All Reflections are Light

Functional Neurological Disorder from the Inside

Earlier this year (2020) I had the pleasure of preparing a video for FND Hope, as part of their virtual conference marking World FND Month. It had the aim of explaining some of the brain science of FND to patients who might not be familiar with it.

Getting an FND diagnosis can be a confusing, unnerving, and isolating experience. So I tried to explain it in a way I think could have helped the me of a few years ago. I hope you find it helpful too.

In reflecting (ha!) back on this some months later, it occurs to me that at the moment of diagnosis, both patient and doctor are at a disadvantage. The doctor has to explain a disorder without accidentally giving the impression that FND is “all in your head” (which I imagine must be hard to do), and the patient usually doesn’t have enough time with the doctor – 15 minutes is not enough – to really understand what FND is, how it affects the body, and what it means for you as a person.

If nothing else, I hope that as FND becomes more well-known, the idea that people are just “imagining symptoms” or are “just stressed” can be laid to rest. While there is evidence that mental processes like emotion and attention can intersect with FND in important ways, you can’t simply think yourself out of FND, and most people don’t just “get more FND when they get more stressed.” The disorder just doesn’t work the way that it’s so often imagined.

Instead, FND is something both more subtle and more severe, which challenges our traditional categories of what “neurological” and “psychological” mean. It’s just as accurate to call FND a sensorimotor disorder as a “psychological” one, and while it doesn’t act like many other traditionally “mental” conditions (like depression or schizophrenia), there’s also good evidence to show that how we use our brains – our thoughts, emotions, behaviors, and expectations – can change the course of FND. The fact that FND refuses to be easily sliced into either neurological or psychological categories is, I think, the central point I wanted to get across with this video. The existence of FND itself implies to me that the brain works differently, in disease and health, than most people – including many doctors – would imagine.* And indeed, research from several areas of brain science (including interoception, embodied cognition, and predictive processing) imply that FND likely does have much to teach us about the brain.

*(The fact that people with other “structural” neurological disorders, like MS and Parkinson’s, often develop FND with no prior history of mental illness, might be an example of the mind / brain distinction falling apart under closer scrutiny. And what are emotions, after all, other than an enacted function of the brain, just like everything else the brain does?)

If we can stop trying to explain away the things it’s trying to tell us.

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