Morgellons and Noble Lies

Here’s a poser: imagine that your patient comes to you reporting the canonical symptoms of a condition that is untreatable.  You agree that this patient is suffering from something, and that the reported symptoms tally with those that are reported by other sufferers.  However, the reason that the disease is untreatable is that – frankly – there’s no such thing.

Or, rather, there is a medical condition associated with these reported symptoms, but there’s no evidence for it being anything other than psychosomatic.  Frankly, anyone suffering from this “disease” is delusional.  And yet “sufferers” are well-organised, and by no means stupid; they are convinced not only that they’re ill, but that at least parts of the medical establishment are being (at best) pig-headed in ignoring their plight.  Welcome to the world of Morgellons.  (According to some, it’s very close to the world of Chronic Fatigue Syndrome.  Both conditions are medically controversial, both lead to undeniable suffering, both boast active lay activists, and so on.)

Being told that they are not deserving of medical attention risks alienating sufferers and will not make them abandon their false beliefs; and, besides, it would miss the point.  Noone denies that putative Morgellons patients are suffering from something debilitating: it’s the identity of that something that’s open to doubt.  Besides: there is something medicine can do.  It can provide placebos, for example.  Or it can provide anti-psychotics.  Of course, a patient who’s convinced that there is something organically amiss won’t take kindly to being given anti-psychotics – so you’d have to lie and say that they were something else.  Result: patient gets better, but the disease “diagnosis” gains some gravitas: if people can suffer from it, and it can be treated, then it looks like a proper illness.

So there’s a pragmatic worry, with an ethical dimension, that we may associate with this course of action.  But there’s also a couple of more direct ethical worries.  In the first place, in prescribing antipsychotics, you’d be prescribing a powerful drug that would be unnecessary.  Well – hang on: would it be unnecessary?  if it shifts a debilitating condition, and is the most immediately effective way of doing so, what’s the criterion of necessity here?  (Granted, psychotherapy of some sort might get the same results, but that’d depend on the patient accepting that psychotherapy was in order, and turning up to the appointment.)  But it would be prescribed under false pretences – as would a placebo – and this raises questions about truth-telling.  (Martin Robbins has more on this.)

It seems that we might be getting into noble lie territory here: the idea that doctors may distort the truth in order to achieve results that all would agree are desirable.  Note that “noble lie” is a translation of gennaion pseudos, and the verb pseudesthai means originally not to lie, but to twist.  Twisting is what would be going on here: medics would be treating a real problem – just not quite the one that the patients think they have, and not in the way that they think it’s being treated.  Still, implicit in going for medical help is the expectation that you’ll be made better, and if a little twisting is necessary for that, then what’s the problem?  Anyone – doctor or patient – who wills the end of health presumably infallibly wills also the means necessary thereto.

The point is this: it’s very easy to get carried away by the need for truthfulness – but claims made about the importance of truthfulness may potentially come a cropper when people have a strong belief in an illness’ existence and effects on them.  The notion of valid consent, which requires truth, seems to demand that the patients have something like a truth-tracking lebenswelt.  If that’s not the case, then many bets seem to be off.  In such cases, when claims about the nature of an illness are (as far as anyone can tell) systematically erroneous, then there may be a case for ditching truth in favour of something more like truthiness – the quality by which one’s statements have the emotionally satisfying ring of plausibility without actually having all that much to do with reality.  The occasional noble lie might have a place in decent medical practice.

 

Oh – incidentally: if you’re an ME or Morgellons sufferer and you want to post an angry response, please note that I’m going to be away for a week, so I won’t be able to get back to you too quickly.  And if you’re going to complain about my Greek – well, you wouldn’t be the first.  It’s terrible.

  • John Coggon

    Just to be clear – am I better off believing what you’ve written here than not doing so?

  • Danser

    To name your ignorance ‘noble lies’ pretty much sums up your article.

    I can not find a single “fact” in it. Yet I know many reputable MD’s and researchers around the world who study Morgellons Disease, none the least of which is the US CDC who is finalizing their 1.5 year study in Oakland California.

    Delusions of Parasitosis is a subset of Schizophrenia and unless a patient is diagnosed with Schizophrenia, the diagnosis is meaningless.

    Your thinking is reminiscent of 30 years ago when patients presented with HIV and were told that if “wasn’t in the ‘book’, then it did not exist.” These poor victims of this level on not-thinking resulted in very ill patients being branded “nuts” by the established medical community and some were locked up in mental institutions. In either case, they were denied any real medical treatment. Perhaps if you visited this site, you would begin to see the truth about this disease: http://brandytwirl.multiply.com/photos/album/1/Morgellons_Pictures_Before_and_After_Treatment

    Morgellons victims are not nuts; they are ill with a real disease that is spreading globally. I know since I speak with many of them each day. Some are MD’s and researchers themselves who have Morgellons. Talk to Dr. Susan Kolb in Atlanta who advises the CDC on Morgellons Disease from time to time. She see many Morgellons victims every month and she can give you the facts on this dreadful disease, assuming you wish to know the facts.

