Medically Unexplained Symptoms A Brain-Centered Approach

Despite the rapid advances in medical science, the majority of people who visit a doctor have medically unexplained symptoms (MUS), symptoms that remain a mystery despite extensive diagnostic studies. The most common MUS are back pain, abdominal pain, headache, fatigue, and dizziness.  This book addresses the obstacles of managing people with MUS in our modern day society from both a historical and contemporary perspective.

Most MUS are psychosomatic in origin, caused by a complex interaction between nature and nurture, between biological and psychosocial factors.  Psychosomatic symptoms are as real and as severe as the symptoms associated with structural damage to the brain.  Unique and concise, the book explores the biological and psychosocial mechanisms, the clinical features, and current and future treatments of common MUS. 

Exploring the unsolved in an accessible manner, Medically Unexplained Symptoms invokes the methodologies of medical science, history, and sociology to investigate how brain flaws can lead to debilitating symptoms. 

Introduction

Chapter 1. Overview of Medically Unexplained Symptoms

                Pain

                Brain flaws

                Fear

                Anxiety

                Dizziness

                Stress

                Fatigue

                Diagnostic uncertainty

Chapter 2. Early ideas on hysteria

                Hysteria and female sexuality

                Bizarre behaviors

                Hysteria and the occult

                Nerves

                Hysteria, a nervous disorder

                Early treatments of hysteria

                Spinal irritation and the spinal reflex theory

                The attack on the female genitalia

                Hysteria and fasting girls

Chapter 3. The Golden age of Hysteria

                Briquet’s syndrome

                Charcot and his hysterical circus

                Hysteria and hypnosis

                Borderlands of hypnosis

                Nature or nurture

                Ideas about hysteria evolve

                Neurasthenia and neurosis

                S Weir Mitchell and the Civil War

                The Rest Cure

                S Weir Mitchell, the enigma

                Nerve doctors

                Evolution and the brain

Chapter 4. Psychosomatic illness in the 20th Century

                Freud, the early years

                Breuer’s famous patient, Bertha Pappenheim

                Freud and Breuer’s book on hysteria

                Suppressed memories and childhood sexuality

                Freud’s model of the mind

                Overall impact of psychoanalysis

                Physicians, patients and psychosomatic symptoms

                Common sense psychotherapy

                Alternate medical treatments and suggestibility

                War and Psychogenic Illness

                PTSD the prototypical delayed stress disorder

                Relationship between PTSD and mild traumatic brain injury (mTBI)

                Psychosomatic medicine

                The biological link between stress and illness

                                The hypothalamic-sympathetic-adrenal axis

                                The brain’s emotional center, the limbic system

                                The hypothalamic-pituitary-adrenal axis

                Pavlov and neural plasticity

                Hebb’s Synapse

                Molecular mechanisms of brain plasticity

                Stress and the limbic system

                                Nerve growth factors and stress

                                The amygdala-prefrontal cortex connection

                Central sensitization, a model of neuroplasticity

                                The descending pain modulatory system (DPMS)

Robert W. Baloh MD

Distinguished Professor of Neurology

David Geffen School of Medicine at UCLA

Los Angeles, CA