New NYT article describes "functional disorder" - sounds like TMS!

Remember the news articles in late 2016 about the diplomats in Cuba that started having strange symptoms related to hearing things? Here's a really fascinating follow-up that addresses the symptoms as "psychogenic disorders", although a leading researcher (covered extensively in the article) hates that word, because (this is my take) of the same negative implications with the word "psychosomatic".

But anyways... clearly there are a lot of medical and neurological researchers out there who are studying the physical symptoms of what we here call TMS (in honor of Dr. Sarno). Here's the link to the NY Times article, and a few excerpts that I found particularly compelling, in case you're not sure you want to read it:
https://www.nytimes.com/interactive/2019/05/15/magazine/diplomat-disorder.html? (Was It an Invisible Attack on U.S. Diplomats, or Something Stranger?)

excerpts from "Was It an Invisible Attack on U.S. Diplomats, or Something Stranger" by Dan Hurley, New York Times, Mary 15, 2019:

***
Dozens of leading neurologists, psychiatrists and psychologists, meanwhile, have offered an alternative narrative: that the diplomats’ symptoms are primarily psychogenic — or “functional” — in nature. If true, it would mean that the symptoms were caused not by a secret high-tech weapon but by the same confluence of psychological and neurological processes — entirely subconscious yet remarkably powerful — underlying hypnosis and the placebo effect. They are disorders, in other words, not of the brain’s hardware but of its software; not of objective injuries to the brain’s structure but of chronic alterations to how the brain functions, typically following exposure to an illness, a physical injury or stress. And the fact that the State Department and doctors the government selected to treat the diplomats have dismissed this explanation out of hand does not surprise these experts. After all, they say, functional neurological disorders are among the most misunderstood, debilitating and denigrated ailments known to medicine.
***
“I wince when I hear the word ‘psychogenic,’ ” Stone told me during one of many Skype conversations. “It creates a false impression about what these disorders are. They’re like depression or migraine. They happen in that gray area where the mind and the brain intersect.”
***
...estimates that about 15 percent of patients seen by neurologists have a functional disorder. The most remarkable kind involve bizarre movement abnormalities that look, to the untrained eye, exactly like epilepsy, Parkinson’s, multiple sclerosis, blindness, coma or paralysis. Other times, they cause the sort of more mundane yet still debilitating symptoms seen in the diplomats.
***
“In particular,” the editorial stated, “persistent postural-perceptual dizziness (P.P.P.D.) is a syndrome characterized primarily by chronic symptoms of dizziness and perceived unsteadiness, often triggered by acute or chronic vestibular disease, neurological or medical illness or psychological distress.”
***
...Stone co-wrote a letter to the editor, endorsed by 38 prominent neurologists, psychologists and psychiatrists from around the world, which likewise argued for the diplomats’ illness being functional. “In many functional neurological disorders, initial sensory discomfort together with anxiety and heightened attention trigger maladaptive processes that lead to persistent symptoms,” ...
***
The experience is thought to be brought on, in part, by undue attention, fear and expectation. But these conscious processes are only part of the story; much more happens at the deep, neurological level where all our perceptions, feelings, movements and memories are encoded.
***
​

And I love this:

...
I asked Stone if he had ever treated a patient with P.P.P.D. “I had a lady today with P.P.P.D.,” he said. “This lady walked normally into my office. You wouldn’t think anything was wrong with her. But like most of these patients, they come in absolutely at their wits’ end, and they’re quite concerned you’re not going to believe them. What she was describing was a continuous feeling of movement, that things are swaying, which is just driving her nuts — not literally nuts, but it just wasn’t stopping.”
I asked him if she had an actual medical disorder causing her symptoms. “She does have something medical,” Stone answered, a note of exasperation in his voice. “She’s got a functional disorder.”
​

And so on. Lots of great stuff, and IMHO, this is TMS. These excerpts are only from the first half of the article. There's an amazing case study of a 21-year-old college athlete who over the course of a year became completely disabled and wheelchair-bound, but one week after arriving at a clinic for functional-movement disorders, walked out of the clinic as if nothing had ever happened. The clinic uses brain training, CBT, relaxation strategies, and mindfulness regarding self care. He was an extreme case - but the fact is, we do the same thing here in our two programs, folks.

