The treatment of psychogenic movement disorders with suggestion is ethically justified

Abstract

Recent developments in our understanding of psychogenic movement disorders have not yet led to advances in treatment. A potentially beneficial treatment strategy is suggestion, the voluntary use by the physicians of techniques that introduce into the patient's mind a belief that he or she will be healed. Principalism, the dominant school of contemporary medical ethics, holds that the use of suggestion is not ethically justifiable because it undermines patient autonomy and degrades the doctor-patient relationship. However, evidence from a variety of sources (neuroimaging, anecdote, expert opinion, randomized controlled trials, and meta-analysis) supports the efficacy of suggestion as a treatment for psychogenic movement disorders. When issues of choice, consent, deceit, disclosure, and decision-making are analyzed from the perspective of an ethics of care, we see that suggestion may enhance patient autonomy and does not violate the trust between doctors and their patients. I conclude that suggestion is therefore an ethically justifiable treatment for patients with psychogenic movement disorders.

Treatment of Functional (Psychogenic) Movement Disorders

“…It has been argued that suggestion might be unethical, and it may alter the doctor-patient relationship and diminish patient autonomy [34]. Others have suggested that use of placebo is ethically justified in the treatment of FMD [35].…”

O uso da sugestão no diagnóstico e tratamento de cegueira conversiva: um relato de caso

“…O torpedeamento não somente selou o diagnóstico de cegueira conversiva neste caso como também levou à remissão definitiva do sintoma. Evidências recentes de ensaios randomizados e metanálises mostraram a eficácia da sugestão no tratamento dos fenômenos conversivos 8,9 . Os métodos de sugestão podem-se tornar valiosas ferramentas terapêuticas nas mãos do psiquiatra, principalmente porque, diferente do que ocorre com a maioria dos transtornos psiquiátricos, não há tratamento farmacológico específico para a conversão.…”

Attitudes on Mind Over Matter: Physician Views on the Role of Placebo in Psychogenic Disorders

“…Some neurologists advocate placebo therapy for PMD reasoning that since PMD is based around a "belief" in the sickness, a treatment that capitalized on "belief" in getting better might be an effective therapeutic avenue (Shamy 2010). Patients with PMD are thought to be suggestible and historically the diagnosis of PMD was often based on a positive response to placebo therapy (Factor et al 1995;Fahn and Williams 1988).…”