It’s NOT all in Your Head

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The life journey which led to writing this began in 1996, when my spouse went through an excruciating series of root canals. She was in pain for weeks. Two years later, the pain came back to stay. Anti-inflammatory medication didn’t touch the agony she experienced on the side of her face opposite the root canal work (and later at different times on both sides). Not even opioid medications did much for her.

Over a period of a year, she was seen by a dentist, a maxillo-facial surgeon, an ear nose and throat specialist, a general practitioner and two neurologists. The last of these physicians heard her medical history and said “I think you have Trigeminal Neuralgia, but I don’t often see it or treat it. I’m going to prescribe an anti-seizure medicine for you which often helps. For more information, you need to contact the US Trigeminal Neuralgia Association.”

That was it: take these pills and talk to other patients who have your kind of pain.

I have since discovered that this sort of response is not uncommon for patients who have relatively rare or subtle medical disorders. There are over 3,000 such disorders, and others seem to be emerging all the time. Many medical doctors hate chronic medical problems which soak up their time and resources but which don’t get better. This may be particularly true of chronic pain conditions, and is even more broadly true of the medical issues of women.

Over 100 million people in the US suffer from chronic pain – defined as pain lasting longer than 12 weeks. Up to 80% of those sufferers are women, many of whom report having been repeatedly brushed off or referred out by medical doctors who could find no discrete medical cause for the symptoms they reported. Some patients report an even harsher finding by their doctors: “To the best of my ability to determine, your pain is not medical in origin. I believe you need to be evaluated by a psychiatrist or psychologist who is qualified in psychosomatic issues.”

[The quote is exact, from a patient who understandably wishes to remain anonymous]

My response to my wife’s pain was to make myself a layman expert on the subject. As an operations research analyst, I had taught market research and open source intelligence methods to professionals and librarians in those fields. Thus it was natural for me to turn to the Internet. In 1996, there were fewer than 4,000 “hits” on the term “Trigeminal Neuralgia” in Internet search engines. I read quite a few of them. In the Fall of 2013, there are 1.4 million hits. I’d like to think I’ve contributed to that growth of visibility, though it is surprising how often I continue to encounter pain patients who first hear the term from a neighbor, friend, or nurse, rather than from a doctor.

In the volunteer work that I do with pain patients these days, I’ve taken time to ask them about their experiences with medical doctors who referred them for mental health evaluation for symptoms that the doctor couldn’t put a disease name to. In an alarming number of cases, females among this population are written off as “hysterical” — a common rejection or shunning that is quite well established as an issue in both lay and professional literature. The same kinds of referral also occur with men, but significantly less often. For many patients, a better course of treatment emerges later with a different doctor who finally recognizes what is going on after several others have missed the diagnosis. For some, the light never appears at the end of the tunnel. Suicide is a real risk among those who have been told “it’s all in your head.”

The term “hysteria” casts a long shadow over issues of chronic pain. The contemporary roots of the term go back to a French neurologist named Charcot and to one of his students, Sigmund Freud. In my studied opinion, Freud’s theory of “female hysteria” is one of the most widely accepted mythologies ever invented out of thin air and academic surmise. Professionals who regard themselves as learned have invented an entire field of psychological practice around the term. We call that field psychosomatic medicine, and politely ignore the reality that its practitioners are rarely able to help their patients get better in any consistent way.

I am not one of those who claims that there is no relationship between our emotions and our physical health. There is ample evidence in medical and lay literature to the contrary. What I do claim, however, is that the preponderance of evidence shows that physical sickness or prolonged pain cause us to be depressed and anxious, particularly when no cause or effective treatment can be found for medical problems. Depression can wear us down physically by depleting our energy reserves. But in my view, depression does not cause our pain, even if it plays into or amplifies pain of medical origins.

There is no such thing as “psychogenic” pain. PERIOD!

I also agree that sensitivity to pain can sometimes be managed or moderated by resort to methods from the mental health toolbox: rational cognitive therapy, creative visualization techniques, stress control, meditation, the Yogas, moderate physical exercise to promote endorphins, and (perhaps) dietary changes. At least one class of psychoactive medications can also play a positive role in some forms of pain. The Tri-Cyclic Antidepressant (TCA) drugs are known to have a cross-over effect against pain of neuropathic origin, even at doses below those believed to be therapeutic for depression itself.

My message to medical and mental health clients is “It’s not all in your head.”

Footnote: My spouse has proven to be one of the lucky ones who respond positively to anti-seizure medications with minimal side effects. She has managed her pain and lived a full professional, social and family life for the past 16 years. Many chronic pain patients are not as fortunate.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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37 COMMENTS

  1. “There is no such thing as “psychogenic” pain. PERIOD!”

    Thanks for discussing these things. I absolutely agree. Our whole society needs to be more respectful of pain that we cannot see. Even if we do not have medical solutions, respect would go a long way towards not making things worse.

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  2. I had been in a terrible auto accident and when my source of pain was ongoing I was referred to a psychiatrist (soft tissue damage and severe whiplash weren’t “believed” back then). The downhill drugging began.

