Before You Criticise FND, Apparently You Must First Prove You're Not a Terrible Person
FND Nope
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On 25 October 2026, Polly Patterson published The Age of FND in her publication, The Post-Viral Papers. The article questioned the growing prominence of Functional Neurological Disorder (FND), particularly its application to patients with ME/CFS, long COVID and dysautonomia. Patterson examined the history of the diagnosis, the interpretation of positive neurological signs, the influence of biopsychosocial explanations and the potential consequences when an FND diagnosis is applied incorrectly.
Before she could discuss any of that, however, Patterson apparently felt it necessary to establish that she wasn't a terrible person. Her article opens with a disclaimer explaining that she is not claiming FND doesn't exist, that patients aren't suffering, that everyone diagnosed with FND has been misdiagnosed, or that the diagnosis has no legitimate place outside post-viral illness. She also explicitly rejects the suggestion that everyone diagnosed with FND has a psychosomatic illness.
Think about that for a moment. Before questioning a medical diagnosis, a severely ill writer feels compelled to reassure readers that she recognises other patients as human beings who genuinely suffer. This is remarkably close to the frustration expressed in our own I Am Angry article: why must people first demonstrate that they are decent human beings before being permitted to question medical practice?
What Polly Actually Questioned
Patterson's central concern is not whether people diagnosed with FND experience real symptoms. It is whether the diagnosis is sometimes being applied to patients whose symptoms have other explanations, particularly in conditions where diagnostic testing remains incomplete and specialist care is difficult to access. She describes her own experience of severe post-viral illness and reports being warned against pursuing an NHS neurology referral because of concerns about receiving an FND diagnosis that might interfere with her existing treatment.
She also examines positive diagnostic signs, including Hoover's sign and tremor entrainment, and questions what clinicians can legitimately conclude from them. These signs are intended to identify particular patterns of inconsistency or variability in neurological function; they do not, by themselves, establish a psychological cause. Patterson's suggestion that they may be interpreted through a psychosomatic framework deserves careful examination, but so does the question of whether clinicians always use them appropriately and whether other causes are adequately investigated.
Her discussion of treatment raises another concern. Specialist rehabilitation is not simply ordinary exercise or psychiatric intervention, and describing it that way risks oversimplifying clinical practice. Nevertheless, her underlying question is important: what happens when someone with post-exertional malaise, significant autonomic dysfunction or another established condition is directed towards a treatment programme that fails to account for those problems? An FND diagnosis should not automatically erase existing diagnoses or justify stopping medication prescribed for them.
Some of Patterson's broader assertions, particularly those concerning institutional motives, financial incentives and the scale of inappropriate diagnoses, require stronger evidence than the article provides. Patient reports can identify serious problems worth investigating, but they cannot independently establish how widespread those problems are. That distinction matters. It is entirely possible to recognise weaknesses in an article while also recognising that the questions it raises deserve answers.
Then Came Kim Hearne
On 27 October, Kim Hearne, founder and CEO of FND Action, responded to Patterson's article in a nine-part thread on X, posting as @KH118118. Her response challenged Patterson's understanding of neurological examinations, modern diagnostic practice and specialist rehabilitation. She also emphasised the very real disability experienced by people diagnosed with FND and the importance of protecting patients from stigma.
We want to be particularly clear about Kim. We believe her heart is in the right place. Her years of advocacy suggest a genuine commitment to helping people who are suffering, and we have no reason to believe she defends FND out of malice or personal gain. We respect the work she has put into supporting patients, even where we fundamentally disagree with her interpretation of the diagnosis and its clinical foundations. In fact, her public discussions have frequently helped us discover important articles, patient experiences and opposing viewpoints that deserve wider attention. We value that contribution, even if it is probably not quite the contribution she intended to make to this website.
