BBC Radio 4 programme featuring 'Functional Neurological Disorder' (FND)

I haven't listened to this yet, but can be fairly confident that it will be a load of cr*p, knowing Claudia Hammond's views/approach:

"All in the Mind

FND - the most common disorder you’ve probably never heard of; political polarisation; All in the Mind Awards judge ZeZe

Functional Neurological Disorder, or FND, is the most common disorder you’ve probably never heard of. Some say it might be as common as MS or Parkinson’s and yet it’s not well known even by many medical professionals. It can cause seizures, paralysis, convulsions and changes in sensation, as well as pain, fatigue and memory difficulties.

It’s caused by a problem with the system in the brain that connects us consciously into our bodies, leaving sufferers unable to access their bodies properly. Because it doesn’t show up on scans and tests it is often not diagnosed effectively, and patients can face difficulties accessing the help they need or even being believed that their symptoms are real.

Claudia Hammond sits in on a consultation at the Maudsley Hospital between Emma, a new patient who is having exactly those problems, and Mark Edwards, Professor of Neurology and Interface Disorders at King’s College London.

She also meets Callum Alexander, a recovered patient who now volunteers for the charity FND Hope. He was referred by Mark for specialist neurophysiotherapy with Glenn Nielsen at St George’s University Hospital, which had immediate results. Glenn tells us that FND can cause the brain to become excessively focused on actions are normally automatic, such as walking, and that redirecting the brain’s attention can be one way of alleviating it.

Meanwhile, Emma is relieved she finally has a name to put to her condition and Mark is pushing for more positive diagnoses of FND."

https://www.bbc.co.uk/sounds/play/m00237pf

 

Munchausen by physician, again ?

 

Don't know why they settled for this odd framing of the most common disorder you've never heard of, it's not even true, and oh OK this is actually very much on brand for them to lie about this.

But the second paragraph is just absurdly misleading and disqualifying, saying that FND "causes", when actually it's simply the label that is applied to those things when they can't be explained by standard tests. Then of course the ideologues involved apply the exact same reasoning, not showing up on scans or tests, with us saying that makes them invalid.

What a giant load of bullshit. The absolute peak of medical pseudoscience, in the age of AI, invented and promoted almost entirely by MDs. What a bunch of weirdos.

 

Yes- usually used for strokes and brain injury

 

Are they not even reading their own literature?

Machine learning classification of functional neurological disorder using structural brain MRI features (2024, Journal of Neurology, Neurosurgery & Psychiatry)

 

Good point but it probably does not show up on the scans and tests in routine use - so it does not show up on some scans and tests.

 

'They' seem keen on distinctions between "healthy and psychiatric control" when 'they' view pwFND as entirely in psychological/behavioural terms.

For example, the CBT model of non epileptic seizures used in the CODES trial is that patients have 'anxiety that isn't anxiety.' CODES failed so that's been difficult for them. Their reflections article is an exercise in non reflection. At no point do they refect on whether their view of FND or construct is flawed.

There is, I suspect, perhaps some censorship going on too! For example, I have posted and reposted to the CODES reflection piece my thoughts in calm, polite manner in a Rapid Response. I need to check again but I suspect it has not been posted. I also submitted letter re CODES that got rejected as The Lancet was focusing on Covid at the time. As if that actually made a difference, it was an excuse.

I'm collecting my thoughts later this week and next for an NHS chronic pain psychologists SIG meeting re FND on 9th Oct. I'm leading and it will be interesting to hear what my colleagues are experiencing in their clinics.

Before my leave for surgery etc earlier in the year, I was occasionally meeting chronic pain patients in my clinic with FND labels who had travelled via neurology to us. None of them understood how this helped them. I recall one male pt being told 'it's like between MS and Parkinsons'. And more recently a lady who had had CBT for FND which did not help..... Confused her.

FND can mean all things to all people. Catch all for pretty much anything but it often includes CFS, FMS, movement disorders, and non epileptic seizures etc., with issues for validity, reliability etc. Overtly heterogeneous just like MUS, SSD etc. Entirely unfalsifiable.

The confident claims for definitive ""we know" what it/they are in terms of multiple different conditions, and then little objective reality or coherent thinking. Just like Richard Brown's claims in The Psychologist in 2013 "Explaining the Unexplained". It's just stuff they think is true. Misdiagnosis is to them a minimal triviality. It is seductive to some (patients and clinicians) and it will, I fear, have legs in the way MUS did not. For those that are misdiagnosed there will be, I suspect, minimal access to accountability.

It really does seem incredibly hard for some neurologists (and it seems A&E doctors who are apparently in some quarters handing out FND labels....) to say "I/we dunno...." And to some clinicians and patients it will mean just that, even though the models of treatment are 100% psychobehavioural (as in curable CBT/GET type therapy). So much unethical duplicity straight to the patients face and much confusion. Minimal humility in the face of things we dunno what causes them.

