingly that sometimes pessimism and negative thinking are indeed positive psychology, as they lead to better performance and personal growth.(({{pubmed>long:12209860}}))+Positive thinking may be appropriate as one of many successful coping strategies. To attribute more to it or, worse, to insist that patients believe in its power to cure, positive thinking can be stigmatizing, adding an extra burden to an already devastated patient.(({{pmid>long:7697301}})) If patients fail to become healthy, they are to blame as they are not trying hard enough to be positive. Chronic diseases are traumatizing life events. Sometimes crying, anger, or any of the other signs of negative attitude may be useful for effectively coping with the challenges of being sick. Norem //et al.// argue convincingly that sometimes pessimism and negative thinking are indeed positive psychology, as they lead to better performance and personal growth.(({{pmid>long:12209860}}))
  
  
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 Those of us in the profession know that the combination of what is seen under the microscope and the extent of disease have the greatest influence on prognosis. Would it were just so easy as prescribing "positive mental attitude"! Those of us in the profession know that the combination of what is seen under the microscope and the extent of disease have the greatest influence on prognosis. Would it were just so easy as prescribing "positive mental attitude"!
  
-//**Cynthia N. Rittenberg**// (({{pubmed>long:7697301}}))+//**Cynthia N. Rittenberg**// (({{pmid>long:7697301}}))
 </blockquote>  </blockquote> 
  
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   * **somatoform disorder** – From the Greek term "soma" for body, a broad category of mental disorders characterized by physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause. Also known as Briquet's syndrome or Brissaud–Marie syndrome. Currently defined by //Diagnostic and Statistical Manual of Mental Disorders//. Includes conversion disorder (see below), pain disorder (see below), hypochondriasis (see below), body dysmorphic disorders (overly preoccupied by body image), and neurasthenia (exhaustion of the central nervous system's energy reserves).   * **somatoform disorder** – From the Greek term "soma" for body, a broad category of mental disorders characterized by physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause. Also known as Briquet's syndrome or Brissaud–Marie syndrome. Currently defined by //Diagnostic and Statistical Manual of Mental Disorders//. Includes conversion disorder (see below), pain disorder (see below), hypochondriasis (see below), body dysmorphic disorders (overly preoccupied by body image), and neurasthenia (exhaustion of the central nervous system's energy reserves).
   * **conversion disorder** – A type of somatoform disorder in which there is a loss or alteration in physical functioning that suggests a physical disorder but that is actually a direct expression of a psychological conflict or need. The term "functional" sometime is used to imply the existence of a conversion disorder, e.g.  "functional weakness", "functional neurological deficit", etc.   * **conversion disorder** – A type of somatoform disorder in which there is a loss or alteration in physical functioning that suggests a physical disorder but that is actually a direct expression of a psychological conflict or need. The term "functional" sometime is used to imply the existence of a conversion disorder, e.g.  "functional weakness", "functional neurological deficit", etc.
-  * **pain disorder** – A type of somatoform disorder in which a patient experiences chronic pain in one or more areas. This disorder often occurs after an accident or during an illness that has caused genuine pain, and is then thought to take a "life" of its own.(({{pubmed>long:10509617}})) Previously referred to as "psychogenic pain disorder" and "somatoform pain disorder."+  * **pain disorder** – A type of somatoform disorder in which a patient experiences chronic pain in one or more areas. This disorder often occurs after an accident or during an illness that has caused genuine pain, and is then thought to take a "life" of its own.(({{pmid>long:10509617}})) Previously referred to as "psychogenic pain disorder" and "somatoform pain disorder."
   * **hypochondriasis disorder** – A type of somatoform disorder in which patients are said to have excessive preoccupation or worry about having a serious illness. Cyberchondria is a colloquial term for hypochondria in individuals who have researched medical conditions on the Internet. Contrary to popular belief, there is virtually no incentive to be a hypochondriac.  Hypochondria is widely used as a disparaging term for patients with chronic disease. It seems likely that most hypochondriacs genuinely have symptoms of organic cause.    * **hypochondriasis disorder** – A type of somatoform disorder in which patients are said to have excessive preoccupation or worry about having a serious illness. Cyberchondria is a colloquial term for hypochondria in individuals who have researched medical conditions on the Internet. Contrary to popular belief, there is virtually no incentive to be a hypochondriac.  Hypochondria is widely used as a disparaging term for patients with chronic disease. It seems likely that most hypochondriacs genuinely have symptoms of organic cause. 
  
