5 ms·

Medical gaslighting: when conditions turn out not to be 'all in the mind'

41 points by sysadm1n 3y ago

PaulHoule 3y ago
I can get pretty mad that it took so long for me to discover my schizotaxia although it is 100% clear in the psych eval I got in Kindergarten. This condition which is probably the most common neurodivergence and the root cause of much "ADHD", self-diagnosed "autism", "neurosis", anxiety disorders, etc. It is practically erased from the clinical literature though.
- autokad 3y ago
  > subtle and unusual behaviors, thoughts, and perceptions. Individuals with schizotaxia may display odd or eccentric thinking, have difficulty understanding social cues, and show mild perceptual distortions. Sounds like me ...
- user_7832 3y ago
  > schizotaxia Could you explain a little more about this? You're right in terms of not much literature being available about this from a quick Google search. I'm curious as I have ADHD myself. For anyone looking the best website with info appears to be this - https://www.mayoclinic.org/diseases-conditions/schizotypal-personality-disorder/symptoms-causes/syc-20353919 https://www.mayoclinic.org/diseases-conditions/schizotypal-p...
  - PaulHoule 3y ago
    I'll point out the related concept https://pubmed.ncbi.nlm.nih.gov/?term=schizotypy https://pubmed.ncbi.nlm.nih.gov/?term=schizotypy which has quite a few papers in the research literature but the concept has not escaped into clinical practice. (e.g. there is a “schizotypal personality disorder” but it’s not used that often, I’m not quite sure if I want to say I have a PD, it seems it was used way too much in the former USSR) The classification is controversial, particularly it's not really clear that schizotaxia is something you have or don't have (taxonic) or whether it is something dimensional that you might have more or less of. Schizotaxia is believed to be a neurodivergence that is genetically determined, schizotypy is the personality organization that you get when you fail the Turing test in Kindergarten and get treated accordingly. See also https://www.amazon.com/Loners-Life-Path-Unusual-Children/dp/0415066654 https://www.amazon.com/Loners-Life-Path-Unusual-Children/dp/... This book comes the closest to telling a coherent story but it is completely bought into the taxonic approach https://www.amazon.com/Schizotypy-Schizophrenia-View-Experimental-Psychopathology-ebook/dp/B0058VACNG/ https://www.amazon.com/Schizotypy-Schizophrenia-View-Experim... and he completely denies the possibility that you could find something positive in schizotaxia/schizotypy and also doesn't answer my emails. Other than that there are a few conference proceedings that have a few that is more balanced but muddier.
    - user_7832 3y ago
      Thank you so much for your response. I'll look into this. I'm copying your comment for reference. > I'll point out the related concept https://pubmed.ncbi.nlm.nih.gov/?term=schizotypy https://pubmed.ncbi.nlm.nih.gov/?term=schizotypy which has quite a few papers in the research literature but the concept has not escaped into clinical practice. (e.g. there is a “schizotypal personality disorder” but it’s not used that often, I’m not quite sure if I want to say I have a PD, it seems it was used way too much in the former USSR) The classification is controversial, particularly it's not really clear that schizotaxia is something you have or don't have (taxonic) or whether it is something dimensional that you might have more or less of. Schizotaxia is believed to be a neurodivergence that is genetically determined, schizotypy is the personality organization that you get when you fail the Turing test in Kindergarten and get treated accordingly. See also https://www.amazon.com/Loners-Life-Path-Unusual-Children/dp/ https://www.amazon.com/Loners-Life-Path-Unusual-Children/dp/... This book comes the closest to telling a coherent story but it is completely bought into the taxonic approach https://www.amazon.com/Schizotypy-Schizophrenia-View-Experim https://www.amazon.com/Schizotypy-Schizophrenia-View-Experim... and he completely denies the possibility that you could find something positive in schizotaxia/schizotypy and also doesn't answer my emails. Other than that there are a few conference proceedings that have a few that is more balanced but muddier.
- SamoyedFurFluff 3y ago
  If it’s erased from clinical literature I want to know why. It’s entirely possible schizotaxia simply isn’t useful and the notion that it’s related to adhd, autism, etc. isn’t accurate. I know personally adhd and schizo-associated symptoms are quite different. Similarly anxiety and schizo-related hyperarousal/paranoia function differently also. I would consider myself as coming accross as autistic in my day to day life, but having spoken with autistic people my interiority is vastly different to theirs (I have a schizophrenia spectrum disorder). Edited to add: it’s not that I am dismissing schizotaxia out of hand. I’m saying two different things. One, I would be interested to know why schizotaxia isn’t in medical literature. Two, as someone with a diagnosed schizophrenia spectrum disorder, I don’t feel a diagnosis of adhd, autism, or generalized anxiety wouldve fit me as a child due to what I understand about these conditions as a counter anecdotal.
  - PaulHoule 3y ago
