Long COVID vs. functional neurological disorder: Punching down, 2025, Dawson

[Dolphin]

Long COVID vs. functional neurological disorder | 8 | Punching down |

Shelley Dawson’s chapter documents a situation where clashing vulnerabilities are not only not recognised; they are vigorously disavowed and denied. She

www.taylorfrancis.com

Chapter

Long COVID vs. functional neurological disorder​

Punching down
ByShelley Dawson
BookClashing Vulnerabilities, Disability and Conflict
Edition1st Edition
First Published2025
ImprintRoutledge

Pages18


Share

ABSTRACT​

Shelley Dawson’s chapter documents a situation where clashing vulnerabilities are not only not recognised; they are vigorously disavowed and denied. She discusses how a new emerging diagnosis, Long COVID, is being formulated in distinction to another neurological condition, functional neurological disorder (FND). Dawson examines how people associated with similarly medically ambiguous (and socially suspicious) neurological conditions such as myalgic encephalomyelitis/chronic fatigue syndrome and, now, Long COVID, are treating FND as what in language studies is called a “false friend” (embarazada in Spanish doesn’t mean “embarrassed”. It means “pregnant”).

 

[SNT Gatchaman]

But as I will explain, the diagnosis of Long COVID seemed to me that it could open a door to potentially legitimising other stigmatised (chronic) disorders, one of which has been the focus of my own research since 2021. Functional neurological disorder (FND) is a common and disabling neurological condition that has existed for centuries but remains misunderstood and intensely stigmatised. Until recently regarded as “hysteria”, FND is freighted with discourses of femininity, emotionality, and mental illness that deny seriousness or even reality to the disorder and posit the “cause” as psychological, and hence firmly within the control of the person affected.

I had not heard of FND before a family member was diagnosed with it in 2021.

But then one day in my home in Wellington, New Zealand, I was listening to a radio interview about Long COVID research. A New Zealand immunologist and Long COVID researcher was discussing a patient who had been diagnosed with FND after developing neurological symptoms post‑COVID. The immunologist opposed this diagnosis of FND. She said that the patient, instead, was a textbook case of Long COVID. Why? Because the patient’s symptoms were “not psychological”. The patient’s symptoms are very real, she noted, and terribly debilitating. And she observed that New Zealand medical practitioners should be above such a “sham” diagnosis as FND.

For anyone diagnosed with FND, or for anyone who knows, cares for, and loves a person affected by FND, words like these are harsh, and they reveal significantly outdated understandings of the condition. But what is FND?

The analogy of hardware and software is often used to aid understanding, and to differentiate between the brain as a structure (hardware) and the abnormalities between circuits (software), which are glitching and preventing the normally automatically smooth communication between the brain and the body. These glitches result in debilitating motor and sensory symptoms—seizures, impaired vision or speech, uncontrollable movements, gait difficulties, or paralysis and limb weakness, among others. What this means, in essence, is that the brain itself is “fine”. It is not degenerating per se, as it would be in more commonly known disorders such as multiple sclerosis (MS). The problem lies in how the brain functions and how the signals it sends and receives are processed.

The symptoms of FND are either hyper visible or invisible; they are unpredictable and dynamic. Onset is typically sudden, and there is a rapid progression.

In Aotearoa New Zealand, as elsewhere, FND is a prevalent and marginalised condition affecting people of all ages, ethnicities, genders, sexualities, and backgrounds, though women have consistently been overrepresented across time. Grassroots organisations are speaking about the likelihood of FND being “particularly acute for Māori”, and calling for use of Kaupapa Māori research methods by way of ensuring culturally safe research approaches.

A common thread connects this diversity: people with FND know what it is like to, as they often say, “come undone”. Their bodies and brains betray them in violent and unexpected ways, and they know intimately the isolation, terror, and grief that this condition triggers. Despite leaps in FND research and brain technology internationally, people in Aotearoa are still dismissed or treated with suspicion in medical encounters.

 

[SNT Gatchaman]

The history of FND is in itself a clash between epistemologies about how FND should be understood. For over 150 years, FND has been batted between neurology and psychiatry, as these specialisations grew into distinct poles which reflected the increasing mind/body dualistic underpinnings of modern western biomedicine.