-A relatively uncritical [[http://emedicine.medscape.com/article/294908-overview|eMedicine article]] on somatoform disorders offers more specific criteria by which the DSM-IV-TR recommends diagnosis of these conditions.+A relatively uncritical [[https://emedicine.medscape.com/article/294908-overview|eMedicine article]] on somatoform disorders offers more specific criteria by which the DSM-IV-TR recommends diagnosis of these conditions.
  
  
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-  * //[[http://www.amazon.com/Hystories-Elaine-Showalter/dp/0231104596|Hystories]]// – //Hystories// is a torturous read authored by Elaine Showalter, a //literary// critic, who seems to genuinely believe that hysteria is a genuine medical condition. In her book, Showlater lumps in CFS patients with... self-described alien abductees. This comparison is at once quite consistent with the thinking of certain segments of the medical community and plainly absurd. As one Amazon.com reviewer commented, "If you want a laugh, I recommend reading Showalter's latest in //Journal of Literary Criticism of Immunology//." In the preface to the revised edition, the author laments that her book elicited such outrage from upset patients. +  * //[[https://www.amazon.com/Hystories-Elaine-Showalter/dp/0231104596|Hystories]]// – //Hystories// is a torturous read authored by Elaine Showalter, a //literary// critic, who seems to genuinely believe that hysteria is a genuine medical condition. In her book, Showlater lumps in CFS patients with... self-described alien abductees. This comparison is at once quite consistent with the thinking of certain segments of the medical community and plainly absurd. As one Amazon.com reviewer commented, "If you want a laugh, I recommend reading Showalter's latest in //Journal of Literary Criticism of Immunology//." In the preface to the revised edition, the author laments that her book elicited such outrage from upset patients. 
-  * [[http://www.richardwebster.net/freudandhysteria.html|Hysteria, medicine and misdiagnosis]] – An essay that combines a section from the opening of Chapter 5 of //[[http://www.amazon.com/Why-Freud-Was-Wrong-Psychoanalysis/dp/0465091288/ref=sr_1_1?ie=UTF8&qid=1290889579&sr=8-1|Why Freud Was Wrong]]// with the Appendix ("The Diagnosis of 'Hysteria'") which was originally written as a continuation of that section. Webster offers a truly excellent treatment of his topic. +  * [[https://www.richardwebster.net/freudandhysteria.html|Hysteria, medicine and misdiagnosis]] – An essay that combines a section from the opening of Chapter 5 of //[[https://www.amazon.com/Why-Freud-Was-Wrong-Psychoanalysis/dp/0465091288/ref=sr_1_1?ie=UTF8&qid=1290889579&sr=8-1|Why Freud Was Wrong]]// with the Appendix ("The Diagnosis of 'Hysteria'") which was originally written as a continuation of that section. Webster offers a truly excellent treatment of his topic. 
-  * [[http://brain.oxfordjournals.org/content/132/10/2889.full|In the psychiatrist’s chair: how neurologists understand conversion disorder]] – A 2009 paper containing selections from 22 interviews with neurologists on how they understand and diagnose conversion. +  * [[https://brain.oxfordjournals.org/content/132/10/2889.full|In the psychiatrist’s chair: how neurologists understand conversion disorder]] – A 2009 paper containing selections from 22 interviews with neurologists on how they understand and diagnose conversion. 
-  * //[[http://www.amazon.com/Charcots-Bad-Idea-Simon-Overton/dp/1409265420|Charcot's bad idea]]// – A book that looks at how the diagnosis of hysteria and conversion disorder was revitalised by a group of like-minded physicians under the terms of "functional weakness" and "functional neurological deficit" in order to "develop constructive ways of talking with patients."+  * //[[https://www.amazon.com/Charcots-Bad-Idea-Simon-Overton/dp/1409265420|Charcot's bad idea]]// – A book that looks at how the diagnosis of hysteria and conversion disorder was revitalised by a group of like-minded physicians under the terms of "functional weakness" and "functional neurological deficit" in order to "develop constructive ways of talking with patients."
  
