Stigma and functional neurological disorder: a research agenda targeting the clinical encounter.

Stigma against patients with functional neurological disorder (FND) presents obstacles to diagnosis, treatment, and research. The lack of biomarkers and the potential for symptoms to be misunderstood, invalidated, or dismissed can leave patients, families, and healthcare professionals at a loss. Stigma exacerbates suffering and unmet needs of patients and families, and can result in poor clinical management and prolonged, repetitive use of healthcare resources. Our current understanding of stigma in FND comes from surveys documenting frustration experienced by providers and distressing healthcare interactions experienced by patients. However, little is known about the origins of FND stigma, its prevalence across different healthcare contexts, its impact on patient health outcomes, and optimal methods for reduction. In this paper, we set forth a research agenda directed at better understanding the prevalence and context of stigma, clarifying its impact on patients and providers, and promoting best practices for stigma reduction.

Stress: perceptions, manifestations, and coping mechanisms of student registered nurse anesthetists.

Stress is a response to change from the norm. Stress affects all individuals to varying degrees and can be positive, such as eustress, or negative, such as distress. The purpose of this qualitative, cross-sectional study was to investigate the stressors of the typical student registered nurse anesthetist (SRNA), with the objective of identifying trends in the perceptions, manifestations, and coping mechanisms of stress. An online (SurveyMonkey) questionnaire composed of 54 study-specific questions was developed to assess stress in the SRNA population. The questionnaire was sent to members of the American Association of Nurse Anesthetists via email invitation. The study yielded a sample of 1,282 SRNA participants. Analysis revealed statistically significant relationships between self-reported stress and negative outcomes, such as increased sick days, decreased health and wellness, and depression. The study demonstrated that SRNAs perceive their stress as above average, and it remains a central concern for them.

Masks in Medicine: Metaphors and Morality.

We have never been so aware of masks. They were in short supply in the early days of COVID-19, resulting in significant risk to health care workers. Now they are highly politicized with battles about mask-wearing protocols breaking out in public. Although masks have obtained a new urgency and ubiquity in the context of COVID-19, people have thought about both the literal and metaphorical role of masks in medicine for generations. In this paper, we discuss three such metaphors-the masks of objectivity, of infallibility, and of benevolence-and their powerful role in medicine. These masks can be viewed as inflexible barriers to communication, contributing to the traditional authoritarian relationship between doctor and patient and concealing the authenticity and vulnerability of physicians. COVID masks, by contrast, offer a more nuanced and morally complex metaphor for thinking about protecting people from harm, authentic and trustworthy communication, and attention to potential inequities both in and beyond medical settings. We highlight the morally relevant challenges and opportunities that masks evoke and suggest that there is much to be gained from rethinking the mask metaphor in medicine.

Lauren Slater and the Experts: Malingering, Masquerade, and the Disciplinary Control of Diagnosis.

The work of psychologist and author Lauren Slater has elicited strong reactions from both medical professionals and disability studies theorists, ranging from criticism to high praise. Attending to these responses, I argue that her work, in perhaps perverse fashion, can provide a narrative touch point for attempts from both fields to complicate the outdated binary division of the medical and social models. I illustrate the need for this collaboration through the example of malingering, suggesting that reading Slater's work through the lens of Tobin Siebers's theory of "masquerade" can open progressive conversations about "illness deception," which is an issue of central importance in disability rights, psychiatry, and political conversations. By using Slater's work and research on malingering as a test case, I point to potentially productive convergences among academic, medical, and social fields.