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10 Controversial Medical Questions Answered by Dr. Dalrymple

Where do you stand on these challenging ethical and scientific debates?

by
Theodore Dalrymple

Bio

March 15, 2014 - 8:00 am
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From October 2012:

3. Are psychiatric disorders the same as physical diseases?

Even when their causes are organic, our minds make us who we are.

A great deal of effort has gone into persuading the general population that psychiatric conditions are just like any others: colds, arthritis, and so forth. I have never found this convincing; psychiatric disorders, including organic ones, are precisely what it is that makes us most ourselves. No one boasts that his symptoms are of psychological origin, though any of us may suffer such symptoms.

In 1982, the neurologist and writer Oliver Sacks wrote a book A Leg to Stand On, in which he described an accident while walking in Norway. He injured the tendon of one of his thigh muscles which was repaired by operation; but afterwards he found that he could not walk because he could not move his leg. He had “forgotten” how to do so. In addition, he no longer experienced his leg as part of himself, but as a completely alien object.

In his book, he rejected the hypothesis that his paralysis was hysterical, that is to say by unconscious mental conflict. Rather he preferred to believe that his peripheral nerve and muscle injuries had somehow affected his brain, and therefore his inability to move his leg was not psychological but physical.

In the latest edition of the Journal of Neurology, Neurosurgery and Psychiatry, three neuroscientists, including a neurologist and a psychiatrist, reinterpret Sacks’ symptoms and say that they were indeed psychogenic, or what used to be called hysterical. They say that his pattern of symptoms was incompatible with a purely neurological explanation, indeed that they were typical of hysterical paralysis, though they emphasize that this does not mean in the least that they were “fake” or “imaginary.” As a 19th century doctor put it of female patients with hysterical paralyses (most patients with such paralyses were female): “She says, as all such patients do, ‘I cannot’; it looks like ‘I will not’; but it is ‘I cannot will.’’’

Sacks was given the right of reply to the authors and he sticks by his original contention that the paralysis from which he suffered was not psychological in origin. One has the impression that he does not merely disagree with this idea, but finds it uncomfortable and does not like it. Even if hysterical paralysis existed, it would be confined to others.

A third paper in the same journal by the Professor of Cognitive Neuropsychiatry at the Maudsley Hospital Anthony David has an interpretation that might not have pleased Dr Sacks:

Is it not one of the mechanisms whereby a minor injury can lead to major disability that it sows the seeds of what it might be like to be disabled and hence to be looked after, pitied, lionised? None of us is immune to this but like Sacks perhaps, most having glimpsed what life might be like on the “other side” returns with haste to the land of the healthy.

We have two attitudes to psychological vulnerability: either we assume it to an extraordinary degree to demonstrate our superior sensitivity, or we deny it altogether, believing ourselves to be completely invulnerable.

I tend to the latter; but once learned differently when I was in a distant land famed for its inefficient bureaucracy. There was a problem with my ticket home and it took days to sort out. During those days I suffered from severe and almost incapacitating backache that I did not connect to the problem with my ticket. The backache, which was severe, disappeared, however, within minutes of the problem having been sorted out. As Dr. Chasuble put it in The Importance of Being Ernest:

Charity, my dear Miss Prism, charity! None of us are perfect. I myself am peculiarly susceptible to draughts.

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All Comments   (9)
All Comments   (9)
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More than half of these questions would simply go away if everyone (or their family or close friends as needed) paid for their own health care. For the remainder - perhaps excerpting parental responsibility for an obese child - it is sufficient for everyone to have their own opinion and act accordingly.
31 weeks ago
31 weeks ago Link To Comment
There's so much PC BS on most topics that it's startling to hear or read TS, "true speak." Thanks, Doc.
31 weeks ago
31 weeks ago Link To Comment
RE: Obesity & RE:Healthy Diet. I know 17 people with Hypo-Throidism, & most continue to gain weight eating healthy low cal diets with lots of aerobic exercise. I doubt most overweight people have this, but some do have a medical reason for obesity, likely a small minority. Those who simply choose a poor diet likely fall into one of these categories...1) I will eat what I want (needs immediate & constant gratification). 2) Too uninformed (or ill informed) to make intelligent choices. 3) Too poor to buy healthy food (the price, per calorie, of junk food has dropped, while the cost of real food has skyrocketed). If most people would eliminate all processed foods made with white flour & white sugar, & replace that with a MUCH SMALLER amount of whole grains than the food pyramid recommends & eat mostly lean sources of protein + lots of organic produce, they would naturally loose weight. For weight loss to be permanent, you have to make permanent changes!! "Let thy food be medicine & let thy medicine be food"...Hippocrates
31 weeks ago
31 weeks ago Link To Comment
Here in NV our absurd Medical Marijuana laws require a patient to break the law BEFORE they can comply with it. First, you have to break the law & illegally obtain the seeds. Then you apply for a Medical Marijuana card ($50.00), then pay another $50.00 for an "Illegal Contraband Tax Stamp", (no I'm NOT making that up). Then you have to "grow your own". Once "your crop comes in"...you FINALLY have your medicine. As a patient who laid in bed CRYING AND SCREAMING IN AGONIZING PAIN FOR MONTHS ON END, because pain pills don't work on me, NOT opiates & NOT NSAIDS, I can tell you that "witch hunt" leveled against Medical Marijuana is merely "cover" to TORTURE cancer patients like me. I choose not to break the law, because there's no telling when/who the Fed. Gov't. will turn on next & my Hubby is a legal immigrant, here on a Green Card from Canada...so I SUFFERED!! The freely available (by RX) dangerous, highly addictive, toxic narcotics & their horrific side-effects they "experimented on me with" are what we should be worried about...NOT a plant that grows out of the ground!!
31 weeks ago
31 weeks ago Link To Comment
With the understanding that people should be free to obtain help for obesity, addiction, and all health issues at any age, but cannot demand that others pay for this treatment (Charity given by others is ok and encouraged), my take is as follows. Let the debate begin.

1. Obesity is neither a disease nor a moral failing
2. Alcoholics should not be denied available medical care
3. Psychiatric illnesses merit treatment as much as physical illnesses
4. Doctors sometimes are guilty of giving pain killers to addicts who con them
5. Elderly should not be denied available medical care
6. Marijuana can be a medicine, with side effects
7. Nutrition is important to health
8. Drug addiction is not like non-addiction illnesses but addicts should be treated
9. Obese children are not victims of child abuse
10. Parents should vaccinate their children
31 weeks ago
31 weeks ago Link To Comment
Interesting that the author chose only one vaccine to discuss pros and cons.
31 weeks ago
31 weeks ago Link To Comment
He must be in on the CONSPIRACY!!!!!!!
31 weeks ago
31 weeks ago Link To Comment
A government funded psychiatrist on an NHS pension in on 'the conspiracy'? No. Not possible.
31 weeks ago
31 weeks ago Link To Comment
Thank you, Doctor, for this thoughtful and objective article. These are two qualities that in tandem are virtuous but rarely encountered today.
31 weeks ago
31 weeks ago Link To Comment
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