  
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 +<nodisp>
 ===== Notes and comments ===== ===== Notes and comments =====
  
 //broken link// //broken link//
-[[http://socrates.berkeley.edu/~kihlstrm/freuddead.htm|resonate]] +[[https://socrates.berkeley.edu/~kihlstrm/freuddead.htm|resonate]] 
  
  
-While it may be true that patients with CFS/ME, for example, exhibit a "loss of adaptability,"(({{pubmed>long:20695975}})) fixate on a physical cause for disease(({{pubmed>long:16443043}})) or, to use a demeaning phrase, display "illness behavior"(({{pubmed>long:16443043}})) –  the same could be said for anyone who suffers from any disease.+While it may be true that patients with CFS/ME, for example, exhibit a "loss of adaptability,"(({{pmid>long:20695975}})) fixate on a physical cause for disease(({{pmid>long:16443043}})) or, to use a demeaning phrase, display "illness behavior"(({{pmid>long:16443043}})) –  the same could be said for anyone who suffers from any disease.
  
  
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-  * **men who have suffered an industrial accident, employees in a health profession or health insurance, and recipient of care by a "devoted spouse"**(({{pubmed>long:2581282}})) ((Fahn S. Psychogenic movement disorders. In: Marsden CD, Fahn S, eds. //Movement Disorders III//. Oxford: Butterworth-Heinemann; 1994:+  * **men who have suffered an industrial accident, employees in a health profession or health insurance, and recipient of care by a "devoted spouse"**(({{pmid>long:2581282}})) ((Fahn S. Psychogenic movement disorders. In: Marsden CD, Fahn S, eds. //Movement Disorders III//. Oxford: Butterworth-Heinemann; 1994:
 359–372)) 359–372))
  
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 Chronic diseases are not culturally transmitted Chronic diseases are not culturally transmitted
  
-Many have argued that the tendency for conversion disorder to wax and wane in certain groups at certain times illustrates how these diseases are culturally transmitted and could not be somatic in origin. According to a frequently invoked view, the media should be blamed for hysterical outbreaks: "culture increasingly encourages patients to conceive vague and nonspecific symptoms as evidence of real disease and to seek specialist help for them," and the "the media and the breakdown of the family encourage patients to acquire the fixed belief that they have a given illness." He goes on, "Patients tend to adopt them on the basis of what the culture considers to be legitimate illness."(({{pubmed>long:9060486}}))+Many have argued that the tendency for conversion disorder to wax and wane in certain groups at certain times illustrates how these diseases are culturally transmitted and could not be somatic in origin. According to a frequently invoked view, the media should be blamed for hysterical outbreaks: "culture increasingly encourages patients to conceive vague and nonspecific symptoms as evidence of real disease and to seek specialist help for them," and the "the media and the breakdown of the family encourage patients to acquire the fixed belief that they have a given illness." He goes on, "Patients tend to adopt them on the basis of what the culture considers to be legitimate illness."(({{pmid>long:9060486}}))
  