    The original problem was pain and I ended up being told I was permanently mentally ill and later told I’d never been mentally ill?? Makes no sense.

    Later when I was suffering from a progressive neuro-muscular disease I was told (the aha moment) this too was not real and the disease progressed till a neurologist diagnosed me. This makes no sense either?

    There has been quite a lot of research and study into pain and its consequences but with females being repeatedly told what they are suffering is not real what are we to do? Many of us are not well enough to keep fighting.I do believe the majority of doctors are frightened by chronic pain and without proper training do an auto pilot referral to psychiatrists.

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    • Aria, I agree that general practitioners and even some neurologists are inadequately trained in the management or cure of chronic pain conditions. I also agree that women are disproportionately affected by this deficiency, which seems to have led many mainstream medical practitioners to write off their “difficult” female patients as hysterics. I am actively working to challenge these patterns and to recommend appropriate assertiveness training to patients who encounter casual dismissal of their reports of chronic pain from their physicians.

      Watch this space for further articles. I’ll try to get back every few weeks, around the edges of providing real-time online assistance to almost 5,000 chronic face pain patients in 117 countries.

      Regards and best,
      Red Lawhern, Ph.D.
      Resident Research Analyst
      Living With TN: http://www.livingwithtn.org

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  3. Amazing article, and not one I expected to read here. This was the source of my second bout with pharmaceutical damage. I suffered a dental injury that led to excruciating pain, and after several months of not ever being diagnosed with anything (and getting lots of weird looks from doctors) I finally got the “trigeminal neuralgia” DX. The neurosurgeon who gave it, however, did consider the possibility that it was injury induced and at least atypical TN. I do NOT handle pharmaceuticals well, and suffered an interaction that almost killed me. However, I survived and the injury (or whatever it was!) healed, never to return. Which is great, because half my face was paralyzed and the muscles were visibly drooping. I was obviously a mess, and found it shocking, while being unable to even smile, that many (even doctors) acted as if I was being simply trouble (until I got to my neurosurgeon).

    I’m just shocked to see such a familiar story here! Whenever I discuss damage I’ve suffered from medications, I’m always asked why I was ever on them, and this was the reason. It was facial pain following another chronic pain condition that is, at this point, barely background noise to me. But few people even know about TN, and those who do assume it’s never to do with injury and cannot ever heal.

    I’m very glad your spouse’s is being managed well.

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    • Thank you for your good wishes, Menin,

      In the support work and online research that I do with chronic face pain patients, I see stories like yours fairly often. I find that a lot of physicians simply do not acknowledge that response to medications is highly individual and some people are clearly “hyper-sensitive” or outright allergic to a wide range of them. Several of the meds used to treat chronic trigeminal pain have been implicated in potentially lethal reactions by a few patients. So far, there are no FDA approved meds specifically targeted on the trigeminal system.

      In a case where traumatic injury is indicated, most specialists would probably attribute your face pain to neuropathy rather than to neuralgia. Neuropathy heals in some patients — and not in others. The tri-cyclic antidepressants seem to be one of the few classes of meds that work with neuropathy. But we don’t always know how to distinguish between who is a good candidate for medication against neuropathy and who isn’t. Likewise, follow-up and blood testing are needed periodically to ensure patient safety, and not a few doctors don’t seem to do this very well.

      In the more classic “spontaneous” emergence of classic TN with its volleys of electric-shock stabs, (as contrasted to constant burning, throbbing, achy pain in what is called “atypical” TN), the alternatives available presently tend to focus on off-label use of anti-seizure meds and anti-convulsants. Five different surgical procedures are available, each with their benefits, but each also carrying risks of horrid down-stream side effects if something goes wrong or if pain recurs after healing. Sometimes it’s a Hobson’s choice between them.

      For others concerned with chronic face pain issues, I would recommend the US National Institutes of Health fact sheet on trigeminal neuralgia as a place to start: http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/detail_trigeminal_neuralgia.htm In a spirit of fair disclosure, I re-wrote this fact sheet and negotiated with NINDS for over a year to get it approved.

      Go in Peace and Power
      Red

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      • Thank you for your reply, as well as for your work in this area. More awareness is definitely needed. I remember the neurosurgeon I ended up with telling me that many of his patients with TN (he had never considered neuropathy, apparently, but thank you for mentioning it, that was likely the case with me) “falsely attributed” the onset of the disease to a dental injury or procedure, but that the origins of the condition had nothing to do with it. I discounted this statement once I healed.

        If nothing else, the experience was horrible to even remember, so I just let it go. I had been put on too many medications, and simply not the type of person who tolerates tegretol well. Surgical procedures were mentioned, and one of the risks mentioned were permanent facial paralysis. I was only 34! Thankfully, it is now over. I’m just grateful that you’re doing this work, thank you again. To this day I know few people who can even conceive of facial nerve pain illnesses, and it remains largely ignored.

