Mind + Body

The split

A while back, it became fashionable to think of humans as being split down the middle: mind/body. This is an unhelpful way of looking at FND, but it is useful to look back for a moment to understand how it affects us now. 

Academia has been writing about the mind body split for hundreds of years. Science became fixated on this idea when René Descartes (1596–1650) famously wrote that the only things that he could be certain of were his own thoughts and the information he thought he gained through his senses. 

His groundbreaking observation "I think therefore I am" basically means, "I am certain that I am thinking, and therefore I know I exist, but I'm not sure of anything else". It is widely accepted that this basic understanding became the foundation of modern science. The way the idea became used in science goes like this....

The scientist must assume nothing and doubt everything. The scientist must observe the outside world through their senses only. They must be objective. The inner workings of their own imagination must be put aside. Emphasis is put on things that can be seen, measured, recorded and replicated. If it cannot be observed, it can not be considered real.

Mind/body medicine 

Scientists could see and touch the body but they could not see and touch the mind. Philosophy declared that the mind and body were made of two different things, and therefore must be split. 

Medicine began to put problems into one of two baskets: mind or body. Until very recently, scientists and doctors were unable to see physical aspects of FND's impact on the body. They could see patient symptoms, but without corroborating observable changes in the body, FND symptoms began to be understood as problematic voluntary 'behaviour' rather than involving involuntary physical symptoms. This is because, along with their inability to 'see' the source of the problem, doctors observed that FND mainly affected people with traumatic histories and that they often had trauma related mental illness. FND became known as Conversion Disorder, was declared a disease of the mind, and focus shifted exclusively to psychological talking therapies. 

Conversion disorder theory is now not so popular. Nowadays, most medics who specialise in FND tend to think of it as a disorder that straddles the mind/body split, with a foot both camps. This presents a philosophical problem for most doctors who are accustomed to thinking either/or mind/body. It's also difficult for patients and their families to understand. 

We believe that our FND community is currently suffering more than most groups from this ongoing mind/body split in medicine. This is because: 

• as we have grown up in the same philosophical environment as our doctors, we struggle to understand the role of the mind in generating such overwhelming physical symptoms 

• medics dismiss our physical symptoms as being purely psychological, and then dismiss us as patients completely. 

This can be fixed with better communication and empathetic open minds. This goes for all parties. Doctors need to take the physical needs of FND patients seriously and do what they can to help. Patients and whanau too need to be open to the information that they are being offered, assuming the information is good, of course. 

Re-connection

We understand that our bodies and minds are not separate. They are inextricable. We all need stop thinking about them as separate if we are going to understand and survive this thing. 

Our brains and nervous systems are physical objects that are part of our bodies. Our thoughts are bodily events that have physical results outside of our brains. Conversely, the body affects the brain. We understand that when we make love our mood improves. We understand that when we break our leg, our mood declines. 

We blush in embarrassment, shit ourselves in fear, shit bricks, freeze in shock, bubble with excitement, swell with pride, are struck dumb, shiver in anticipation, worry ourselves sick, gasp in astonishment, sweat the small stuff and wage heated arguments. All of these phrases involve the body mind connection and we instinctively understand them.

It's just when we are asked to understand that a functional illness can have these violent and debilitating involuntary symptoms, it can seem a pretty long stretch.  

FND is not a problem with faulty thoughts or moral failings. It is a matter of the mind-body connection being scrambled. For you, it might be like an intermittent mobile signal coming and going throughout the day. 

You may have no prior trauma, stress or mental health problem. You may be one of those people who has already been through years of ACC therapy, and yet you still got FND. Nonetheless, there's a bug in the software and we have to reboot: again and again and again and again and again...... 

The mind-body circuit is malfunctioning and needs attention. 

Recent advances 

The scientists don't understand how it works yet. They are working on it. Some scientists observed differences in functional MRI scans. The Scientific American reported that:

Scientists have found decreased activity in supplementary motor areas and the right temporoparietal junction, which influence whether a patient's symptoms feel under their control. There are also abnormalities in the connections between brain areas responsible for
interpreting internal physical sensations and motor planning.

This means they have been able to see FND brains working/behaving differently. 

Most sources say that FND affected brain cells themselves are not physically different, other than observable differences in blood flow. However, this study here shows that structural changes have been found in the brains of FND patients. 

A diagram of structural neuroimaging findings in FND research can be found here.

As more science comes in, we will learn more. In the mean time, we have to work out how to cope and heal.