    It is all over the research literature but hasn't diffused into practice. I got my psych eval in 1978, I practically look like an index case for the syndrome Rado and Meehl describe in 1962. One some level I'd blame "politics" and selfish memes. There is a developmental approach that is associated with Freud and then attachment theorists like Bowlby which would have it that I was parented wrong before the obvious big trauma of Weston Elementary and I tried a long time to conform with this belief system and discover some pathway by which my mom taught me to be anxious, I never found it although I had the thread that her own attachment could have been insecure because her mother died when she was a toddler. I had a relative one time who was one of those people involved with the PTA who went a rant about how autistic and other disabled kids were draining the school budget dry and ruining it for the normal kids, so I think there's a political reason to deny syndromes that might create more protected classes that need more resources. I managed to get one year at a private school where the bullying was not tolerated, I was treated like a human being, and I actually got some friends but we weren't able to get funding for more than that. A safe school environment plus recognition of my condition could have changed the course of my life in a big way. And that's a very good reason schizotaxia/schizotypy to be ignored, to keep resources available for the normies and the other protected classes. There is also a stigma associated with schizophrenia that makes it a very difficult label to accept. The problems with executive function could be similar to ADHD and probably would respond somewhat to stimulant medication just as everybody else. My parents took me out of school when they tried to put me on stimulants and I'm pretty glad because I've seen what happened to many early adopters of stimulant medication. I think that whole enterprise of prescribing dangerously addictive drugs is not wholesome. This book describes a pseudo-autistic syndrome https://www.amazon.com/Loners-Life-Path-Unusual-Children/dp/0415066654 https://www.amazon.com/Loners-Life-Path-Unusual-Children/dp/... that may very well be related to schizotaxia according to Lenzenweger where you get the social isolation, special interests. In that case (like myself) social perception is intact and possibly hypersensitive (I wouldn't look people in the eye because I saw things they didn't want me to see, things they'd often get defensive about and deny, maybe it was my paranoia some of the time but I know sometimes I was right). I would test normal for social perception in a controlled environment but my social perception screws up 10-20% of the time in the real world which I've compensated for in various ways, limiting what I do is a major one. At the moment I'm mad at the branch of the "autism awareness" movement that has encouraged self-diagnosis, I went and got an eval for autism and found I didn't have it, it was quite the journey for me to find the truth. On some level I think there is a limited amount of headspace and I think various selfish memes (developmental theories about the family which were discredited in the case of autism, ADHD pill pushing, the neurotypical flocking "autism awareness" movement) have sucked the oxygen out of the room for one thing.
johnsutor 3y ago
TIL where the term gaslighting came from...
- ompogUe 3y ago
  Well actually (!), they didn't get it quite right. There was one in '40 (which was based on a play), but still, the '44 film with Bergman and Boyer is my favorite. It uses actual gas lights for some of the lighting, which is very moody. Also, Angela Landsbury's first role. Was happy to see it arrive again on The Criterion Channel this month.
shortcake27 3y ago
> One of the best-known examples relates to heart disease, where a woman’s symptoms are twice as likely as a man’s to be simply written off as mental illness Or “that time of the month”. It’s incredible, in this day an age, a huge number of doctors will immediately ask if it’s “that time of the month” in response to literally any mental or physical issue. Ask your female friends. I guarantee they have all experienced this.
- willcipriano 3y ago
  My wife tries this all the time. Tells me she is on her period and therefore more emotional, bloated and experiencing several physical symptoms. She says she needs extra help. Nonsense I tell her.
- n8henrie 3y ago
  Interesting. I'm a male physician, more often than not I chide myself for entirely forgetting to ask / think about menstruation.
  - 28304283409234 3y ago
    I live with two daughters and my wife. I learned about the “four seasons of menstrual cycle”, and they are real. I recommend every male to read up on them.
- jstarfish 3y ago
  Why is it "incredible" that doctors think to account for routine hormone spikes when performing diagnostics?
  - falcolas 3y ago
    Because its routinely used to dismiss unrelated symptoms. Take the parent’s advice and talk with a woman about it. The amount of medical gaslighting they receive is astonishing.
    - 3y ago
SamoyedFurFluff 3y ago
I wonder how we can adequately address this. The dismissal of women and minorities (especially woman minorities) has been well studied for literally decades and we haven’t put a dent in it. Why? Wtf is going on?
- codeTired 3y ago
  White, tall, decently build, straight male and I was still affected by this. Read my other comment.
- kelseyfrog 3y ago