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        • In this blog, I will generally try to concentrate on issues of psychosomatic medicine as they impact pain patients and other medical patients. However, for Menim particularly, I can say in defense of doctors, that classic trigeminal neuralgia is so rare that many general practitioners never see a case in a 40 year career (estimated 12 new cases per hundred thousand per year is “in the noise” compared to mainstream illnesses like MS or heart disease).

          On the other side of this equation, however, it seems to be the case that dentists are generally very ill trained in the assessment of non-dental facial pain. In a demographic survey that I conducted among 1100 members of “Living With TN”, about a quarter attributed the beginning of their chronic facial pain to a dental procedure — almost always utterly disclaimed by the dentist. I is possible that some of these cases involved coincidental emergence of neurological pain that would eventually have occurred whether or not a root canal had been done. But we really have no way of knowing with precision.

          Regards, Red

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  4. Thank You for sharing. I am only 39 years old, and broke my jaw in 1999 and didn’t have any major pain until the year 2011. Found out I had TMJD (Temporomandibular Joint Disease) and Fibromyalgia. I finally found a good family Doctor and Specialist that work together to help manage pain without addictive drugs. I take Neurontin, and Cymbalta. I have to work VERY hard to manage my pain. Eating right, getting enough sleep, staying stress free, and exercise all help me. I thought of suicide when I had a Doctor tell me there was NOTHING wrong. Finally, I had an MRI and CAT Scan done when my new Doctor actually was listening to me. They found out, I have ZERO Meniscus in my Jaw Joints, rubbing bone on bone, and major bone loss in both jaw joints. Doctors need to listen to their patients. I was begging to not be on Muscle Relaxers or Pain Killers just FIND THE PROBLEM and let’s work on relieving symptoms. I love my Doctor of now 2 years. He cares about me as a PERSON. Pain is real, and even if you look okay on the outside, you may not be okay. I have a Handicap Permit, I don’t use it unless I have to, and the stares I get are awful. People shouldn’t judge.

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    • Yours is a story that I hear rather often from patients with fibromyalgia, Lupus, Psoriatric Arthritis, and various auto-immune diseases. Medical symptoms are rather often mis-diagnosed in the early stages, and written off by general practitioners as “somataform” issues (a fancy word for “I don’t know what you have, so you must either be shamming for attention, or have a mental disorder.” In some cases, the misdirections created by assignment of a psychosomatic diagnosis can be traced directly to the death of the patient from the actual but missed disease, or from suicide induced BY THE DOCTOR due to the depression caused by dismissal and marginalization of the patient. If it were up to me, the entire DSM category of psychosomatic disorders would be embargoed as invalid, unproven, and actively dangerous to patient welfare.

      Regards and best, Red

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  5. I’m glad I remembered this article. I have finally found a doctor who listened to me with my latest hip/pelvic injury after 3 months of being referred out and not treated while slowly becoming completely disabled. All the doctor I found could say was, “Why did they let this get this far?” My (former) trainer asked the same thing. I was in the hospital over Christmas, and for all the scans they did, I couldn’t get a single doctor to examine the fact that the right side of my pelvis has dropped by an entire inch following a pelvic joint injury. They scanned my brain for something neurological. They scanned my spine. They scanned for inflammation (after I’d received a huge steroid shot that tamped down inflammation) and then told me there was no “anatomical cause for” my pain and dysfunction. Now my new team is hoping it’s not too late, and it wouldn’t have been when I first sought treatment.

    All I could tell either my new doctor and my trainer when they keep asking how I was ignored for so long is that I’m a woman who was having referred pain and spasm from a joint in my pelvis, and that tends (apparently) to make doctors and PTs, especially male ones, to pass you along instead of bothering to diagnose. I’m beyond frustrated now and completely disabled. Thanks for letting me rant. I just hope they can do something at this point, but am less and less hopeful as the days go on.

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    • Menin, yours is a story that I hear entirely too often from women. It is well established in medical literature that proportionately more women than men will die from their first heart attack, because they have been ignored as “hysterical” by an examining doctor. Likewise, it is not uncommon for women to be labeled as “depressive” or “anxious” when they come to a general practitioner with complaints of breathing problems or chest pain. Anxiety can indeed be associated with these symptoms, but there is simply no excuse for a doctor refusing to do appropriate medical testing or imaging, to rule out physical disease.

      Early in 2013, an article in the Daily Mail, a UK newspaper, reported the sad story of Lisa Smirl, a female University professor. She was been written off this way by ” a string” of UK general practitioners. The woman died of lung cancer at age 37. I haven’t seen any evidence that the doctors have been disciplined, much less thrown into prison for voluntary manslaughter. But they should have been.

      See http://www.dailymail.co.uk/health/article-2290128/University-professor-37-dies-lung-cancer-doctors-dismissed-symptoms-anxiety-depression.html

      Regards and best, Red

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      • What a heartbreaking story! But believably egregious, really. Yes, those doctors should be punished, and severely.

