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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

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
      [deleted]
    - haberman 11y ago
      It's dismissive if the cause is not actually anxiety. Your entire argument only works if you accept the premise that this condition stems from anxiety alone. Since you have accepted this with what appears to be near certainty, then of course the rest of your argument makes sense to you, and your diagnosis of anxiety probably feels compassionate and sensitive. To a person who does not share your confidence that anxiety is the only factor in play here, your dismissal of other possible factors is crazy-making. Just acknowledging that there might be a factor here we don't fully understand would be enough. It's fine if anxiety is the best diagnosis and treatment plan given what we know right now. But the certainty that it's the entire story is off-putting. You said yourself that depression/anxiety for physical symptoms are "diagnoses of exclusion, coming long after everything else has been exhausted." They are a fallback when you don't have another explanation. So why do you present a fallback diagnosis with certainty?
  - cpncrunch 11y ago
    >If someone is experiencing a physical symptom and you tell them it's not actually physical, that is dismissing it Nobody is saying that at all. The physical causes should be investigated, obviously. Suggesting to the patient that it might be psychological is not "dismissing" anything. Of course, it is true that most patients are vehemently opposed to the idea of psychosomatic pain, as well as many/most doctors. John Sarno's books are a fascinating read. In this case there doesn't appear to be any pain, or physical sensation at all. You can't sense a "hole", any more than you can sense inflammation or the like.
msandford 11y ago
The whole "lived experience" folks are often overly self-important when they suggest that no-one can ever understand another person unless they literally are that other person because lived experience is the only thing that counts. But there's some truth to that idea, just because you think you know what's happening to another person doesn't mean you actually do.
ghufran_syed 11y ago
"dismiss"..."nothing but anxiety": Your question seems to imply that a psychological etiology is somehow less important than a physical etiology. Wouldn't the most important thing be developing a standard reproducible diagnostic criteria, then working on preventing or curing the problem? The parent comment seems to me to be a well-reasoned, nuanced description of the difficulties of dealing with this clinical scenario, and doesn't impose any value judgements regarding the 'intrinsic worth' of a medical symptom or etiology.
YeGoblynQueenne 11y ago
>> 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? By all fairness if you haven't had turbinate reduction it's going to be very hard to think you're suffering from a condition that is said to be caused by turbinate reduction.
- haberman 11y ago
  > By all fairness if you haven't had turbinate reduction it's going to be very hard to think you're suffering from a condition that is said to be caused by turbinate reduction. In all fairness, did you read the article? The patient suffered the symptoms first (before ever hearing of the syndrome), then went looking for an explanation, then found a syndrome exactly matching his symptoms linked to turbinate reduction, thought that was weird because he didn't think he'd had that, and only then saw "turbinate reduction" in the records from his surgery.
  - k__ 11y ago
    On the other hand its a standard procedure performed on many people. And if anxiety after surgery is common, then there is a good chance he will find enough people on the internet that they will already have formed a theory about this. I had anxiety with panic attacks that had came with (for me) real physical (pain) experience for a few years. so I think that those people really need help, but not in the form of creating new disease-names for them. They need psychological treatment and maybe some physical 'placebo' treatment/surgery to cure them. I got cured by telling myself over and over everything is okay, which felt like lying to myself.
    - incongruity 11y ago
      Then why aren't we seeing a similar set of cases for other frequent surgeries that result in such debilitating pain as to drive people to suicide? I'm guessing we could look at appendectomies, gallbladder removals, wisdom tooth extractions, c-sections, etc - where are the similarly acute cases if it's purely anxiety unrelated to the specifics of the surgical procedure?
arkades 11y ago
First of all, because anxiety and depression are well known to manifest with physical symptoms. Which is why if you present with physical symptoms, anxiety and depression are diagnoses of exclusion, coming long after everything else has been exhausted. Notably, I didn't say they're /imaginary/ - just psychogenic. Anxiety is well known for significantly reducing the threshold for attention to stimulus: someone having an anxiety attack can feel things without somatic prompt, or they can feel something horrible with an underlying somatic prompt that, if they weren't having an anxiety attack, they'd never have even noticed. Generally people don't get brushed off as having mental disease. Although that's the popular narrative, again, (1) it's usually the last dx, and (2) even in these people's narratives, they go from physician to physician. Doctor after doctor looks at them and detects nothing. This doesn't mean nothing is there, of course, but mystery illness is rare and anxiety is very common. It would be bad medicine to overlook the prevalent condition that explains your symptoms. Second, post-surgical anxiety is quite common for a variety of conditions. I actually addressed it at the end of the post I suspect you didn't read. You presume this is somehow unique to turbinate reduction; that is an untrue assumption.
- haberman 11y ago
  > I actually addressed it at the end of the post I suspect you didn't read. Are all medical professionals (which I presume you are) this condescending, or just the ones on this thread? > Anxiety is well known for significantly reducing the threshold for attention to stimulus: someone having an anxiety attack can feel things without somatic prompt, or they can feel something horrible with an underlying somatic prompt that, if they weren't having an anxiety attack, they'd never have even noticed. Right. So how do you know that this isn't the result of a real physical stimulus that manifests primarily in anxious people because they are more sensitive to that stimulus? How do you know that anxiety/depression are the "underlying issue", and not merely something that surfaces/amplifies the true underlying issue?
  - Dylan16807 11y ago
    Everyone has slight physical discomforts. If it's being magnified tremendously, the magnifier is the problem.
Peradine 11y ago
> Would you similarly dismiss phantom pain and prescribe anti-depressants and CBT? Well, there is good evidence that both antidepressants and CBT work for phantom limb pain, so yes... Phantom Limb Pain: Mechanisms and Treatment Approaches, Subedi et. al., 2011