That respect does not prevent us from disagreeing with her response to Patterson. Kim asked whether Patterson had observed an FND assessment, spoken to specialist neurologists or meaningfully engaged with the patient community. She challenged Patterson's interpretation of positive signs and argued that specialist neurorehabilitation had been inaccurately reduced to behavioural modification, psychiatric treatment and exercise. Those are legitimate areas for disagreement, and the clinical details should be examined rather than waved away.
But much of the thread moved away from the questions Patterson was asking. Kim emphasised that people with FND can experience paralysis, seizures, walking difficulties, loss of speech and profound disability. She discussed the historical mistreatment of women with FND, the underrecognition of men and the importance of respecting patients whose illnesses are misunderstood. These are worthwhile concerns. They are also concerns Patterson had not disputed.
Kim wrote: "Nobody has a monopoly on suffering. Healthcare isn't a competition over whose illness is more legitimate or disabling."
We agree. And that principle must include people who believe they have been incorrectly diagnosed with FND. Their suffering is no less real, their experiences no less deserving of investigation, and their concerns no less legitimate because they question a diagnosis that others consider helpful. Respect cannot operate in only one direction.
What disappointed us most was the tone of the closing criticism. Kim suggested that the most glaring ignorance in Patterson's article belonged to its author, rather than the medical practices being questioned. She subsequently reported that Patterson had blocked her and described the decision as ironic. We cannot know what prompted the block, and nobody is obliged to continue an argument on social media. What we can observe is that an exchange which could have examined diagnostic evidence instead became increasingly personal.
We would have liked to see Patterson afforded the same generosity of interpretation that we are happy to extend to Kim. We believe Kim is sincere, even when we disagree with her. We would hope that a writer raising concerns about potentially harmful diagnoses could receive similar consideration without first having to establish her compassion, credentials and moral character.
The Disclaimer That Should Never Have Been Necessary
There is something deeply frustrating about the structure of this disagreement. Patterson anticipated that questioning FND might be interpreted as denying patients' suffering, so she explicitly rejected that interpretation before presenting her argument. Yet much of the subsequent criticism still revolved around patient suffering, stigma and respect. The disclaimer did not prevent the discussion from drifting towards precisely the accusations it was intended to avoid.
We have seen this pattern before. Someone questions whether a diagnosis was correct, whether a particular neurological sign is sufficiently specific, whether alternative diseases were adequately investigated or whether a treatment recommendation was appropriate. Instead of answering those questions directly, the discussion becomes about whether the critic respects disabled people. The original clinical question is left hanging while everyone argues about who has shown sufficient compassion.
There is an obvious distinction between saying that patients diagnosed with FND are not suffering and saying that some patients may have received an incorrect diagnosis. The first dismisses people. The second questions medical judgment. Conflating the two makes it harder to investigate diagnostic errors and can ultimately harm the very patients everyone claims to protect.
Nor does this require us to accept every argument Patterson makes. Her interpretation of clinical signs can be challenged. Her characterisation of rehabilitation can be corrected. Her claims about institutional incentives can be scrutinised. That is what serious criticism should look like: identify the claim, examine the evidence, explain the disagreement. It should not require deciding whether the person asking the question is sufficiently compassionate to deserve an answer.
There is also a basic issue of consistency. Lived experience is rightly recognised as important when patients describe how FND affects their lives. It should remain important when other patients describe the consequences of a diagnosis they believe was mistaken. Neither experience automatically settles a scientific dispute, but neither should be dismissed merely because it challenges an established narrative.
We hope Kim continues advocating for patients, and we hope Polly continues asking difficult questions. Both activities have value. But defending patients and defending a diagnosis are not interchangeable responsibilities. Sometimes protecting patients means asking whether the diagnosis they received was correct in the first place.
Polly Patterson should not have needed five disclaimers before asking those questions. And after providing them, she certainly deserved a response that engaged with what she actually wrote.
References
- Patterson, P. (25 October 2026). The Age of FND: Has Bad Science and Outdated Stigma Returned in Disguise? The Post-Viral Papers.
- Kim Hearne (@KH118118), X profile and discussion of Patterson's article, 27 October 2026.
- FND Action — official charity website.
