Psychogenic illness–real and common

I learned much from a Neurologist/Psychiatrist (in those days it was a double board), Cliff Daneel, when I was a medical student.

He showed me how to test people for psychogenic symptoms by making them hyperventilate, for example.

He told me that in neurology much of the pathology seen is psychogenic, related to stress.

I get to stress indirectly, asking people how they are sleeping, if they find themselves anxious, looking for signs of mood and stress disorders.

Many problems that don’t fit Koch’s postulates for identifying a disease end up being syndromes, and nosology in medicine is often confronted with stress/anxiety/mood disorders that present as medical complaints that are the product of mind/body interaction.

Many illnesses that get labeled ‘syndromes’ are somatization problems.

My experience is that many times people are relieved to know that stress may be causing their problem.

Conversion disorders are defined as unconscious and usually involve some disability. Somatization disorders are merely stress being expressed in physical complaints, hypochondriasis is excessive or pathological awareness that results in worry and anxiety about one’s health, malingering and Munchausen’s are intentional deceptive complaints to achieve some secondary gain.

One of the most troublesome malingering or somatization problems is pseudo seizures. I take care of a jail and work as an emergency physician and see pseudo seizures a lot, but pseudo seizures are common in people who have real seizures.

Often the pseudo seizure patient get’s labeled and treated as a partial or complex seizure, or “spells” of apparent involuntary activity. Medicine is a challenging thing.

I teach the jailers to look for signs of fake seizures–one is that they aren’t unconscious and make purposeful movements, and another telling thing is that fakers do pelvic thrusting (kind of like the boogaloo) and that is not possible in a true grand mal seizure, which causes the back muscles to be in spasm.

Fake seizures are dancing, real generalized seizures are stiff then symmetric rhythmic arm flexing accompanied by tongue biting and salivation, breath holding and noisy breathing. Fake seizures are less violent disorganized asymmetric jerking.


2 responses to “Psychogenic illness–real and common

  1. luisadownunder

    It’s not easy. Over the years, various layers are added which completely trick the mind again… and again … and again.
    Which trick came first?
    But, I am learning a lot through this site.

  2. I am bothered by the need to label all illness. Somehow, putting a name like “Hurts Me Sydrome” makes the whole thing seem medical and legitimate. It’s not your fault them. However, if it was your emotions causing the symptoms, you could find a cure and be better. You would learn new ways to deal with life more successfully. I knew a doctor once who very honestly told a relative of mine “There’s no antidepressant out there that can fix your messed-up life. If you won’t confront the problem and act, you’ll be miserable.”

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s