Wednesday, May 29, 2002

This is a disaster

Many of the patients we see have this disorder, and we have no idea what to do with it. We don't even know what it is! Neurologists take a close look, and, scratching their heads in bewilderment, send these patients off to psychiatrists, who, equally puzzled, send them right on back to the neurologists.
The head of my laboratory Mark Hallett makes an impassioned plea at this evening's dinner conference of neurologists specializing in movement disorders from NIH, Hopkins, and UMD. What group of strange disorders does Dr. Hallett speak of? He doesn't like to call them Psychogenic, and neither do other experts, but he doesn't seem to like to call them anything else. A patient comes in with the most bizarre of symptoms, precipitating often from even more mysterious and bizarre circumstances. The definitive unifying characteristic fo these disorders is one: patients' brain and nervous system show no sign of damage or degeneration
A woman walks in on her son hooking up with his girl and suddenly cannot walk properly: half of her body clenches us involuntarily whenever she takes a step making it quite difficutl for her to move about regularly. Every so often, yells "Ami" as uncontrollably as one might hiccup. Her speech patterns develop weird characteristics, like that of "baby talk." But when attention is diverted from her unsteady gait by, say, asking her to run, her uncontrollable movement disorders become subdued.
The stories and the symptoms of those who bear them are each quite unique--while some patients, especially after only having carried this illness with them for a short period, can be cured through some combination of physical therapy and psychological therapy, others that have suffered longer often cannot come out of it, cannot shed their disease.
For the elite experts in the field that had gathered to dine on white wine and rack of lamb, these patients present the huge gaping chasm between neurology and psychiatry. While most will when question acknowledge that these patients suffer from a serious illness that is often still untreatable, many remained mired in the great cartesian mind-body duality. If there is no brain damage, and the causes are "emotional" "mental" "cognitive" "psychological"
the disease loses some of its reality for these great doctor scientists
takes on a ludricrous, and even hillarious character.
these diseases are somehow not "organic"
like seth, even these neuroscientists are hesitant to let go of the idea that who we are can somehow be separated from what we are made of. That we
cannot reduce to chemicals
and that our identity resides in a separate world from the organic, the biological.
The merging of real "organic" disease and illness with psychological disorder and trauma is widely manifest and cannot be ignored simply because we know it is hiding in one of our most sensitive blind spots. Earlier in the evening, for example, a doctor presented her story of Huntingtons patients, a large portion of whom displayed obsessive compulsive behaviors beneath the more easily visible currents of physical degeneration and disease.
Despite head-scratching, incredulity, and nervous laughter, the concensus was unquestioned. Neuroscientists and psychologists must begin to learn
how to hold hands.