  Take a very focused topic, IUD insertion pain for example, and read the first hand accounts and the corresponding medical practice. > Passed out during IUD insertion[1] > Today I went in to get the Mirena IUD inserted in me, and instead, I passed the fuck out and started having a seizure and had to be taken to the ER.[2] > I had my copper IUD inserted an hour and a half ago, it was the most painful thing I’ve ever experienced in my life.[3] > Passed out from IUD.[4] Contrast this with studies and the routine practice of IUD insertion[5]. > After an IUD insertion procedure, the researchers compared the pain scores of the participants. The pain scores were significantly lower in the group that received the lidocaine treatment, compared to the group that didn’t. > In general, doctors don’t routinely offer lidocaine injection because the injection itself can be uncomfortable. I don't know about you, but there seems to be a discrepancy. Perhaps the cervix is an outlier, but in my experience, all injections are a bit uncomfortable. Still, we don't require patients to ask for lidocaine before getting stitches, biopsies, or dental work. Local anesthesia before potentially painful procedures is a sensible default. Note: I'd like to get better sources than Reddit for first-hand accounts of IUD insertion, but sometimes we have to work with the data we have, not the data we want. 1. https://www.reddit.com/r/birthcontrol/comments/znda0k/passed_out_during_iud_insertion_tips_for_pain/ https://www.reddit.com/r/birthcontrol/comments/znda0k/passed... 2. https://www.reddit.com/r/TwoXChromosomes/comments/15i90r/so_i_tried_to_get_an_iud_inserted_today_and_ended/ https://www.reddit.com/r/TwoXChromosomes/comments/15i90r/so_... 3. https://www.reddit.com/r/birthcontrol/comments/ysapvs/normal_to_cry_with_pain_after_iud_inserted/ https://www.reddit.com/r/birthcontrol/comments/ysapvs/normal... 4. https://www.reddit.com/r/Endo/comments/b96wry/passed_out_from_iud/ https://www.reddit.com/r/Endo/comments/b96wry/passed_out_fro... 5. https://www.healthline.com/health/birth-control/is-iud-painful https://www.healthline.com/health/birth-control/is-iud-painf...
vcg3rd 3y ago
Straight white man. Diagnosed myself with sleep apnea. Kept telling drs it wasn't anxiety. After 10 years got one to order a sleep study by demanding one. Celiacs. Told it was IBS and mental. Told to eat more grain for fiber. Finally developed peripheral neuropathy from B-12 deficiency. I was referred to a neurologist and I told her after all the test and only found very low B-12 I thought I had celiacs. She referred me to gastroenterologist for biospy of villus. I'm then 40, celiacs from childhood, never enough B-12. Fibromyalgia Known I had it for decades. Flaired bad in 2020. PCM told me it was arthritis. She referred me to Occupational Health. After testing he said it clearly wasn't arthritis. I told him I thought I had mild fibro for 15 years that has flaired to border-line severe and already have one diagnostical confirmed autoimmune disease. He referred me to a rheumatologist who diagnosed fibro. Narcolepsy type 2 without cataplexy. Excessive daytime sleepiness not resolved by CPAP so severe I would pull into parking lots or lay under a desk. Prevented me from finishing grad school. After 5 sleep drs for apnea over 25 years one finally prescribed me armodafinil.
codeTired 3y ago
This is right up my alley. I have seen 40+ physicians after my reaction to flouroquinolones 11 years ago. They denied it was possible for the medication to cause issues. Even Mayo fucking clinic. I kept hearing the med is out of my system. In the mean time the label received a new warning because of people like myself reporting neurological symptoms to the FDA. Still, my EMG was normal so several neurologist told me I’m fine. Then, I diagnosed myself with small fiber neuropathy with mild autonomic involvement, this is after years of research and learning about any possible causes of neuropathy and symptoms. Requested nerve punch biopsy from a new neurologist at a top medical institution. Came back normal, so he said „no small fiber neuropathy”. Well that’s incorrect. Skin punch biopsy has about 60-70% accuracy. He doesn’t offer any more help and says he can’t help me. I find a new physician at another top medical hospital. They know how to perform the tests I want, which was some autonomic tests and QSART, which is a sweat test. The autonomic test was normal. QSART revealed small fiber neuropathy. I’m sorry but it is absolutely fucking unacceptable. I did most of the research and had to gently steer physicians myself. I would never get a proper diagnosis. 11 years! I kept hearing its anxiety. It’s in my head. This is all while seeing top docs, and even professors. The medical community is not doing their job. There needs to a system in place that looks at results. If a patient gives up and goes to another doctor that actually finds something then there is clearly an issue. I do have an idea for a business that would help physicians. Basically a central intake form that is constantly being updated with new research, it would provide physicians with some key areas to investigate and possible tests/treatments. Also inform the patient why such and such tests are being done and why the symptom is difficult to diagnose.
- wjnc 3y ago
  It must have been a quite terrifying experience. I don’t want to seem heartless but I do imagine some doctors preferring clear cut cases to corner cases and perhaps even understand the sentiment. I agree that that is wholly unfair and sub optimal, but I imagine that for every few patients with complaints with a physical cause, there is one with a psychological cause. How could one solve that under economic constraints if all tests have only a chance of finding the physical cause? Bottom line the question is: should the medical profession give you 40 chances to find a diagnosis? (Again, this is a very rational-ethical approach so after you’ve been through this it might feel as an ad hominem. It’s not. Had my share of medical mistakes in the family as well. Father died and wife and baby lived.) The business idea is a great idea. I just mail my doctor yearly to check if procedures X, Y and Z are done in my country yet and always get a polite nay. But that’s for a situation where the root cause is well understood only the procedure too expensive for our doctors to implement. (With all respect for the failings of US healthcare, the availability of best in class procedures is pretty awesome.)