Ultimately unable to locate the “dynamic lesion” in the brain that he had come to believe was the cause of hysteria, Charcot’s mantle, upon his death in 1893, was taken up by a young neurology student—Sigmund Freud—who had become impassioned by both hysteria and Charcot while studying alongside him in Paris.

Freud shifted understandings of hysteria from “the brain” to “the mind”. His “conversion” model of symptoms (leading to the new name of “conversion disorder”) captured his own theoretical position of a psychic trauma (often sexual in nature) being converted into a physical symptom.

Current scientific understandings define FND as a neuropsychiatric, multinetwork condition, a “brain‑mind‑body” disorder that affects the whole person. The cause, or rather the “factors and mechanisms underpinning FND”, are best conceptualised within a biopsychosocial framework comprising “predisposing, precipitating, and perpetuating factors that affect the neural mechanisms of the disorder”. These understandings speak to the necessary interdisciplinarity that characterises FND research and they unsettle taken‑for‑granted understandings of “physical” and “psychological”.

If we think for a moment about the immunologist I quoted at the beginning of this chapter—the one who dismissed the idea that Long COVID was FND, because the patient’s symptoms were “not psychological”—we can see how that expert’s blithe use of the word “psychological” to refer to FND deftly brings history crashing back into the present, activating notions of suspicion and undermining important advances to move beyond FND stigma.

By raising a clash between Long COVID and FND, the immunologist joined a chorus of Long COVID researchers who—allied with researchers who work on ME/CFS and activists in and for those communities—deny the reality of FND, thereby shoring up the legitimacy of their own neurological conditions at the expense of the medical underdog.

 

[SNT Gatchaman]

David Putrino is a neuroscientist and physical therapist in New York who has gained a significant following on X for his work and approach to Long COVID. His dedication to ensuring that people diagnosed with Long COVID are treated respectfully and seriously is clear, as is his frustration when he speaks of the stigma experienced by those with Long COVID in healthcare settings. But when his posts centre on FND—and specifically on how Long COVID is not FND—this frustration functions as a dog whistle to FND‑deniers, unleashing a torrent of comments calling for rectitude of what appears to be experienced as the ultimate insult.

(Twitter thread from Putrino)

Notice what this language is doing. Of immediate note is that “science” functions as the ultimate benchmark, the ultimate arbiter, one that we should hold in gratitude (“thanks to science”). “Science” is contrasted with the adjective “uninformed”, which is used to describe the clinician who is reported as saying that Long COVID is “just” FND. While this clinician is said to be “well‑meaning”, this description is qualified by the diminutive “quasi”, and the sly insertion of the trivialising “just” before FND. The use of capitalisation at the end of the post—“LC IS NOT FND”—clarifies the intention of the remaining components of the post, signalling assuredness, and a hint of zeal. A post like this ensures that readers affected by Long COVID will feel seen, but at the same time, it invites readers to regard FND with distaste, as a kind of illegitimate competitor.

Three elements emerge as salient in relation to these processes of “othering” FND that were evident in the subsequent cascade of posts that followed @PutrinoLab’s post. First is the ongoing direct appeals to “science” and its conflation with “reality”. @PutrinoLab emphasised that “the point of this thread is not to attack the validity of FND”—noting that FND’s existence is “immaterial to this conversation”. But then he asserted: “Instead, let’s discuss how WE KNOW that #LongCovid *is not* FND”. Note, again, the strong epistemic stance of certainty evoked through capitalisation.

 

[SNT Gatchaman]

A review article published in the Journal of Personalized Medicine which recently popped up in my university library feed is pointedly titled: “Long COVID is not a Functional Neurological Disorder”. The authors contrast the “accumulating body of evidence regarding the pathobiology of long COVID” with the “psychogenic and functional interpretations of the illness presentation [of FND]” (Davenport et al., 2024, p. 799, my italics). Note the ordering of the adjectives, with “psychogenic” taking precedence and thereby infusing “functional” with its aftertaste, as well as being directly opposed to Long COVID’s “pathobiology”.

Biological rendering like this is anchored in protective discourses of scientific progress.

The “first path”—and note the positioning as first—directly appeals to “the scientific process” as the undergirding guidance of the “pathogenic disease model”, which has resulted in a “rich literature” describing “pathobiology” and “various attempts” at “creating specific case definition criteria”. These “various attempts” connect to shared understandings of scientific process, with this implied precision and testing indexing the rigour and objectivity valued by positivist science. That this path “has resulted in the label of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)” is a triumph of legitimacy for ME/CFS.

