Pugnacious? Is he really quick to quarrel? ;) Sorry, couldn't resist.

Hopefully he's tenacious or veracious or both.

Maybe that's my problem... I've been willing my doctors to be more pugnacious rather than tenacious. My belief that the word means 'determined' is apparently overridden by all the characteristics that have driven me crazy at these doctor's appointments. Out with pugnacious, in with tenacious. Now let's have the planets realign....

That's what I meant when I said " it was just one other thing to mention and check off the list. "

There are no objective tests to diagnose many diseases, but they can still be ruled out and they can still be diagnosed by patient report, history, review of symptoms, etc. If Seshien was suffering from anxiety, she would probably feel anxious, and a trained professional would be able to discern that in a diagnostic interview. I've worked with many people who have come into ERs experiencing panic attacks, thinking they were having a heart attack, and they were relieved to find out they were experiencing anxiety. I've also dealt with anxiety in the past myself; it's debilitating and I would not wish it on anyone. To walk around with it untreated and undiagnosed is horrific.

It would be a disservice to anyone to leave it out of the list of possibilities when they are experiencing symptoms that could be anxiety and haven't been explained medically despite a thorough workup. It would also be a disservice to assign the diagnosis simply because no other can be found, which I was not remotely suggesting.

I'm not sure why this seems so offensive, except perhaps it touched people's bad experiences with doctors disregarding them. I know you've been through the ringer with the medical profession.

Anxiety and depression are as valid a diagnosis as any other medical diagnosis, even if this isn't the case for either of you. My reason for mentioning it briefly was that if they were by chance the root cause of these symptoms, it would be a relief to find that out and get proper treatment.

I thought the whole point here was to brainstorm possibilities and share experiences. I also suggested POTS/Dysautonomia as a possibility, and have suggested Lyme Disease to many people...but no one was offended. It feels like people are stigmatizing disorders that originate in our brain as not being valid.

As I said, it's another thing to bring up and check off the list. I never indicated it should be high on the list... not at all.

This is exactly what therapists go to school for years and years for. There is a huge difference between being "clinically depressed" and "situationally depressed." That is what therapists are skilled in discerning.

There is also a difference between "mourning a loved one" and "complicated bereavement." It depends how much your daily life is impaired by your depression, for how long, and to what extent. There is even a book of rules (called the DSM IV) that lists out the criteria for diagnosing people. I'm sure you've heard of it.

Tracy,

I highly recommend this book- http://www.oup.com/us/catalog/genera...=9780195313048

Also look at the proposed DSM-V criteria for functional neurological disorder.
http://www.dsm5.org/Lists/ProposedRe...Form.aspx?ID=8

This will possibly help you understand the dangerous black hole in the border of neurology and psychiatry that I was referring to.

I am not saying that anxiety or fear or depression or sadness should not be properly recognized or that patients suffering from them should not receive proper support. On the contrary, even if they are a completely normal reaction to a devastating illness they are still real and lead to suffering.

I honestly think that my situational depression is leading to clinical depression. It sucks being sick. I did not start out with a psychosomatic illness, but now I think that I am overly cautious and attribute problems that may or may not be real to my illness.

Basically, my neurological problem is making me crazy.

Tracy9

I think Alice md has hit the nail on the head. Labels like anxiety, functional disorder, depression, conversion disorder etc etc are, for many people, catastrophic. The medical profession dumps people into their "heart-sink" bucket with these labels and stops bothering to look any further. As you will see from many comments earlier in the thread, people are constantly misdiagnosed with these mental health labels (on the back of no evidence base, medical ignorance of how the the body works and highly questionable logic) when they actually have a physical disorder that doctors were too lazy, incompetent, unwilling, disinterested, or inexperienced to actually correctly diagnose.