n8henrie 3y ago
Preface: I'm a hetero white male physician. I care for an underserved 99.9+% non-white population that has an incredibly robust history of trauma due to while males (I live and work on the Navajo Native American reservation, USA). That said, I was really expecting more content, but this article just seems like more "hetero while male bad" without many specifics cases, details, or statistics. The (only?) linked study[0], referring to women presenting with symptoms of heart disease (and referring to it as a "missed diagnosis" in the following sentence) used professional actors and actresses to portray symptoms (not looking at real patients with real symptoms or real outcomes). - If my interpretation of figure 1 is correct, heart disease was considered more frequently in women and mental health diagnoses considered more frequently in men. - According to table 3, for people 75 and older, heart disease was the final "most certain diagnosis" more frequently for women than men, and the mental health causes were exactly equal. If a diagnosis is being considered, but ultimately decided against, could that have anything to do with differing baseline rates[1]? Particularly if risk at a younger age were in part sex-dependent[2]? The study authors discuss this possibility (and even make a Bayes reference), and begin their concluding paragraph with "In summary, our results support the hypothesis that gender alone is not sufficient to produce bias in the diagnosis of patients with CHD symptoms." That part didn't make the article. (Also, I'm not sure that I agree with the authors statement that the difference in risk is independent of age -- CDC data[4] shows both sexes relatively sky-rocketing at about 80). Now I'm not saying that "medical gaslighting" is not a thing, but AFAICT "gaslighting" almost always implies bad intentions (I don't have access to the full text of the BMJ article discussing the term[3]). I'm quite sure that there are some physicians with bad intentions, but I think that's the exception. Based on my experience in the field, I would guess there are many more of us who misdiagnose due to being lazy, tired, stupid, or apathetic -- but I still think that's different than gaslighting. * What I am saying is that this article does a poor job making the case and tries to misrepresent its referenced study. * I would speculate that even more common is physicians that are bad at admitting "I don't know" or "that's out of my scope of training" -- for example, I'm an emergency physician, so I know relatively little about most medical conditions that generally won't kill or permanently disable you if not acted on immediately. For better or worse, I readily confess "I don't knows," usually phrased as "you deserve the expertise of a doctor that knows more about X." [0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825679/pdf/jwh.2008.1007.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825679/pdf/jwh... [1]: https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7115a4-H.pdf https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7115a4-H.pdf [2]: https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7046a8-H.pdf https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7046a8-H.pdf [3]: https://www.bmj.com/content/378/bmj.o1974.full https://www.bmj.com/content/378/bmj.o1974.full [4]: https://wonder.cdc.gov/controller/saved/D157/D357F285 https://wonder.cdc.gov/controller/saved/D157/D357F285
mortify 3y ago
It would be interesting to see data showing how often some symptoms are "all in their head." If certain symptoms are commonly presented by people who are drug seeking or have bonafide psychological problems, it creates a large amount of noise in which doctors need to find a signal. I suspect, useless as my suspicions can be, that HOW symptoms are presented play an important role in how seriously a doctor takes their patients. Someone whose symptom descriptions change with each visit, whose symptoms are contradictory, or even patients who feel the need to describe every minuscule detail of their lives in hopes that anything helps provide a diagnosis can give the impression that the patient is not experiencing a treatable medical condition. Long-term histories with patients can taint a physicians outlook when James comes in one week because of an "itchy nose," and the next demanding prescriptions for his mild cold symptoms, etc. It can be hard to take him seriously when he presents with vague symptoms of what could be more serious.
WirelessGigabit 3y ago
Anecdotally, but the missus experienced the same. Fatigue, brain fog. Oh you're just bored said the doctor. Blood turned out fine. This lasted for about 3 years (short, when I read other people's experiences here). We moved, and got a new PCP. The missus brought up her fatigue again and lo and behold, through a series of tests and referrals, all initiated by the new PCP, the ended up being diagnosed with Ehlers Danlos Syndrome. Does that change that she feels tired? No, but at least it gives a reason and that does help in allowing yourself the liberty of taking it slower for a day.

