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In fairness: the patient has typical anxiety and depressive symptoms, focused on a prior medical intervention, with fairly typical manifestations. It's the natu

by arkades 11y ago

In fairness: the patient has typical anxiety and depressive symptoms, focused on a prior medical intervention, with fairly typical manifestations. It's the nature of these sorts of conditions that they have enormous and interesting heterogeneity in particular focuses of obsession for the patients. It doesn't make his suffering, or the suffering of patients with similar ailments, any less real or traumatizing. Its effects aren't any less tragic. However, fundamentally, there isn't really a great model of care for people who won't or can't believe that their ailment is psychological and requires psychological treatment ("But he didn’t stick with them or the psychologist. He felt like no one was listening to him. His head wasn’t the problem — someone needed to fix his nose!")It doesn't help anyone to keep making up new diagnoses for every manifestation of depression and anxiety, just so people can feel "acknowledged" - and validated in not treating the underlying issue. So many of these emerging conditions ultimately show little response to their supposed underlying mechanisms, and normal responses (for depression and anxiety) to anti-depressants and cognitive behavioral therapy. (" He spent most of his time alone in his bedroom with a humidifier. After doctors treated him with cognitive therapy and an antidepressant, many of his symptoms cleared up.") Of more interest to me, personally, is the frequency of post-surgical anxiety. I've seen it in enough patients to know that it's not restricted to turbinate reductions, it doesn't always correlate to pre-existing mental health problems, and that it can often resolve when the surgery is "fixed" (e.g., removing lap-bands). This is a general phenomenon that receives little attention, causes a lot of suffering, and would help a lot of patients if we understood it better. Chasing down rabit-holes by pretending the anxiety is something /else/ doesn't help anyone.

haberman 11y ago
On what basis do you dismiss the physical sensations felt by these people as nothing but anxiety resulting from surgery? How do you explain the fact that this only appears to manifest when turbinates are reduced, and not as a result of any other surgical interventions on the nose? Would you similarly dismiss phantom pain and prescribe anti-depressants and CBT? https://en.wikipedia.org/wiki/Phantom_pain https://en.wikipedia.org/wiki/Phantom_pain
- cpncrunch 11y ago
  >On what basis do you dismiss the physical sensations felt by these people as nothing but anxiety resulting from surgery? The parent comment wasn't dismissing it. Quite the contrary. You, however, do seem to be dismissing it, by saying "nothing but anxiety". Anxiety is very real. >Would you similarly dismiss phantom pain and prescribe anti-depressants and CBT? Pain can quite often be caused/exacerbated by psychological factors. Perhaps you should google "central sensitization". The parts of the brain that registers pain (the insular cortex and ACC) are also responsible for attaching emotional feelings to pain. In some cases (e.g. fibromyalgia) the pain persists in the absence of any physical pain signal.
  - haberman 11y ago
    If someone is experiencing a physical symptom and you tell them it's not actually physical, that is dismissing it. If someone has whiplash from a car crash and you tell them the pain is just a result of their anxiety about the crash, that is dismissing their physical pain. Because the pain actually has a cause independent of their psychological state that you are declining to acknowledge or treat directly. More specifically, if the physical sensation is caused by something physical, then this is really quite dismissive (from grandparent): > there isn't really a great model of care for people who won't or can't believe that their ailment is psychological and requires psychological treatment Maybe it's your problem that you won't or can't believe that the ailment might not be psychological. > You, however, do seem to be dismissing it, by saying "nothing but anxiety". Anxiety is very real. I am not dismissing anxiety in the least. I know more about it than I would like to, and yes it is very real.
    - arkades 11y ago
      >If someone is experiencing a physical symptom and you tell them it's not actually physical, that is dismissing it. If you think diagnosing something as anxiety is the same as dismissing that person's experience and suffering and need for help, you're part of the problem.
      - deleted 11y ago
ScottBurson 11y ago
But how do you know the condition is psychogenic? You seem to have jumped to this conclusion based on your experience with other patients whose symptoms turned out to be psychogenic. Even granting that there's some similarity in the symptoms, I don't see how that provides strong evidence that this condition is also psychogenic. I'm not saying it's an unreasonable hypothesis, but how can one have enough confidence in it to abandon the search for organic causes? -- Particularly when, if there were an organic cause that therefore got overlooked, the cost to the patient would be very high.
- powera 11y ago
  If it walks like a duck, and it talks like a duck, and it responds to treatment like a duck, then it's a duck. Absolute proof isn't really necessary.
  - ScottBurson 11y ago
    If it really does respond to treatment, then fine. But though the article doesn't go into this, it's hard to imagine that the doctors who consider ENS to be probably psychogenic haven't attempted to treat it with antidepressants etc. If that had worked in all cases, Dr. Houser wouldn't have had to develop an implant to mimic the lost turbinate, and indeed, this article wouldn't have been written at all. So we have more than a little reason to think that ENS doesn't always respond to psychiatric treatment -- I'm sure there's more written about this if we cared to dig it up -- and proves resistant often enough to make at least a few doctors think there's something else going on. And then arkades waltzes in here and dismisses all of that.
    - powera 11y ago
      I couldn't possibly prove that ENS will always respond to psychiatric treatment, and it's an absurd thing to even ask for in an argument. There's certainly evidence it sometimes works. Beyond that, this is an obscure condition; this article may in fact be the most substantive thing ever written on it for a non-medical audience.
    - 11y ago
zyxley 11y ago
> However, fundamentally, there isn't really a great model of care for people who won't or can't believe that their ailment is psychological and requires psychological treatment To quote from the article: > “We detected a statistically significant central location in the nasal airway that swells in the CT scans of ENS patients, but not in any control patients,” Nayak says of the soon-to-be-published study. That doesn't sound psychological to me.
oschencloss 11y ago
> it can often resolve when the surgery is "fixed" (e.g., removing lap-bands) If the ailment is exclusively psychological, then presumably you believe this would hold even for a sham surgical intervention. E.g. you tell/convince the patient it's been removed but it's still there, and they get better. Is that the case? Otherwise it sounds like a mixture of physical and psychological, and you are being overly reductive.