 This explanation is suspect. Whatever label physicians have chosen to give medically unexplained symptoms, they have always existed. One commonly held misconception about the history of psychoanalysis was that Freud’s early patients came to him because they were suffering from emotional difficulties or because they displayed symptoms which clearly had a psychological origin. In reality, a large proportion of the patients whom Freud treated during his early years in private practice had initially sought medical advice because they were suffering from physical symptoms; they had enlisted the help of a physician for no other reason than that they believed themselves to be ill. Among their symptoms were headaches, muscular pain, neuralgia, gastric pain, tics, vomiting, clonic spasms, petit mal, epileptoid convulsions, and a host of other physical reactions.((Webster, R. 1996. //Why Freud was wrong: sin, science and psychoanalysis//. London, HarperCollins.))  This explanation is suspect. Whatever label physicians have chosen to give medically unexplained symptoms, they have always existed. One commonly held misconception about the history of psychoanalysis was that Freud’s early patients came to him because they were suffering from emotional difficulties or because they displayed symptoms which clearly had a psychological origin. In reality, a large proportion of the patients whom Freud treated during his early years in private practice had initially sought medical advice because they were suffering from physical symptoms; they had enlisted the help of a physician for no other reason than that they believed themselves to be ill. Among their symptoms were headaches, muscular pain, neuralgia, gastric pain, tics, vomiting, clonic spasms, petit mal, epileptoid convulsions, and a host of other physical reactions.((Webster, R. 1996. //Why Freud was wrong: sin, science and psychoanalysis//. London, HarperCollins.)) 
  
-Given the frequency with which patients complain of medically unexplained symptoms, it is presumptuous, if not preposterous, to claim that hundreds of millions of people suffer from a type of psychological condition that has minimal biological evidence to support it. It is much more likely that certain disease states have not been sufficiently characterized and that conversion disorder or any of its historical predecessors are just examples of an invalid diagnosis applied subjectively. Interviews with practicing neurologist certainly suggest as much.(({{pubmed>long:19321463}})) +Given the frequency with which patients complain of medically unexplained symptoms, it is presumptuous, if not preposterous, to claim that hundreds of millions of people suffer from a type of psychological condition that has minimal biological evidence to support it. It is much more likely that certain disease states have not been sufficiently characterized and that conversion disorder or any of its historical predecessors are just examples of an invalid diagnosis applied subjectively. Interviews with practicing neurologist certainly suggest as much.(({{pmid>long:19321463}})) 
  
  
 In 2000, Thomas English authored this excerpt response to a review that dismissed CFS as a "self-perpetuating, self-validating cycle." In 2000, Thomas English authored this excerpt response to a review that dismissed CFS as a "self-perpetuating, self-validating cycle."
  
-[{{ :home:alternate:conversion.gif?400|**Supposed misdiagnoses of conversion disorder** In their 2005 //BMJ// systematic review, neurologist Jon Stone //et al.// conclude "due to improvements in study quality" (as opposed to improvement in diagnostic vigilance), the rate of misdiagnoses for conversion disorder has fallen to around 4%.((Stone J, Smyth R, Carson A, Lewis S, Prescott R, Warlow C, Sharpe M [[http://www.ncbi.nlm.nih.gov/pubmed/16223792|Systematic review of misdiagnosis of conversion symptoms and "hysteria"]] //BMJ//. 2005;331:989.)) If systematic reviews existed when Charcot and Freud lived, it seems likely the neurologists of their time would estimate misdiagnoses at a similarly low rate. However, if history is any guide, the actual number of misdiagnoses for "conversion disorder" approaches 100%.}}]+[{{ :home:alternate:conversion.gif?400|**Supposed misdiagnoses of conversion disorder** In their 2005 //BMJ// systematic review, neurologist Jon Stone //et al.// conclude "due to improvements in study quality" (as opposed to improvement in diagnostic vigilance), the rate of misdiagnoses for conversion disorder has fallen to around 4%.((Stone J, Smyth R, Carson A, Lewis S, Prescott R, Warlow C, Sharpe M [[https://www.ncbi.nlm.nih.gov/pubmed/16223792|Systematic review of misdiagnosis of conversion symptoms and "hysteria"]] //BMJ//. 2005;331:989.)) If systematic reviews existed when Charcot and Freud lived, it seems likely the neurologists of their time would estimate misdiagnoses at a similarly low rate. However, if history is any guide, the actual number of misdiagnoses for "conversion disorder" approaches 100%.}}]
  