41 points by sysadm1n 3y ago

I can get pretty mad that it took so long for me to discover my schizotaxia although it is 100% clear in the psych eval I got in Kindergarten. This condition which is probably the most common neurodivergence and the root cause of much "ADHD", self-diagnosed "autism", "neurosis", anxiety disorders, etc. It is practically erased from the clinical literature though.

autokad 3y ago
> subtle and unusual behaviors, thoughts, and perceptions. Individuals with schizotaxia may display odd or eccentric thinking, have difficulty understanding social cues, and show mild perceptual distortions. Sounds like me ...
user_7832 3y ago
> schizotaxia Could you explain a little more about this? You're right in terms of not much literature being available about this from a quick Google search. I'm curious as I have ADHD myself. For anyone looking the best website with info appears to be this - https://www.mayoclinic.org/diseases-conditions/schizotypal-personality-disorder/symptoms-causes/syc-20353919 https://www.mayoclinic.org/diseases-conditions/schizotypal-p...
- PaulHoule 3y ago
  I'll point out the related concept https://pubmed.ncbi.nlm.nih.gov/?term=schizotypy https://pubmed.ncbi.nlm.nih.gov/?term=schizotypy which has quite a few papers in the research literature but the concept has not escaped into clinical practice. (e.g. there is a “schizotypal personality disorder” but it’s not used that often, I’m not quite sure if I want to say I have a PD, it seems it was used way too much in the former USSR) The classification is controversial, particularly it's not really clear that schizotaxia is something you have or don't have (taxonic) or whether it is something dimensional that you might have more or less of. Schizotaxia is believed to be a neurodivergence that is genetically determined, schizotypy is the personality organization that you get when you fail the Turing test in Kindergarten and get treated accordingly. See also https://www.amazon.com/Loners-Life-Path-Unusual-Children/dp/0415066654 https://www.amazon.com/Loners-Life-Path-Unusual-Children/dp/... This book comes the closest to telling a coherent story but it is completely bought into the taxonic approach https://www.amazon.com/Schizotypy-Schizophrenia-View-Experimental-Psychopathology-ebook/dp/B0058VACNG/ https://www.amazon.com/Schizotypy-Schizophrenia-View-Experim... and he completely denies the possibility that you could find something positive in schizotaxia/schizotypy and also doesn't answer my emails. Other than that there are a few conference proceedings that have a few that is more balanced but muddier.
  - user_7832 3y ago
    Thank you so much for your response. I'll look into this. I'm copying your comment for reference. > I'll point out the related concept https://pubmed.ncbi.nlm.nih.gov/?term=schizotypy https://pubmed.ncbi.nlm.nih.gov/?term=schizotypy which has quite a few papers in the research literature but the concept has not escaped into clinical practice. (e.g. there is a “schizotypal personality disorder” but it’s not used that often, I’m not quite sure if I want to say I have a PD, it seems it was used way too much in the former USSR) The classification is controversial, particularly it's not really clear that schizotaxia is something you have or don't have (taxonic) or whether it is something dimensional that you might have more or less of. Schizotaxia is believed to be a neurodivergence that is genetically determined, schizotypy is the personality organization that you get when you fail the Turing test in Kindergarten and get treated accordingly. See also https://www.amazon.com/Loners-Life-Path-Unusual-Children/dp/ https://www.amazon.com/Loners-Life-Path-Unusual-Children/dp/... This book comes the closest to telling a coherent story but it is completely bought into the taxonic approach https://www.amazon.com/Schizotypy-Schizophrenia-View-Experim https://www.amazon.com/Schizotypy-Schizophrenia-View-Experim... and he completely denies the possibility that you could find something positive in schizotaxia/schizotypy and also doesn't answer my emails. Other than that there are a few conference proceedings that have a few that is more balanced but muddier.
SamoyedFurFluff 3y ago
If it’s erased from clinical literature I want to know why. It’s entirely possible schizotaxia simply isn’t useful and the notion that it’s related to adhd, autism, etc. isn’t accurate. I know personally adhd and schizo-associated symptoms are quite different. Similarly anxiety and schizo-related hyperarousal/paranoia function differently also. I would consider myself as coming accross as autistic in my day to day life, but having spoken with autistic people my interiority is vastly different to theirs (I have a schizophrenia spectrum disorder). Edited to add: it’s not that I am dismissing schizotaxia out of hand. I’m saying two different things. One, I would be interested to know why schizotaxia isn’t in medical literature. Two, as someone with a diagnosed schizophrenia spectrum disorder, I don’t feel a diagnosis of adhd, autism, or generalized anxiety wouldve fit me as a child due to what I understand about these conditions as a counter anecdotal.
- PaulHoule 3y ago
  It is all over the research literature but hasn't diffused into practice. I got my psych eval in 1978, I practically look like an index case for the syndrome Rado and Meehl describe in 1962. One some level I'd blame "politics" and selfish memes. There is a developmental approach that is associated with Freud and then attachment theorists like Bowlby which would have it that I was parented wrong before the obvious big trauma of Weston Elementary and I tried a long time to conform with this belief system and discover some pathway by which my mom taught me to be anxious, I never found it although I had the thread that her own attachment could have been insecure because her mother died when she was a toddler. I had a relative one time who was one of those people involved with the PTA who went a rant about how autistic and other disabled kids were draining the school budget dry and ruining it for the normal kids, so I think there's a political reason to deny syndromes that might create more protected classes that need more resources. I managed to get one year at a private school where the bullying was not tolerated, I was treated like a human being, and I actually got some friends but we weren't able to get funding for more than that. A safe school environment plus recognition of my condition could have changed the course of my life in a big way. And that's a very good reason schizotaxia/schizotypy to be ignored, to keep resources available for the normies and the other protected classes. There is also a stigma associated with schizophrenia that makes it a very difficult label to accept. The problems with executive function could be similar to ADHD and probably would respond somewhat to stimulant medication just as everybody else. My parents took me out of school when they tried to put me on stimulants and I'm pretty glad because I've seen what happened to many early adopters of stimulant medication. I think that whole enterprise of prescribing dangerously addictive drugs is not wholesome. This book describes a pseudo-autistic syndrome https://www.amazon.com/Loners-Life-Path-Unusual-Children/dp/0415066654 https://www.amazon.com/Loners-Life-Path-Unusual-Children/dp/... that may very well be related to schizotaxia according to Lenzenweger where you get the social isolation, special interests. In that case (like myself) social perception is intact and possibly hypersensitive (I wouldn't look people in the eye because I saw things they didn't want me to see, things they'd often get defensive about and deny, maybe it was my paranoia some of the time but I know sometimes I was right). I would test normal for social perception in a controlled environment but my social perception screws up 10-20% of the time in the real world which I've compensated for in various ways, limiting what I do is a major one. At the moment I'm mad at the branch of the "autism awareness" movement that has encouraged self-diagnosis, I went and got an eval for autism and found I didn't have it, it was quite the journey for me to find the truth. On some level I think there is a limited amount of headspace and I think various selfish memes (developmental theories about the family which were discredited in the case of autism, ADHD pill pushing, the neurotypical flocking "autism awareness" movement) have sucked the oxygen out of the room for one thing.

