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Functional neurological disorder is a feminist issue
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  • Published on:
    Feminism demands radical revision to functional neurological disorder

    In “Functional neurological disorder is a feminist issue” by McLoughlin et al.,[1] authors explain that FND patients “suffer subtle and overt forms of discrimination”, suggesting that “FND clinical services and research are chronically underfunded in line with the neglect of disorders disproportionately affecting women”. Ultimately, they insist that feminists should support “parity of esteem” for FND with other neurological conditions.

    I suggest that the idea of an alliance between feminism and FND is highly problematic. First, authors minimize the seriousness of human rights violations against women in the name of hysteria. Second, they fail to consider the role that FND plays in healthcare gender bias across specialties. Third, they perpetuate the myth that functional diagnosis rarely errs, further threatening women’s safety in the healthcare system.

    First, while authors do acknowledge “objectification and exploitation” of women diagnosed with hysteria, their concern is merely that “some sociologists and scientists have opined that the diagnosis was used as a ‘patriarchal tool’ to silence or ignore complaints of women”. There’s no mention of sexualization of women’s symptoms in the name of hysteria, even as recently as ICD-10, or the range of sexual treatments to which “hysterical” women have been subjected, including genital mutilation. There’s no acknowledgment that these treatments, like sectioning based on the wishes of husbands, fathers, or sons, are...

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    Conflict of Interest:
    None declared.
  • Published on:
    Functional neurological disorder - Gender, care and cost
    • Khichar Shubhakaran, Senior Professor Neurology MDM Hospital, Dr S N Medical college Jodhpur, Rajasthan, India

    Functional neurological disorder is an important aspect with respect to burden and cost of management irrespective of gender as the authors have pointed out very rightly1.
    It can be chronic but most of the times present as an emergency therby increasing panic, inpatient admissions. Smooth care, workup and appropriate guidelines for the same may help a lot in such conditions.
    There is limited information, awareness, health care utilities, and economic burden of such patients which makes the situation more grim.
    So there should be multidisciplinary approach i.e. physiotherapy, occupational therapy, speech and language therapy, and psychological assessment. Functional neurological disorders overlap with refractory neurological conditions i.e. headache, seizure, focal deficit etc., so better these patients be subdivided in these categories. Framing universal guidelines all across the world according to subdivisions with appropriate line of care as is being done in various other disorders may help a lot to smoothen improve management and help reduce the cost of therapy and gender bias.
    1. Caoimhe McLoughlin, Ingrid Hoeritzauer, Verónica Cabreira et al.
    2. Christopher D. Stephen, Vicki Fung, Codrin I. Lungu et al Alberto J. Espay Assessment of Emergency Department and Inpatient Use and Costs in Adult and Pediatric Functional Neur...

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    Conflict of Interest:
    None declared.
  • Published on:
    A good start?

    Dear Editor,

    Whilst long overdue this paper represents a good start, to me. However it leaves me with several questions. Here are a few of them.


Will we see an immediate reduction in the number of ‘dustbin’ FND diagnoses, including amongst people deemed to be in the FND Subtypes? Will patients be empowered to define what a ‘dustbin’ diagnosis is?

    Do the authors believe that the FND Society will promptly appoint an equalities expert as their new Patient Engagement Executive? I am not alone in receiving a suboptimal response from them, especially when compared to their approach to FND Portal. I was happy that he got ‘rockstar’ treatment; I got ‘appalling contempt’ and what amounts to ‘we control the narrative, you’re not welcome here’ which was interpreted as their attempt to silence women. 

    Was the decision not to include patient representation in the FND Subtypes paper made by a feminist?

    Same question regarding the lumping of Conversion Disorder under FND in DSM, which has made it harder than ever for people with rare conditions such as Stiff Person Syndrome and Moyamoya Disease to record an initial misdiagnosis of Conversion Disorder.

    Is it ethical (from a feminist perspective or any other) to use the word ‘functional’ to aid acceptance of a FND diagnosis on the basis that it doesn’t overtly point to a mental disorder diagnosis?

    Can the authors assure your readers that ‘functional’ no longer means ‘hysteric...

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    Conflict of Interest:
    None declared.