-Stone //et al.//(({{pubmed>long:16223792}})) and Allin //et al.//(({{pubmed>long:18568070}})) have argued that in the time since Slater (see above) the number of misdiagnoses of somatoform disorder have declined to an acceptable level: no more than several percent. The criteria used for such a conclusion is the frequency with which diagnoses are later changed. Even if these data were valid, the fact that somatoform disorder is applied more consistently does not mean that the diagnosis is any less problematic. It seems more likely that medicine has not satisfactorily described a disease state. +Stone //et al.//(({{pmid>long:16223792}})) and Allin //et al.//(({{pmid>long:18568070}})) have argued that in the time since Slater (see above) the number of misdiagnoses of somatoform disorder have declined to an acceptable level: no more than several percent. The criteria used for such a conclusion is the frequency with which diagnoses are later changed. Even if these data were valid, the fact that somatoform disorder is applied more consistently does not mean that the diagnosis is any less problematic. It seems more likely that medicine has not satisfactorily described a disease state. 
  
    
 20th century – decline in diagnoses of hysteria  20th century – decline in diagnoses of hysteria 
  
-Over the course of the early 20th century, the number of diagnoses of female hysteria sharply declined. Several historians addressing the "disappearance" of hysteria have attributed the phenomenon to psychological and sociocultural factors. For example, some critics have blamed this decline on laypeople gaining a greater understanding of the psychological principles behind conversion disorders such as hysteria, explaining that with such understanding psychoanalysis no longer achieves the desired response from patients.(({{pubmed>long:8282518}})) +Over the course of the early 20th century, the number of diagnoses of female hysteria sharply declined. Several historians addressing the "disappearance" of hysteria have attributed the phenomenon to psychological and sociocultural factors. For example, some critics have blamed this decline on laypeople gaining a greater understanding of the psychological principles behind conversion disorders such as hysteria, explaining that with such understanding psychoanalysis no longer achieves the desired response from patients.(({{pmid>long:8282518}})) 
  
  
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 <blockquote>Ms. Showalter correctly alerts us to the medicalizing of problems caused by strong emotions and psychological stresses, she overlooks an equally common diagnostic error: the psychologizing of problems with organic causes. Until the bacillus that causes tuberculosis was identified, TB was thought to be a result of having a ''tubercular personality.'' Until the bacterium that causes peptic ulcers was identified, ulcers were said to be caused by repressed anger -- still a favorite psychoanalytic culprit. In California, a woman spent 12 years in therapy, her muscles getting steadily weaker until she couldn't lift her hand to brush her teeth. The psychiatrist said that her problem was her ''repressed rage'' at her parents; she turned out to have myasthenia gravis, a progressive muscular disease. <blockquote>Ms. Showalter correctly alerts us to the medicalizing of problems caused by strong emotions and psychological stresses, she overlooks an equally common diagnostic error: the psychologizing of problems with organic causes. Until the bacillus that causes tuberculosis was identified, TB was thought to be a result of having a ''tubercular personality.'' Until the bacterium that causes peptic ulcers was identified, ulcers were said to be caused by repressed anger -- still a favorite psychoanalytic culprit. In California, a woman spent 12 years in therapy, her muscles getting steadily weaker until she couldn't lift her hand to brush her teeth. The psychiatrist said that her problem was her ''repressed rage'' at her parents; she turned out to have myasthenia gravis, a progressive muscular disease.
  
