Doctors behave as if medical knowledge was exhaustive, and infer that symptoms they don’t understand come from mental illness.

Most diseases have a psychological component, but patients are seldom referred to a psychiatrist for treating their heart ache when they get an infarction.

I just mentioned these findings (and others about autoimmunity against the satellite cells in dorsal root ganglia) to my mum, a doctor specialized in physical therapy and rehab. She went into retirement this year and many patients with ME/CFS.

Her reaction: "So fibromyalgia is real now. I have a hard time believing it… I spent my career fighting it."

Doctors literally say "you're making it up." In those exact words. There is no misunderstanding.

My wife had an emergency department refuse to treat her because they disagreed with an unrelated diagnosis that was in her medical record. Until she admitted that she was "making it up" and didn't have it, so they could "correct" the record, they would not treat her. She ended up having to leave and go to another hospital.

Sometimes it is exactly what they're doing. 15 years ago, shortly after surgery to remove a tumor from my femur, I ran into a physical therapy assistant whom I'd been working with when my doctors thought my leg pain was a soft tissue problem. He said he'd heard about my surgery and was glad I was doing well, and then as we parted ways he cheerfully commented offhand that when I'd been working with him and his supervisor, "I thought you were making it all up!" (I still feel angry about that occasionally, all these years later.)

I am not buying that psychiatry actually helped. With this type of condition, some people get better over time. So those people would have gotten better anyway without the psychiatry. I also think the medical community should also rethink the notion some symptoms are psychosomatic. Why is that true? Because doctors can't spot the cause, so it must be psychosomatic? Maybe the cause is there but undetectable or not understood yet.

No, your wife _was_ dismissed. Not only that, she was misdiagnosed. And she’s part of a huge patient population that gets misdiagnosed routinely. She has every right to be angry. Misdiagnosis is not benign. It sends you down the wrong path and costs you years.

> My wife felt dismissed and was really mad about it, but the reality is that some sets of symptoms are psychosomatic, and psychiatry can help,

Depression is a comorbidity of chronic illness. It's hard not to become depressed when dealing with an unexplained illness.

Psychiatric treatment can reduce the contribution of the comorbid depression, which can create a net improvement for these patients.

Too many patients with chronic illness will refuse any psychiatric treatment because they are resistant to the idea, but they end up suffering more than necessary.

When doctors can't identify or treat the core illness, they can at least address comorbidities and work on increasing quality of life. Psychiatric care is at the top of the list for helping people's quality of life in these situations.

My wife was recently diagnosed with fibromyalgia and the doctor explained it exactly this way. It literally just means "nerve pain". There were no markers for rheumatoid arthritis so they just give it a label that is essentially just a placeholder. They can only treat symptoms anyway so it doesn't matter. I've got narcolepsy which was identified decades ago, but the mechanism was only isolated about 20 years ago and there's no direct treatment. Only ways to reduce symptoms. My condition definitely originates in the brain and can be treated with the same kind of CNS stimulants they give to people with depression or ADHD. So declaring a condition to be "in your head" isn't really synonymous with it being imaginary. For narcolepsy, most patients have a very explicit emotional trigger for symptoms. Emotions trigger neurotransmitters and neurotransmitter failure is the specific mechanism for causing the syndrome. So you can say it is most assuredly "psychosomatic" without that connotating it being some kind of emotional weakness. Your brain is part of your body. It controls thought, perception (including pain), emotion and literally every physical process beyond basic reflexes. Malfunctions in your brain can do all sorts of unpredictable things.

The problem really is the stigma associated with mental illness as opposed to other kinds of illness. There are clearly mechanisms through which psychiatric effects manifest as real physical symptoms. If there's no obvious physiological cause to symptoms, working with it having a psychiatric basis seems perfectly reasonable. That doesn't mean we shouldn't try to understand more about it though.

There is no evidence for functional neurological disorder, it is simply a hypothesis. As a diagnostic category it is essentially a "god of the gaps" construct. Remember also that the name is a re-branding of what used to be called conversion disorder (previously known as hysteria), that was found to be an acceptable term to patients.[1]

It's heavily published on and widely accepted as valid by neurologists, but that does not make it true.

The concept with FND is that there is no identifiable structural pathology, but that the neural circuits are dysfunctional, and that this can be fixed with things like cognitive behavioural therapy. This is typically framed to the patient as "the hardware is completely OK, there's just a problem with the software." (As most of this audience would recognise there is very little overlap between how brains work and how computers work.)

However, more advanced imaging techniques, such as 7T MRI are now showing structural abnormalities in these patients, which is a pretty fundamental problem for the above hypothesis. An attempt to rationalise this by FND proponents is made here.[2]

A recent example involves a 10yo child who developed a movement disorder following Covid.[3] Typically these would be diagnosed as functional movement disorder [4][5][6] and psychological therapy advised. However this group showed that in fact it was due to a neuroimmune pathology, with auto-antibodies forming that targeted some portion of the basal ganglia. The patient recovered completely with immunosuppression.

[1] https://www.bmj.com/content/325/7378/1449

[2] https://neurosymptoms.org/en/faq-2/can-people-with-fnd-have-...

[3] https://link.springer.com/article/10.1007/s00415-023-11853-5

[4] https://movementdisorders.onlinelibrary.wiley.com/doi/10.100...

[5] https://cp.neurology.org/content/11/5/e686

[6] https://adc.bmj.com/content/106/5/420