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pspa123
672 Posts |
 Posted - 11/20/2012 : 19:54:52
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A decade or so ago, I was convinced I had an undiagnosed physical problem and was referred to Dr. Barsky. At the time, I very much resented his message that there was nothing wrong with me and that I was suffering the physical effects of psychiatric issues. With the passage of time, I now see he was very wise. Here is an abstract of his seminal 1999 article. It seems closely aligned with TMS theory, although one does not read about him (at least I have not) in the TMS literature.
Ann Intern Med. 1999 Jun 1;130(11):910-21.
Functional somatic syndromes.
Barsky AJ, Borus JF.
Source
Division of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Abstract
The term functional somatic syndrome has been applied to several related syndromes characterized more by symptoms, suffering, and disability than by consistently demonstrable tissue abnormality. These syndromes include multiple chemical sensitivity, the sick building syndrome, repetition stress injury, the side effects of silicone breast implants, the Gulf War syndrome, chronic whiplash, the chronic fatigue syndrome, the irritable bowel syndrome, and fibromyalgia. Patients with functional somatic syndromes have explicit and highly elaborated self-diagnoses, and their symptoms are often refractory to reassurance, explanation, and standard treatment of symptoms. They share similar phenomenologies, high rates of co-occurrence, similar epidemiologic characteristics, and higher-than-expected prevalences of psychiatric comorbidity. Although discrete pathophysiologic causes may ultimately be found in some patients with functional somatic syndromes, the suffering of these patients is exacerbated by a self-perpetuating, self-validating cycle in which common, endemic, somatic symptoms are incorrectly attributed to serious abnormality, reinforcing the patient's belief that he or she has a serious disease. Four psychosocial factors propel this cycle of symptom amplification: the belief that one has a serious disease; the expectation that one's condition is likely to worsen; the "sick role," including the effects of litigation and compensation; and the alarming portrayal of the condition as catastrophic and disabling. The climate surrounding functional somatic syndromes includes sensationalized media coverage, profound suspicion of medical expertise and physicians, the mobilization of parties with a vested self-interest in the status of functional somatic syndromes, litigation, and a clinical approach that overemphasizes the biomedical and ignores psychosocial factors. All of these influences exacerbate and perpetuate the somatic distress of patients with functional somatic syndromes, heighten their fears and pessimistic expectations, prolong their disability, and reinforce their sick role. A six-step strategy for helping patients with functional somatic syndromes is presented here.
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Peregrinus
250 Posts |
Posted - 11/20/2012 : 20:19:46
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PSPA123:
I think Sarno would find some fault with Barsky’s ideas at least as far as they are described in the abstract you provided. Barksy doesn’t seem to address the question of “Why?”. His analysis is syndrome-centric. Sarno’s approach is reflected by several of the contributors to this forum who urge participants to get more “psychological” and spend more time discussing their stress than discussing their physical symptoms.
I find his observation that patients have “profound suspicion of medical expertise and physicians” amusing since that tendency is shared by TMS believers.
Keep thinking healing thoughts!
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pspa123
672 Posts |
Posted - 11/20/2012 : 20:31:22
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http://www.psy.med.br/textos/somatizacao/somatic_syndromes.pdf
The full article. I believe Barsky's "why" is somatization disorder, the experience of psychological distress as physical symptoms. But perhaps I am misunderstanding or oversimplifying.
EDIT Actually here is what he says.
Overlap and Common Characteristics
Each functional somatic syndrome is seen in a
heterogeneous group of patients. In some patients,
symptoms are attributable to a known disease entity;
in others, they result from an unrecognized
disorder that may involve physiologic or immunologic
hyperreactivity and perceptual hypersensitivity.
Other patients have symptoms that are caused by a
psychiatric disorder, and still others have symptoms
that are best understood as a response to stressful
life circumstances. Our knowledge of the functional
somatic syndromes is incomplete, and we do not
fully understand the etiologic roles of biological,
psychological, and sociocultural factors in these syndromes.
Although complex, poorly understood, and
heterogeneous, the functional somatic syndromes
nonetheless have enough in common to justify our
discussing them together as variants of a common
biopsychosocial process. |
Edited by - pspa123 on 11/20/2012 20:35:04 |
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Peregrinus
250 Posts |
Posted - 11/20/2012 : 20:39:07
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PSPA123:
Thanks for the article: it looks interesting.
All the best! |
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pspa123
672 Posts |
Posted - 11/20/2012 : 20:51:39
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| The abstract really does not do justice to the full article, which I strongly recommend. |
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tennis tom
USA
4746 Posts |
Posted - 11/20/2012 : 20:54:59
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"...and a clinical approach that overemphasizes the biomedical and ignores psychosocial factors."
