Functional Neurological Disorder (FND): Mental is Physical
Functional Neurological Disorder (FND) is a condition that blurs the lines between what we traditionally separate as “physical” and “psychological” health. Often misunderstood, FND manifests in symptoms that are neurological - such as weakness, tremors, or speech difficulties - yet there’s no structural damage to the brain. It’s a condition that highlights the importance of recognising that the brain is, like any other organ, a physical entity capable of malfunction. This shift in perspective is vital in both understanding and treating FND.
The Brain as a Physical Organ
Historically, there has been a perceived duality between physical and psychological health, often leading people to believe that if something cannot be found on a scan or in lab results, it must be purely “mental.” However, FND challenges this distinction. Just as the heart can suffer from irregular rhythms without being structurally damaged, the brain can also “malfunction” in ways that are not detectable through conventional imaging.
Neurologist Jon Stone uses the analogy of a software problem to explain FND. Imagine that your computer’s hardware is intact, but there’s a glitch in the software. The computer may slow down, fail to perform tasks, or even shut down, but there is no visible damage to the machine. Similarly, FND represents a “software problem” in the brain’s function, not a hardware issue, like stroke or brain tumour. This perspective is crucial for understanding why FND symptoms are very real, even when tests show no physical abnormalities. For an expert view on FND, Prof Stone’s website, www.neurosymptoms.org is a truly excellent resource.
Symptoms and Common Misunderstandings
The symptoms of FND can vary widely and often resemble other neurological conditions. Patients may experience limb weakness, tremors, seizures (known as functional seizures or non-epileptic attacks), speech disturbances, or gait abnormalities. These symptoms can come on suddenly and seem completely out of the person’s control, similar to how someone with laryngospasm experiences sudden, temporary choking without any physical obstruction in the throat.
Likewise, FND can be compared to panic attacks. During a panic attack, a person may feel like they’re having a heart attack, with symptoms such as chest pain, rapid heartbeat, and difficulty breathing. Although there is no heart damage, the experience is undeniably real and rooted in the brain’s misinterpretation of signals from the body. Similarly, FND involves real, physical symptoms that emerge due to the brain’s abnormal processing, rather than resulting from a clear injury or disease.
Therapies That Help
One of the most hopeful aspects of FND is that, unlike many neurological disorders, its symptoms can often be improved through treatment. However, treating FND requires a multidisciplinary approach that involves neurologists, physiotherapists, speech therapists, and psychological therapy.
Physiotherapy: One of the most effective treatments for FND is physiotherapy, which focuses on retraining the brain and body to move more effectively. For instance, a person with FND-related weakness or tremors can gradually learn to regain control over their movements through specific, guided exercises. A physiotherapist will help the patient re-establish the correct movement patterns, which can lead to long-term improvements.
Speech Therapy: For those experiencing speech disturbances, speech and language therapists play a key role. They work with the patient to address both physical aspects of speech, like articulation and breathing, and the cognitive components of communication. Over time, speech therapy can improve both speech clarity and the individual’s confidence in their ability to communicate.
Psychological Therapy: Cognitive Behavioural Therapy (CBT) has been found to be particularly helpful for FND patients. It addresses the emotional and cognitive processes that may contribute to the development and persistence of symptoms. For instance, catastrophic thinking - believing that a tremor might indicate a serious, life-threatening condition - can perpetuate anxiety and worsen symptoms. CBT helps patients challenge these thoughts and reduce the distress associated with their symptoms.
Neurological Involvement: Neurologists remain a central part of the care team for diagnosing FND. It is not a diagnosis of exclusion: is based on positive diagnostic signs, such as Hoover’s sign, carried out during assessment. Tests are also used to screen for any comorbid conditions. Their involvement also helps to validate the patient’s experience, emphasising that the disorder is not “all in their head” but a genuine brain malfunction that can be managed.
Learning to Control Symptoms
One of the most empowering aspects of FND treatment is the potential for patients to regain control over their symptoms. With consistent therapy, many people can learn to reduce the frequency and severity of their symptoms. For example, someone who experiences non-epileptic seizures may, over time, learn techniques to identify early warning signs and engage in exercises that prevent a full seizure from occurring.
Similarly, people with functional movement disorders often find that as they become more aware of how their body responds in different situations, they can consciously engage in movement strategies that reduce tremors or stiffness. This process requires patience and practice, but the brain’s neuroplasticity - the ability to rewire and form new connections - makes it possible for these changes to occur.
Conclusion
FND is a complex condition that requires a holistic understanding of the brain as a physical organ, capable of both “hardware” and “software” disruptions. The symptoms, though seemingly “psychological,” are as real as any other neurological disorder, and they can be debilitating. However, with the right combination of therapies - physiotherapy, speech therapy, psychological intervention, and neurological oversight - many people with FND can learn to manage their symptoms and regain significant control over their lives.
The road to recovery may be gradual, but it’s important to remember that the brain, like any other organ, can heal and adapt when given the right support.