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I had a thought: Let us say Hannah had a fault with her fridge so that it kept beeping an alarm and turning itself off so the food went bad. She calls out an engineer. He comes and twiddles a knob at the back and says 'The fan overload sensor was stuck at the wrong setting and I have fixed it.'...

There is no suggestion that any malice was aimed at patients but perhaps not unreasonably the FND patients objected to being told by ME patients that their disease did not exist when of course ME patients are equally insulted if they were told ME did not exist. A lot people do not get involved...

That was a very informed answer! @Janna Moen PhD

I think you have just misunderstood that the points I have been making are about the complexity of the reality and the fact that there is no simple 'zero option' way out. Of course not. I have made it very clear that I don't think that. You are missing the point that the horse has bolted...

This is not quite what I was referring to. I am referring to the documented fact that the apparent denial of FND as a valid diagnosis by PWME has upset some people diagnosed with FND. In a perfect world that diagnosis would not have the double meaning it does. But that is not their fault and...

Yes, I would include movement disorders and seizures that did not fit with structural lesions. Presentations suggesting specific brain malfunctions.

They were misdiagnosed.

No need for new specialisms. You will always need to have doctors seeing patients fresh and deciding what speciality is most appropriate but that could be done far more efficiently if people with dysuria went straight to a urinary specialist and people wit heavy periods to a gynaecologist. And...

Except that you cannot do that every time. Largely because in many cases there are no tests that actually rule many things out. The tests are much better at that than when I was a houseman but they are still capable of missing lots of things. And as I mentioned, as soon as you start chasing tiny...

The blobs in most cases probably aren't causing anything. But I agree you could just call it idiopathic but that has its downside too. We do know a bit about FND patterns. They can be fairly typical across many cases. Not so much unknown disorders as unknown disorder type A or type B. And the...

ME/CFS could be considered functional in operational terms but I wouldn't call it FND because the malfunction may be entirely outside the nervous system, even if expressed via it. In FND it is reasonably clear that the problem is in the brain because it affects selective functions - like...

But we have the evidence from the patient's lived experience. The nervous system is malfunctioning - they tell us that and we can see it - but no structural changes are found so the reasons must be more subtle. That is all the 'functional' officially means and all it need mean.

But you must admit that some people with ME/CFS have upset the FND people in that way. As I say, I doubt this. Regular follow up would help but that is lacking not because of medical professionals but government cutbacks on clinics. As soon as you start doing MRIs you start finding little...

Exactly, but when I was practicing most of my colleagues acknowledged this sort of category without that implication. Conversion disorder was considered out of date Freudian Woo-woo. I think things have changed a lot in the last ten to twenty years. Quack psychology has been allowed to return...

Why should we be so cruel? What is wrong with their current situation? The person has exactly the sort of support they need. They do not need easier employment, just some more support from junior staff which is precisely what they have been provided with. Before making suggestions like that...

Indeed.

The whole point is that we have no idea. And we have to work with that and try to keep people afloat not knowing that. The NIH paper didn't seem to be able to agree with itself what process it was studying. The critical question is whether or not whatever else happening is causing the subtle...

I know what you mean but it isn't that simple. I have looked after people with 'FND' although I did not call it that. We do have information about these people. We know from long communal experience that a high proportion of people with certain patterns of presentation turn out over years not...

I am not suggesting FND is an appropriate category for ME/CFS - very much not. FND should cover people with specific neurological symptoms and signs that appear to be due to subtle brain dysfunction of a sort that does not progress to anything else. That diagnosis can of course be wrong and...

But all diagnoses are made up to some extent. They all represent imperfect and partial understanding of mechanisms and prognosis. There is a serious problem with FND, yes, but inasmuch as it indicates that the patient does not warrant open brain surgery which might leave them with a real stroke...