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
    [deleted]
  - haberman 11y ago
    It's dismissive if the cause is not actually anxiety. Your entire argument only works if you accept the premise that this condition stems from anxiety alone. Since you have accepted this with what appears to be near certainty, then of course the rest of your argument makes sense to you, and your diagnosis of anxiety probably feels compassionate and sensitive. To a person who does not share your confidence that anxiety is the only factor in play here, your dismissal of other possible factors is crazy-making. Just acknowledging that there might be a factor here we don't fully understand would be enough. It's fine if anxiety is the best diagnosis and treatment plan given what we know right now. But the certainty that it's the entire story is off-putting. You said yourself that depression/anxiety for physical symptoms are "diagnoses of exclusion, coming long after everything else has been exhausted." They are a fallback when you don't have another explanation. So why do you present a fallback diagnosis with certainty?
- cpncrunch 11y ago
  >If someone is experiencing a physical symptom and you tell them it's not actually physical, that is dismissing it Nobody is saying that at all. The physical causes should be investigated, obviously. Suggesting to the patient that it might be psychological is not "dismissing" anything. Of course, it is true that most patients are vehemently opposed to the idea of psychosomatic pain, as well as many/most doctors. John Sarno's books are a fascinating read. In this case there doesn't appear to be any pain, or physical sensation at all. You can't sense a "hole", any more than you can sense inflammation or the like.

msandford 11y ago

The whole "lived experience" folks are often overly self-important when they suggest that no-one can ever understand another person unless they literally are that other person because lived experience is the only thing that counts. But there's some truth to that idea, just because you think you know what's happening to another person doesn't mean you actually do.

ghufran_syed 11y ago

"dismiss"..."nothing but anxiety": Your question seems to imply that a psychological etiology is somehow less important than a physical etiology. Wouldn't the most important thing be developing a standard reproducible diagnostic criteria, then working on preventing or curing the problem? The parent comment seems to me to be a well-reasoned, nuanced description of the difficulties of dealing with this clinical scenario, and doesn't impose any value judgements regarding the 'intrinsic worth' of a medical symptom or etiology.

YeGoblynQueenne 11y ago

>> 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? By all fairness if you haven't had turbinate reduction it's going to be very hard to think you're suffering from a condition that is said to be caused by turbinate reduction.

haberman 11y ago
> By all fairness if you haven't had turbinate reduction it's going to be very hard to think you're suffering from a condition that is said to be caused by turbinate reduction. In all fairness, did you read the article? The patient suffered the symptoms first (before ever hearing of the syndrome), then went looking for an explanation, then found a syndrome exactly matching his symptoms linked to turbinate reduction, thought that was weird because he didn't think he'd had that, and only then saw "turbinate reduction" in the records from his surgery.
- k__ 11y ago
  On the other hand its a standard procedure performed on many people. And if anxiety after surgery is common, then there is a good chance he will find enough people on the internet that they will already have formed a theory about this. I had anxiety with panic attacks that had came with (for me) real physical (pain) experience for a few years. so I think that those people really need help, but not in the form of creating new disease-names for them. They need psychological treatment and maybe some physical 'placebo' treatment/surgery to cure them. I got cured by telling myself over and over everything is okay, which felt like lying to myself.
  - incongruity 11y ago
    Then why aren't we seeing a similar set of cases for other frequent surgeries that result in such debilitating pain as to drive people to suicide? I'm guessing we could look at appendectomies, gallbladder removals, wisdom tooth extractions, c-sections, etc - where are the similarly acute cases if it's purely anxiety unrelated to the specifics of the surgical procedure?

arkades 11y ago

First of all, because anxiety and depression are well known to manifest with physical symptoms. Which is why if you present with physical symptoms, anxiety and depression are diagnoses of exclusion, coming long after everything else has been exhausted. Notably, I didn't say they're /imaginary/ - just psychogenic. Anxiety is well known for significantly reducing the threshold for attention to stimulus: someone having an anxiety attack can feel things without somatic prompt, or they can feel something horrible with an underlying somatic prompt that, if they weren't having an anxiety attack, they'd never have even noticed. Generally people don't get brushed off as having mental disease. Although that's the popular narrative, again, (1) it's usually the last dx, and (2) even in these people's narratives, they go from physician to physician. Doctor after doctor looks at them and detects nothing. This doesn't mean nothing is there, of course, but mystery illness is rare and anxiety is very common. It would be bad medicine to overlook the prevalent condition that explains your symptoms. Second, post-surgical anxiety is quite common for a variety of conditions. I actually addressed it at the end of the post I suspect you didn't read. You presume this is somehow unique to turbinate reduction; that is an untrue assumption.

haberman 11y ago
> I actually addressed it at the end of the post I suspect you didn't read. Are all medical professionals (which I presume you are) this condescending, or just the ones on this thread? > Anxiety is well known for significantly reducing the threshold for attention to stimulus: someone having an anxiety attack can feel things without somatic prompt, or they can feel something horrible with an underlying somatic prompt that, if they weren't having an anxiety attack, they'd never have even noticed. Right. So how do you know that this isn't the result of a real physical stimulus that manifests primarily in anxious people because they are more sensitive to that stimulus? How do you know that anxiety/depression are the "underlying issue", and not merely something that surfaces/amplifies the true underlying issue?
- Dylan16807 11y ago
  Everyone has slight physical discomforts. If it's being magnified tremendously, the magnifier is the problem.

Peradine 11y ago

> Would you similarly dismiss phantom pain and prescribe anti-depressants and CBT? Well, there is good evidence that both antidepressants and CBT work for phantom limb pain, so yes... Phantom Limb Pain: Mechanisms and Treatment Approaches, Subedi et. al., 2011