“The second path” is said to be a “psychosomatic/sociogenic illness construction”. This phrasing is in direct opposition to the serious “disease model” of ME/CFS and suggests a kind of non‑reality or hoax through the term “construction”, which invites suspicion. This interpretation is supported in the phrase “an unbroken conceptual chain linking back to neurasthenia”, which suggests a wasteful focus on theory as opposed to “real” empirical evidence, and implies a lack of progression and testing.

But apart from all that, and as I have discussed above, what this passage says is also not true. FND does not have direct roots in neurasthenia but rather in Charcot’s work on hysteria, followed by Freud’s “conversion” period. Neurasthenia was the precursor for what is now known as ME/CFS just as hysteria was for FND. While both hysteria and neurasthenia were common nervous disorders of the day, the “common root” the authors propose is factually incorrect.

 

[SNT Gatchaman]

FYI @DrAnnaNZ as the immunologist being (mis)quoted.

 

[SNT Gatchaman]

FND Portal wrote on Bsky a month ago —

Sociolinguist Shelley Dawson has an insightful chapter in this new book called "Long Covid vs. Functional Neurological Disorder: Punching Down"It details the dismissal, rhetorical tricks, and stigma that a handful of Long Covid researchers use to invalidate FND […] The truth is that there's still a lot more to learn about both FND and Long Covid, and both groups of people have real disabilities. Instead of "punching down" on people w FND, as Dawson incisively describes and analyzes, we should be working together for disability rights + better research.

 

[Jonathan Edwards]

What the author seems to miss is that 'functional' is deliberately designed to mean something different to patients and to doctors and to hoodwink the patients - people like Wessely are even proud of that.

 

[Sasha]

What the author seems to miss is that 'functional' is deliberately designed to mean something different to patients and to doctors and to hoodwink the patients -

Although a neurologist helpfully explained to me, talking about a different condition, 'Functional - by which I mean, "all in your head".'

 

[Yann04]

I don’t understand how they expect us to go along with FND eating up ME / Post-COVID.

When many of us have experienced Medical Professionals using FND as a way to delegitimise our diagnoses, prescribe harmful treatment that wouldn’t be prescribed under ME/LC (theoretically), and postulate a significant psychological component to our illness. These same experiences are extremely paternalistic, non-respecting of consent, and ironically, since these doctors are always babbling about some hidden trauma long time ago causing the illness, a source of psychological trauma.

I do understand that if you’ve accepted the label FND as your illness it will be uncomfortable to see how strongly ME/LC communities are resisting the “FNDisation” of their conditions. But perhaps you should listen to why as opposed to taking it as a personal affront.

 

[Eleanor]

By raising a clash between Long COVID and FND, the immunologist joined a chorus of Long COVID researchers...

It's only "raising a clash" between the two conditions if you start with the belief that the two are the same or essentially similar.

 

[Yann04]

It's only "raising a clash" between the two conditions if you start with the belief that the two are the same or essentially similar.

And acting like the provocation came from Post-COVID researchers. Not FND researchers basically denying post-covid or saying “it’s just fnd”.

 

[Utsikt]

Someone drank the functional kool-aid..

 

[rvallee]

I have rarely seen anything as appalling as the people creating a system of discrimination pretending to be fighting for the little guy. They are really trying to pretend that people opposing their psychosomatic dogma are the real stigmatizers here. And failing, obviously, this is a pathetic attempt at it, but when you have 100% of the balance of power you can say anything you want and it never matters.

They're even pretending that pointing out that it's meant to be a purely psychological disorder is itself stigmatizing. Even though it's pretty much the bulk of the literature that both asserts it and tries to market it without people grasping that. The level of dishonesty is seriously over-the-top for a typical cult leader.

The software-hardware analogy was never invented to provide an explanation, it plays exactly the same role as the bullshit "chemical imbalance" made up for depression because they noticed that too many people they labelled with depression said they had a great life with no psychosocial hardship, and their psychosomatic models couldn't account for that so they made up biobabble and called it a day. Then pretended like it never happened, even as it keeps happening. This system is mad. Like, actual mad.

On the unethical scale, psychosomatic medicine has actually crossed over and become more appalling than what the tobacco industry did. No one knew about the harms of smoking before they were revealed. It's impossible to miss how harmful psychosomatic is, how it's even designed to be maximally so. And they keep doing it and destroying lives by the millions.

