Discussion in 'Fibromyalgia Main Forum' started by lenasvn, Oct 27, 2006.

  1. lenasvn

    lenasvn New Member

    Interesting article! I know most of us have felt judged at times, here comes a practitioners guide how to evaluate what's what.


    Ron Lechnyr, PhD
    and Henry Holmes, MD

    Health care providers frequently encounter patients whose emotional issues, coping style, and psycho-social factors complicate the clinical picture. Though all types of physical illnesses and problems have psychological issues that need to be considered in the delivery of services, there are some patient?s whose response style makes the diagnostic picture more confusing.

    When this happens, such patients are many times given the label of ?hystronic,? ?neurotic,? or as having a ?functional overlay? to their pain or medical problems. Others involved in the case, from physicians, nurses, psychologists, clinical social workers, case managers, and insurers, start to wonder whether the patient has ?psychological problems? as the main cause of their difficulties.

    Once this is done, the patient feels that others no longer listen to them resulting in their needing to ?work harder? to ?get others to listen.? This results in a stalemate for all concerned. In fact, the difficulties encountered by the physician with the traditional medical approaches in this population is often due to their inability to deal effectively with functional syndromes, rather than to the severity of the organic pathology.

    Every physician faces functional overlay/psychological problems in his/her practice, whether with pain or non-pain conditions. This article is directed at assisting psychologists, physicians and other, in understanding, and in turn, responding in a more therapeutic manner to this confusing and complex syndrome.


    The term functional overlay is no more precise than the term "heart disease," "GI disorder," or "endocrine imbalance." Precision is demanded if our treatment is to be appropriate and specific. A breakdown of some of the commonly seen functional overlays makes it apparent that the provider can often address these fully or partially. The physician can be the key professional in developing an effective treatment approach and coordinating resources for this syndrome.

    Since functional overlay syndrome do exist and are common, they will either be managed, mismanaged, or neglected. Doing nothing can have as severe and iatrogenic effect as reacting inappropriately. Labeling the patient has having ?psychological problems? frequently results in the patient being ?discharged? from the health care system since the problems are ?obviously in their head.? All providers, and others, require an understanding of diagnostic categories and respective treatment approaches. Just providing for the ?non-diagnostic label of functional overlay? does not make the condition ?go away? or resolve things as many think.

    For practical purposes, functional overlay can be defined as whatever else the patient brings along with their organic (real) pathology. If we "make believe" that it is possible to separate mind from body, then functional overlay is what remains when we subtract organic pathology from the whole. The remainder is what makes medical practice both challenging and frustrating - the human factor, with all its complicated emotional interactional response styles.

    This definition assumes that there are both positive and negative functional overlays. In practice, however, use of the term usually carries a sense of at least mild frustration and impatience since the process of diagnosis and treatment are made more difficult. At times, the term is used quite judgmental, if not derogatorily.

    It is important to understand that the patient's response and coping style, which results in this overlay, is only their attempt to cope in the manner in which they know best with a ?foreign? situation that creates fear and anxiety because of the changes impacting the person?s life and functioning. Further, the patient is ?forced? to rely on a medical and psychological system that they do not fully understand. The professional jargon confuses patients who do not understand what is being said or the procedures that have to be followed.

    Unfortunately, functional overlay may represent to the user of the term a condition which his/her specialty does not treat. This may leave the patient without a treating physician for their functional overlay which can be as disastrous as leaving a surgical patient without proper management of their diabetes. Involving a psychologist or clinical social worker with a speciality in pain management is critical to coordinating treatment. The involvement of a mental health professional should not be seen as a way of dismissing the patient?s complaints or problems.

    If psychiatry, psychology and clinical social work professionals are the only ones assigned this territory, a systems problem is possibly created: (1) Many patients will never be seen in a psychological setting either for financial, or insurance, reasons or by personal preference; (2) Those seen in a psychological setting often have concerns that can only be answered medically and this requires at a minimum a combined approach; (3) Justifications will be found by evaluators, insurers, legal systems, and others to reject the real physical problem by implying that all of the patients problems are psychological and therefore untreatable; and (4) the fact that these types of patients will always present to medical practices requiring the physician to respond in some manner.

