Functional neurological disorders in personal injury , 2021, Phillips

The expert report
The structure of the expert report and the role of the expert witness are beyond the scope of this article. However, certain points are relevant when considering a claimant’s functional symptoms. In the history section, it is useful to describe a typical day and the range of activities undertaken on both ‘good’ and ‘bad’ days; this is important in interpretation of video surveillance. It helps to include a brief vignette of the claimant’s life, including any childhood adversity, if relevant—they may be more at risk of developing functional neurological disorder (FND), for example.1 It is worth asking the claimant what they feel about the accident; if they believe there is permanent damage done, they are less likely to improve2 and if they harbour grievance towards the ‘perpetrator’, they are more likely to develop post-traumatic symptoms.3 4

Reliability of the claimant
In legal claims, and in clinical experience, claimants/patients with FND, and indeed with any neurological condition, may have a degree of volitional symptom control. This may be produced in order to gain relief from responsibilities, for example, or a more subconscious exaggeration to convince others of the patient’s/claimant’s suffering. At the other end of the spectrum is factitious disorder, a psychiatric condition, where patients willfully fabricate symptoms; and malingering, whereby symptoms are consciously fabricated for (usually material) gain. Given that, in FND, it will superficially appear the claimant’s symptoms and signs are under voluntary control, it is not possible to be sure if that claimant is fabricating or not. However, there may be suggestions that the claimant is an unreliable witness; for example, prominent mismatch between reported and actual function (observed by covert surveillance, for example), markedly different histories given to different professionals (although physical examination findings may vary), or a microbiology report suggesting a wound may have been tampered with. Ultimately, reliability of a claimant is for the court, not the expert, to decide.
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Acknowledgments
I would like to thank Professor Jon Stone and Dr Christopher Bass for reading the manuscript, and their helpful suggestions.

https://neurologyopen.bmj.com/content/3/1/e000100

 

consciously fabricated for (usually material) gain. this is the entire problem with this field of research the principals involved know their bread and butter work is largely paid for by people trying to deny illness or harms in order to save company money.

 

Yet with a fluctuating condition there can be a prominent mismatch. Sometimes a person can be bedbound, sometimes able to go out for most of a morning or take a long walk. Even attend a social event.

The problem is, when filming, you can't always see an invisible illness.

I think an honest, impartial assessor who knows what they're doing & whose primary aim is to discover the truth should be able to find out the truth simply by asking the right questions and listening carefully to the answers.

The blanket assumption that people are lying is counterproductive IMO. There's a lot of talk about the "type" of person who might develop long term health problems.

Like many of you here, I studied well into my twenties & uprooted myself in order to find work. I progressed up a career ladder and took on responsibilities both in work and outside by way of a mortgage and so on. I would have been far better off if I could have stayed in work and it's not as if I can pursue regular hobbies now I'm sick. Like so many other people, there isn't a history of responsibility dodging, quite the opposite. So as motivation goes that's a nonsense.

Now, I'm not saying that those who've never worked are responsibility dodgers either. I can't imagine teens who get sick are so desperate to avoid adult responsibility and attention seek from their parents. I know times change but when I was a teen, especially mid teens on, the people I most wanted attention from were my peers, I was desperate for more freedom and understood that with each new freedom gained the price was responsibility for using it wisely (or face the music!). The last thing I wanted was to spend all.my time at home under my parents ' beady eye.

For people who claim to know so much about people the limited view of what makes people tick is staggering.

I would also add I have met people at work who are extremely lazy and all too willing to let others do all the work. It doesn't take a psychology degree to recognise them. A few minutes of conversation is usually all you need to know that they're just there to watch the clock.