johnsutor 3y ago

TIL where the term gaslighting came from...

ompogUe 3y ago
Well actually (!), they didn't get it quite right. There was one in '40 (which was based on a play), but still, the '44 film with Bergman and Boyer is my favorite. It uses actual gas lights for some of the lighting, which is very moody. Also, Angela Landsbury's first role. Was happy to see it arrive again on The Criterion Channel this month.

shortcake27 3y ago

> One of the best-known examples relates to heart disease, where a woman’s symptoms are twice as likely as a man’s to be simply written off as mental illness Or “that time of the month”. It’s incredible, in this day an age, a huge number of doctors will immediately ask if it’s “that time of the month” in response to literally any mental or physical issue. Ask your female friends. I guarantee they have all experienced this.

willcipriano 3y ago
My wife tries this all the time. Tells me she is on her period and therefore more emotional, bloated and experiencing several physical symptoms. She says she needs extra help. Nonsense I tell her.
n8henrie 3y ago
Interesting. I'm a male physician, more often than not I chide myself for entirely forgetting to ask / think about menstruation.
- 28304283409234 3y ago
  I live with two daughters and my wife. I learned about the “four seasons of menstrual cycle”, and they are real. I recommend every male to read up on them.
jstarfish 3y ago
Why is it "incredible" that doctors think to account for routine hormone spikes when performing diagnostics?
- falcolas 3y ago
  Because its routinely used to dismiss unrelated symptoms. Take the parent’s advice and talk with a woman about it. The amount of medical gaslighting they receive is astonishing.
  - 3y ago

SamoyedFurFluff 3y ago

I wonder how we can adequately address this. The dismissal of women and minorities (especially woman minorities) has been well studied for literally decades and we haven’t put a dent in it. Why? Wtf is going on?