    This does not dispute the fact that research has demonstrated the significant and positive impact of a task-focused psychological/pain management intervention. It just suggests that the physician, and others involved in the case, must become more skilled in dealing with this very common patient group. Dismissing them once they have been labeled as having a functional overlay does not make the problem go away.

    It also does not come to understand the significant and varied aspects of such patients. Understanding that there are varied ways of assessing, treating and viewing such patients may be more helpful in bringing about a more effective resolution of the problem for all concerned including the patient. It also is critical to understand the patient from a larger perspective than the broad term of ?psychological/functional overlay.?


    The following categorization into 11 types of functional overlay is meant to be practical rather than exhaustive. Comments are addressed to the practicing physician, psychologists, evaluators, legal representatives, insurers, and others in hopes that they will be helpful. These "pearls of wisdom" have been extracted from years of success and failure, trial and error, and reflect a true desire to unburden the provider from undesired heavy burdens and heavy frustrations for this very common problem.

    I. The Frightened Patient

    Either directly or indirectly, the message is "I'm scared" which may be conveyed in language noting a high physiologic arousal (fear), or in protective posturing (an attempt to avoid any further damage). Examples are the person who fears paralysis or further nerve damage, that their "arthritis" is progressive and will be disabling (like Aunt Maud's), or that their symptom means cancer or that surgery or painful treatment is needed (particularly if there have been personally traumatic medical episodes, or injury, in the past). The patient's internal images of what their symptom means are catastrophized. As a result, the patient may talk too much, ask too many questions, be overly-dramatic, emotional, and have a sense of on-going panic and reactivity that makes ?being with them? a little overwhelming.

    Treatment Approach: The need is for in-depth education directed at changing the patient's conception of the problem to one which is less threatening and more under personal control. Since the patient is frightened, this may need repetition several times, most effectively in the presence of a significant other whom the patient trusts. The medical world is a ?strange place? for most people. It has it?s own language which is not understood by the average person. They misinterpret what is said and have ?selective attention? to what they hear. They need to have things patiently explained over and over again until they feel comfortable that someone is helping them with what seems to be changing their ?world view of life.? Term and procedures that are common sense to health care providers are not so common or understood by patients.

    II. The "Please Hear Me" Patient

    The patient complains either verbally or non-verbally that no one cares or takes the time to listen and understand. This patient values relationship above technical information and before developing confidence in any treatment will need to be treated as an individual. Otherwise, very technically competent medical attention may be discounted. The ?relationship? helps the patient feel ?safe.?

    Treatment Approach: Listen carefully, examination carefully, and take the time to develop a relationship. These patients can be very grateful and loyal if handled appropriately. They need time to ?digest? the information told to them so that they can be assured that others understand and ?hear them.?

    III: The "I Hurt Everywhere You Touch" Patient (Low Pain Tolerance)

    This patient is difficult to examine; light palpation and examination procedures cause greater than expected pain and resistance. The patient exhibits a poor discrimination for the severity of their felt-sensations. The physician finds exact diagnosis is often difficult or impossible.

    The problem is one of lowered pain tolerance. Close questioning usually discloses the symptoms of endogenous depression with exhaustion, sleep disorder, mood and concentration difficulties. This patient often expects a great deal of themselves and may exhibit embarrassment, a fear of having a psychological problem, or a sense of inadequacy.

    Further, new research has led to the understanding that some patients may be genetically ?programmed? to ?feel things more intensely.? This does not reduce the reality of the organic problem. It just requires a different approach and understanding of how such patient react, especially when they feel exhausted and overwhelmed.

    Treatment Approach: Express concern that the patient's pain or medical problem has been so severe that they have become exhausted. Explain that this is common and related to depletion of brain chemistry which causes the lowered pain tolerance, sleep problems, etc. This organic explanation is generally much more acceptable than using the word "depression" or using psychological terms. Antidepressants should be prescribed in appropriate dosage with adequate explanation to ensure compliance. Explain that as their sleep and natural resistance to pain improves, you will continue to work with them to treat the original medical problem. Give them permission to "back off" the usual demands they make on themselves. Encourage them to see a psychologist who has special expertise in dealing with chronic pain and illness issues as part of helping them to cope and manage their problems better.