-Pursued by Fashionable Furies, http://www.nytimes.com/books/97/05/04/reviews/970504.04tavrist.html?_r=2</blockquote>+Pursued by Fashionable Furies, https://www.nytimes.com/books/97/05/04/reviews/970504.04tavrist.html?_r=2</blockquote>
  
  
 As the preeminent scientific philosopher Karl Popper pointed out, Freud's – and, by logical extension, his heirs' – theories of the psyche are ultimately unscientific, because they are not testable.((Karl Popper, Conjectures and Refutations, London: Routledge and Keagan Paul, 1963, pp. 33-39; from Theodore Schick, ed., Readings in the Philosophy of Science, Mountain View, CA: Mayfield Publishing Company, 2000, pp. 9-13.)) As the preeminent scientific philosopher Karl Popper pointed out, Freud's – and, by logical extension, his heirs' – theories of the psyche are ultimately unscientific, because they are not testable.((Karl Popper, Conjectures and Refutations, London: Routledge and Keagan Paul, 1963, pp. 33-39; from Theodore Schick, ed., Readings in the Philosophy of Science, Mountain View, CA: Mayfield Publishing Company, 2000, pp. 9-13.))
  
-http://www.prohealth.com/me-cfs/blog/boardDetail.cfm?id=1389548+https://www.prohealth.com/me-cfs/blog/boardDetail.cfm?id=1389548
  
 highly elaborated self-diagnoses highly elaborated self-diagnoses
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 One study of health care utilization estimates that 25–72% of office visits to primary care doctors involve psychological distress that takes the form of somatic (physical) symptoms.  One study of health care utilization estimates that 25–72% of office visits to primary care doctors involve psychological distress that takes the form of somatic (physical) symptoms. 
-http://www.minddisorders.com/Br-Del/Conversion-disorder.html#ixzz16RO2OxL4+https://www.minddisorders.com/Br-Del/Conversion-disorder.html#ixzz16RO2OxL4
  
  
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-http://emedicine.medscape.com/article/294908-overview+https://emedicine.medscape.com/article/294908-overview
  
-http://bigthink.com/ideas/23883+https://bigthink.com/ideas/23883
  
-http://www.wikidoc.org/index.php/Conversion_disorder+https://www.wikidoc.org/index.php/Conversion_disorder
  
  
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 famous //belle epoque// (beautiful age) of hysteria famous //belle epoque// (beautiful age) of hysteria
-{{pubmed>long:8282518}}+{{pmid>long:8282518}}
  
  
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-http://www.wikidoc.org/index.php/Conversion_disorder+https://www.wikidoc.org/index.php/Conversion_disorder
  
  
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-http://www.amazon.com/gp/product/0674031660/ref=s9_simh_gw_p14_d1_i2?pf_rd_m=ATVPDKIKX0DER&pf_rd_s=center-2&pf_rd_r=1BWXHNWVWVH5FJABGQN7&pf_rd_t=101&pf_rd_p=470938631&pf_rd_i=507846+https://www.amazon.com/gp/product/0674031660/ref=s9_simh_gw_p14_d1_i2?pf_rd_m=ATVPDKIKX0DER&pf_rd_s=center-2&pf_rd_r=1BWXHNWVWVH5FJABGQN7&pf_rd_t=101&pf_rd_p=470938631&pf_rd_i=507846
  
-http://www.amazon.com/Hystories-Elaine-Showalter/dp/0231104596+https://www.amazon.com/Hystories-Elaine-Showalter/dp/0231104596
  
-http://books.google.com/books?id=ovXV7amJgL0C&pg=PA109&lpg=PA109&dq=A.+Steyerthal,+Was+ist+Hysterie&source=bl&ots=IfJ2TmeV1P&sig=kuaI049aCu2pbfWBWWNzMNW2efc&hl=en&ei=8mbyTPnzDIT7lwen2PGzDA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBMQ6AEwAA#v=onepage&q=A.%20Steyerthal%2C%20Was%20ist%20Hysterie&f=false+https://books.google.com/books?id=ovXV7amJgL0C&pg=PA109&lpg=PA109&dq=A.+Steyerthal,+Was+ist+Hysterie&source=bl&ots=IfJ2TmeV1P&sig=kuaI049aCu2pbfWBWWNzMNW2efc&hl=en&ei=8mbyTPnzDIT7lwen2PGzDA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBMQ6AEwAA#v=onepage&q=A.%20Steyerthal%2C%20Was%20ist%20Hysterie&f=false
  