codeTired 3y ago
White, tall, decently build, straight male and I was still affected by this. Read my other comment.
kelseyfrog 3y ago
Take a very focused topic, IUD insertion pain for example, and read the first hand accounts and the corresponding medical practice. > Passed out during IUD insertion[1] > Today I went in to get the Mirena IUD inserted in me, and instead, I passed the fuck out and started having a seizure and had to be taken to the ER.[2] > I had my copper IUD inserted an hour and a half ago, it was the most painful thing I’ve ever experienced in my life.[3] > Passed out from IUD.[4] Contrast this with studies and the routine practice of IUD insertion[5]. > After an IUD insertion procedure, the researchers compared the pain scores of the participants. The pain scores were significantly lower in the group that received the lidocaine treatment, compared to the group that didn’t. > In general, doctors don’t routinely offer lidocaine injection because the injection itself can be uncomfortable. I don't know about you, but there seems to be a discrepancy. Perhaps the cervix is an outlier, but in my experience, all injections are a bit uncomfortable. Still, we don't require patients to ask for lidocaine before getting stitches, biopsies, or dental work. Local anesthesia before potentially painful procedures is a sensible default. Note: I'd like to get better sources than Reddit for first-hand accounts of IUD insertion, but sometimes we have to work with the data we have, not the data we want. 1. https://www.reddit.com/r/birthcontrol/comments/znda0k/passed_out_during_iud_insertion_tips_for_pain/ https://www.reddit.com/r/birthcontrol/comments/znda0k/passed... 2. https://www.reddit.com/r/TwoXChromosomes/comments/15i90r/so_i_tried_to_get_an_iud_inserted_today_and_ended/ https://www.reddit.com/r/TwoXChromosomes/comments/15i90r/so_... 3. https://www.reddit.com/r/birthcontrol/comments/ysapvs/normal_to_cry_with_pain_after_iud_inserted/ https://www.reddit.com/r/birthcontrol/comments/ysapvs/normal... 4. https://www.reddit.com/r/Endo/comments/b96wry/passed_out_from_iud/ https://www.reddit.com/r/Endo/comments/b96wry/passed_out_fro... 5. https://www.healthline.com/health/birth-control/is-iud-painful https://www.healthline.com/health/birth-control/is-iud-painf...

vcg3rd 3y ago

Straight white man. Diagnosed myself with sleep apnea. Kept telling drs it wasn't anxiety. After 10 years got one to order a sleep study by demanding one. Celiacs. Told it was IBS and mental. Told to eat more grain for fiber. Finally developed peripheral neuropathy from B-12 deficiency. I was referred to a neurologist and I told her after all the test and only found very low B-12 I thought I had celiacs. She referred me to gastroenterologist for biospy of villus. I'm then 40, celiacs from childhood, never enough B-12. Fibromyalgia Known I had it for decades. Flaired bad in 2020. PCM told me it was arthritis. She referred me to Occupational Health. After testing he said it clearly wasn't arthritis. I told him I thought I had mild fibro for 15 years that has flaired to border-line severe and already have one diagnostical confirmed autoimmune disease. He referred me to a rheumatologist who diagnosed fibro. Narcolepsy type 2 without cataplexy. Excessive daytime sleepiness not resolved by CPAP so severe I would pull into parking lots or lay under a desk. Prevented me from finishing grad school. After 5 sleep drs for apnea over 25 years one finally prescribed me armodafinil.

codeTired 3y ago

This is right up my alley. I have seen 40+ physicians after my reaction to flouroquinolones 11 years ago. They denied it was possible for the medication to cause issues. Even Mayo fucking clinic. I kept hearing the med is out of my system. In the mean time the label received a new warning because of people like myself reporting neurological symptoms to the FDA. Still, my EMG was normal so several neurologist told me I’m fine. Then, I diagnosed myself with small fiber neuropathy with mild autonomic involvement, this is after years of research and learning about any possible causes of neuropathy and symptoms. Requested nerve punch biopsy from a new neurologist at a top medical institution. Came back normal, so he said „no small fiber neuropathy”. Well that’s incorrect. Skin punch biopsy has about 60-70% accuracy. He doesn’t offer any more help and says he can’t help me. I find a new physician at another top medical hospital. They know how to perform the tests I want, which was some autonomic tests and QSART, which is a sweat test. The autonomic test was normal. QSART revealed small fiber neuropathy. I’m sorry but it is absolutely fucking unacceptable. I did most of the research and had to gently steer physicians myself. I would never get a proper diagnosis. 11 years! I kept hearing its anxiety. It’s in my head. This is all while seeing top docs, and even professors. The medical community is not doing their job. There needs to a system in place that looks at results. If a patient gives up and goes to another doctor that actually finds something then there is clearly an issue. I do have an idea for a business that would help physicians. Basically a central intake form that is constantly being updated with new research, it would provide physicians with some key areas to investigate and possible tests/treatments. Also inform the patient why such and such tests are being done and why the symptom is difficult to diagnose.

