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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

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.
  - arkades 10y ago
    1) Many people who have post-surgical anxiety do respond to treatment. You'll note that in the article being discussed, one of the other examples given was treated with CBT and anti-depressants and got better. The fact that the article pretty much built itself around the narrative of "people thought he was crazy. Then a doctor somewhere took him seriously, and it was real" does not mean the author of the article in any way did a sweeping education in psych and anxiety. 2) Anxiety is difficult to treat even in people who believe they have it and are committed to treatment; it's not meaningful to say "doctors who consider ENS to be probably psychogenic haven't attempted to treat it with antidepressants." The article itself leads with a number of ENTs saying it's psych and not seeing the patient - because he needed to go to see a psych, not an ENT, and he /refused/ to go. He eventually got brief treatment, and bailed, because he was never actually convinced it was anxiety. There was only one other example of a patient in the article who was treated for psych., and that patient's symptoms resolved. You're assuming that these patients get regularly treated for psych disorders, and that therefore the persistence of this meme indicates it's not psychogenic. That, despite the fact that many of these patients refuse to believe they have a psychological disorder, and thus refuse to seek or continue treatment for that disorder. You, in fact, make this assumption despite just having read an article that stated repeatedly that he had pre-existing and untreated anxiety; that he went to multiple ENTs and got told "it's psych" but avoided going to a psych for it; and when ultimately he admitted himself for psych care, he bailed after literally a couple of days because he was convinced the problem was his nose, not his mind. Somehow, despite literally reading an entire biography of "man with anxiety gets surgery, blames anxiety symptoms on surgery, avoids all psych care," you can still make an argument based on the assumption that these patients are getting adequate psych care, and thus we ought to rule it out. But, hey, no. Let's ignore the disease that has an 18% prevalence among US adults and accounts for all his symptoms, of which he has a history of even pre-dating the surgery, and instead suggest that it's some rare new disease that just happens to overlap completely with anxiety symptoms.
    - ScottBurson 10y ago
      > You're assuming that these patients get regularly treated for psych disorders, and that therefore the persistence of this meme indicates it's not psychogenic. You're overstating my position. I'm saying the question deserves further investigation. You seem to be claiming that it's settled.
- EdHominem 11y ago
  It seems wrong to even say the treatment works - of course it appears to when you drug someone's concerns away but it doesn't seem to change the underlying wrongness of the sensations. If I broke my leg I'm sure I'd appreciate an Ativan but I'd really need a splint.
  - powera 11y ago
    What is there to treat anyhow? There's a "suffocating sensation" but no claim of any actual trouble breathing.
    - DanBC 11y ago
      There appears to be considerable suffering that interferes with a persons day to day living.
      - powera 11y ago
        "Considerable suffering" that can be treated by anti-depressants or anti-anxiety drugs, at least in some cases.
        EdHominem 11y ago
        Being drugged into not noticing something as much isn't quite the same as having it treated. With enough morphine you wouldn't even care about a broken leg.
        Dylan16807 11y ago
        Maybe you don't need to, if it's still supporting your weight and not being damaged further.

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.
- arkades 10y ago
  1) Many people who have post-surgical anxiety do respond to treatment. You'll note that in the article being discussed, one of the other examples given was treated with CBT and anti-depressants and got better. The fact that the article pretty much built itself around the narrative of "people thought he was crazy. Then a doctor somewhere took him seriously, and it was real" does not mean the author of the article in any way did a sweeping education in psych and anxiety. 2) Anxiety is difficult to treat even in people who believe they have it and are committed to treatment; it's not meaningful to say "doctors who consider ENS to be probably psychogenic haven't attempted to treat it with antidepressants." The article itself leads with a number of ENTs saying it's psych and not seeing the patient - because he needed to go to see a psych, not an ENT, and he /refused/ to go. He eventually got brief treatment, and bailed, because he was never actually convinced it was anxiety. There was only one other example of a patient in the article who was treated for psych., and that patient's symptoms resolved. You're assuming that these patients get regularly treated for psych disorders, and that therefore the persistence of this meme indicates it's not psychogenic. That, despite the fact that many of these patients refuse to believe they have a psychological disorder, and thus refuse to seek or continue treatment for that disorder. You, in fact, make this assumption despite just having read an article that stated repeatedly that he had pre-existing and untreated anxiety; that he went to multiple ENTs and got told "it's psych" but avoided going to a psych for it; and when ultimately he admitted himself for psych care, he bailed after literally a couple of days because he was convinced the problem was his nose, not his mind. Somehow, despite literally reading an entire biography of "man with anxiety gets surgery, blames anxiety symptoms on surgery, avoids all psych care," you can still make an argument based on the assumption that these patients are getting adequate psych care, and thus we ought to rule it out. But, hey, no. Let's ignore the disease that has an 18% prevalence among US adults and accounts for all his symptoms, of which he has a history of even pre-dating the surgery, and instead suggest that it's some rare new disease that just happens to overlap completely with anxiety symptoms.
  - ScottBurson 10y ago
    > You're assuming that these patients get regularly treated for psych disorders, and that therefore the persistence of this meme indicates it's not psychogenic. You're overstating my position. I'm saying the question deserves further investigation. You seem to be claiming that it's settled.
EdHominem 11y ago
It seems wrong to even say the treatment works - of course it appears to when you drug someone's concerns away but it doesn't seem to change the underlying wrongness of the sensations. If I broke my leg I'm sure I'd appreciate an Ativan but I'd really need a splint.
- powera 11y ago
  What is there to treat anyhow? There's a "suffocating sensation" but no claim of any actual trouble breathing.
  - DanBC 11y ago
    There appears to be considerable suffering that interferes with a persons day to day living.
    - powera 11y ago
      "Considerable suffering" that can be treated by anti-depressants or anti-anxiety drugs, at least in some cases.
      - EdHominem 11y ago
        Being drugged into not noticing something as much isn't quite the same as having it treated. With enough morphine you wouldn't even care about a broken leg.
        Dylan16807 11y ago
        Maybe you don't need to, if it's still supporting your weight and not being damaged further.