Okay, one more excerpt, from the neurologist who runs the clinic mentioned above, which

...has drawn patients from across the United States. “There’s a huge unmet need,” she told me. “More patients have these disorders than have multiple sclerosis. Everyone has heard of multiple sclerosis. There is an M.S. treatment center in every large city. And yet here we are with these functional disorders, which are more common, yet nobody has heard of it, and there are almost no treatment centers. It’s mind-boggling.”​

I highly recommend this.

~Jan

 

Hi Jan,

Thanks for this. Add "functional disorder" to the long list of other names for TMS variations.

This is just a classic! Count us in!

Of note in the article is that

-many people got the condition (suggestion) in this case
-the condition in other cases is often triggered by some trauma/injury which does not account for the intensity of symptoms observed
-the symptoms in this case got worse in time--no doubt with many diagnoses and/or treatments
-there was a lot of fear around the symptoms, in this case not only the symptoms, but the unknown cause and unknown treatment

This list sounds like TMS experience.

Then there is the fact that many experts think crickets caused the "attack." So here is your possible source of initial "trauma," or triggering event: weird sounds which feel comfortable.

https://www.nytimes.com/2019/01/04/science/sonic-attack-cuba-crickets.html (The Sounds That Haunted U.S. Diplomats in Cuba? Lovelorn Crickets, Scientists Say)

Andy B

 

I live in the South. We have a rotating schedule of cicada outbreaks on a 17 year cycle and a 13 year cycle. I have heard cicada's many times before, but when the outbreak year happens it was like something from a movie Foley artist. Non-stop, overlapping cicada calls from near and far blend into one continuous, 24 hour a day symphony. I personally thought it reminded me of that UFO sound you hear in your head right before you pass out on nitrous oxide. It sounded a lot like the cricket sound in the embassy IF you ran it through a phase shifter or a flanger.
When it happened some people said it kept them up all night and was driving them crazy. There is No way to escape it, except maybe in a skyscraper (and we don't have many of those) or some sealed basement.
Regardless, I found it hypnotic and fell asleep to their screechy, modulated mating call. Just remembering it makes me drowsy.

I can totally see it having an effect on people but I think the spy vs spy anxiety on top of the weird noise probably made for some collective Nocebo. On top of that we live in a WebMD culture now, where everybody has super rare allergies and sensitivities and of course the connected diagnoses....such special delicate little snowflakes we have all become! Knowing I have a TMS personality, whenever I see a new person posting with some new weird named diagnosis I can't read it lest my mind wander down dark paths of the NOceBo monster.

Good Post!

 

Hi Jan,

I wonder if you saw the article in today's Seattle Times about Walmart's effort to reduce unnecessary surgeries for its employees. It reports that "about half of the company's workers who went to the Mayo Clinic and other specialized hospitals for back surgery in the past few years turned out not to need those operations. They were either misdiagnosed by their doctors or needed only nonsurgical treatment." About half!

The main problem, says the article, was high error rates in diagnostic imaging, especially CT scans and MRIs. Walmart is trying for better diagnostic accuracy by incentivizing its employee's to go to top quality imaging centers even though they may be more expensive.

Unsurprisingly, the article does not mention improving nonsurgical treatment by focusing on the psychological component of persistent back pain. But at least wider recognition that the cause of back pain is so often misdiagnosed might be a step in the right direction.

 

Interesting, @Duggit! They should have sent those patients to Dr. Hanscom!

 

What I don't like about such articles is that they sometimes fail to see that there can be a simple solution - it's as if they enjoy discussing the complexity of the problem and they get lost in this complexity. Only learning about TMS provides people with a simple solution and an action plan that they can actually implement.