A guide to functional disease for a trauma conscious generation, 2021, Whitfield

[Andy]

ABSTRACT

In part due to a greater understanding of trauma and its manifestation as disease, the field of functional neurology has seen rapid development over the past decade with the inauguration of the Functional Neurological Disorder Society. Recent developments in our understanding of functional neurology are translatable to other functional disorders and have laid the groundwork for future research opportunities that foundation trainees can contribute towards. At the very least, trainees have a responsibility to be aware of the involuntary nature of these conditions and direct patients towards appropriate help. This guide to functional neurology aims to clear the fog on this collection of poorly recognised conditions so that empathy and understanding can shine through.

Open access, https://www.rcpjournals.org/content/clinmedicine/21/5/e519

 

[Arnie Pye]

In part due to a greater understanding of trauma and its manifestation as disease

I accept that trauma may manifest as disease e.g. give someone a severe shock and they might have a heart attack - see Takotsubo cardiomyopathy. But, personally, I think it would be far more likely that untreated disease would cause trauma, rather than the other way around.

 

[Mithriel]

Yes, except they found that many of their patients did not have any trauma so it is not a requirement any more. They move the goalposts so often they must be chronically fatigued ...

They have a theory and they are going to twist everything into it because they are not quitters!

 

[Invisible Woman]

"Recent developments in our understanding of functional neurology are translatable to other functional disorders and have laid the groundwork for future research opportunities that for foundation trainees can contribute towards." to board the unfalsifiable gravy train.

 

[Sean]

I think it would be far more likely that untreated disease would cause trauma, rather than the other way around.

Not to mention misdiagnosed and mistreated disease.

 

[Hutan]

What a lot of nonsense. I note that this is copyrighted to the Royal College of Physicians, 2021. Andrew Whitfield is the author, and clearly he was drinking too much Kool aid as he wrote this guide for junior doctors.

He seems convinced that these conditions (weakness in specific parts of the body, walking funny, seizures that aren't epilepsy) are caused by trauma.

Rigorous new meta-analyses confirm that physical, sexual and emotional abuse, particularly in childhood, predispose to the development of FND with up to 74% of patients having suffered emotional neglect before adulthood

As for treatments:

Disappointingly, 67% of patients report symptoms as the same or worse at 1-year follow-up, suggesting there is much room for improvement in terms of treatment efficacy

Well, yes.

It's suggested that physiotherapy helps:

Specialist physiotherapy has demonstrated improvement in 60%–70% of patients with FMD.13 Contrary to typical physiotherapy, strength in individual joints are not the focus and whole-body movement is encouraged. Despite all current evidence being favourable, very few NHS trusts provide the specialist physiotherapy services. It is hoped that robust evidence will sway commissioners to recognise the utility of the treatment.

The #13 reference is Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry 2015;86:1113–9. It's interesting in the context of the issue we are having with the Royal Colleges, so I'll make a thread for it, edit : here. It's also interesting that they specifically note in 2015 that there is a move away from the idea that 'a purely psychological model' is enough to explain FMD, whereas Whitfield here is most enthusiastic about the link with trauma.


Even Whitfield can't manage to suggest that CBT is helpful:

In terms of psychotherapy for FND, cognitive behavioural therapy (CBT) has thus far had the most inquiry. In PNES, the evidence for CBT improving seizure frequency is inconclusive, however, a number of additional benefits have been noted with patients reporting higher overall quality of life, seizures to be less bothersome and lower levels of psychological distress than controls.

 

[Trish]

Looks like yet another case where CBT persuades people to fill in questionnaire differently.

 

[Adrian]

Looks like yet another case where CBT persuades people to fill in questionnaire differently.

He seems to suggest that patients report seizures as being 'less bothersome' but if you use CBT to tell people not to worry about seizures and basically ignore them then it makes sense that people report them as less bothersome to the people who told them that.

 

[spinoza577]

Recent developments in our understanding of functional neurology are translatable to other functional disorders and have laid the groundwork ...

Which development? Which groundwork?

Apart from BPS-blabla lacking any honest empirical evidence there are only very few, minor and completely inaccurate hypotheses on dysfunctions (in the brain).

 

[rvallee]

Which development? Which groundwork?

Apart from BPS-blabla lacking any honest empirical evidence there are only very few, minor and completely inaccurate hypotheses on dysfunctions (in the brain).

Ironic but it's basically sooth-saying, telling themselves they're right and good even though they're complete failures, or probably more accurately because they are failing. You can go back decades and read the same thing and those "developments" are never spelled out, it's always speculative potential. In recent years Wessely was asked and Chalder and Crawley wrote an article on those "developments" and they literally could not name a single one, all speculation and hopium.

Ironic because of a recent paper on soothing in CFS. Because every damn thing they say about us is pure projection. They just never seem to know when something applies to the circumstances so they just say generic fluff like this to reassure themselves.

 

[spinoza577]

Ironic because of a recent paper on soothing in CFS. Because every damn thing they say about us is pure projection. They just never seem to know when something applies to the circumstances so they just say generic fluff like this to reassure themselves.

There is also the sociological knowledge on institutions which are re-iterating themselves (ie their existence), regardless how unsuccessful they are. All these fluffy words though may be successfully trying to evade proper controlling.

 

[Sean]

"Recent developments in our understanding of functional neurology are translatable to other functional disorders and have laid the groundwork ..."

Recent developments in our understanding of marketing functional neurology are translatable to other functional disorders and have laid the groundwork... for better marketing.