Psychogenic disorders are very common, but attract a proportionally tiny spot in medical education and in research budgets. Much clinical time and resources are used mistreating people with these conditions. Stigma is common, and doctors talk of 'real' and 'not real' symptoms; such judgements are more a reflection of medical ignorance than ability to see into the patient's mind.
Stigma probably arises from the patients being difficult, and the doctors being impotent to manage them.
A key distinction used in diagnostic manuals is between voluntary disorders (factitious and malingering) versus involuntary ones (conversion and sanitisation). However these distinctions are largely inadequate outside of conceptual distinctions, because they rely on mind reading.
Mind body dualism abounds in all these discussions, with references to "psychological or neurological", or "in the mind or a real disease". Perpetuating those dualist throwbacks are an obstacle to the patient's recovery: giving patients clear and accurate information on their condition improves their outcome substantially. Saying "your condition doesn't have a known cause other than stress and emotion" validates the condition whilst being honest. To often clinicians will feign from discussion, perhaps not knowing what to say. But patients are reliant on clear advice from doctors in order to engage in their treatment and improve.
The plot thickens when we consider that existing neurological disease can be fuel for an psychogenic predisposition, resulting in one disease's symptoms being exaggerated or morphed from recognition.
A shift is required in how we perceive the psychological dimensions of illness, and to be compassionate toward them.
