How we came to our organizational vision?
FND has a difficult history. Patients with this condition commonly presented with neurological concerns. They were typically diagnosed with "psychogenic" disorders. This seemingly mismatching diagnostic process came on a backdrop of centuries-old belief in mind-body dualism. Research advises us that dualistic thinking and the psychogenic diagnosis left patients with sense of invalidation. Understandably, patients' acceptance of the diagnosis of "Psychogenic Disorders" was and still is low.
We optimistically viewed that, in 2013, the American Psychiatric Association, in its 2013 DSM 5 publication, opted to withdraw the term “psychogenic” from describing Functional Neurological Disorders. Concurrent with this change, robust research into FND rapidly expanded, evidenced by the marked increase in controlled studies into this condition. Publications investigating this condition on grounds of the observable, the measurable and the physiological increased in number. Associated with this research expansion, patients involvement in their care and in shaping the research agenda also increased. The number of patient-led organizations for this condition, zero in 2012, rose to almost ten in 2019. Some of these organizations are contributing to academic work, and are active in shaping the modern understanding of FND. We see the changes that occured since 2013, collectively, as an example of progression based on joint effort, after decades of separation.
Our journey to developing our vision statement started with the changes in the DSM 5 in 2013. As founders of this society, we learnt a lot from past models of FND. Past models provided understanding into vulnurabilities to FND, and the function of some of FND symptoms. We had always been puzzled, however, by the assumption that the genesis of an illness, any illness, is the function of the “psyche”. "Psyche" Latin for soul, spirit or self, is a term that has been used in healthcare practices since the 1600s, perhaps even earlier. Throughout the last four centuries, “Psyche” was seen as causative to many old as well as more contemporarily identified illnesses. One after another, many of these illnesses became amenable to more specific and physiological explanations. What came to be adequately explicable was often removed from the realm of the "Psychogenic".
"Psyche" is an overarching metaphor. It has no specific physiological correlate. Our belief is that this metaphor doesn't rise to explain health or disease. While no one can object to the use of metaphors to aid scientific understanding, we now believe it is time for the term "Psychogenic" to give way in clinical practices as it did in classifications. We hope to see more developments towards accurate physiological and other scientific understandings of the cognitive, responsive and emotional processes in FND. In fact, we foresee with optimism a future when the term 'Functional Neurological DIsorder' starts to give way to more specific diagnostic terms. For this change to happen, scientifc advances have to take place. We hope to work together, with our patients, and with our limited means, to make some contributions to these advances.
We should confirm that our vision, mission and activities do not in anyway undermine the role of emotions in health and disease. In fact one of the pillars of our programs is evidence-based cognitive therapies with focus on emotional symptom. We support research that extends to emotional states, cognitions, and responses commonly seen in patients with FND. We believe that past FND models were crucial to today's understanding. Vulnarabilities to some FND states were well explained by some of these models. The functions of some FND symptoms was well discerned through the prism of these models. As science progresses, relevant findings from past models continue to be integrated with current understanding.
As professional members of this program, our endeavour is to wholeheartedly subscribe to this new FND model, with a vision of genuine care to patients with FND, as partners, guiding the understanding of their own illness, enlightened by their own wisdom, and aided by our knowledge.