Content warning: Please be aware that this article includes discussion of mental illness, medical malpractice, and ableism.

Functional Neurological Disorder (FND) is very simple to explain. It is a problem with how the brain functions. More specifically, it is a problem with how the brain sends and receives messages, resulting in diverse motor, sensory, and cognitive symptoms. But unlike other neurological conditions, FND does not appear to be caused by any identifiable structural damage to the nervous system. As a catchy metaphor: the brain is a computer, and FND is a ‘software’ problem as opposed to a ‘hardware’ problem. If that all feels frustratingly vague, I’m afraid you are out of luck — but in good company. Since developing FND a year and a half ago, I’ve become closely acquainted with confusion. My own body has felt alien sometimes, and the way others have reacted to my disability has been equally disorientating. Instead of accepting that neuroscience is yet to make sense of FND, many people — including medical professionals — rush to dismiss symptoms, or question their very existence. Understanding this condition is not just a matter of advancing scientific knowledge. Judgement and shame must be replaced with compassion.

Turns out FND is far from simple to explain. Symptoms often develop rapidly and ‘out of nowhere’, most typically in adolescence or adulthood (1). These can include functional tics, non-epileptic seizures, limb weakness, paralysis, gait disorders, and speech difficulties (2). The list goes on. From the array of possible symptoms alone, it is clear that FND encompasses a broad range of presentations. Fluctuation and inconsistency can exist even within an individual’s experience. Most days, I appear completely ‘normal’. Sometimes, my disability is glaringly obvious. My FND is confusing and isolating; because there is so little information available, it is difficult to get the support I need. It doesn’t help that myths about this condition are rife within both medical and everyday settings, despite it being one of the most common diagnoses made by neurologists (3). I would like to dispel the idea that FND is just a fancy way of saying that doctors have ruled out ‘real’ neurological conditions. Neurologists can observe positive signs, or patterns of sensation and movement, that indicate functional symptoms, such as a Hoover’s sign for functional weakness (1). Therefore, although the cause of symptoms remains unknown, FND is a meaningful diagnosis. The very label itself represents progression away from the harmful beliefs that defined this condition in earlier centuries.

Sometimes I joke about how I might have been treated if I was living in the past. Would people try to exorcise me, or burn me at the stake? Or would I perhaps be sent away to a charming seaside retreat? A mental asylum may have been more likely. Indeed, symptoms of FND once would have awarded me a diagnosis of ‘hysteria’. This label originates from ancient beliefs about the uterus punishing the female body with illness if left infertile, representing an ideological burden forced on suffering women for centuries (4). In the words of Eliot Slater in 1965, the term was “a disguise for ignorance and a fertile source of clinical error” (5). As theories of psychology and neurology were reworked, clinicians began using the term ‘Conversion Disorder’ (4). FND symptoms were misunderstood as manifestations of psychological trauma being ‘converted’ into physical distress (4). It’s an interesting idea, but an inaccurate one. Many people with FND have not experienced significant trauma prior to developing symptoms (5). It is now understood that mental and physical harm, such as a severe illness or injury, may increase the risk of an individual developing FND (1,7). However, this is not a requirement, and certainly not the cause of this condition. Unfortunately, the medical field has not unanimously moved on from the misunderstandings of the past. 

Since my episodes of collapse, unresponsiveness, and uncontrollable movements were not typical of epilepsy, they didn’t seem to concern the first, second, or even third medical professional who saw me. I am glad that my condition is not inherently life-threatening — but declaring that there is nothing wrong with someone is a far cry from reassuring them that their brain isn’t in danger. The attitudes I encountered leant strongly towards the former. Doctors seemed eager to attribute my symptoms to ‘stress’, and prove that I could directly control what was happening to me, while some even tried to convince my mum that I was faking everything for attention. These experiences are not an anomaly. In fact, being dismissed or disbelieved is an almost characteristic part of having FND (8,9). It often takes years for people to be correctly diagnosed (8), let alone be offered any semblance of support. After a month, I was privileged enough to receive a diagnosis — and compassion — from a neurologist who took me seriously. Despite this, there are lingering impressions from that first month without any understanding or guidance. It urges me to ignore what I know to be true about FND, and about my own body, to entertain the idea that my thoughts are secretly orchestrating everything. I am crazy, or too weak minded to stop choosing thoughts that make me have FND. Don’t ask me how one can subconsciously do something on purpose. I didn’t put this idea in my own head, just like I didn’t put FND in my own head. Nevertheless, these things exist. People with FND are tasked with navigating not only frightening symptoms, but also ignorance, stigma, and shame.

Sometimes science doesn’t give us a satisfying answer. Future research can hopefully provide people with FND more concrete answers, including ways of understanding ourselves and possibilities for symptom management and recovery. Health and disability are complex, and we can never fully understand what someone else is going through. When it comes to FND, I barely understand my own body half of the time. Fortunately, I now understand that I deserve to be treated with respect. Compassion doesn’t need to be confusing. It shouldn’t take a breakthrough in neuroscience for people with FND to be listened to and cared for.

References

1. Bennett K, Diamond C, Hoeritzauer I, et al. A practical review of functional neurological disorder (FND) for the general physician. Clinical Medicine. 2021;21(1):28-36. doi: 10.7861/clinmed.2020-0987

2. FND Hope. Symptoms. 2012. Accessed May 11, 2025. https://fndhope.org/fnd-guide/symptoms/ 

3. Stone J, Carson A, Duncan R, et al. Who is referred to neurology clinics?--the diagnoses made in 3781 new patients. Clinical Neurology Neurosurgery. 2010;112(9):747-51. doi: 10.1016/j.clineuro.2010.05.011

4. Raynor G, Baslet G. A historical review of functional neurological disorder and comparison to contemporary models. Epilepsy & behavior reports. 2021;16:100489. 10.1016/j.ebr.2021.100489 

5. Slater E. Diagnosis of “Hysteria”. Br Med J. 1965;1:1395–1399. doi: 10.1136/bmj.1.5447.1395

6. Ludwig L, Pasman JA, Nicholson T, et al. Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies. Lancet Psychiatry. 2018;5(4):307-320. doi: 10.1016/S2215-0366(18)30051-8

7. Espay AJ, Aybek S, Carson A, et al. Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders. JAMA neurology, 2020;75(9):1132–1141. Doi: 10.1001/jamaneurol.2018.1264

8. Robson C, Lian OS. “Blaming, shaming, humiliation": Stigmatising medical interactions among people with non-epileptic seizures. Wellcome Open Research, 2017:2, 55. Doi: 10.12688/wellcomeopenres.12133.2

9. FND Australia Support Services Inc. Experiences of Functional Neurological Disorder - Summary Report. Canberra (AU): Australian Government National Mental Health Commision; 2019. 13p.