Believing and colluding in conversion disorder. (360G-Wellcome-079743_Z_06_Z)

£188,616

Conversion disorder is a very common and highly disabling psychiatric condition, where it is thought psychological distress is in some way 'converted' into neurological symptoms such as paralysis or blindness. Thoughthe psychogenic model is the orthodox view, no neuroscientific basis has been found for it; indeed, faced with the lack of a convincing model, and the paradoxical features of the disorder, some may be tempted to conclude the patient is simply feigning (known as Factitious disorder). The neurologist who sees such a patient is put in a very awkward position. Thoughthey have determined the patient to be neurologically normal, as far as current medical knowledge goes, the patient is still disabled, and the only treatments are psychiatric. Attempts to explain this, however - that they have a Conversion or Factitious disorder, and would benefit from psychiatric help - will probably be fiercely opposed by the patient, who may complain, seek alternative opinions, or simply leave, consigning themselves to lifelong disability. Faced with these likelihoods, and in the interests of eventual successful treatment, the neurologist may be inclined to misrepresent his view, in the hope that the patient may one day accept a psychiatric referral. Though some neurologists have long maintained this avoidant position - telling their patients one thing, and their colleagues, and the notes, another- this clearly raises ethical questions, for it may be considered collusion. It is also directly challenged by current and imminent changes to clinical practice. The requirement that clinic letters are now copied to patients and the introduction of the National Patient Electronic Record means that diagnosis will be forced into the open, or driven more deeply underground. And now the very diagnostic basis of Conversion - the Diagnostic and Statistical Manual (DSM) - is due for revision, with some arguing that the psychogenic label should be removed from these disorders entirely, largely to ease this situation. This study aims to inform that debate, and to present directly to the DSM committee. Firstly I shall delineate the models employed in conceptualising Conversion by philosophical analysis. Guided by this, using a mixed-methods approach, I shall explore which models neurologists believe, what they tell their patients, and why - in a qualitative analysis ofin-depth interviews, and quantitative analysis of a national questionnaire. Lastly, I shall explore the ethical and policy implications of the current position, the imminent changes, and the proposed revisions.

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Grant Details

Amount Awarded 188616
Applicant Surname Kanaan
Approval Committee Biomedical Ethics Funding Committee
Award Date 2006-03-02T00:00:00+00:00
Financial Year 2005/06
Grant Programme: Title Research Fellowship in H&SS
Internal ID 079743/Z/06/Z
Lead Applicant Prof Richard Kanaan
Partnership Value 188616
Planned Dates: End Date 2009-11-30T00:00:00+00:00
Planned Dates: Start Date 2006-06-01T00:00:00+00:00
Recipient Org: Country United Kingdom
Region Greater London
Sponsor(s) Prof Simon Wessely