Functional Neurological Disorder (FND), otherwise known as Conversion Disorder, is characterized by abnormal sensory or motor symptoms that are determined to be “incompatible” with neurological disease. FND patients are a challenge for...
moreFunctional Neurological Disorder (FND), otherwise known as Conversion Disorder, is characterized by abnormal
sensory or motor symptoms that are determined to be “incompatible” with neurological disease. FND patients
are a challenge for contemporary medicine. They experience high levels of distress, disability, and social isolation,
yet a large proportion of those treated do not get better. Patients with FNDs are often misdiagnosed and
suffer from stigma, dysfunctional medical encounters and scarcity of adequate treatments. In this paper we argue
that an anthropological understanding of these phenomena is needed for improving diagnosis and therapies. We
argue that cultural meaning is pivotal in the development of FND on three levels. 1) The embodiment of cultural
models, as shared representations and beliefs about illnesses shape the manifestation of symptoms and the meanings
of sensations; 2) The socialization of personal trauma and chronic stress, as the way in which individuals
are socially primed to cope or to reframe personal trauma and chronic stress affects bodily symptoms; 3) Moral
judgment, as stigma and ethical evaluations of symptoms impact coping abilities and resilience. In particular,
we focus on the disorder known as PNES (Psychogenic-Non-Epileptic Seizure) to show how cultural meaning
co-determines the development of such seizures. We introduce the notion of interoceptive affordances to account
for the cultural scaffolding of patients’ bodily experiences. Finally, we suggest that effective treatments of FND
must act upon meaning in all of its aspects, and treatment adequacy must be assessed according to the cultural
diversity of patients.