        Listen, I even had to fire my therapist of 3 years for trying to chalk up an injury to psychosomatic illness. She knows my sensitivity and opinions of psych meds, yet she tried to talk me into going on meds. Psych meds for a hip injury. It didn’t go much better with other doctors. My father died within a year after being told he was just suffering from stress–after they missed the tumor on the MRI that was clearly visible to his oncologist 6 months later.

        It’s enough to make you want to privately hire doctors to read your scans and take control of diagnosing you, except that that’s already what we’re doing! Thanks again for letting me vent a bit.

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        • I should add one balancing precautionary note. Some few of the psycho-active medications do have a role to play in management of neuropathic pain such as can occur in a hip injury or any blunt trauma injury. The tri-cyclic antidepressant family (in low doses) has been demonstrated useful in managing neuropathic pain. It is felt by some researchers that the TCA’s reduce the sensitivity of a neurochemical “channel” which serves multiple functions in both acute pain and emotional affect involved in depression. That said, I would suggest that even the use of TCA meds should be carefully managed to assess the ongoing need and balance that need against untoward side effects.

          Keep on truckin’, Menim… I wish you wellness.
          Red

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  6. Dr. Lawhern, thank you so much for your messages of support. I pursued this relentlessly and finally found a doctor who would listen that this was not some chronic pain syndrome and checked me into a hospital to do tests until the issue was resolved. A new MRI (they missed this somehow the first time) showed a labral tear to the hip and a tear of the hamstring tendon. Unfortunately, in the 4 months since injury it has caused significant damage to the muscles in the area as well, but I’m now being gotten to the best surgeon possible within 3 days to be evaluated for surgery.

    I can’t even explain how traumatic it is to not be taken seriously for 4 months as some malingering female pain patient when I repeatedly told them how active I had been and that this happened suddenly. I had doctors who refused to even examine me “diagnose’ pelvic floor dysfunction, only to be told I don’t have this problem (which I knew I didn’t) from the specialists they sent me to. I swear, when this is over I”m writing a book. Hopefully they’ll start having me fixed up within the next few weeks.

    I just wanted to thank you. This has been hellish. I went from injured to disabled in 4 months of being ignored while having quite obvious injuries to the very area I went in saying were injured. Your article is absolutely required reading. Please keep on trucking yourself, and keep raising awareness.

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  7. Menim,

    I am continuing to work at keeping the issues of chronic pain and the many abuses of psychosomatic medicine in the public eye. So far, Mad In America hasn’t chosen to support an ongoing blog for me. But I posted the following commentary on the personal Blog of Dr David Healy in the UK. Healy describes himself as a psychiatrist, psycho-pharmacologist, and author of over 150 peer-reviewed professional articles.

    ==========Comment as published============

    May I add to the discussion of the mistreatment of mental disturbance with psycho-active medications? As important as the issue is, over-prescription is by no means the only failing of modern psychiatry.

    As a patient advocate and online community moderator, I frequently interact with people who are under medication for chronic pain conditions. It is amazing and disheartening how many of these people have been labeled as psychosomatic, and thus effectively denied further medical evaluation or treatment for rare conditions that have little to do with mental health.

    Some are told explicitly that their depression or anxiety have “caused” a psychogenic condition of pain, fatigue, or generalized debility. Prior to the May 2013 publication of the 5th edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, such patients might be diagnosed with “somatoform” disorders on grounds that they persistently presented with “unexplained medical symptoms (UMS)” that a doctor could trace to no known medical entity. The DSM-5 reversed that logic, proclaiming that any patient whose life is affected by prolonged “disproportionate concerns” for their medical condition can now be diagnosed with so-called Somatic Symptom Disorder — *whether or not* they have medically unexplained symptoms.

    Does anybody else detect a “Catch 22” in this disordered and illogical professional thinking by psychiatrists? You are anxious because six doctors have failed to find an explanation or treatment for pain which leaves you in a fetal ball on the floor several times a day. So now your anxiety becomes a mental health disorder? It’s your fault?

    By writing off “difficult” or “hysterical” patients as head cases, medical doctors and their psychiatric accessories are likely directly contributing to patient suicides. There is ample plausible evidence for this association in recent large-sample patient surveys. I offer this case in a paper titled “Psychogenic Pain and Iatrogenic Suicide”, published on the Global Summit for Diagnostic Alternatives of the Association for Humanistic Psychology. See http://dxsummit.org/archives/1002 .

    I believe it is time and past time that organizations like the APA and its non-US equivalents are sued for their complicity in massive patient harms. And legislators need to be held to account for taking political campaign contributions from pharmaceutical companies.

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    • The sad thing, in my case, is that I don’t suffer from depression or anxiety. I was just extremely anxious because my hip was inexorably giving out and I was losing the ability to do anything. Yet the soft tissue injuries are there, and once they’re missed on an MRI once it’s hard to get taken seriously.