The above quote from Dr. Barsky, jumps out to me. TMS detractors often cite the lack of "clinical" evidence to prove the Good Doctor's theory. They are comparing apples to oranges, you can't put a humans's life experiences into a test-tube for examination. TMS detractors dismiss a lifetime of common sense, close observation and reason as not being "scientific".
Dr. Barsky seems very complementary to Dr. Sarno from what I've read here, thanks for the reference. |
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pspa123
672 Posts |
Posted - 11/21/2012 : 07:05:13
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This is a section from the article explaining that the belief that one is sick results in what Barsky calls "symptom amplification." See especially the highlighted sentence.
Bodily perception is an active, not passive, process.
Myriad somatic and visceral stimuli are constantly
filtered in the brain, and only a small fraction
reach conscious attention (109, 113–115). Our
suspicions about the causes of our sensations guide
this filtering and appraisal process: Sensations
thought to have pathologic significance are selected
for conscious attention and are amplified. The influence
of cognitive beliefs on somatic perception is
evident in studies showing that disease labeling results
in decreased psychological health and increased
absenteeism (116). For example, patients
who did not know that they were hypertensive show
a threefold increase in days of work missed after
diagnosis; this effect is independent of the antihypertensive
regimen (117). In a prospective study
of herpes zoster (118), the persistence of pain at
follow-up was predicted by the extent of the patient’s
conviction about the disease at inception.
Among patients with chest pain but not serious
coronary artery disease, the persistence of pain was
predicted by the patient’s earlier belief that he or
she was prone to serious heart disease (119). Similarly,
the persistence of fatigue after viral infection
has been associated with the patient’s belief in his
or her vulnerability to viruses and with the tendency
to ascribe ambiguous bodily symptoms to disease
(120). In two prospective studies of the chronic
fatigue syndrome (22, 23), the strength of the sufferers’
belief that their fatigue had a medical basis
predicted poor subsequent symptomatic outcome.
Finally, patients’ convictions that they had severe
lactose intolerance led them to misattribute various
benign abdominal symptoms to this disorder (67).
Beliefs about disease also bias recall of past
symptoms (121). In a comparison with uninjured
controls, patients with whiplash were found to underestimate
their preinjury history of neck symptoms
(62, 122). Compared with women who had less negative
views of menstrual distress, women who believed
that menstruation is a negative experience
recalled past menstrual periods as more symptomatic
than they had reported them to be when they
were experiencing them. The two groups of women
did not differ, however, in their recall of intermenstrual
symptoms (123). Similarly, informing healthy
volunteers in an experiment that they had just
tested positive for a disease caused them to recall
symptoms that were said to characterize that disease
and to recall more behaviors that were described as
risk factors for the disease (124).
Thus, the more convinced patients with functional
somatic syndromes are that their symptoms
are serious and pathologic, the more intense, prolonged, and disabling the symptoms become. Such
symptom amplification is fostered by physicians who
prematurely focus exclusively on medical explanations
for the symptoms, by alarming anecdotes in
the popular press and on the Internet, and by organized
campaigns to designate a particular syndrome
as a serious disease (24, 125, 126). |
Edited by - pspa123 on 11/21/2012 07:07:17 |
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pspa123
672 Posts |
Posted - 11/21/2012 : 07:44:35
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Another wonderful quote.
"Excessive medical
testing and treatment expose patients to iatrogenic
harm and amplify symptoms. Exclusive emphasis on
a search for structural abnormalities can distract
physicians from eliciting the patient’s beliefs, expectations,
and personal circumstances. Patients with
functional somatic syndromes can become so engrossed
in establishing the legitimacy of their condition,
so invested in discovering the cause of their
symptoms, and so preoccupied with assigning fault
and culpability that palliative treatment is made
more difficult or is forgone."
The last sentence seems particularly applicable to chronic fatigue syndrome, based on my unfortunate experience chasing that diagnosis and participating in various online communities. I don't mean to offend and I could be completely wrong in my new attitude, but I really wonder about some of those people pursuing more and more obscure tests and theories in a search for biomedical explanations, and pursuing more and more elaborate and intricate supplement regimes and diligently monitoring their responses to every pill they swallow. Does that really make sense? Are we that delicate that we won't function right without the perfect, precise supplement regime? |
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Peregrinus
250 Posts |
Posted - 11/21/2012 : 09:02:24
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PSPA123:
I’ve noticed that many people with back pain, carpal tunnel syndrome, fibromyalgia, etc. strongly identify with their affliction. It becomes who they are. They have a history, a set of beliefs, a mythology all related to their affliction. You can’t talk to someone like that for five minutes before they are telling what they have, how they acquired it, what they do about it, etc. This identity also provides them with a built in social life comprised of other sufferers, care givers, disability lawyers, homeopaths, chiropractors, and guys like us. This is why it is so difficult to convince people that their suffering may be psychogenic. To do so leaves them without an identity and the fear of aloneness.
