Excited to share this feature I wrote in the November issue of @sciam, about a condition known as functional neurological disorder (FND).

Here's a thread https://www.scientificamerican.com/article/decoding-a-disorder-at-the-interface-of-mind-and-brain/

Many of you probably have never heard of FND, a condition in which neurological symptoms (paralysis, seizures, weakness, etc) arise without any "medical" explanation. But you might recognize some of these alternative names: hysteria, psychosomatic illness, conversion disorder.

FND is one of the most common conditions seen in neurology clinics. But patients have long been stigmatized & dismissed by doctors who didn't believe a condition without a traditional medical explanation was "real" or were worried they'd be fooled by people faking their symptoms.

Throughout history, FND has been misunderstood. For example, up until the 19th century the condition (which was labelled "hysteria" at the time) was thought to be a uniquely female one. That turned out to be wrong. Anyone can get FND.

Freud said that FND (which he called "conversion disorder") arose when psychological trauma "converted" into physical symptoms. Now, many FND experts say it's wrong to point to psychological factors as the sole driver of the illness. (But this is a matter of heated debate.)

Freud & many of his contemporaries considered FND a disorder or the mind rather than the brain. But a growing body of research by a new generation of scientists has made clear that it's BOTH. FND has proven that mind-body dualism is an outdated idea.

How does FND happen? This is still an open question, but there's some interesting ideas: Some think it's a consequence of the brain's predictive machinery gone awry. Others suggest it happens when the brain's emotional circuitry hijacks the motor system.

To solve this and other remaining mysteries about FND, we really need to bridge the gap between psychiatry & neurology. As @PerezMGHLab says, “We need a new science of brain and mind that really encapsulates that brain health equals mental health and physical health.”

Anyway, that's a short preview of what you can read about in my piece. I hope it's intrigued you enough to read the entire story

(Condensing this into a Twitter thread was tough--it was hard enough trying to get this piece down to 4,000 words!)

Thanks to @jonstoneneuro @PerezMGHLab @LaFaverMD @MarkHallett007 @Tim_R_Nicholson @SelmaAybek @valvoon @popkirov @AlanCarson15 @lauramcw @FndPortal & all the other patients, doctors and researchers who took the time to speak with me. This wouldn't have been possible without you!

And a big thanks to @Madhusree1984 for her edits!

One important additional point: FND has recently changed from a diagnosis of exclusion (a label reserved for those whose symptoms defied all other explanations) to one given after identifying distinct signs & symptoms. FND isn't (or at least shouldn't be) a "catch-all" diagnosis.

After reading some of the comments here, I think it's worth making a few additional clarifications. Here's another thread (1/6):

2/6 Unfortunately, there's still a lot of misunderstanding about what FND is in the medical community and general public. As a result, people with FND are often dismissed because they don't have a so-called "organic" condition & others may receive the diagnosis in error.

3/6 There are ways of distinguishing FND from other conditions, and a doctor with actual FND expertise will pinpoint these signs before giving a diagnosis. This recent article by @jonstoneneuro et al provides a very comprehensive summary: https://www.bmj.com/content/371/bmj.m3745.full

4/6 Just because a person's neurological symptoms can't be explained by an "organic" illness doesn't mean they have FND. But when given properly, FND is a legitimate diagnosis and there are FND-specific treatments that can help.

5/6 A small but growing group of physicians are now approaching FND in a compassionate and evidence-based way. I encourage you to check out their research, some of which is highlighted in my piece. There are also groups such as @FNDHope working hard to raise awareness about FND.

6/6 Finally, I hope you'll reserve judgement on this story until you've read it. There's only so much that can be conveyed by a Twitter thread, and it's difficult to capture all the nuances of FND in this medium.

7/6 An FND diagnosis should never be used to deny someone care. FND deserves to be treated with the same level of compassion as any other neurological illness & it's terrible that many medical professionals dismiss patients because they don't believe it's a serious condition.