Conversion disorder and/or functional neurological disorder: How neurological explanations affect ideas of self, agency, and accountability

Abstract

An estimated 15% of patients seen by neurologists have neurological symptoms, such as paralysis, tremors, dystonia, or seizures, that cannot be medically explained. For a long time, such patients were diagnosed as having conversion disorder (CD) and referred to psychiatrists, but for the last two decades or so, neurologists have started to pay more serious attention to this patient group. Instead of maintaining the commonly used label of conversion disorder – which refers to Freud’s idea that traumatic events can be converted into deviant behaviour – these neurologists use the term functional neurological disorder (FND) and explain that the problems are due to abnormal central nervous system functioning. The situation that some patients with medically unexplained neurological symptoms are diagnosed with CD and treated by psychiatrists while others are diagnosed with FND and stay under the control of neurologists provides a unique case for analysing how neurological and psychological explanations affect subjectivity. In this article, I compare patient reports from English-language websites from the past 15 years to find out how minds, bodies, brains, and selves act and interact in the accounts of both patient groups. I conclude that the change in label from CD to FND has not only influenced ideas of medically unexplained disorders, but also affected ideas of the self and the body; of self-control and accountability.

Primordial Brains and Bodies: How Neurobiological Discourses Shape Policing Experiences

“…We not only gained an understanding of the everydayness and shaping of the body within society but also of ‘the resonance between discourse and a sense of embodiment’ (Binkley, 2018). Finally, the article enriches scholarship on how minds, bodies, brains and selves (inter)act, and affect ideas of self-control, subjectivity and accountability (Brenninkmeijer, 2020).…”

“…By believing biological processes are beyond purposeful control officers may circumvent accountability. Indeed, neurobiological explanations are deemed to reduce responsibility for actions or feelings of blame or guilt (Brenninkmeijer, 2020). However, colleagues take over tasks, such as frisking a suspect, as a strategy to allow officers to (re)gain control over their bodies and thus self-responsibility.…”

How to do things with words: Two seminars on the naming of functional (psychogenic, non-epileptic, dissociative, conversion, …) seizures

“…He referenced recent research on the different language used by people with diagnoses of "FND" compared with "conversion disorder", describing how those with the FND diagnosis are more likely to describe their minds or selves as passive, in relation to a body or brain that is 'out of control'; those with a conversion diagnosis are more likely to view the mind as active agent, and the self as a resilient entity, able to find ways to reinstate control. 34 There remains an open question whether any terminology for or model of the disorder could capture all that is most relevant to those experiencing it. Many people with the condition have lived through and been unable to prevent experiences that are irreconcilable with their core moral beliefs, morally injurious "soul wounds."…”