      I can’t imagine how this must be for people going in to doctors with a psych diagnosis and a list of meds, though. They thought my pain was unexplainable and possibly in my head and I’m not on any meds at all. I got asked in the hospital if I suffered from anxiety. I never have, but told her very calmly that anyone who goes from being athletic to unable to walk without a doctor being able to explain why while also experiencing excruciating pain without becoming anxious likely does need a psych med. I don’t need a psych med, I need a malpractice attorney! (Though I wouldn’t say that to a doctor…lol)

      Thanks, I’ll check out that site. Isn’t Dr. Healy the one who runs Rxisk? I’m interested in what you do in terms of advocacy. Bless you as well, not many spouses would devote so much time to an illness as you have.

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      • I believe Rxisk is indeed run by Dr. Healy.

        There may also be something of value to you in the directions of advocacy, at “The Law Project for Psychiatric Rights” — http://psychrights.org/

        Increasing numbers of people are coming to see that many dimensions of psychiatry are misapplied — not only in medical cases like yours, but far more generally. The psychiatric establishment has refused to wake up and own up for their complicity in the vast over-medication of millions of people, and the forced medication of kids with psychoactive drugs that cause serious harm. The tendency of medical doctors to write off their harder cases as “head” cases is only one dimension within this overall context.

        I wish you well. Go talk with a lawyer. I think you may need one.

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  8. I thought I had successfully navigated unfriendly, uninformed waters to avoid the sort of physician who doesn’t believe in things such as fibromyalgia pain, who are audacious enough to state it’s psychosomatic, or who are just so jaded that they are apt to find any way to dismiss a patient they don’t know how to treat. I haven’t even turned 40 years old yet, but I’ve been dealing with chronic illness and doing the doctor dance for the past 15 years. And I just ran into my second physician with an abhorrent attitude towards me and my illness. A physican’s assistant stated to me, “It’s all in your head” and even tapped her head for emphasis, and refused to manage my pain. I was so shocked that I inadvertently stated in a flat tone, “That’s f-ing ridiculous.” However, I said the actual curse word.

    She refused to address my pain issue despite no history of drug dependency. And my regular doctor, who unfortunately wasn’t available, had normally and recently prescribed adequate pain relief for me. We had just decided to try an alternate medication which was not working and I wanted to go back to my original medication which did work, it was just only effective for 24 hours vs the 48-72 hours the manufacturer indicated. However, I had another medication I was able to use with it, so it wasn’t really an issue. I had just been reporting how it worked for me to my Dr. But when he said I should try something else, I figured I would be considered a bad patient for not trying what he suggested. And I had also figured if the alternate medication didn’t work, which it didn’t, I would be able to switch back to the original.

    I contacted a patient care advocate for assistance in the matter, as I didn’t feel I could wait the full month to see my regular Doctor. The advocate passed my email off to the practice director. I didn’t receive any response. I ended up having to wait the month for my appointment. When I showed up for my appointment, I found out I had been cancelled. The director wrote a letter stating as such the day before my appointment, but didn’t actually send it until one week after my appointment. The reason stated was because I had cursed at the staff member. Technically, I hadn’t cursed AT her, and regardless, that wasn’t anywhere in the rules or guidelines which I had signed when I first joined the clinic. And if it had been, the rule would have included maintaining a therapeutic relationship and professional conduct which the physician’s assistant clearly broke first and I was merely deflecting the attack which she initiated. It was a human reaction, and just an unfortunate choice of words, nothing more. Their response to cancel me was cruel punishment and is effectively pulling the plug on my life support and kicking me out of the door. I have chronic fatigue syndrome, fibromyalgia and chronic epstein-barr virus and they prescribe several of my maintenance medications for me. It’s criminally negligent to just drop me without enough time to be able to procure another doctor who is able to take over the prescriptions and manage my care.

    Then, when I attempted to find another physician, I set up for a representative to contact me to set up an appointment from a specialist, and I was called back only to be told that I needed was a referral by my doctor, even though their literature stated they only needed referrals if required by insurance. My insurance doesn’t require referrals. When I contacted my PCP, their office stated that I don’t get to decide which specialist I see, they decide, and they don’t want me to see a rheumatologist as I had chosen to see, they want me to see a pain management specialist again, and they only refer to one. So, I wouldn’t be able to call around to find whomever would be able to get me in quickly either. They said they would set up the appointment and then contact me. This was a week ago and I haven’t heard back and my medications will run out in less than two weeks. It seems as though nobody seems to care that I’ll be completely unable to care for myself again, not to mention how it will feel with the pain, fatigue, not sleeping, … But, it’s all in my head, so I should just get over it.

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  9. Alanamous—keep looking. Ignore any of these idiots who tell you its in your head. I am likely writing a book on this subject soon, as I have just (finally!!) had surgery to address my issues (the ones that were all “psychosomatic”, supposedly, despite happening in two distinct injuries). I had to have my hip repaired (torn labrum, FAI) along with a tendon and SEVEN torn core muscles.

