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Draft:Morgellons: A Medical Anthropology Perspective

  • Comment: Well done on creating the draft, and it may potentially meet the relevant requirements (including WP:GNG) but presently it is not clear that it does. The draft does not appear to use language appropriate for an encyclopaedia. Also ensure draft meets WP:NOR. Cabrils (talk) 23:59, 20 August 2024 (UTC)

Morgellons[pronunciation?] is a multi-faceted condition that impacts people physically, psychologically, socially, and, due to its highly contested nature, politically. Consequently, any reductionistic approach towards treating this condition may reinforce potential harms and conflicts rather than reducing them. A medical anthropological perspective seeks to subvert these limitations by emphasising the critical importance of understanding the lived experiences of patients within their broader social and cultural contexts.

Background

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Anthropologists have suggested that the body that conforms to cultural expectations of ‘healthy’ is symbolic not only of individual wholeness and harmony but also reflective of its society.[1] Similarly, the ‘sick’ or deviant body may conversely represent ‘social disharmony, conflict, and dis-integration’ [1] Considering this, those who encounter mainstream biomedicine presenting with symptoms of Morgellons disease represent what the anthropologist Mary Douglas described as ‘matter out of place’,[2] referring to something that disrupts order and harmony within a given cultural framework.  

Those suffering with Morgellons, irrespective of its aetiology, represent something beyond the currently accepted and defined taxonomic boundaries of biomedical classification and identification,[3][4] and therefore diagnostically challenging to the accepted biomedical paradigm.[5] Consequently, mainstream biomedical epistemologies have strived to bring it back into 'order' through what could be considered critically as a process of reductive objectification.

Morgellons and biomedicine

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Considered through a biomedical perspective, Morgellons is an example of a disease which has medically unexplained symptoms (MUS). Consequently, people with Morgellons are often diagnosed as suffering from delusions (according to the criteria in the DSM-5).[6] In cases of MUS, it is often left to the discretion of the general practitioner or other medical professional to consider whether the patient's symptoms are legitimate, thus becoming the gatekeepers of illness legitimacy.[7] This opens to a consideration of Morgellons from an anthropological perspective: that disease is not necessarily a biological fact, but rather the product of a decision made by society to consider it so.[8]

Diagnostic practices in biomedicine can serve to reproduce social order, whereby having a formally recognised diagnosis gives the patient permission to be believed and to assume a 'sick role' in society.[7] Patients with MUS who are dismissed by biomedical practitioners as suffering from delusions or hypochondria often experience considerable distress, with first person accounts of people with Morgellons showing that they feel stigmatised and isolated.[9][10] This approach has the potential to drive some individuals with Morgellons further into online communities where conspiracy theories and paranoia can fester.[11] As such, this may create the potential for further marginalisation of the afflicted.

Classifying Morgellons

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The contested nominalisation of the condition as both ‘Morgellons Disease’ and ‘delusions of parasitosis’[12] foreshadow potential conflict between the patient, the medical practitioner, and their respective communities. Whilst Morgellons Disease is often considered by patients as a biological condition, biomedical practitioners generally diagnose the condition as a form of delusion, a psychological condition.[5] How health conditions are classified can impact how they are perceived by patients, medical practitioners, and their communities.[13][14]

This underlying conflict can be considered through the lens of the “shamanistic complex”,[15] in which a patient believes in their condition and seeks validation from an authority on health and disease. Anthropologists have noted the powerful impact that beliefs (formed and sanctioned by culture) can have upon the healing process, both positive and negative.[16] Therefore, for healing to occur there must be a shared belief in both the diagnosis and the treatment, not just between the patient and healer, but through group consensus of their community.[17]  When a patient doesn’t receive validation, they potentially lose faith in the medical practitioners’ ability to treat them.[18] The rejection of the classification of the condition as psychological rather than somatic can negatively impact treatment by constructing a nocebo effect.[19]

Psychological dimension

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The subjective experience of Morgellons has been described as comparable to an invasion by a "terrorist" or something "from outer space,"[20] metaphors that echo Douglas’ concept of ‘matter out of place’. Clearly, Morgellons is a highly disturbing and distressing condition to endure. This leads to a consideration of how mainstream medicine conceptualises Morgellons as a psychological illness by categorising it as a form of delusional parasitosis.[21]

