I recently discovered your podcast and, after listening to a couple of episodes, found myself looking forward to listening to more. I appreciate the effort to make psychology and mental health topics accessible to a broader audience. That’s why I was particularly surprised when I came across the episodes on conversion disorder / Functional Neurological Disorder (FND).
What puzzled me most was the lens through which FND was discussed. Many of the things you describe as suspicious (multiple consultations, extensive records, wanting validation, frustration after negative tests, continuing to search for answers, etc.) can also be what you would expect from someone living with unresolved or disabling symptoms. FND is one of the more common presentations in outpatient neurology, not a rare fringe issue. And seeing multiple providers does not automatically mean “doctor shopping.” Often, patients are sent from primary care or neurology to psychiatry, neuropsychology, PT, OT, speech therapy, or specialty clinics because the symptoms are complex and cross systems.
What concerned me most was how often the discussion drifted from FND into language that sounds much closer to malingering or factitious disorder: “doing their homework,” “feigning,” “secondary gain,” seeking disability, seeking sympathy, wanting to be the “special case.” That seems difficult to reconcile with the acknowledgment that patients are genuinely experiencing their symptoms. Malingering can happen, of course, but it is a separate issue involving intentional deception. Neither FND nor any other condition should be treated as malingering-adjacent by default. The possibility of deception may belong in a careful differential in specific contexts, but it should not become the interpretive lens through which an entire patient population is discussed.
I also think the discussion risks confusing consequences of illness with causes of illness. Sympathy, accommodations, disability benefits, or relief from responsibilities may sometimes follow illness, but that does not mean they explain why the illness exists. A person may bring a binder of records because they have spent months or even years being passed between specialists. They may seek validation because losing the ability to walk, speak, work, or function while being told “nothing is wrong” is profoundly destabilizing.
To me, the thread running through the discussion is a shift from mechanism to motive. Instead of asking how real symptoms are being generated, it repeatedly asks what the patient might be getting out of them. I also noticed that much of the conversation was framed around “conversion disorder,” while the field has increasingly moved toward the FND framework because it better captures a real disorder of nervous-system functioning without reducing it to presumed psychological motive or character pathology.
I hope you’ll consider revisiting this topic through that more current lens. I also think there is a responsibility, when speaking from a position of expertise, to distinguish clearly between established evidence, personal clinical impressions, and areas where the field has evolved or remains complex. Much of the discussion was presented with a high degree of certainty, even when describing what appeared to be personal observations rather than settled conclusions about FND. Comments about “doctor shopping,” “feigning,” “secondary gain,” or personality pathology carry real weight when they come from a clinician. Without that clarification, listeners may come away thinking those ideas reflect the current understanding of FND as a whole, rather than one interpretation. That influence matters, especially for a condition that is already so stigmatized and misunderstood.