This text more than anything I noticed before, although it's a growing trend, is literally borrowing our own language and framing as a weapon. They are pretending to be as discriminated as we are. Even as they openly discriminate against us. Poor small uwu widdle billionaires who control the entire system can't catch a break against those powerful homeless armies. Good grief the hubris and delusion here.

 

[SNT Gatchaman]

https://achronicvoice.com/liams-fnd-story-how-he-achieved-his-dreams/

Here's the story of a young man who suddenly developed "severe FND" at age 13. Without wishing to diagnose someone via an article, I'll simply say that from the description he gives I have doubts about the diagnosis and even bigger doubts about the treatment.

 

[rvallee]

Here's the story of a young man who suddenly developed "severe FND" at age 13. Without wishing to diagnose someone via an article, I'll simply say that from the description he gives I have doubts about the diagnosis and even bigger doubts about the treatment.

Honestly, the FND fanatics don't hesitate to do that, have even done that multiple time in 'studies' and other academic output. So, really, go for it, at least when it comes to ye olde conversion disorder. It's not a good idea to fight back against something with our hands behind our backs when they don't bother following any rules.

 

[SNT Gatchaman]

OK, some summary quotes. Let me know if any of this sounds… familiar.

When I was a child, I acquired a debilitating chronic illness that would have a major impact on my life for years to come. I went from being a healthy child to one who couldn’t move or even speak. FND suddenly took my mobility and speech and placed me in a wheelchair, then caused me to become bedridden and locked inside my own mind and body.

I personally had severe FND, and my symptoms were mainly in the form of paralysis, cognitive and speech problems. My physical and cognitive skills deteriorated to the point where I had all my abilities taken away from me.

Within a few days, I had lost my ability to walk and talk, and was rushed to hospital. The doctors were baffled by my mystery illness, and said that I had an unknown disorder. They even filmed my case for medical research for universities around the world. I had so many scans, tests and medical procedures, yet all the results came back as "normal".

After spending 4 months in the hospital, I was finally diagnosed with severe Functional Neurological Disorder. I had at least 20 health professionals involved in my care from across different specialties.

For 6 months my mind was blank, and I didn’t know what or who anything was. As my brain's function improved slowly, it was then that I could understand what was happening to me.

In the midst of regaining function, FND struck again, causing me to lose the ability to sit up. I was given different types of wheelchairs, but nothing was suitable due to my deteriorating posture.

It got to the stage where my body couldn't tolerate being on any form of equipment apart from my hospital bed. I was bedridden for 3 years and I felt trapped inside my own body, and uncertain about my future.

I wasn't able to talk for a whole year either, but slowly began to regain my voice with determination, and also with the support of my loved ones.

The CAMHS (Child and Adolescent Mental Health Service) and a specialist team from Great Ormond Street Hospital created a progress chart that would help motivate me to achieve my dreams. I would get a point on the chart whenever I moved an arm or finger, which meant that I was one step closer to achieving my wishes.

After 3 long years, my body felt less stiff as my FND started to improve. I had to relearn how to move my arms and managed to do so within a few months, which was a huge milestone for me.

Next, I had to learn how to sit up on my own again. […] Even though I could only lift my head slightly above my knees, it was a huge achievement.

I was transferred to the chair every day for 10 minutes, which was the maximum amount of time my body could tolerate sitting. I would then need to lie down in bed again. However, just being able to sit in the chair for 10 minutes was another huge milestone. Before that, I wasn't able to tolerate sitting on anything for even one second. Slowly but surely, my body regained strength, and I could tolerate sitting in an upright position after many months.

 

[SNT Gatchaman]

Note this sequence —

The doctors were baffled by my mystery illness, and said that I had an unknown disorder. They even filmed my case for medical research for universities around the world. I had so many scans, tests and medical procedures, yet all the results came back as "normal".

After spending 4 months in the hospital, I was finally diagnosed with severe Functional Neurological Disorder. I had at least 20 health professionals involved in my care from across different specialties.

Remember that this "mystery illness" that was "an unknown disorder" was — after 4 months — clearly FND. Which as we all remember is said to be the most common neurological disorder seen in neurology practice, with clearcut rule-in signs.

 

[Sean]

Someone drank the functional kool-aid..

Drowned themselves in a vat of it.