Thanks for bringing Barsky’s paper to our attention.
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pspa123
672 Posts |
Posted - 11/21/2012 : 09:28:41
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Exactly. "We" and "us" and "our" are very common pronouns in the online support groups, as they search for the perfect lineup of supplements to counteract the obscure multi-systemic cellular level problem resulting in some amorphous "toxicity." Having been there myself, it is a very seductive way of thinking, for the reasons you mention.
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Wavy Soul
USA
779 Posts |
Posted - 11/21/2012 : 21:41:35
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Peregrinus:
YES! I think this is a very important and good point you make, about the forums and the loss of social support if you let go of identification with your illness.
I had phases where my docs were most of who I saw.
At the same time, although I agree that this identification with symptoms is a problem for those practicing TMS recovery, I just feel like both/and-ing it and saying that, from a compassionate point of view, these groups are not a bad thing, for many people.
In other words, we are not talking about the whole "negative secondary gains" thing here. That is not the theory of TMS. If it were, I would not be here. The unconscious feelings that express as symptoms (whether for distraction or expression) are not caused by some fiendish desire to have a support group, etc. as though sufferers are some kind of medical Facebook addicts.
The implication that this is so could be part of a kind of disapproving and judgmental thought-field that can make your life quite hellish if you are suffering from pain or other symptoms. In fact, if you don't know about TMS and if you don't have a VERY practical way to gain relief through this knowledge, then it's better to have a group of other sufferers to talk to than to be in the near-suicidal isolatton of a person with a mysterious disease.
Having had at least 20 years of being judged as though I was doing it for attention etc. (although in fact my symptoms caused me painful isolation and rejection more often than not), I actually wish I had had more of a support group, until the TMS thing arrived.
However, for those people who are ready for this work, those support forums can be really counterproductive, and now when I hear people having conversations at parties and colluding about their TMSy illneses, I cringe.
And... nothing is absolute, and we really can't know everyone's multiple contributing factors or what is right for others.
xx
Love is the answer, whatever the question |
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Peregrinus
250 Posts |
Posted - 11/22/2012 : 07:38:49
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Wavy Soul:
I see nothing wrong per se with forums, medical doctors, disability lawyers, etc. I agree with Sarno that “knowledge is power” and if these resources can provide that for you then all the better. However, I think that the cause of much TMS is having a false identity. A false identity leads to conflicts which challenge the identity. To defend that identity our body creates a distraction, i.e., TMS. The patients Barsky is discussing in his paper have adopted identities as the result of a process akin to mass hysteria. They will resist any effort that denies a physical cause for their affliction because the belief that there is something physically wrong with them is part of their identity. The fellowship they get from fellow sufferers and health workers complements that identity. It gives them a sense of belonging.
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pspa123
672 Posts |
Posted - 11/22/2012 : 09:16:44
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As a veteran of more than one of said forums, and someone who was obsessed with chronic fatigue syndrome for many years, I think the forums really are a mixed blessing. Yes, they provide comfort for people whose families and friends and doctors probably are sick of their complaining and don't support them. It can be very reassuring to be part of a group of people misunderstood by the world. "We" is a very powerful pronoun.
At the same time, hopefully without sounding patronizing, I think at least in the case of CFS the forums may lead people in the wrong direction, away from any examination of their lives and relationships and psychological issues that might be contributing to the way they feel, and towards the belief that they are the passive victims of some biological phenomenon causing them to be "toxic" or whatever other euphemisms they use to describe their condition. As far as I can tell, nothing has changed since Barsky's 1999 article in terms of discovering the "cause" of CFS. Theories and tests and diagnostic criteria come and go. There are viral theories, bacterial theories, heavy metal theories, neurotoxin theories, mitochondrial theories, methylation cycle theories, they go on and on. Indeed, one of the great gurus of the CFS community, Dr. Paul Cheney, seems to completely change his theory every two years or so, proclaiming the latest one with the same enthusiasm as he proclaimed the last (now presumably discarded) one. Honestly, it was Cheney's migrations that finally provided the impetus to me to reconsider my whole perspective, and to realize I was (forgive the cliche) barking up the wrong tree.
For the most part, supplements always are proposed as the answer. And so, people spend boatloads of money on drawers full of supplements, and seem to devote a tremendous amount of their time to monitoring their reactions to each supplement change. But do they get better?
I would imagine a similar phenomenon takes place on Lyme Disease forums, on fibromyalgia forums, and perhaps others.