Delusional parasitosis has been used by the medical profession to explain Morgellons largely due to the presence of skin lesions on patients. People with delusional parasitosis are often convinced that they are infested with parasites and may consequently exhibit symptoms of paranoia.[22] In some instances, such beliefs may negatively impact and distort people’s perceptions of their bodies, potentially leading to self-mutilating behaviours as a desperate and drastic measure to rid themselves of the parasites they believe they are infested with such as self-inflicted skin trauma, chemical therapy, or excessive practices of self-cleansing.[23] Such problematic behaviours are common in cases of delusional parasitosis.[24]

Similar to other forms of diagnosed delusional parasitosis, low self-esteem can also be a common side effect in those suffering with Morgellons, which can potentially to increased levels of social phobia.[25] Increased levels of social isolation may then exacerbate low self-esteem,[26] as such, therapeutic measures such a cognitive-behavioural therapy, a method intended to foster self-worth in a patient are applied to manage the psychological dimension of Morgellons[27]

References

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  1. ^ a b Scheper-Hughes, Nancy; Lock, Margaret M. (March 1987). "The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology". Medical Anthropology Quarterly. 1 (1): 6–41. doi:10.1525/maq.1987.1.1.02a00020. ISSN 0745-5194.
  2. ^ Douglas, Mary (2010). Purity and Danger: an analysis of concept of pollution and taboo. Routledge classics (Repr ed.). London: Routledge. ISBN 978-0-415-28995-5.
  3. ^ Cutlip, Hunter A; Mogallapu, Raja; Ang-Rabanes, Michael (23 May 2022). "Morgellons Disease Treated as a Psychosomatic Condition". Cureus. 14 (5): e25236. doi:10.7759/cureus.25236. ISSN 2168-8184. PMC 9217663. PMID 35755571.
  4. ^ Rice, Samantha; Wymore, Randy (17 February 2023). Molecular Analysis of the Systemic Dermatoses of Morgellons Disease. Oklahoma State University Center for Health Sciences Research Week 2023.
  5. ^ a b Beuerlein, Katherine G.; Balogh, Esther A.; Feldman, Steven R. (2021). "Morgellons disease etiology and therapeutic approach: a systematic review". Dermatology Online Journal. 27 (8). doi:10.5070/D327854682. PMID 34755952.
  6. ^ Dib El Jalbout, Jana; Sati, Heba; Ghalloub, Perla; El Bejjani, Grace; Karam, Rim; Mago, Arpit; Salame, Marita; Saoudi, Lara; Desangles, Antonio Baez; Emmanuel, Nancy (1 June 2024). "Morgellons disease: a narrative review". Neurological Sciences. 45 (6): 2579–2591. doi:10.1007/s10072-024-07361-7. ISSN 1590-3478. PMID 38319480.
  7. ^ a b Mik-Meyer, Nanna; Obling, Anne Roelsgaard (September 2012). "The negotiation of the sick role: general practitioners' classification of patients with medically unexplained symptoms". Sociology of Health & Illness. 34 (7): 1025–1038. doi:10.1111/j.1467-9566.2011.01448.x. ISSN 0141-9889. PMC 3555361. PMID 22384857.
  8. ^ Joralemon, Donald (2017). Exploring medical anthropology (Fourth ed.). London New York: Routledge. ISBN 978-1-315-47060-3.
  9. ^ Mobini, Sirous (31 December 2015). Walla, Peter (ed.). "Psychology of medically unexplained symptoms: A practical review". Cogent Psychology. 2 (1): 1033876. doi:10.1080/23311908.2015.1033876. ISSN 2331-1908.
  10. ^ Murphree, Jeremy (19 July 2023). "Morgellons Stigma". Morgellons Survey. Retrieved 13 August 2024.
  11. ^ Söderfeldt, Ylva; Groß, Dominik (April 2014). "Information, Consent and Treatment of Patients with Morgellons Disease: An Ethical Perspective". American Journal of Clinical Dermatology. 15 (2): 71–76. doi:10.1007/s40257-014-0071-y. ISSN 1175-0561. PMID 24671866.
  12. ^ Fair, Brian (May 2010). "Morgellons: contested illness, diagnostic compromise and medicalisation". Sociology of Health & Illness. 32 (4): 597–612. doi:10.1111/j.1467-9566.2009.01227.x. ISSN 0141-9889. PMID 20149149.