There is so much that medics still simply do not know about how the brain and nervous system works. Neurologists have an extremely limited range of tests they can perform. It is only a few decades since multiple sclerosis was thought to be a hysterical mental disorder because at that stage there were no tests capable of picking up the physical changes in the brain. Once MRI came along, everything changed. Medical science still has a long way to go and it is undoubtedly the case that many people written off as having psychological problems will, in the future, be found to have physical diseases once new testing methods and better understanding comes along.

Once a psychiatric or psychological label has been applied, it becomes extremely difficult to get any further investigation, help or treatment for physical symptoms. Not only that, any new symptoms or future health issues are also too often conveniently put down to the psychological cause instead of effort going into properly ruling out physical causes. For high proportions of such people, no psychological therapies have any effect whatsoever - the doctors then simply blame the patients for this lack of any progress. It's crazy and there is no logical or evidence base for this opinion but nevertheless they get away with it. Doctors dismiss patients and simply don't believe them. This may be unpalatable but it is the real experience of countless people.

Many people don't share your confidence in the years of training that therapists have had. So many of us have had experience of truly hopeless and incompetetent mental health practitioners of all sorts, psychiatrists, psychologists and so on. Years of training or practice don't give any assurances of quality or ability, sadly.

I am not trying to undermine mental health conditions as less important than physical ones or to suggest that doctors shouldn't test patients properly for psychiatric or psychological causes of their symptoms. I have suffered with reactive depression for over 5 years (caused by the life changing consequences of coping with my diagnosis of an incurable physical condition) and its truly, truly awful. However, in this blurred area where neuro meets psychiatry, proposing anxiety as a cause of someones symptoms is a bit like a red rag to a bull for these reasons, especially for someone who is struggling to be believed.

I agree with you all completely. As a therapist, I honestly never believed in conversion disorder and every time I got a patient sent to me with that diagnosis from an MD I simply tried to help them dig further for a medical cause. My training is that you rule out a medical cause first for everything. Also, having Chronic Lyme disease, which is called The Great Imitator and consists of numerous non specific symptoms, I am very accustomed to the whole "it's all in your head" mentality and rebuke that wholeheartedly.

The closest I've ever seen to what I refuse to call "conversion disorder" would be a couple of kids/teens with choking problems that were not medically based, but anxiety related. I diagnosed them with anxiety, not conversion disorder.

I know that most therapists/clinicians are much more likely to assign a pathological root to everything than I am. I preferred (when I was working) to look at environment, stressors, etc; not pathology until every other option was ruled out. I'd like to think all mental health professionals were well trained and appropriately skilled, but there are more screwballs and crackpots in this field than any other, in my experience!

Tracy,

One of the problems is that biological systems are much more complex than our understanding. This is why there is still place for research and finding more answers to numerous questions.

With the growing knowledge and understanding of biological systems there have been numerous paradigm shifts and it is naive to think that there are not going to be many more in years to come.

I once read an excellent historical review regarding myasthenia gravis. What amazed me most was the following paragraph:

Despite this understanding of the limitations (and also strengths) of science and medicine, he goes on as if we are now at the time of ultimate enlightenment in the understanding of MG.

This was written in 2003, there is no mentioning of MuSK, there is no mentioning of possible mechanisms leading to myasthenia which are not due to abnormalities of the AchR itself. (Despite growing evidence, this is suprisingly still controversial in the MG community and the SFEMG is still seen as the gold standard by many). There is very little mention of open questions in the understanding and management of MG.

In fact he writes that

Obviously, this is correct if you take out all those patients with normal tests that don't fit the accepted paradigm of MG, all those patients who continue to have myasthenic-like symptoms of fatigue despite being in full remission, all those patients who fail to respond to effective treatments because they are not "positive" enough.

This near-sited view of a leading expert in the field of myasthenia-A very smart and knowledgeable physician, is the best example for why this approach is so problematic.

How can you rule out a disease which has not been described yet?

For instance, how could you rule out MuSK MG in 1998, when it was only discovered in 2000?