    IV. The "Overwhelmed" Patient

    This patient may present similarly to the low pain tolerance patient. The difference is that the stressors are more external -marital, financial, children's behavioral problems, death in the family, etc. - have grown to a crisis proportion with the patient becoming overwhelmed. The emotional energy behind their complaints is a "cry for help."

    Treatment Approach: The crisis intervention model is most appropriate. Explain the medical problem in relationship to their severe, understandable stress. Treat the medical condition, but explain that it will not resolve without simultaneously treating the "cause." Connecting the patient with resources for support and problem solving to regain control and stability of their situation is the focus. Generally, this may be beyond the scope of the physician's role, time and skills, and psychological resources must be enlisted. The physician must not allow the medical problem to become the sole source of attention or appropriate help may be delayed for the actual "dis--ease."

    V. The Angry/Blaming Patient

    This patient expresses anger either directly or indirectly which interferes with an adequate doctor-patient relationship.

    Importantly, anger is usually a "smoke screen" covering more human emotions and concerns. Anger is a communication which calls for understanding at a deeper level. Unfortunately, many practitioners react personally; now too have a problem interpersonally, rather than one having an emotion which she/he can be assisted to understand.

    Treatment Approach: Allow the anger to be expressed. Don't take it personally! If the angry tone of the interaction continues, comment and validate the anger. At the same time insist on your desire to be of help and have a good doctor-patient relationship. Question the patient to determine what the anger is about. Ask what the patient wants. Listen. Anger can be a defense and you may learn what the patient fears and wants (instead of what he/she may have gotten before and not wanted). Give a sense of control to the patient and change your approach to match expectations, if possible. Allow time, perhaps over several office visits, for a relationship to develop. Handled well, angry patients often become "pussy cats" who see "eye to eye" with their physician. Many times, the anger is the result of ?not feel they were heard or taken seriously? by other providers.

    VI. The Somatizer

    The problem here is emotional "dis--ease" expressed physically or somatically. The intensity of the focus on symptoms reflects the intensity of the emotional disturbance. Unfortunately, the patient is searching for relief "in all the wrong places" without conscious awareness of the emotional basis of symptoms or because considering the emotional side appears impossible or overwhelming. Frequently, such patients have had poor childhood emotional training or have sustained significant trauma and abuse. It is important that the patient is actively asking for help, even though the help needed may be very different than she/he believes. There is a spectrum of somatization from simple to complex conversion disorders such as hysterical paralysis or hemianesthesia.

    Treatment Approach: When taking the history, intersperse medical and psychosocial questions weighing each equally. Listen carefully to the imagery of the patient's symptom description for clues (most somatizers are not difficult to spot!). Emanate acceptance of the person and their condition, offering the caricature of a non-judgmental attitude. Even if completely unnecessary medically, do some workup to demonstrate your thorough attention and your professional medical competence. Chuckle (to yourself!) and thoroughly enjoy the patient while you sift for clues to what the patient really needs from treatment. Offer structure and set limits to diagnostic and therapeutic forays. Remember that the symptoms the patient offers are not what needs to be "cured," but the clues to their personal mystery. The myth that these patient are untreatable is presumed by most providers and insurers. In reality, these patient has sufficient anxiety and concerns that they can become very active participants in a pain management psychological approach to treatment.

    When a relationship has been built, the physician may take risks and lead the patient to the real "pay dirt" in the emotional arena. Getting the patient to accept psychological intervention is tricky but can be done if the patient feel accepted and sees the referral as part of a coordinated approach to their care. Alternatively, hold the line with regular brief office visits rather than requiring the patient to be symptomatic to get an appointment. Learn to enjoy, but do not shelter these patients when they are capable of more functional lifestyles.

    VII. The Passive Patient

    This patient does little to actively participate in their own care. Many varieties of behavior may be involved including failing to follow through with treatment even after agreed to, appearing helpless, overwhelmed, or incapable of acting on their own behalf, offering many excuses usually based on being controlled by others or by circumstances.