  • Rudy Strohmeier

    Dear buffoon.

    Not only is this condition real, it is becoming increasingly common. You are way behind the curve.

    WTF do you think the CDC and Kaiser have been doing since January of ’08?

    According to Dale Carnegie, in his words, “it is almost impossible for a person not to believe what they want to believe.” I see examples of this around me every day. It is why smart people are constantly doing dumb things… they are duped into making lame decisions purely by their own biased wants and wishes.

    What I see happening is an entire medical establishment completely blinded by their own inability to acknowledge that they are a fledgling industry and are stumbling and bumbling their way through history. So confident that they have the answers… that they can handle anything that mother nature can throw at them. It is a tragedy that they would rather label an individual as delusional than face their own delusions of infallibility.

    I can provide proof to any doctor willing to spend a 1/2 hour with me, and not too lazy to pick up a magnifying glass, the bizaare nature of this condition. So far I have not been able to find one.

    Mark my words, friend. Morgellons will become required reading for future medical students as a case study in how virtually the entire medical establishment was unable to identify and treat a burgeoning epidemic, simply because the symptoms were too difficult to explain or even believe.

    The blogs are full of detractors that find some strange sense of fullfillment by mocking the sufferers of this condition. I just wonder how many “how did we miss this?” blogs we’ll see once the truth is finally known.

    I, along with so many thousands of others, need only to have patience while we wait for the rest of you to catch up, to finally be overwhelmed by the reality of yourselves or someone very close to you contracting this pathogen, whatever it is.

    Maybe Joni Mitchell will be the one to finally break the silence, maybe some other high-profile individual… but know this… it is coming, and when it does you will know and feel every bit the dumbass that is who you are.

  • Excellent and very thought provoking article by Bassington. It should be noted that the world of Morgellon’s is also very much like the world of “chronic Lyme disease”. In fact, the same individuals appear to be actively involved in championing both causes. Perhaps the most rational approach to take would be to lump these and other poorly defined “maladies” into one single group called Medically Unexplained Syndromes (MUS). This would enable physicians and medical researchers to start from scratch with no preconceived ideas to decide what to do about them.

  • Propable Sufferer

    Here is a question to the logic in your article.

    In your paragraph 1, the patient is reporting some symptoms, I’d call that empirical evidence. You agree with symptoms being present, empirical evidence being present. You or the patent categorise these symptoms as possibly being the syndrom called Morgellons. Your next induction: “There is no such thing.”

    Question: On what ground do you deny empirical evidence?

    On ground that somebody at some stage wrote a falsifiable hypothesis that such a disease does not exist? Does somebody’s writing present more truth than actual visible symptoms? The facts dont fit the theory, so the facts must be wrong …

  • Iain Brassington

    Thanks for the comments. From what I know about Morgellon’s, to say that the jury is still out on the matter is to put it mildly: from what I’ve seen, the general consensus seems to be overwhelmingly sceptical that there is a somatic problem. It doesn’t follow from that that there’s not a problem – as is made clear in the Lay Scientist post to which I linked.

    Now, should there be evidence produced that there is something physical going on, then that’s all grand; and the fact that a lot of people – lay or medical – believe that there’s something going on is at least some kind of reason to investigate the matter. That’s the sort of thing that bodies like the CDC should be doing, I’d’ve thought: surveying the landscape to see if there’s anything there. That there’s a study underway doesn’t prove the reality of a somatic condition, though: why should it? Until there’s strong evidence for the existence of a new medical condition, though, then there seem to me to be strong Ockhamite reasons for not believing in its existence.

    However, the point of the post here was not to put the boot into Morgellon’s per se – it was to raise a problem about truth and placebos. Had I talked about “Brassington’s Syndrome”, my thought-experiment would stand. Would that help? If so, do your own substitutions.

    And, Rudi – that’s not very friendly, now, is it?
    🙂

  • MARY

    I’M INTERESTED IN FINDING PHYSICIANS THAT ARE ACTUALLY HELPING ANYONE WITH MORGELLENS
    I HAVE HAD THIS HORRIBLE ILLNESS SINCE 2007 AND UNFORTUNATELY HAVE LEARNED TO LIVE WITH THIS BUT MY LIFE HAS CHANGED 100 PER CENT FOR THE WORSE.
    I HAVE HAD MANY BAD EXPERIENCES AS EVERYONE HAS WITH TRADITIONAL PHYSICIANS BUT WOULD LIKE TO GET SOME NAME AND NUMBERS OF SOMEONE WHO HAS ACTUALLY HELPED SOMEONE