INS NYC 2024 Program

Custom Content	Poster Session 05 Program Schedule 02/15/2024 02:30 pm - 03:45 pm Room: Shubert Complex (Posters 1-60) Poster Session 05: Neuropsychiatry \| Addiction/Dependence \| Stress/Coping \| Emotional/Social Processes Final Abstract #2 Poster Symposium: Neuropsychology and Functional Neurological Disorders: An Evaluation of Practice Through Clinical Case Studies and Historical Analysis — Abstract 1 Blind Spots in the Medical Gaze: A Historical and Theoretical Critique of Functional Neurological Disorder Jakob Thorn, Mercer University, Atlanta, United States Hanul Choe, University of Georgia, Athens, United States Category: Medical/Neurological Disorders/Other (Adult) Keyword 1: symptom validity Objective: Functional Neurological Disorder seems to represent a conundrum in the “normal science” of psychology and psychiatry. Theoretical treatments on the history of science and of medicine can offer a reconceptualization that explains the emergence of FND as a diagnosable condition. The current project aims to contextualize FND against turn-of-the-century professionalization using key texts in the philosophy of science. Participants and Methods: A review of the literature regarding Functional Neurological Disorder, stemming both from early and contemporary sources, was conducted. Information obtained from this review was evaluated with the intent of examining diagnostic practices and conceptualizations of FND within historical and theoretical contexts. Key tenets of an FND diagnosis were reconsidered in light of foundational concepts in the philosophy of science, including those espoused by Kuhn, Popper, Foucault, and Starr. Results: A review of the literature highlights the ever-present connection between the emergence of professional medicine, psychoanalysis, and the diagnosis of conversion disorders. First coined by Breuer and Freud (1897), the term “conversion disorder” is arguably best understood as little more than a repackaging of the proto-scientific diagnosis of “hysteria,” now substituting verifiably false pathophysiology with an unfalsifiable psychopathology. One would be forgiven for drawing the same parallels with modern diagnoses of Functional Neurological Disorder, insofar as this diagnosis offers little in the way of etiological explanation and is disproportionately diagnosed in women, those with lower educational attainment, those from rural areas, and those with lower socioeconomic status (Ali et al., 2015). While requirements for psychological disturbance have been revised in the diagnostic criteria of FND, connections with psychoanalytic theory are still prevalent, with a review of misdiagnoses of FND in patients with Multiple Sclerosis finding that an over-reliance on past psychiatric history is a main contributor to diagnostic error (Walzl et al., 2020). Conclusions: Medicine, including the behavioral sciences, occupies an almost singular prestige among the professions. Its proximity to science and the scientific community grants it the allure of accessing the most complete and most up-to-date pool of knowledge. Professionalization of the various health-related disciplines at the turn of and through the twentieth century delivered generally standardized levels of care that augmented the public’s faith in the medical community as a whole, thereby establishing authority and privilege over delineations of truth. Practitioners have largely enjoyed—barring malpractice findings, though even those channels reify authority—perceptions that they have command and mastery over knowledge relating to the human body. However, the conversion disorder—now Functional Neurological Disorder—reveals a potential gap and threatens the modern interpretation of medicine. It appears to be an unfalsifiable diagnosis, failing to meet the standards of a post-positivist episteme. Structurally, it appears to represent an anomaly, expected to be answered by a new, contesting paradigm; post-structurally, it represents an effort to maintain authority and obfuscate challenges to its status. We propose a theoretical conceptualization of FND and a critique of its use in behavioral science.

Custom Content

02/15/2024
02:30 pm - 03:45 pm
Room: Shubert Complex (Posters 1-60)

Poster Session 05: Neuropsychiatry | Addiction/Dependence | Stress/Coping | Emotional/Social Processes

Final Abstract #2

Poster Symposium: Neuropsychology and Functional Neurological Disorders: An Evaluation of Practice Through Clinical Case Studies and Historical Analysis — Abstract 1

Blind Spots in the Medical Gaze: A Historical and Theoretical Critique of Functional Neurological Disorder

Jakob Thorn, Mercer University, Atlanta, United States
Hanul Choe, University of Georgia, Athens, United States

Category: Medical/Neurological Disorders/Other (Adult)

Keyword 1: symptom validity

Objective:

Functional Neurological Disorder seems to represent a conundrum in the “normal science” of psychology and psychiatry. Theoretical treatments on the history of science and of medicine can offer a reconceptualization that explains the emergence of FND as a diagnosable condition. The current project aims to contextualize FND against turn-of-the-century professionalization using key texts in the philosophy of science.

Participants and Methods:

A review of the literature regarding Functional Neurological Disorder, stemming both from early and contemporary sources, was conducted. Information obtained from this review was evaluated with the intent of examining diagnostic practices and conceptualizations of FND within historical and theoretical contexts. Key tenets of an FND diagnosis were reconsidered in light of foundational concepts in the philosophy of science, including those espoused by Kuhn, Popper, Foucault, and Starr.

Results:

A review of the literature highlights the ever-present connection between the emergence of professional medicine, psychoanalysis, and the diagnosis of conversion disorders. First coined by Breuer and Freud (1897), the term “conversion disorder” is arguably best understood as little more than a repackaging of the proto-scientific diagnosis of “hysteria,” now substituting verifiably false pathophysiology with an unfalsifiable psychopathology. One would be forgiven for drawing the same parallels with modern diagnoses of Functional Neurological Disorder, insofar as this diagnosis offers little in the way of etiological explanation and is disproportionately diagnosed in women, those with lower educational attainment, those from rural areas, and those with lower socioeconomic status (Ali et al., 2015). While requirements for psychological disturbance have been revised in the diagnostic criteria of FND, connections with psychoanalytic theory are still prevalent, with a review of misdiagnoses of FND in patients with Multiple Sclerosis finding that an over-reliance on past psychiatric history is a main contributor to diagnostic error (Walzl et al., 2020).

Conclusions:

Medicine, including the behavioral sciences, occupies an almost singular prestige among the professions. Its proximity to science and the scientific community grants it the allure of accessing the most complete and most up-to-date pool of knowledge. Professionalization of the various health-related disciplines at the turn of and through the twentieth century delivered generally standardized levels of care that augmented the public’s faith in the medical community as a whole, thereby establishing authority and privilege over delineations of truth. Practitioners have largely enjoyed—barring malpractice findings, though even those channels reify authority—perceptions that they have command and mastery over knowledge relating to the human body. However, the conversion disorder—now Functional Neurological Disorder—reveals a potential gap and threatens the modern interpretation of medicine. It appears to be an unfalsifiable diagnosis, failing to meet the standards of a post-positivist episteme. Structurally, it appears to represent an anomaly, expected to be answered by a new, contesting paradigm; post-structurally, it represents an effort to maintain authority and obfuscate challenges to its status. We propose a theoretical conceptualization of FND and a critique of its use in behavioral science.