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Well, here goes nothing.
What can Outkast teach us about FND?
Let’s find out.
What can Outkast teach us about FND?
Let’s find out.
In Outkast’s song “Humble Mumble”, fantastic rapper and fashion icon Andre 3000 debates the merits of rap with a critic:
“She said she thought hip-hop /
was only guns and alcohol /
I said ‘Oh hell naw!”, /
but yet it’s that too” /
“She said she thought hip-hop /
was only guns and alcohol /
I said ‘Oh hell naw!”, /
but yet it’s that too” /
I think there’s something here we can learn about FND. Strap in as I try to explain, brushing up against the limits of my competence + hopefully without taking us
over
a
cliff.
Starting with the hip-hop:
over
a
cliff.
Starting with the hip-hop:
Andre’s objection is that the critic’s characterization of rap as “guns and alcohol” is not itself inaccurate, but that the word “just” excludes other important aspects of rap. This constitutes a larger inaccuracy.
Rap isn’t JUST guns and alcohol. It’s about family and friends and danger and geography and church and race and policing and bragging about how awesome you are and love and paranoia and whatever you feel like talking about.
Guns and alcohol are a part of rap, but by reducing the concept of rap to its most easily characterized elements, the critic is missing the bigger picture.
What does this have to do with FND? Well, some people insist on thinking of FND as “just” a psychological disorder, distinct from purely neurological disorders and thus not really a neuro disorder in any meaningful way.
Let’s have a quick look at the evidence.
Let’s have a quick look at the evidence.
First, is FND a psych disorder at all?
Yes, there is a good case to be made that FND has prominent “psychological” or emotional elements. Trauma, abuse, and neglect are prominent risk factors for FND, and figure in many patients’ backgrounds.
But not all patients have them.
Yes, there is a good case to be made that FND has prominent “psychological” or emotional elements. Trauma, abuse, and neglect are prominent risk factors for FND, and figure in many patients’ backgrounds.
But not all patients have them.
FND symptoms can also often be treated by altering attentional mechanisms - like training someone to walk again by having them focus on the goal and not their legs, rebuilding normal function gradually. CBT can help too.
OK so
psych factors are often but not always relevant to causing FND
psych approaches can be used to treat it.
But there’s a reason it’s called Functional Neurological Disorder. Because FND reflects a specific kind of disturbance of neurological *function*.
psych factors are often but not always relevant to causing FND psych approaches can be used to treat it. But there’s a reason it’s called Functional Neurological Disorder. Because FND reflects a specific kind of disturbance of neurological *function*.
Many people find the idea that a “psychological” disorder can give you a real tremor or paralysis hard to fathom. Can you blame them? But again, I’m arguing FND isn’t exclusively psychological. Brain science to the rescue!
It’s easier to understand this by linking it to the relevant parts of the brain. FND seems to mostly (but not entirely) occur in the higher cortical areas of the brain. That’s the big top part of the brain that looks like purple noodles packed together in this pic.
Ignore the included shark brain, please.
Specifically, recent studies have implicated certain specific *brain networks* - groups of brain areas that often work together to handle certain things.
For example, the Salience Network. Which helps us identify important stimuli in our environment, but is also involved in a TON of other things, like processing hunger signals and so on.
As we’ve previously discussed here, the salience network is considered to be highly involved in the creation of consciousness, “as well as integrating emotional, cognitive and sensory-motor experiences”.
BTW you can read about the salience network and some recent findings in FND patients here: https://www.sciencedaily.com/releases/2017/08/170828105358.htm
One more thing to know is that the insula, a brain structure that’s part of the salience network, is understood to underlie our sophisticated emotions by basically reading signals from the internal body and using them as a basis to construct what we call emotional feelings.
Perhaps that’s why you’re such a jerk to your boyfriend when you’re hungry. ANYWAY
Without getting too much into the hard neuroscience, two important networks that seem to underlie FND are the just-mentioned Salience Network and the Default Mode Network, which is activated when you turn your attention toward the state of your own body.
https://en.m.wikipedia.org/wiki/Default_mode_network
https://en.m.wikipedia.org/wiki/Default_mode_network
As Lisa Feldman-Barrett explains in this excellent video, these brain networks are involved in processing a staggering variety of tasks and experiences.
(Check out around 45:00)
(Check out around 45:00)
That makes sense if you think about it. Since these areas are involved in consciousness, + since everything we do depends on consciousness and most daily experiences are suffused with some degree of conscious experience, then yeah. Makes sense theyd be activated most of the time.
A number of researchers believe that these brain networks also generate predictions of what we experience inside and out. Because, the theory goes, they’re involved in running simulations of our experience (and thus constructing our sensory experience from inside our skulls.)
Whatever the case, we can say for sure that these are not just “emotion” networks. They are highly involved in many aspects of our experience.
That’s why it makes sense that a physical injury or emotional event could prompt the same FND symptom. The same networks involved in emotion are also responsible for sensing your body and assembling higher levels of consciousness from body-sensing signals.
So it follows that a big emotional disruption or getting a sudden painful injury could create the same brain problem because they affect the same brain systems.
(I should digress for a second and mention that motor areas of the brain - and their connections to “emotional” circuits - seem to be disrupted in FND as well.)
The big point is this:
The big point is this:
As Feldman-Barrett points out, these are MULTI-MODAL brain areas. That means they’re like Millennials - always expected to do several jobs at once. And some of those jobs are basic functions that maintain homeostasis and keep us alive.
In other words, if you could magically and bloodlessly remove the “emotional” parts of your brain, you would not become a Spock-like master of logical reasoning. You would have major problems.
Why? Because you removed parts of your brain that help keep your body within the narrow bounds that must be maintained for you to survive. Besides constructing emotion and guiding motor function and everything else.
That leads to a final question: why in the world should “emotional” brain areas also be in charge of keeping you alive? Because feelings and emotions make sense if you consider them sophisticated value-oriented judgments and responses.
We want things that make us feel good. We want to avoid or prevent things that make us feel bad. Feelings let us consciously and intimately perceive these questions of what is beneficial for us or not. We can feel our own guidance systems.
These inform our actions, and can be felt in the body. Think of how one tiny bite of an ice cream sundae looks to you before you’ve eaten 99% of the whole thing vs how it looks after.
So besides constructing consciousness and emotion, these same systems lend an emotional and hedonic tinge to everything we do.
To sum up:
As far as I understand the existing literature, there are no exclusively “emotional” brain circuits in humans.
It’s all one big team effort, always trying to make more accurate predictions and interpret sensations and keep us alive.
As far as I understand the existing literature, there are no exclusively “emotional” brain circuits in humans.
It’s all one big team effort, always trying to make more accurate predictions and interpret sensations and keep us alive.
(Experts, do please feel free to weigh in if I screwed something up here. This is my best understanding as of this sleep-deprived evening)
Anyway, given the integrated multi-modal nature of these FND-related brain networks, the fact that FND produces genuine neurological symptoms, and that all psychological dysfunction arises from the material neurological conditions of the brain anyway...
Doesn’t insisting on “only” psychological or neurological terms for FND start to seem a little silly? I think it does.
So is FND a “just” psychological disorder? Hell naw. But yet it’s that too.
And the truth is much cooler than the boundaries we drew.
And the truth is much cooler than the boundaries we drew.
Thanks everyone who’s offered thoughts + feedback on this. I fully expected the response to be “WTF are you talking about”
And that would have been OK too!
Still learning a lot from you all, esp FND patients, and happy to have the chance to do so
And that would have been OK too!
Still learning a lot from you all, esp FND patients, and happy to have the chance to do so
