Faking symptoms? Too lazy to work? No!
Functional neurological symptoms, such as tremors, limb weakness or numbness, facial functional disorders and tics, gait disorders, blackouts, dizziness and many others that seem to have no physical cause, are the second most common reason for outpatient neurology consultation (after headaches). These symptoms have been described in the medical literature as the 17th century, when this collection of symptoms was called “hysteria”. It has been extensively studied since then, and we have a wealth of careful clinical descriptions of the symptoms that are remarkably similar to 21st century presentations. Also, studies from diverse global locations such as Tanzania, Pakistan, Turkey, Iran and China all describe similar phenomenology of FND presentations to those reported in the European and North American literature.
Now called “Functional Neurological Disorder” this problem is considered a common and significant cause of disability and impaired quality of life. Nonetheless, sufferers still encounter skepticism and ignorance when trying to get medical help for their symptoms. One survey of clinicians showed that as many as 13% believed that people with functional symptoms were always faking them, and more than 50% apparently believe that there is significant overlap between faked symptoms and functional symptoms.
In a 2023 article1 in Nature Reviews Neurology, Edwards, Yogarajah, and Stone review a wide range of evidence, including historical and cross-cultural consistency, reported subjective experience, treatment response, and comorbidities to explain why “feigning” or “malingering” are not convincing explanations. They also report on several experimental studies that, taken together, support the reality of the symptoms, and the difficulty or impossibility of feigning them in a consistent manner.
Dr. Stone also has an extensive website designed for people experiencing functional symptoms, where he describes how the neurological pathways getting disrupted can cause some of the strange symptoms people have, and what kinds of treatment have been shown to be helpful. Basically, he says, the need is for patients to come to a better understanding of what is happening to them so that they can begin to train the brain to behave normally again.
The positive takeaway here is that there is always hope. Even if the medical personnel you have encountered so far have not been educated in this field, the research is ongoing, and information is being made available in more outlets and contexts. Persistence can be rewarded!
1 Mark J. Edwards, Mahinda Yogarajah,& Jon Stone. Why functional neurological disorder is not feigning or malingering. Nature Reviews Neurology | Volume 19 | April 2023 | pp 246–256. https://doi.org/10.1038/s41582-022-00765-z