    Unfortunately, unless the physician learns to understand and handle passive patients well, she/he will either learn some tactic to eject them from the practice or become burdened by the load of being a "sheltering wing." The patient is asking the physician to validate either in word or behavior that she/he has no control over health or circumstances. It is very flattering to "be needed," but this can become a trap to the unsuspecting physician who ends up validating the patient's helplessness.

    Treatment Approach: The physician's attitude must be one of respect and firm expectation that the patient learn to manage their own problems. This includes withholding attention, prescriptions, or passive treatments until the patient has fulfilled their obligations. The agreement is, "I'll provide these medical services, provided you follow through with the recommendations which only you can do for yourself: I'll take one step for each step of yours, but no more." This attitude defines the treatment relationship as adult to adult rather than adult to child. The physician will often reap the reward of having believed in the patient or of being "a tough guy" (but respected). This helps the patient reach out for behavioral pain management therapy in appropriate active self-care ways.

    VIII. ?Secondary Gain?/Malingering

    Disease and disability are, from one perspective, learning opportunities. For some it may become more comfortable to remain ill than to recover or adjust. Illness may "gain" the patient attention and care they don't otherwise receive, or it may relieve them of responsibilities which were burdensome or overwhelming. For some patients, continued pain and illness may be the only means of securing access to drugs in dependency states. Illness can be a retaliation on others or even a protection from further physical abuse.

    The basic principal is that continued illness "makes sense" to the patient?s ?private logic? from a holistic point of view. True malingering is rare, while secondary gain factors are common and will remain so as long as people lack viable options or the confidence to successfully make changes in their lives.

    It is important to understand that secondary gain factors are ones the patient is not aware of on a conscious level. They may strongly motivate a patient towards specific goals of an unconscious psychological nature. Primary gain factors are the ones the patient is very aware of trying to obtain, such as increased, or continuing, compensation. These are not as frequent as many people think that they may be in patients with disability and illness.

    Treatment Approach: The physician must take an adequate psychosocial history, probing gently the presence of primary and secondary gains. Except in the case of drug dependency, it may not be therapeutic to directly confront the patient unless there is a strong therapeutic alliance. However, basing treatment extent and duration on objective findings rather than subjective complaints will avoid most pitfalls. Don't expect to be considered fair and do expect emotional intimidation. Mobilizing resources, particularly referring them to a pain psychologist, or a pain center program, which can assist the patient to have more options and choices provide them options for coping more effectively. This is preferable to the "good swift kick" approach which will often simply land the patient in another physician?s office schedule without any awareness or resolution of the problem.

    IX. Hysterical Personality/Over-Dramatization

    These patients simply express themselves with greater vigor, ?color,? and flamboyance. This is often a learned behavior, and it can be cultural (such as known differences in emotionality during labor and delivery among cultures). The patient believes that this is what is required to get your attention and proper treatment. This is not personal. They present these same behaviors in most aspects of their lives. They tend to be colorful in language and have a strong need to describe symptoms in extensive and dramatic terms.

    Treatment Approach: It helps to have seen the patient over a period of time so that the stability of the style is apparent. The task is to simply accept (and perhaps even enjoy!) this manner of self-expression. Importantly, the extent of evaluation and treatment should reflect objective findings and not the level of the patient's emotionality or drama. The patient needs to be educated as to why their manner of approach may ?get them less of a positive response from providers.? Developing a structured way of relating and establishing a therapeutic "holding environment" which can help the patient contain, manage and focus their feelings in a more productive manner can be very helpful. However, this can be a difficult task for the patient, psychologist and physician. It is important to remember that the patient?s manner of responding only means that they are trying, through their ?colorful dramatics,? to insure that other pay attention to their symptoms. The physician need to complete the medical evaluation even in the presence of the ?dramatics? in order to treat any organic problem that ?co-exist? with the psychological issues.

    X. Major Psychiatric Disorders

    Patient's with major psychiatric problems develop medical illness and complaints even more frequently than the population at large. Unfortunately, many define their psychiatric problems in physical medical terms. This can create a significant obstacle to engaging in appropriate mental health care. Obviously, such patients should have a combined medical and psychiatric/psychologic approach both for their own benefit and the physician's comfort.