  13. ^ Hacking, Ian (2004). Historical ontology (1. Harvard Univ. Press paperback ed.). Cambridge, Mass.: Harvard Univ. Press. ISBN 978-0-674-01607-1.
  14. ^ Bowker, Geoffrey C.; Star, Susan Leigh (1999). Sorting things out: classification and its consequences. Inside technology. Cambridge, Mass.: MIT Press. ISBN 978-0-262-26907-0.
  15. ^ Lévi-Strauss, Claude (1963). Structural anthropology. New York: Basic Books. ISBN 978-0-465-09516-2.
  16. ^ Hahn, Robert A.; Kleinman, Arthur (October 1983). "Biomedical Practice and Anthropological Theory: Frameworks and Directions". Annual Review of Anthropology. 12 (1): 305–333. doi:10.1146/annurev.an.12.100183.001513. ISSN 0084-6570.
  17. ^ Wirth, Daniel P. (1 July 1995). "The significance of belief and expectancy within the spiritual healing encounter". Social Science & Medicine. 41 (2): 249–260. doi:10.1016/0277-9536(94)00312-H. ISSN 0277-9536. PMID 7667686.
  18. ^ Kennedy, Betty M.; Rehman, Matloob; Johnson, William D.; Magee, Michelle B.; Leonard, Robert; Katzmarzyk, Peter T. (2017). "Healthcare Providers versus Patients' Understanding of Health Beliefs and Values". Patient Experience Journal. 4 (3): 29–37. doi:10.35680/2372-0247.1237. ISSN 2372-0247. PMC 5751953. PMID 29308429.
  19. ^ Grosso, Francesca; Barbiani, Diletta; Cavalera, Cesare; Volpato, Eleonora; Pagnini, Francesco (1 July 2024). "Risk factors associated with nocebo effects: A review of reviews". Brain, Behavior, & Immunity - Health. 38: 100800. doi:10.1016/j.bbih.2024.100800. ISSN 2666-3546. PMC 11252084. PMID 39021437.
  20. ^ Sandlin, Jennifer A.; Wallin, Jason J., eds. (2018). Paranoid Pedagogies: Education, Culture, and Paranoia. Palgrave Studies in Educational Futures (1st ed. 2018 ed.). Cham: Springer International Publishing : Imprint: Palgrave Macmillan. ISBN 978-3-319-64765-4.
  21. ^ Middelveen, Marianne J; Fesler, Melissa C; Stricker, Raphael B (February 2018). "History of Morgellons disease: from delusion to definition". Clinical, Cosmetic and Investigational Dermatology. 11: 71–90. doi:10.2147/ccid.s152343. ISSN 1178-7015. PMC 5811176. PMID 29467580.
  22. ^ Prakash, Jyoti; Shashikumar, R; Bhat, P. S.; Srivastava, K; Nath, S; Rajendran, A (2012). "Delusional parasitosis: Worms of the mind". Industrial Psychiatry Journal. 21 (1): 72–74. doi:10.4103/0972-6748.110958. ISSN 0972-6748. PMC 3678185. PMID 23766584.
  23. ^ Lai, Jianbo; Xu, Zhe; Xu, Yi; Hu, Shaohua (1 October 2018). "Reframing delusional infestation: perspectives on unresolved puzzles". Psychology Research and Behavior Management. 11: 425–432. doi:10.2147/PRBM.S166720. PMC 6171510. PMID 30319296.
  24. ^ Grant, Matthew (8 January 2020). "Between a Rock and a Hard Place: Balancing Physician Deception and Patient Self-Harm in the Management of Delusional Infestation". The American Journal of Tropical Medicine and Hygiene. 102 (1): 3–4. doi:10.4269/ajtmh.19-0755. ISSN 0002-9637. PMC 6947769. PMID 31701863.
  25. ^ Al-Imam, Ahmed Mohammed Lutfi (1 January 2016). "A systematic literature review on delusional parasitosis". Journal of Dermatology & Dermatologic Surgery. 20 (1): 5–14. doi:10.1016/j.jdds.2015.11.003. ISSN 2352-2410.
  26. ^ Lyyra, Nelli; Thorsteinsson, Einar Baldvin; Eriksson, Charli; Madsen, Katrine Rich; Tolvanen, Asko; Löfstedt, Petra; Välimaa, Raili (January 2021). "The Association between Loneliness, Mental Well-Being, and Self-Esteem among Adolescents in Four Nordic Countries". International Journal of Environmental Research and Public Health. 18 (14): 7405. doi:10.3390/ijerph18147405. ISSN 1660-4601. PMC 8308002. PMID 34299857.
  27. ^ Waykar, Vijayendra; Wourms, Katherine; Tang, Michael; Joseph, Verghese (September 2021). "Delusional infestation: an interface with psychiatry". BJPsych Advances. 27 (5): 343–348. doi:10.1192/bja.2020.69. ISSN 2056-4678.
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