Hysteria, a rose by any other name

The act of relabelling is ancient, but it surged in the 20th century as an euphemistic attempt to appear more humane and sensitive, aiming to destigmatize the meanings certain labels carry.

For example, instead of calling someone "mad", the label shifted to "mentally ill", and later softened further to a "mental health issue".

Sure, I agree. We don’t want derogatory terms, as using them can contribute to iatrogenic harm (was intended to help the patient, but made things worse). However, we need to be careful when relabelling, because in doing so, words often lose meaning and can obscure the truth originally conveyed by those labels.

It’s also important to note that relabelling is not always intended as a direct swap of terms, but often reflects evolving understanding, which can inadvertently obscure the original meaning of these labels.

FND is a shining example of this issue.

Originally labelled as hysteria, this diagnosis represented one of the darkest periods in medical history, as virtually all unexplained female medical conditions were placed under it. In those days, conditions like endometriosis were even classified under this label.

With growing understanding and the empirical identification of more conditions, Sigmund Freud redefined the label as Conversion Disorder, based on the idea that psychological symptoms could convert into physical ones. Some clinicians still maintain this perspective today. Under this label, FND would have been classified as a mental disorder rather than a neurological one (I suspect that the neurologist who operated under the assumption that my wife could "think herself better" was still working with the conversion disorder framework).

As modern analysis progressed and more conditions were removed from this classification, even Sigmund Freud's intuitions were found to be statistically unreliable, and the label was redefined once again. Today, it is understood as a disorder of how the brain networks communicate intentions along neural pathways.

Some proponents of FND attempt to separate the label from its history, but evolution is not a complete redesign. Elements of the original "DNA" remain, with hysteria still embedded in the disorder and occasional modern cases of endometriosis (and others) erroneously classified under it.

Given all this history and evolution, what aspects do I feel have been obfuscated?

FND, like hysteria, is still predominantly attributed to women, with a ratio of about 2:1 to 3:1. Biological differences between men and women may play a fundamental role in these symptoms (neurological health in women is still poorly understood).

What is worse, however, is that, just like hysteria, FND still inherently involves the dismissal of symptoms. Instead of dismissing the patient, we are now dismissing them based on supposed neural system failures, failures we cannot truly, if we are being honest, prove. Just like physicians of the past, we rely on the clinician’s intuition, and at no point does anyone admit they have reached a clinical impasse.

The worst part is that hysteria is not the original label. At its core, MUS (medically unexplained symptoms), the starting point for all illnesses until proven otherwise, remains the only honest label. It never should have been bagged, tagged, and relabelled.

Still, as a treatment framework, despite remaining MUS, it might be useful.