    Treatment Approach: The goal is to bring the patient into psychiatric or psychological management while providing appropriate medical care simultaneously. It helps to state concerns as follows: "I am worried that your medical condition has been so severe and difficult that it has taken a toll on you physically and emotionally. I see the signs of strain. I believe you need support to help you through until we can get your medical condition under better control. I would like you to see Dr. Shrinkman while I continue to see you for medical treatment and we will coordinate closely." This explanation rarely engenders resistance and avoids the frequent patient interpretation that "he/she thinks it's all in my head," which can lead to an unproductive change of physicians. The mental health professional receives a better prepared and more receptive client.

    XI. The "Normal" Patient

    Many normal patients faced with an injury, or illness, may react in uncharacteristic ways from their usual manner of relating when not under stress or facing a traumatic event. At these times it is easy to see the obvious pathology in regressed functioning which can interfere with appropriate recovery. When patients are in dependent positions they can regress in their functioning. It is tempting to assign the obvious psychopathology as the cause of the problem. It is important to remember that each of us, when under stress, can be "difficult" patients who react in immature ways in order to defend against "attack" and vulnerability.

    Treatment Approach: Explain the issues of crisis and trauma and its impact on the normal person. Explain the stages of grief and how we all react to illnesses. Help family members to understand the issues and enlist their support in the recovery process. Help all members understand that their reactions are normal and will subside with time. Be open to referring for psychological consultation even if they are "normals." We all need support and help at times of crisis. Such psychological help and support can assist patients to recover more quickly and with less complications.


    In the 1999 issue of the Journal of Pain (83:2, 183-192) explored the issue of why chronic pain patients so frequently experience depression. The article explored whether or not depression was the cause of the pain syndrome or was a direct result of the stress of living with chronic pain. The results of this study suggested that living with chronic pain contributed to the elevated levels of chronic pain. Chronic pain syndromes were found to be risk factors for developing various major depressive disorders (p. 190). Depression was not found to be the cause of the pain syndrome. (Dohrenwend, B., et. al., ?Why is depression comorbid with chronic myofascial pain? A family study test of alternative hypotheses.).

    MMPI-2 INTERPRETATION ISSUES: The MMPI-2, which was first developed in 1939 and later updated and revised in the 1990's, is focused on understanding psychopathology, behavioral issues, and problems in functioning. It is one of the more researched assessment instruments with over 365 research articles being published annually since its first development. Interpreting the MMPI-2 test now needs to involve more than the basic three validity and ten clinical scales. There are now numerous subscales that allow for a more indepth understanding of an individual?s functioning, motivation, prognosis, issues of chemical abuse potential, traumatic responding patterns, and an understanding of the psycho-social issues impacting the patient?s functioning. Some evaluators have utilized this test inappropriately as a way of finding fault with suggestions of ?permanent pathology? that should be used to discredit a patient. Such an approach violates the research on this important assessment instrument. It should be used as a guide for treatment interventions that helps to guide the clinician towards ways of intervening and assisting the patient in therapy. In chronic pain management treatment the MMPI-2 has proved useful in identifying the issues that are blocking the patient?s progress in treatment interventions. Kevin C. Murphy, Ph.D., in the April, 1999 issues of the American Journal of Pain Management (9:2, 55-58) published an article Psychological Assessment: MMPI Changes Following Interdisciplinary Pain Treatment which supported how patients involved in pain management treatment showed positive and dramatic changes (decreases) on the MMPI Scales 1, 1 & 3, 2, and 7 & 8 profile elevations (the scales of an over-concern with somatic (body) symptoms, depression, and over-reactiveness to symptoms, following treatment compared to assessments prior to when the patient started treatment.

