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Anyone who follows or participates in Paralympic sport will be in no doubt that it provides as much drama, excitement, elation and despair as its Olympic counterpart. In addition, it has undoubtedly contributed to reducing stigma against disabled people. However, an ongoing challenge for the Paralympic movement is to decide which impairments can compete in which sports and how to group athletes to ensure fair competition.
Understanding the effects of stigma around disability and dealing with them are part and parcel of work in medicine but especially the mental health field. Within the medical specialities there is a ‘race to the bottom’ for whose disorders are the most stigmatised. Psychiatry has a strong claim on this with mental illness generally regarded as among the most feared and least understood.1 And within psychiatry there is a similar hierarchy such that patients with ‘hysteria’ or conversion disorder (CD) are those found to be least satisfying to treat and are least liked by psychiatrists—the feeling is mutual of course.2 ,3
Paralympics and CD (or functional neurological syndromes (FNS)) have recently come together over a number of well-publicised episodes. These are well-worth considering. First, and most simply, they might encourage a useful partnership between the organisers of such sport and the psychiatric profession, which might prevent individuals becoming targets of media speculation and reputational damage to the Paralympic Games. Second, they might tell us something about attitudes to disability and mental health which may not be evident in more measured discourse. Finally, these episodes may focus our minds on tightening up our concepts regarding the rights and obligations inherent in the sick role and the perennial debates around diagnostic criteria for CD.
What is the process for deciding whether an athlete is eligible to compete in Paralympic sport? First, it should …