wjnc 3y ago
It must have been a quite terrifying experience. I don’t want to seem heartless but I do imagine some doctors preferring clear cut cases to corner cases and perhaps even understand the sentiment. I agree that that is wholly unfair and sub optimal, but I imagine that for every few patients with complaints with a physical cause, there is one with a psychological cause. How could one solve that under economic constraints if all tests have only a chance of finding the physical cause? Bottom line the question is: should the medical profession give you 40 chances to find a diagnosis? (Again, this is a very rational-ethical approach so after you’ve been through this it might feel as an ad hominem. It’s not. Had my share of medical mistakes in the family as well. Father died and wife and baby lived.) The business idea is a great idea. I just mail my doctor yearly to check if procedures X, Y and Z are done in my country yet and always get a polite nay. But that’s for a situation where the root cause is well understood only the procedure too expensive for our doctors to implement. (With all respect for the failings of US healthcare, the availability of best in class procedures is pretty awesome.)

n8henrie 3y ago

Preface: I'm a hetero white male physician. I care for an underserved 99.9+% non-white population that has an incredibly robust history of trauma due to while males (I live and work on the Navajo Native American reservation, USA). That said, I was really expecting more content, but this article just seems like more "hetero while male bad" without many specifics cases, details, or statistics. The (only?) linked study[0], referring to women presenting with symptoms of heart disease (and referring to it as a "missed diagnosis" in the following sentence) used professional actors and actresses to portray symptoms (not looking at real patients with real symptoms or real outcomes). - If my interpretation of figure 1 is correct, heart disease was considered more frequently in women and mental health diagnoses considered more frequently in men. - According to table 3, for people 75 and older, heart disease was the final "most certain diagnosis" more frequently for women than men, and the mental health causes were exactly equal. If a diagnosis is being considered, but ultimately decided against, could that have anything to do with differing baseline rates[1]? Particularly if risk at a younger age were in part sex-dependent[2]? The study authors discuss this possibility (and even make a Bayes reference), and begin their concluding paragraph with "In summary, our results support the hypothesis that gender alone is not sufficient to produce bias in the diagnosis of patients with CHD symptoms." That part didn't make the article. (Also, I'm not sure that I agree with the authors statement that the difference in risk is independent of age -- CDC data[4] shows both sexes relatively sky-rocketing at about 80). Now I'm not saying that "medical gaslighting" is not a thing, but AFAICT "gaslighting" almost always implies bad intentions (I don't have access to the full text of the BMJ article discussing the term[3]). I'm quite sure that there are some physicians with bad intentions, but I think that's the exception. Based on my experience in the field, I would guess there are many more of us who misdiagnose due to being lazy, tired, stupid, or apathetic -- but I still think that's different than gaslighting. * What I am saying is that this article does a poor job making the case and tries to misrepresent its referenced study. * I would speculate that even more common is physicians that are bad at admitting "I don't know" or "that's out of my scope of training" -- for example, I'm an emergency physician, so I know relatively little about most medical conditions that generally won't kill or permanently disable you if not acted on immediately. For better or worse, I readily confess "I don't knows," usually phrased as "you deserve the expertise of a doctor that knows more about X." [0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825679/pdf/jwh.2008.1007.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825679/pdf/jwh... [1]: https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7115a4-H.pdf https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7115a4-H.pdf [2]: https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7046a8-H.pdf https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7046a8-H.pdf [3]: https://www.bmj.com/content/378/bmj.o1974.full https://www.bmj.com/content/378/bmj.o1974.full [4]: https://wonder.cdc.gov/controller/saved/D157/D357F285 https://wonder.cdc.gov/controller/saved/D157/D357F285

mortify 3y ago

It would be interesting to see data showing how often some symptoms are "all in their head." If certain symptoms are commonly presented by people who are drug seeking or have bonafide psychological problems, it creates a large amount of noise in which doctors need to find a signal. I suspect, useless as my suspicions can be, that HOW symptoms are presented play an important role in how seriously a doctor takes their patients. Someone whose symptom descriptions change with each visit, whose symptoms are contradictory, or even patients who feel the need to describe every minuscule detail of their lives in hopes that anything helps provide a diagnosis can give the impression that the patient is not experiencing a treatable medical condition. Long-term histories with patients can taint a physicians outlook when James comes in one week because of an "itchy nose," and the next demanding prescriptions for his mild cold symptoms, etc. It can be hard to take him seriously when he presents with vague symptoms of what could be more serious.

WirelessGigabit 3y ago

Anecdotally, but the missus experienced the same. Fatigue, brain fog. Oh you're just bored said the doctor. Blood turned out fine. This lasted for about 3 years (short, when I read other people's experiences here). We moved, and got a new PCP. The missus brought up her fatigue again and lo and behold, through a series of tests and referrals, all initiated by the new PCP, the ended up being diagnosed with Ehlers Danlos Syndrome. Does that change that she feels tired? No, but at least it gives a reason and that does help in allowing yourself the liberty of taking it slower for a day.