    Additionally he use of the MMPI-2 Psychological Test in the diagnosis and understanding of chronic pain patients requires a more full understanding of how to assess such a patient population. Other recent research into this subject was covered by Alexander Vendrig, et. al, in their article in the Journal of Pain, 76: 1-2, May, 1998, entitled ?Assessment of chronic back pain patient characteristics using factor analysis of the MMPI-2: which dimensions are actually assessed?, 197-188, reviews a number of similar research articles into the subjects. Their research supports these past assessments of understanding chronic pain patients. ?...the elevations on the Depression (D) and Hysteria (Hy) scales among chronic pain patients to be mainly the result of distress and somatic preoccupation (related to the situation of present pain problem) rather than psychopathology....high scores on the Schizophrenia (Sc) scale to reflect the symptoms and consequences of physical problems, including decreased coping defenses and abilities, and not necessarily indicating severe psychopathology (p 180).? This suggests that the elevations of scales on the MMPI-2 tells more about the degree of fear and distress experienced by the patient in reaction to the injury, disability, and pain situation. Other research has also pointed to how these scales have returned to normal once the patient has completed a pain management treatment program. As a result, the MMPI-2 is more helpful as a guide to understanding the patient?s distress, manner of coping, and fears. This helps to guide treatment directions and work with the patient. This also fits research by Barnes, D., et. al, entitled Changes in MMPI Profiles of chronic back pain patients following successful treatment. In the Journal of Spinal Disorders, 1990: 3: 353-355.


    Rarely do these categories of functional overlay exist in pure form, the clinician usually encountering mixtures and combinations. Hopefully, however, this simple formulation of types and approaches is useful. It is apparent that some factors affecting functional overlays can only be or are best dealt with by physicians who can then assist in the coordination of other treatment approaches including psychological interventions. These include the need for education to dispel unreasonable fears, the behavioral approach to passive patients, those requiring drug prescription (or a commitment not to prescribe), and those in which the physician's personal reaction may contribute iatrogenically to the problem.

    Physicians do enjoy complex and challenging problem solving. The expertise and creativity brought to difficult surgical and medical problems is "awesome." Functional overlay is just as challenging an area of medicine and psychology and deserves the same disciplined differential diagnosis and specific treatment approaches, as well as acknowledgment of limitations. A patient with several interacting medical conditions needs treatment approaches which honor each. Functional overlay can be viewed simply as a second medical condition which requires that we modify our approach to the first and to the two issues together. The problem in managing these cases is in our own personal reactions to these patients' psychological response style. It is hoped that this article will provide the physician, psychologist, and other, with a way to understand and respond therapeutically to these complex syndromes.


  2. Slayadragon

    Slayadragon New Member

    Did you really think that doctors are there to help us? Or at least, that they're going to?

    As far as I can tell, less than 5% of people on this board have received any help from doctors. (This does not count fibro patients who have been given drugs like oxycontin, which is not really "helping" exactly.....)

    A far higher percentage of people here have been helped by things that they've figured out and done for themselves.

    Occasionally, when those things require a prescription, I have seen that some kindly doctors have provided one, at least as a trial. The conventional wisdom of "don't suggest anything to your doctor" (which may be the right one with most doctors) seems not to be applicable here.

    Doctors themselves generally don't have _any_ suggestions. Especially for those doctors who are used to using an authoritarian style, it's easier to write us off as malingering or fire us.

    In their defense, I would imagine it's disheartening to be the doctor of a CFS patient.

    It's not as frustrating to be a doctor who can't help a patient as it is to be one who can't be helped. In the scheme of things, it's not fun either.

    Maybe when a drug company comes up with some suggestions for doctors in terms of what they can do, they'll change their approach. Manic-depressives used to be sent to psychologists too.

    Until then, I wouldn't have too high of expectations for doctors. We're kind of on our own, kids.

    Of course, all this is easy for me to say, since I actually do have a doctor who's very good with regard to this disease.

    I had to search the whole country and pay a huge amount of money in order to put him on retainer, though.

    It's fairly rare that he helps me in a way that I haven't already figured out myself might be useful, but at least he knows more about almost everything I bring up than I do.

    Other doctors think I'm out of my mind if I bring any of those suggestions up or tell them what has worked for me. Anyone ever had _that_ feeling?
  3. lenasvn

    lenasvn New Member

    I hear ya, we all deal with this frustration. I liked to read this article, knowledge is power! The more I know as a patient (know thy enemy) the better off I will be in seeking what I as a patient deserve. As for me, not knowing enough made me waste too much time with the wrong doc. Sometimes there are obvious reasons to move on fast, sometimes not.