    I’m also at a surgical institute rather far from home and everyone has the same story here. I heard from several more people today over there that it took them anywhere from 2 1/2 years, to 4 years to up to 8 or 10. YEARS. To get a diagnosis of something easily seen on an MRI. So, all things considered, I’m quite lucky that I only had to be physically disabled for 6 months. However, the things I heard from docs in that time period were so egregious as to warrant me calling every media outlet in my city and start writing about all of this. I was told I had gone into early menopause–suddenly, during a sports injury. That I was just aging. That my injuries were caused by “marital relations”. That it was in my head, asked what my psych diagnosis was and if I had a psychiatrist (it’s none and no). You know the routine.

    Then I get to a center specializing in the sports injuries and hip injuries I have, had new MRIs done, had surgery and am on the road back to full health. And surrounded by people who were all treated exactly like everyone on this thread has described–despite having injuries clearly seen on MRIs, many prior to even getting here.

    Saying it’s “all in your head” is medical speak for “I don’t know what’s causing the pain, and am therefore taking no time or interest in your problem, as it’s far easier to just refer you to a psychiatrist or gaslight you until you end up ignored into disability.

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  10. For all of those who have been mistreated (aka “abused”) by medical practitioners who have applied mythical diagnostic labels of psychosomatic disease, there is a book which you may wish to share with your physicians. Angela Kennedy is tough reading but necessary: “Authors of Our Own Misfortune? Problems with psychogenic explanations for physical illnesses”. I will shortly be submitting a review to Amazon on this important book. It utterly demolishes the imprecise terminology, circular reasoning, bias, and outright incompetence of practitioners of so-called “psychosomatic medicine”.

    Even if you find the prose difficult to get through on your own, you may find it appropriate to buy a copy and deliver it to practitioners who still pretend that there is any “science” beneath their specious claims of psychogenic or psychosomatic illness. There isn’t.

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  11. Dr. Lawhern, I sincerely thank you for this article. I was involuntarily detained in a psychiatric hospital and had an ongoing domestic violence situation I was in ignored by the police because a psychiatrist, who spoke to me for all of, maybe, twenty minutes, declared that a medical condition I had been previously diagnosed with did not exist and I was really just delusional. While hospitalized, I was forced to stop taking all medications and supplements that were prescribed to me or encouraged by my medical doctors, and coerced into taking antipsychotics. Within days, I became largely unable to walk, which the hospital staff appeared to believe was intentional on my part. My doctors were left completely out of any decision-making, and the psychiatrist on staff refused to speak to them, citing that it would “feed into my delusions.” The larger tragedy for me is that I now have to live with a very dangerous situation indefinitely, because as soon as the police heard the word “delusional,” any charges that would have been brought on my behalf against the individual who was repeatedly sexually assaulting me were not. Psychiatric opinion was deemed more reliable than medically-proven fact, even when a nurse who had administered a rape kit following one of these attacks informed the police that there was, in fact, physical evidence of sexual assault. I’ve written more of my story on a blog article called, “I Am Justina Pelletier,” at http://thesystemisbrokenblog.wordpress.com/2014/03/26/i-am-justina-pelletier/. Atrocities such as these have to stop.

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    • I believe that many people of good will already realize that psychiatric atrocities exist and must be stopped. The rub has always been “how to make it happen.” A few months ago, I posted a long article on DxSummit.org, the “Global Summit on Diagnostic Alternatives” of the Society for Humanistic Psychology. It was titled “Lead, Follow, or Get Out of the Way — A Layman Perspective on Change”. It may be read at http://dxsummit.org/archives/1290 . It is very telling that among the 120 or so subscribers to that worthy forum, the response to the article has been a crashing silence. It would seem that many of the professionals who regularly contribute to the site may be more interested in discussing change, than they are in developing any program to actually make change happen in real terms.

      Ultimately, I intuit that a large part of what needs to happen will likely be facilitated by lawyers rather than even the most informed psychiatrists and psychologists who have sold their books by the tens of thousands. Insurance companies are going to have to decide that it is potentially ruinously expensive to protect physicians who apply prevailing “standards” such as the DSM-5 without a scrap of evidence that the disorders being diagnosed are even real — much less that the treatments forced on patients are actually effective. Class action suits may be needed to make the point that the American Psychiatric Association is in effect if not in detailed purpose, a Racketeer Influenced and Corrupt Organization.

      I will read your blog posting in the coming week.

      Regards, Red

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  12. Regardless of diagnosis, recommendation, terminology, and/or any institution or organization which acts in an authoritative role acting as a service for the public, then any individual representing such an entity should not in any way take away another individual’s rights to freely make decisions about his/her body, mind and soul as long as those decisions do not interfere with, damage or harm the rights of another person. Yet so many people seem to think that they are more intelligent, more powerful, more responsible, and/or more deserving in some way to make decisions for other people. Other people can make recommendations, suggestions, advisements and such, however they are not executive guardians, masters, promulgators, or in any other way the administrators over anybody else’s life. And furthermore, those who feel as though the severity of consequences for not adhering to the guidance and/or decisions of their misguided attempts at control is a matter of life and potentially death that is the only part in which they are correct. However, their perception is off in that the matter is that whence somebody loses the right to their own life decisions, they have lost their own life. If a person doesn’t have a right to live their life and pursue their beliefs then there isn’t a value in living inside a shell of somebody else’s beliefs.

