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In Men, It’s Parkinson’s. In Women, It’s Hysteria.

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David Armstrong reports in ProPublica:

Once it was called “hysterical” movement disorder, or simply “hysteria.” Later it was labeled “psychogenic.” Now it’s a “functional disorder.”

By any name, it’s one of the most puzzling afflictions — and problematic diagnoses — in medicine. It often has the same symptoms, like uncontrollable shaking and difficulty walking, that characterize brain diseases like Parkinson’s. But the condition is caused by stress or trauma and often treated by psychotherapy. And, in a disparity that is drawing increased scrutiny, most of those deemed to suffer from it — as high as 80% in some studies — are women.

Whether someone has Parkinson’s or a functional disorder can be difficult to determine. But the two labels result not only in different treatments but in different perceptions of the patient. A diagnosis of Parkinson’s is likely to create sympathy, but a functional diagnosis can stigmatize patients and cast doubt on the legitimacy of their illness. Four in 10 patients do not get better or are actually worse off after receiving such a diagnosis and find themselves in a “therapeutic wasteland,” according to a 2017 review of the literature by academic experts.

“This is the crisis,” said University of Cincinnati neurologist Alberto Espay, the author of guidelines on diagnosing functional movement disorders. “It shouldn’t be stigmatized but it is. No. 1, patients are wondering if it is real. ‘Does my doctor think I am crazy?’ Secondly, doctors can approach it in a way that implies this is a waste of their time.”

A study published last year in a leading neurological journal stoked the growing controversy. Of patients diagnosed with functional symptoms, 68% were women. This finding, the authors wrote, “suggests that female sex may be an independent risk factor for the development” of functional symptoms.

The study prompted a furious letter to the journal’s editor from Dr. Laura Boylan, a New York City neurologist. She argued that the study’s results might demonstrate instead that symptoms thought to be psychogenic were actually the result of Parkinson’s, and that doctors were slow to identify the brain disease in women. “Disparities in healthcare for women are well established,” she wrote, adding, “Women commonly encounter dismissal in the medical context.”

For Boylan, the issue was more than a professional debate. It was personal. She had been diagnosed with Parkinson’s-like symptoms that her doctors, all top caregivers at some of the world’s leading medical institutions, largely believed to be psychogenic or side effects of medication. Most of her doctors were men, but two were women. Boylan, herself a brilliant neurologist, disagreed vehemently with them. She attributed her problems to a physiological cause, a tiny cyst in her brain, and grew despondent when other neurologists doubted her theory. She gave up her medical practice, became housebound and contemplated suicide. Even today, her case remains a mystery.


The first sign that something was wrong came in 2008.

At the time, Boylan was busy with a successful career that included work as a teacher, researcher and clinician. She was an assistant professor of neurology at the New York University School of Medicine; the director of the behavioral neurology clinic for the VA in New York City; and an attending physician at a hospital in Pennsylvania. She was married to another neurologist, Daniel Labovitz, who is a professor at the Albert Einstein College of Medicine and practices at Montefiore Medical Center in the Bronx.

It was while driving at night on a Pennsylvania highway that Boylan experienced a vivid hallucination. She saw a cartoonish chipmunk on the steering wheel, smiling and waving at her. Another time, two blue men with red hats appeared on either side of her. She knew the images were not real, but she couldn’t make them go away.

Her doctors at the time blamed the hallucinations on side effects of psychiatric medicine Boylan took for her long-diagnosed bipolar disorder. Her bipolar condition would later add another element of uncertainty to the debate over her Parkinson’s-like symptoms. Studies show that people with preexisting psychiatric disorders are more likely to develop Parkinson’s — or have a functional disorder with similar symptoms. Boylan said she sees a psychiatrist for the bipolar disorder, but it’s “just not a big deal in my life.”

Over time, her health continued to worsen. In early 2011, . . .

Continue reading.

Written by LeisureGuy

24 August 2019 at 12:10 pm

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