-http://www.ncbi.nlm.nih.gov/pubmed/8282518+https://www.ncbi.nlm.nih.gov/pubmed/8282518
  
-http://www.wikidoc.org/index.php/Conversion_disorder#_note-16+https://www.wikidoc.org/index.php/Conversion_disorder#_note-16
  
-http://www.google.com/search?sourceid=chrome&ie=UTF-8&q=tourette's+conversion+disorder#hl=en&expIds=17259,27642,27744&sugexp=ldymls&xhr=t&q=historical+examples+conversion+disorder&cp=11&qe=aGlzdG9yaWNhbCBleGFtcGxlcyBjb252ZXJzaW9uIGRpc29yZGVy&qesig=L-3yhmx74MyTPNeppDfWfQ&pkc=AFgZ2tkrf1IyFbYv-4PQv5p5JBVHoTfNDalnZhPeaiCbHZjiGNqIve_j1II-RZWZHc8HBLBjJnpzlZc_eujqRl54eu6jNNQlUg&pf=p&sclient=psy&safe=off&aq=f&aqi=&aql=&oq=&gs_rfai=&pbx=1&fp=74b11d96122089a2+https://www.google.com/search?sourceid=chrome&ie=UTF-8&q=tourette's+conversion+disorder#hl=en&expIds=17259,27642,27744&sugexp=ldymls&xhr=t&q=historical+examples+conversion+disorder&cp=11&qe=aGlzdG9yaWNhbCBleGFtcGxlcyBjb252ZXJzaW9uIGRpc29yZGVy&qesig=L-3yhmx74MyTPNeppDfWfQ&pkc=AFgZ2tkrf1IyFbYv-4PQv5p5JBVHoTfNDalnZhPeaiCbHZjiGNqIve_j1II-RZWZHc8HBLBjJnpzlZc_eujqRl54eu6jNNQlUg&pf=p&sclient=psy&safe=off&aq=f&aqi=&aql=&oq=&gs_rfai=&pbx=1&fp=74b11d96122089a2
  
-http://www.jstor.org/pss/235644+https://www.jstor.org/pss/235644
  
-http://books.google.com/books?hl=en&lr=&id=Jxfm86wOR8UC&oi=fnd&pg=PA156&dq=%22medically+unexplained+symptoms%22+OR+%22medically+unexplained+diseases%22&ots=fdW16xDT4P&sig=bis1b69GZZYrCnxbgSqEphaMtsY#v=onepage&q=%22medically%20unexplained%20symptoms%22%20OR%20%22medically%20unexplained%20diseases%22&f=false+https://books.google.com/books?hl=en&lr=&id=Jxfm86wOR8UC&oi=fnd&pg=PA156&dq=%22medically+unexplained+symptoms%22+OR+%22medically+unexplained+diseases%22&ots=fdW16xDT4P&sig=bis1b69GZZYrCnxbgSqEphaMtsY#v=onepage&q=%22medically%20unexplained%20symptoms%22%20OR%20%22medically%20unexplained%20diseases%22&f=false
  
-http://apt.rcpsych.org/cgi/content/full/12/2/152+https://apt.rcpsych.org/cgi/content/full/12/2/152
  
 Briquet's syndrome Briquet's syndrome
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 More studies on cancer here:  More studies on cancer here: 
-http://www.amazon.com/Health-Psychology-Theory-Research-Practice/dp/1412903378+https://www.amazon.com/Health-Psychology-Theory-Research-Practice/dp/1412903378
  
  
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 ===== References ===== ===== References =====
 +</nodisp>
  
home/alternate/psychosomatic.1562470978.txt.gz · Last modified: 07.07.2019 by sallieq
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