Monday, April 2, 2012

You're faking

Earlier this year, 18 people living in LeRoy, NY developed a strange set of symptoms:  uncontrollable jerky movements, non-epileptic seizures and unpredictable hums and grunts.  A girl on the cheerleading squad was the first to display symptoms, which then 'spread' to her friends and other cheerleaders, then to different  high school girls and even to a 36 year old woman and a boy.

The top diagnosis called this development a combination of conversion disorder and mass psychogenic illness.  This diagnosis suggests the patients' symptoms were physical manifestations of stress and that these symptoms were subconsciously adopted by people close to the original patients.

The first girls to develop symptoms were certainly close, they were best friends and teammates on the cheerleading squad.  The were also good students and active teenagers under one stress or another; however, they believe that their stress-level at the time their symptoms developed was no higher than it had been in the past.  They were fully supported by their parents, who believed something must be causing their daughters' disorder. 

The trouble with this is that the diagnosis never implied that the disorder was prompted by nothing.  It suggested that the disorder developed from stress in one or a few patients, then the symptoms were subconsciously picked up by other people.  The spreading of this disorder exemplified a psychological pattern of transmission, which is more abstract and difficult to understand than, say, a bacterial infection.

Patients, parents and bystanders in LeRoy and elsewhere took this psychological diagnosis as a fancy way of saying the girls were faking, which is both a false interpretation and an all too common response to psychological issues. 

Psychological disorders are constantly fighting this 'fake' stereotype.  It may come from working on the most complex organ in the human body, or trying to make biological sense of processes that are invisible, or collecting knowledge from the very non-scientific method of case studies, or being associated with patients (and even scientists) that are 'crazy'.  In fact just using the word 'psychological' or 'mental' or 'crazy' evokes images of wide-eyed, wild-haired people babbling nonsensically to themselves, which in turn perpetuates this unjust stereotype.  But psychological disorders are as real as a broken bones and should be treated with a fair amount of attention. 

Based on the 'falseness' of the diagnosis, about half of the patients in LeRoy are taking antibiotics for a rare neurological disease associated with the bacterium Streptococcus.  Although the vast majority of physicians do not believe this disease would produce the given symptoms or affect 18 people, the antibiotics appear to be helping these patients.  Another group of the patients has been undergoing cognitive behavioral therapy, counseling and taking antidepressants, which also appears to help.  A comparison of the success of these different approaches makes it difficult to say which is due to a placebo effect and which is due to a treatment of the problem.  In my opinion, either one is good news.  The placebo effect can be extremely strong and beneficial to people and provides good evidence for the power the brain can have over the body.  In this case, it could be exactly what the girls need to balance whatever imbalance occurred in their brains.  If instead they are being treated by an effective antibiotic, regression of their disorder shows the progress scientists have made in treating neurological illnesses. 

Although psychological disorders seem both foreign and frustrating, we must approach them openly.  Science has discovered many 'whys' and 'hows' over the years and we must be confident that it will continue to do so. 

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