    Anyways, this article is informative, and I hope it will help someone!!

  4. lenasvn

    lenasvn New Member

    hayley, I would like to hear this about depression and major illness when you have your brain back in order.

    I think maybe the problem with many docs are that they turn things around abit. They can deside that it's psychological before even running important medical test applying to the patient. They are supposed to exclude every physical cause before even venturing into assuming it's psychological.

    I see many docs don't do this. Even my own doc (not sure what to do with'im yet) don't run tests he obviously should, like EEG, holter monitor, neurocognitive testing, MRI, nerve conduction test- the list goes on. Just because I'm female (?), or because I have complex PTSD (?). I don't know. I know that others get these issues addressed and I don't. Bad, doc, who knows, I am tired of looking for docs! I'm SOOO tired of it.

    I like those klinds of articles, I get something nice to put in my docs lap when I seek the medical assistance I am supposed to recieve.
  5. suz45

    suz45 New Member

    I agree with your post that individuls that are often seen in the mental health settings do have real medical problems. I have noticed that if the clinician does not pay proper attention and utilize ongoing evaluation procedures that many people slip through the cracks regarding real medical dx because the focus has been on the psychological piece.

    Often I have made medical referrals for the clients I have to have them brushed off by parents, caseworkers etc...

    Even if an individual tends to be dramatic or somatic in nature careful consideration always must be given in order to avoid a medical problem going undiagnosed and treated.

    The two world must meet together.

  6. Callum

    Callum New Member

    Sometimes, it seems impossible to sort out the "chicken & egg" which-came-first scenario with CFS. And, I think, doctors who get caught up in this, even when they believe there is a physiological component, get trapped in treating the psychological component.

  7. monkeykat

    monkeykat Member

    Thanks for sharing this article. It's good to know what your enemy is thinking.

    My husband and I started seeing a counselor who I think pretends to believe I have a physical illness but my intuition is that he thinks it's psychological. I guess b/c they are so focuses on psychological issues that they only see things from that perspective.

    Anyway, I'm going to forward this article to myself and read it more thoroughly b/c then maybe I can beat him at his own game...

    take care, Monkeykat
  8. lenasvn

    lenasvn New Member

    You said it! This was sort of the idea with this thread. You put in words what my pooed brain tried to comlicate,,,LOL!
  9. beeleaf

    beeleaf New Member

    not feel they were heard or taken seriously by other providers."

    Um. Ya think?

    You're doggone right I'm scared, angry, overwhelmed, and also have no idea what you just said, Doc.

    Is there some unspoken rule against talking to us? Seems like that might be easier than trying to figure out what they think we're feeling and making a bunch of assumptions.

    I have a very long list of reasons for not trusting doctors & that's always my starting point, until they give me a reason to feel otherwise. Thankfully, there have been quite a few of them. Unfortunately, none have been primary care or rheumatologists. (Surgeons, Ob-Gyns, & my current pulmonologist have kept that ship from sinking.)
  10. daylight

    daylight New Member

    Doctors get very frustrated when the problem is not an easy fix and they tend to label people with mental issues when the problem doesn't reveal itself quickly.I believe that my doctor does believe that I have other health issues but his staff however thinks I'm a nut. Unfortunately this is the health care system that we have. In the past two months that I haven't seen my doctor my health problems have become very visible. Because of not being able to afford medicine my thyroid is really huge,and my joints are very swollen,rash on my legs,chest,neck,arms and my hair has been falling out,trouble walking,vision,swallowing. I hate to think that it would take this extreme to make them understand that I am not lazy,or try to pull something over on Uncle Sam. I am so glad that we have this website available to help educate us on how to handle doctors/nurses procedures.
  11. wish_to_be_healthy

    wish_to_be_healthy New Member

  12. lenasvn

    lenasvn New Member

    Hayley- thanks for the response. My brain is still on my pillow, I will have to go back and re-read later.

    There are many physical illnesses that can cause mental manifestations, just look at Lyme disease. Children have been diagnosed with ADHD ADD when in fact they have Lyme. There are many other manifestations of course, mental changes are common, personality changes, etc in Lyme. It is so important for doctors to stay on top of these things.