Perhaps on balance they are in fact good for people, but for myself I can say that I allowed them to reinforce an incorrect belief system and I am glad I finally saw the light. |
Edited by - pspa123 on 11/22/2012 09:21:50 |
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Peregrinus
250 Posts |
Posted - 11/22/2012 : 19:04:44
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PSPA123 et al:
I read the Barsky-Borus paper but not the references. The paper is eight pages long and has over 200 references! Their “functional somatic syndrome” includes “multiple chemical sensitivity, the sick building syndrome, repetition stress injury, chronic whiplash, chronic Lyme disease, the side effects of silicone breast implants, candidiasis hypersensitivity, the Gulf War syndrome, food allergies, mitral valve prolapse, and hypoglycemia” . In addition they identify “chronic fatigue syndrome, fibromyalgia, and the irritablebowel syndrome” as potential FSS syndromes. They do not include back and neck pain, headaches, leg and buttock pain, or pain in the hands, knees and feet. In other words most of the conditions that Sarno mentions in his books are not included. The inference here is that these conditions have a potential physical cause. So even though back pain is epidemic as are all FSS syndromes, it does not qualify as FSS.
I was surprised they include hypoglycemia. I believe that it is under-diagnosed, prevalent in a majority of non-diabetics, misunderstood and one of the most costly conditions on the scene.
The Barsky-Borus approach to treating FSS includes determining if psychopathology is present. They mention major depression and panic disorders. They don’t mention (common) emotions such as anger, rage, abandonment, etc. They claim there is co-morbidity of psychiatric disorders and FSS but say it is not clear if the former causes the latter.
The paper is interesting and it is reassuring that some medical doctors recognize mob hysteria as the cause of a lot of costly physical problems. However, Barsky and Borus are not talking about TMS as defined by Sarno and others. This raises an interesting question: “Are they the same?”
Thanks again for letting us know about this paper. |
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pspa123
672 Posts |
Posted - 11/22/2012 : 20:15:12
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Peregrinus, pain in the neck, back, and the other places you mentioned are classic hallmarks of chronic fatigue syndrome and even more so fibromyalgia, so I don't think the gap is as big as you say between Sarno and Barsky. Also reptitive stress injury seems to me to be one of the classic TMS syndromes.
http://www.tmswiki.org/ppd/Repetitive_Strain_Injuries_-_RSI |
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Peregrinus
250 Posts |
Posted - 11/23/2012 : 05:39:32
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PSPA123:
CFS may imply back pain (I'll take your word for that) however back pain does not imply CFS. Some one with a fever doesn't necessarily have measles.
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pspa123
672 Posts |
Posted - 11/23/2012 : 08:15:40
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| I thought Sarno, Sopher et all considered CFS and fibromyalgia, among other things, to be TMS equivalents. |
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Peregrinus
250 Posts |
Posted - 11/23/2012 : 09:40:28
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PSPS123:
The definition Barsky and Borus provide for FSS and its described etiology are not consistent with Sarno's definition of TMS. On the other hand, in his books Sarno deals with chronic fatigue syndrome, fibromyalgia, and other such afflictions in a speculative manner. Sarno, Shubener and others have amassed considerable case files that support Sarno's treatment method for chronic back pain and so the thesis that chronic back pain is caused by emotional stress is, at least for me, unequivocally proven. Participants in this forum seem more than ready to label almost every disorder as TMS. It reminds me of chiropractors and acupuncturists who claim they can cure anything.
I might add that as a medical layman with no first hand experience I strongly suspect that CFS, FM, and other seemingly mass hysterical conditions are psychogenic but the case has not been made. The study of TMS is a work in progress. It is a phenomenon that to some is totally unbelievable. It requires solid proof.
I have been reading a book about the famine caused by Mao’s “Great Leap Forward” (1958-1961). About 40 million lost their lives, mostly from starvation or its immediate effects. There were many instances where all inhabitants of some villages started spouting gibberish and laughing uncontrollably for days. These people were undoubtedly under a lot of stress.
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pspa123
672 Posts |
Posted - 11/23/2012 : 17:52:38
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So true about chiropractors. I know of no other profession where so many practitioners claim expertise so beyond their training. Almost any time you come across on the internet some bizarre energy medicine or other quack modality, it's a chiropractor promoting it.
Here is a classic, the website of a chiropractor in my area.
http://www.doctorbonnie.net/
I went not that long ago to a seemingly legit chiropractor, the chiro for the Boston Red Sox in fact, and with a straight face he told me I should wear a titanium necklace to balance my energy fields. Ugh!!!
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Dr. Arthur Barsky Functional Somatic Syndromes
