The role of placebo in the diagnosis and treatment of functional neurologic disorders.

Placebo therapy can produce meaningful, clinical relief for a variety of conditions. While placebos are not without their ethically fraught history, they continue to be used, largely covertly, even today. Because the prognosis for psychogenic disorders is often poor and recovery may be highly dependent on the patient's belief in the diagnosis and treatment regimen, some physicians find placebo therapy for psychogenic disorders compelling, but also particularly contentious. Yet placebos also have a long tradition of being used for provocative diagnosis (wherein placebo is used to elicit and/or terminate the symptoms as a way of diagnosing symptoms as "psychogenic"). In this chapter we discuss cases describing placebo as therapy for psychogenic disorders and the challenges related to embedded Cartesian beliefs in Western medicine. The legitimate ethical reservations against placebo therapy, in general, have been related to assumptions about their "inertness" and a requirement for deception, both which are being refuted by emerging data. In this chapter, we also re-evaluate the concerns associated with placebo therapy for psychogenic disorders by asking, "Are we harming patients by withholding placebo treatment?"

© 2016 Elsevier B.V. All rights reserved.

KEYWORDS: American Medical Assocation policy; complementary medicine; conversion disorder; ethics; medically unexplained illness; mind–body; movement disorders; placebo treatment; provocative testing; psychogenic; psychogenic nonepileptic seizures

PMID: 27719875 DOI: 10.1016/B978-0-12-801772-2.00049-7