by arkades 11y ago

haberman 11y ago

On what basis do you dismiss the physical sensations felt by these people as nothing but anxiety resulting from surgery? How do you explain the fact that this only appears to manifest when turbinates are reduced, and not as a result of any other surgical interventions on the nose? Would you similarly dismiss phantom pain and prescribe anti-depressants and CBT? https://en.wikipedia.org/wiki/Phantom_pain https://en.wikipedia.org/wiki/Phantom_pain

cpncrunch 11y ago
>On what basis do you dismiss the physical sensations felt by these people as nothing but anxiety resulting from surgery? The parent comment wasn't dismissing it. Quite the contrary. You, however, do seem to be dismissing it, by saying "nothing but anxiety". Anxiety is very real. >Would you similarly dismiss phantom pain and prescribe anti-depressants and CBT? Pain can quite often be caused/exacerbated by psychological factors. Perhaps you should google "central sensitization". The parts of the brain that registers pain (the insular cortex and ACC) are also responsible for attaching emotional feelings to pain. In some cases (e.g. fibromyalgia) the pain persists in the absence of any physical pain signal.
- haberman 11y ago
  If someone is experiencing a physical symptom and you tell them it's not actually physical, that is dismissing it. If someone has whiplash from a car crash and you tell them the pain is just a result of their anxiety about the crash, that is dismissing their physical pain. Because the pain actually has a cause independent of their psychological state that you are declining to acknowledge or treat directly. More specifically, if the physical sensation is caused by something physical, then this is really quite dismissive (from grandparent): > there isn't really a great model of care for people who won't or can't believe that their ailment is psychological and requires psychological treatment Maybe it's your problem that you won't or can't believe that the ailment might not be psychological. > You, however, do seem to be dismissing it, by saying "nothing but anxiety". Anxiety is very real. I am not dismissing anxiety in the least. I know more about it than I would like to, and yes it is very real.
  - arkades 11y ago
    >If someone is experiencing a physical symptom and you tell them it's not actually physical, that is dismissing it. If you think diagnosing something as anxiety is the same as dismissing that person's experience and suffering and need for help, you're part of the problem.
    - deleted 11y ago

ScottBurson 11y ago

But how do you know the condition is psychogenic? You seem to have jumped to this conclusion based on your experience with other patients whose symptoms turned out to be psychogenic. Even granting that there's some similarity in the symptoms, I don't see how that provides strong evidence that this condition is also psychogenic. I'm not saying it's an unreasonable hypothesis, but how can one have enough confidence in it to abandon the search for organic causes? -- Particularly when, if there were an organic cause that therefore got overlooked, the cost to the patient would be very high.

powera 11y ago
If it walks like a duck, and it talks like a duck, and it responds to treatment like a duck, then it's a duck. Absolute proof isn't really necessary.
- ScottBurson 11y ago
  If it really does respond to treatment, then fine. But though the article doesn't go into this, it's hard to imagine that the doctors who consider ENS to be probably psychogenic haven't attempted to treat it with antidepressants etc. If that had worked in all cases, Dr. Houser wouldn't have had to develop an implant to mimic the lost turbinate, and indeed, this article wouldn't have been written at all. So we have more than a little reason to think that ENS doesn't always respond to psychiatric treatment -- I'm sure there's more written about this if we cared to dig it up -- and proves resistant often enough to make at least a few doctors think there's something else going on. And then arkades waltzes in here and dismisses all of that.
  - powera 11y ago
    I couldn't possibly prove that ENS will always respond to psychiatric treatment, and it's an absurd thing to even ask for in an argument. There's certainly evidence it sometimes works. Beyond that, this is an obscure condition; this article may in fact be the most substantive thing ever written on it for a non-medical audience.
  - 11y ago

zyxley 11y ago

> However, fundamentally, there isn't really a great model of care for people who won't or can't believe that their ailment is psychological and requires psychological treatment To quote from the article: > “We detected a statistically significant central location in the nasal airway that swells in the CT scans of ENS patients, but not in any control patients,” Nayak says of the soon-to-be-published study. That doesn't sound psychological to me.

oschencloss 11y ago

> it can often resolve when the surgery is "fixed" (e.g., removing lap-bands) If the ailment is exclusively psychological, then presumably you believe this would hold even for a sham surgical intervention. E.g. you tell/convince the patient it's been removed but it's still there, and they get better. Is that the case? Otherwise it sounds like a mixture of physical and psychological, and you are being overly reductive.