FND adds nothing of clinical or practical value to pt care. Will lead to more referrals and time wasting for pts and NHS. Likely piss pts off when they get wind of it, end up feeling more isolated, marginalised and ashamed. Precisely the opposite of good care.

 

Well put @Joan Crawford

 

Apropos of nothing —

A neural network for religious fundamentalism derived from patients with brain lesions (Aug 2024)
Ferguson, Michael A.; Asp, Erik W.; Kletenik, Isaiah; Tranel, Daniel; Boes, Aaron D.; Nelson, Jenae M.; Schaper, Frederic L. W. V. J.; Siddiqi, Shan; Turner, Joseph I.; Anderson, J. Seth; Nielsen, Jared A.; Bateman, James R.; Grafman, Jordan; Fox, Michael D.

SIGNIFICANCE
Religious fundamentalism is a global and enduring phenomenon. Measuring religious fundamentalism following focal brain damage may lend insight into its neural basis. We use lesion network mapping, a technique that uses connectivity data to identify functional brain networks, to analyze two large, independent datasets of brain lesion patients. We found a network of brain regions that, when damaged, are linked to higher religious fundamentalism. This functional network was lateralized to the right hemisphere and overlaps with the locations of brain lesions associated with specific neuropsychiatric and behavioral conditions. Our findings shed light on neuroanatomy that may influence the emergence of religious fundamentalism, offering implications for understanding the relationship between brain networks and fundamentalist behavior.

ABSTRACT
Religious fundamentalism, characterized by rigid adherence to a set of beliefs putatively revealing inerrant truths, is ubiquitous across cultures and has a global impact on society. Understanding the psychological and neurobiological processes producing religious fundamentalism may inform a variety of scientific, sociological, and cultural questions. Research indicates that brain damage can alter religious fundamentalism. However, the precise brain regions involved with these changes remain unknown. Here, we analyzed brain lesions associated with varying levels of religious fundamentalism in two large datasets from independent laboratories. Lesions associated with greater fundamentalism were connected to a specific brain network with nodes in the right orbitofrontal, dorsolateral prefrontal, and inferior parietal lobe. This fundamentalism network was strongly right hemisphere lateralized and highly reproducible across the independent datasets (r = 0.82) with cross-validations between datasets. To explore the relationship of this network to lesions previously studied by our group, we tested for similarities to twenty-one lesion-associated conditions. Lesions associated with confabulation and criminal behavior showed a similar connectivity pattern as lesions associated with greater fundamentalism. Moreover, lesions associated with poststroke pain showed a similar connectivity pattern as lesions associated with lower fundamentalism. These findings are consistent with the current understanding of hemispheric specializations for reasoning and lend insight into previously observed epidemiological associations with fundamentalism, such as cognitive rigidity and outgroup hostility.

Link | PDF (Proceedings of the National Academy of Sciences)

 

That’s a good explanation of something that I recently realised seems prevalent and involved in many of the problems we see.

Saying ‘I don’t know’ can be hard for all of us. Even more so for people who want to help and/or feel very highly of their own ability and/or feel a pressure to know/help.

But saying we don’t know something is brilliant. It’s the necessary first step in an admittedly often long road to learning. And above all it is honest.

 

Agreed. And to patients and journalists, CBT is just a single amorphous lump of a treatment that can be used for everybody with any kind of health problem. There seems to be little realisation that there are different flavours of CBT for different purposes.

Not that that made any difference to me. I was referred for CBT about 15 years ago and it was utterly useless. My health problems at the time all had a physical origin e.g. untreated hypothyroidism and iron deficiency, but I ended up treating them myself in the end. And surprise, surprise the things I was sent to CBT for were correctly treated as a result of my self-treatment. CBT did not fix them.

Edit : Grammar

 

Amazing what one can do when there is no oversight or accountability and you can just make stuff up.

 

The joys of being in an industry that isn't subject to supply and demand pressures, and in fact you have 10x more demand than supply so you never have to actually bother producing good outcomes beyond whoever supervises/funds you wants out of you.

It does cost them a lot of credibility. But it makes zero difference on their day-to-day operations. None that they can see anyway. Having fewer customers is the best outcome they can hope for, they can even pretend that it means they're doing great when patients don't come back. In fact they routinely do. Looping back to my comment #16 above.

 

Hypothesis: we would likely see similar things from MDs who believe in psychosomatic models.

People get out of fundamentalist ideologies. This isn't a rigid construct in the structure of the brain, has nothing to do with genetics or any fixed conditions. It's a dynamic process. And just as other forms of fundamentalism require deprogramming, the same will be needed for psychosomatic ideology. This is likely why it's so hard to move past it. It's too deep and affects their core identity.

 

I'm reminded of that Simon Wessely quote where he says: For as long a psychiatry exists in the public imagination as it does now, then each generation will find it necessary to discover its own ME.

What he doesn't say is that the reason the names keep changing is because patients realize the label has been hijacked to mean not real.

My response: For as long as medical professionals continue to psychologize unexplained physical illness, each generation will invent their own ME.
The truth:

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