    And sadly, in the medical community, so many will choose the easiest explanation for them, that the patient is not what they claim to be, and instead of helping they pass the buck. It’s far more work to investigate, research, and figure out what is going on with a patient than it is to make a simple statement and pass them off to somebody else who will mistreat and abuse, and collect their paycheck at the end of the day and think nothing further of anybody whom they saw in their quest to pay their bills. But why would there be so many liars? Even if everybody were psychotic, or belligerent what reasoning do patients have for going to see physicians and wasting their time? Who wants to spend money and time going to see somebody who is going to ignore them, treat them like a liar and either try to put them on antidepressants or treat them like a druggie? Illicit drugs are much less expensive and it’s much easier/cheaper to get abused anywhere/everywhere else. Dr’s and attorneys have the biggest egos, but the smallest brains sometimes.

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  13. Richard and others,
    Here are some major pieces of the puzzle you are discussing . I’m coming from lived experience
    Google….. Paracelsus Klinic…. (yes with a K) just to see the approach of a most amazing place and the modalities they use.
    Also see….. yuenmethod.com……..Kam Yuen taught me his energy healing method which is very effective and is the best system for among other things relieving chronic pain or diagnosing health issues.
    Also google about Hal Huggins retired dentist and learn of his life saving dental protocols.
    Best Wishes,
    Fred

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  14. Thank you this well-written article. I wish your wife continued health.

    I was seen by two neurologists and told them that my face hurt all the time and I didn’t know why. After an MRI, I was given the diagnosis of Persistent Idiopathic Facial Pain; in other words, your face hurts all the time and we don’t know why. Frustrating, but at least they don’t treat my pain as imaginary, and have prescribed anti-seizure meds in an effort to control the pain. So things are slightly better, but I’d rather they continue to search for a cause instead of throwing drugs at me.

    But my worst case of medical ignorance was with my orthopedist, whom I was seeing after a slight motor vehicle accident. Part way through physical therapy for what he considered a trapezius injury, I started having more and more difficulty moving my left shoulder up and to the back. At my 2nd follow-up, I gave him this information and tried to demonstrate but was stopped. He said there was nothing wrong with my shoulder, just the trapezius, and he prescribed more PT. At my third follow-up, I again tried to tell him that I continued to have severe pain with my shoulder and the range of motion and decreased since the last exam. He told me that I was a “nice lady” but there was nothing wrong with my shoulder, and that it was just my fibromyalgia. Bull-pucky! A second opinion and MRI showed Adhesive Capsulitis – a frozen shoulder. If he had listed at the send exam, the focus of the PT could have been changed, potentially saving me from many additional weeks of PT.

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  15. I have read every word with hope and new determination. I am a Navy vet who has been in the VA health system since 2004. I was healthy for so many years but in 2008 I was diagnosed first with lichen slerosis and then six months later with squamous cell carcinoma of the vulva (pretty rare. especially at the time). I was turned down for VA care in MI (they used the fact that I had seen a non-VA gyn oncologist as an excuse) so used my Medicare to undergo the surgery at a non-VA hospital. I was given the “twilight sleep” and asked them to be very careful as I am VERY susceptible to medications of any kind. The anesthesiologist then said my doctor thought I would do better with the pain following surgery if they gave me an epidural! By the time I got to the OR the lights were already spinning and the next thing I knew I “came to” in the ICU, having flatlined when the general IV was administered. They called in cardiologist and did every sort of cardio test and discovered my heart is in great shape. (I am 74 yrs. old now). A week later I went back for surgery (removal of my vulva and clitoris) and spent the next few weeks w/ JP drains after removal os 22 lymph nodes. — I will get to the TN soon, I promise. I went 3 1/2 yrs. cancer free and we moved to FL, where my partner received a kidney in 2011 after being on the lists in MI and on dialysis for several years. Now we are going to retire and have fun, right?