    Even better, talk to family members to see history.

  13. carebelle

    carebelle New Member

    I came back to read this again.Its a really good post.I can see right threw my Doctors as to how they have handled me.LOL
    I am at the point that I do not care if they think its mental or not .I just want access to more help.That may or may not include stronger drugs.

    After over 7 years of pain which has become server this pass year ONLY after I fired (Military Group of Doctors)I ask for a new group .They are now helping me to take my care a step forward for help.

    I personally feel that anyone with FM/CFS should be set up into a pain management and Physical management clinic as soon as they have been Dx .These DD gets worse with time so haveing access with these clinics already would help a person know where and what to do as time moves on.

    My biggest problem is that I was DX after a mental breakdown so ofcorse these doctors thought its all in my head.I think now they are learning that they should treat the pain .That they are two separated illness

    I had to become mentally healthy enough that they could not blame everything on a mental problem. I have had to fight for any help I have gotten .I was unable to do that until I got better mentally. Its a shame that we fight within ourselves at the same time our doctors have chalked everything up to a mental cause.

    They have wasted years of my life by not taking an approach that there is real physical pain in these DD's that is not caused by a mental problem.
    Hopefully now that the medical community is accepting our D as something more then "its just in our head" we all will gain access to better health care.

    my advise to everyone with this DD is to force your doctor to share your case with a pain management and physical management clinic . Do not settle for anything less. Do it now do not weight like I did to get your case looked at when you are worse .Take responsibility of your care not.

  14. lenasvn

    lenasvn New Member

    I have turned into the "Hear me" patient. Either direction you turn-seem to work against us.
    [This Message was Edited on 10/29/2006]
  15. homesheba

    homesheba New Member

    yet to even find a pain management dr who will help me... all they do is trade me on lortab and vicodin,
    from one to the other while i am telling him over and over that they do not wk anymore!!!
    and yet still...
    nothing changes..
    this is every pain dr that i have seen.
    its always phyisical therepy..
    yeah right!
    and then injections
    and then lortab- lowest dose of course,
    eventually wking up to highest.
    . and then vicodin and then
    when those dont wk after 2-3 years ,
    i get dumped.
  16. Cromwell

    Cromwell New Member

    Thanks for this. It does make some valid observatuions couched rather demeaningly at times. What struck me is that we need to create a list of Doctor types and how to deal with them accordingly as I sure could list some strange psychological conditions most of my doctors present with!!!

    Maybe when we get time we will start a list going. Virtually all the titles that are linked with patients could equally be applied to doctors and more, but "in reverse" as in

    1) The Passive Doctor

    This doctor will continue to stare into his computer screen with his back to the patient throughout the interview. After 32 seconds he will look at his watch and shuffle papers. He will begine to write out a prescription before the patient has expressed a complete whole sentence. He will not consider a physical examination unless really pressured to do so. He will answer his cell phone just as the patient is in the middle of explaining an important issue.

    Treatment Approach:

    It may be necessary with this particular type of doctor to handcuff one arm to the chair and wheel him away from the computer screen, which will need to be turned off. His cell phone will need to be disarmed.

    The best treatment would be to yell very loudly straight into his face "Are you listening NOW?"

    Sorry Lena, I just could not resist it. (LOL)(As you know I was a psch. for many years and feel a judgemental doctor symptom list could be way overdue!!!)

    Love Anne
  17. lenasvn

    lenasvn New Member

    A superb idea! I love what you just said,,,LOL!

    I'm in a darn flare, can barely sit straight, but when I have the energy maybe we could start a funny thread like what you describe!

  18. julieisfree05

    julieisfree05 New Member


    LMAO!! That was PERFECT!!

    Thanks for the laughs... I've met several of those docs!

    - julie (is free!)
  19. beachwalkerbill

    beachwalkerbill New Member

    Every now and then I do wonderif I'm a crying twit.
    Thanks for the post

    <The results of this study suggested that living with chronic pain contributed to the elevated levels of chronic pain. Chronic pain syndromes were found to be risk factors for developing various major depressive disorders (p. 190). Depression was not found to be the cause of the pain syndrome.>

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