    In 2012 I had a recurrence of my vulvar cancer and a GYN olcologist miraculously removed the cancer without damaging my urethra, which was inches away. I recovered and was just short of being cancer free when I discovered a lump in my groin. Outcome was a golf ball sized lymph node w/ cancer—–successfully removed but this time radiation was ordered. I had me annual mammo and was diagnosed with DCIS 2 wks. before I was to undergo radiation. I skipped a treatment to have a lumpectomy but it was unsuccessful. I opted for reincision but meantime the PET scan had shown an area in my liver/colon area so a colonoscopy was ordered (my second in 6 yrs.) I skipped another treatment for the procedure but was oversedated and it was aborted. My partner was told I “screamed out in pain”. The doctor ordered that I be injected w/ 250 mg. of Fentanyl in the IV to bring me back—also Flumazenil, Naloxone, and I guess initially Midazolam. I know nothing about these drugs but have learned that one is a strong narcotic when my records SHOULD my history w/ anesthetics, etc. I finished my radiation, was given general anesthetic in the OR for a colonsocopy (?????) where two polyps that could have become cancer were removed. I then had the second lumpectomy and ended up with a shrunken pitiful excuse for a breast and the “non-cancer” was only 1mm. from the chest wall so I opted for a mastectomy. Somewhere along the way I began having electric shock jolts on the left side of my face/head and I thought I was dying. They didn’t last long but were very scary. I told no one until recently my breast GYN oncologist whom trust so much (but who was not picked to do the surgery) saw I had had a CT scan of my brain and a chest x-ray and an echocardiagram at my request. He asked why I said I was confused, disoriented, etc. and I explained about the pain. He wrote on a small piece of paper Tic Delouroueaux and said he would be surprised if I wasn’t found to have this ailment—–worst pain in the world but there are drugs I could take to help. He said it is not life threatening however. I immediately went online and ended up on Living w/ TN which is how I received your most welcome missive. I questioned why anyone would take a pain medication when the pain lasted far shorter than the time it would take for any pain med to help. I have learned however that the “episodes” leave my totally fatiqued and I pretty much lose the day and sleep in my chair. The confusion seems to worsen too. I am wondering if instead of controlling the pain I should take the anti seizure meds? I can feel the spot where it starts behind my ear and also feel like my head is in a vice — I hold my head motionless and do nothing till it passes (thank God for retirement) as I read about surgery, etc. and you can clearly see why I just do not consider that an option with my history, unless it becomes way more frequent or more painful (don’t see how it CAN though.) I do water aerobics every day for my lymphadema as well as go for massage therapy and am almost back to normal except for one ankle /leg. I would appreciate any feedback you can spare me the time for. Thanks so much. Kay.

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  16. I am an RN and injured my back in 2008 lifting a patient with a doctor . Within a year, I developed right hip pain. I was soon sent to the pain clinic and given steroid injections in my back which helped my right hip pain. Relief lasted a year. I went back to pain clinic once the effects of the injections subsided. Last year 2014, I took my injection and it didn’t work at all. I was given gabapentin 300mg and it WORKED! I was so happy. I planned a vow renal ceremony, hosted our family reunion, worked as RN instructor and my regular nursing job in Palliative care. I worked out, etc. I had a breast reduction surgery in July and noticed in August the Gabapentin wasn’t working as well. I went to Kaiser PCP to ask for help. Referred to ortho. September I re injured my back lifting again. WORKED light duty. Right leg started dragging. October I noticed a limp. November, right leg and left leg off balance. Pain in right hip at night became more horrific. Went to ER because I was walking slow and very off balance. I did therapy and got a little relief. MRIs were essentially normal. Mild degenerative changes. CT scans normal, small pineal cyst. Lumbar puncture inconclusive, WBC RBC elevated, maybe a traumatic tap Multiple restrictive bands in CSF and serum. Stopped working because I can’t perform normal duties. Neurologist at Hospital seemed to think psychogenic although the psychologist did not agree in December..
    Workers comp MD also feels it is a medical issue. He mentioned ALS. EMG was negative. He still feels strong about this.
    Today I received a diagnosis of conversion disorder because everything else is normal.
    Still walking with a severe limp on right leg, unsteady gait. Pain in right hip is still aching at night. Some days worse than others. I literally feel like I have a stick going from the top of my buttock to my hamstring when I walk. . I have worked so hard and don’t feel it’s all in my head. Had such big plans for my life. I’m used to completing my goals. This is hindering my life.

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    • Larita, as I have heard from a few professional psychiatrists, there is ample reason to regard “Conversion Disorder” as a medical mythology rather than a valid medical entity. The DSM-5 has relabeled the set of symptoms as “Functional Neurological Symptom Disorder (Conversion Disorder)”. They might as well use a code that reads “I can’t figure out what medical problem she has, so she must be mental.”.

      Your case has parallels to quite a number of others I’ve heard about. This label was hung on you by doctors who basically didn’t know how to interpret the inconclusive results they got from testing. It may have been a means for their discharging you as a “problem patient”, thereby freeing up the time they would otherwise have needed to spend doing your workup from scratch with greater rigor and consults from other specialists (notably a rheumatologist familiar with auto-immune disorders).

      I would commend for your reading, Angela Kennedy’s book “Authors of Our Own Misfortune — Problems with Psychogenic Explanations for Physical Illnesses.” (mentioned in the thread above). I would also encourage you to request a peer review board at the practice where this label was hung on you, to have it removed from your medical records. The doctor who entered it there should be sanctioned for negligence and placed under supervision to ensure that he doesn’t do it to others.

      I wish you wellness.

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      • Thank you for responding. I was referred to an orthopedic spine specialist by my workers comp case mgr. This MD immediately diagnosed me with sacroiliac joint dysfunction. I see him again this week to try an injection directly in the joint. Afterwards, he will give me options(surgery, etc) I will be submitting these records once we are finished to my regular MD and request a peer review. Yes, I do want that conversion disorder dx removed from my records. I truly appreciate your advice.

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