Christoff Truter
Public profile
2 posts
38 comments
2 discussions
04 Aug 2026
Software developer, amateur astronomer, reluctant backyard neurologist by necessity while helping my wife navigate a complex neurological illness, creator of FND Nope (fndnope.org) a resource challenging the Functional Neurological Disorder diagnosis, sharing patient stories, and advocating for better investigation of underlying causes, and professional Trekkie.
Posts
2Diagnostic History
Posts exploring the historical development of medical diagnoses, diagnostic categories, and conceptual frameworks, including how older ideas shape current clinical practice.
The Belief Prerequisite: How FND Treatment Echoes Faith Healing
2 months ago
One of the most striking things you notice when you first start reading the literature on FND is how crucial it is considered for patients to accept and believe in the diagnosis. Without that belief, treatment is often regarded as futile. They simply will not get better.
Closing diagnostic doors : The Problem of Psychologisation
8 months ago
The idea that physical health problems could be caused by psychological factors, that is mind, emotion, or behaviour, rather than by physical pathology, is hardly new. Its roots trace back to ancient civilisations, from Egypt, 1900 to 1500 BCE, to classical Greece, 5th to 4th century BCE, where hysteria-like symptoms were first described. These early ideas strongly influenced the development of medical psychologisation, later formalised in the DSM.
Comments
38@Miranda, that is basically blasphemy. When a diagnosis follows a narrative similar to the faith-healing mantra, it raises serious red flags for anyone paying attention.
@Lymewearier
I find it quite ironic that you’re bringing up the faith aspect here.
I've been working on an article over the past week about this very parallel I've been noticing from day one. There's a very clear similarity between how faith healers operate and how this diagnosis is often presented and phrased.
But the parallel goes much deeper than that. I'm not just talking about placebos — I'm also referring to the underlying mechanics used by faith healers, which are strikingly similar in form and function to those seen in CBT and similar approaches (not saying they’re exactly the same, but very similar).
Unfortunately, that mechanism carries a very real danger when accepted and followed blindly. Patients can end up suffering from similar delusions and risks as those seen in churches that promote this kind of practice.
I'll be sure to post the link here as soon as the article is finished.
No, none of this is COVID-related. My wife started deteriorating slowly many years before the pandemic.
Thank you for taking the time to respond.
Firstly, can we agree that communication to Miranda was clearly lacking and poorly delivered? That seems evident from her account.
I fully understand the modern definition of FND as a rule-in diagnosis based on positive signs per DSM-5. However, in practice and even in the DSM-5 wording itself (Criterion 3: not better explained by another medical or mental disorder), exclusionary thinking remains prominent. We should be honest about the criteria: they still contain strong exclusionary elements, and statistics on how clinicians actually apply FND show it is often used when tests are incomplete (CD model still used) or red flags are downplayed.
As you like to constantly remind me, I am not a clinician, I can definitely get details wrong. But I have a serious problem when a diagnosis is applied in such an opaque, almost esoteric way that shuts down further investigation. Constantly pointing out that I am not a clinician also comes across as counterproductive and dismissive to open discussion.
As I understand it, untreated autoimmune encephalitis can allow months of fluctuating symptoms and partial function (including online posting) before severe decline. A relentlessly progressive course with accumulating encephalopathic features (delirium, psychosis, catatonia) and hard signs like Hoffmann’s is atypical for pure FND. Family autoimmune history is relevant to pretest probability.
It is particularly concerning that, rather than directly addressing Miranda's specific concerns and the red flags she highlighted (omitted symptoms in the notes, the ignored positive Hoffmann's sign, the family history of autoimmune disease, and the explicit refusal to pursue autoimmune workup), you chose to frame her scepticism itself as the central problem instead. When a patient raises reasonable doubts, surely good practice involves clearly explaining the reasoning, including how potentially treatable organic conditions have been confidently excluded, rather than dismissing further inquiry.
Why can't you accept skepticism and engage with it constructively?
It is very doubtful whether you thoroughly reviewed the account (seems like a superficial reading only). Let's break down the key mismatches with a functional neurological disorder (FND) diagnosis:
- Relentlessly progressive course steadily accumulating symptoms over months with no sustained improvement or fluctuation. Classic FND is typically variable, waxing and waning, and often shows periods of spontaneous improvement.
- Prominent encephalopathic features delirium, psychosis, catatonia, and rapid cognitive/personality change. These are not core features of FND and are far more suggestive of underlying organic brain dysfunction, such as autoimmune or inflammatory encephalitis.
- Objective hard neurological signs positive Hoffmann's sign and MRI findings of demyelination described as too much for age. FND is a technically a diagnosis of exclusion that requires symptoms to be incompatible with recognised organic disease.
- Lack of documented positive FND signs for most symptoms only leg weakness appears to have had such signs recorded. Surely a robust FND diagnosis should document specific rule in signs (e.g., Hoover's sign, entrainment, give way weakness, etc.) for each major complaint.
- Clear post infectious trigger plus strong family autoimmune history both are well established risk factors for autoimmune encephalitis and other neuroinflammatory conditions that require proper rule out, not dismissal.
- Psychiatrist explicitly ruled out primary psychiatric disorder this significantly weakens any trauma based or psychogenic explanation for the neurological picture (for those following the CD model that is sometimes still used in FND).
Thank you for sharing this, Miranda. I’m really sorry you’re going through something this intense and frightening, especially with symptoms that are so severe, changing, and affecting so many parts of your daily life. It sounds incredibly distressing to be dealing with such significant, debilitating illness while also not being properly heard or properly investigated.
We are in a similar boat, so we do understand how upsetting and isolating it can feel to be stuck in this level of uncertainty, especially when things are progressing quickly and there are no clear answers or direction in care.
I really hope you’re able to get a thorough re-evaluation and access to the appropriate testing and support, so there’s more clarity and a proper pathway forward.
Thank you for taking the time to write this post. I appreciate the effort you’ve put into going through the literature and laying everything out clearly.
You almost get to a point where you would rather withhold data or notes since that can feel like bait that invites bias on the part of the clinician. In our context my wife entering a neurology practice in a wheelchair due to balance issues almost feels futile since it can be misinterpreted especially if you are seeing a neurologist who already has preconceived diagnostic ideas in mind.
"Did the patient in this scenario have a positive Hoover’s sign or not?" - No
The article made it clear from the description itself that Hoover’s sign was not positive. The patient had preserved initial low-demand strength, with fatigability only appearing under higher demand. The isokinetic data supported this presentation — it did not create the assumption.
I have engaged with the arguments raised. However, it remains unclear why reproducible isokinetic data is rejected in favour of a bedside test that cannot assess fatigable weakness.
At no point did I backtrack, introduce new information, or present minimal details to refute challenges. The relevant information was provided consistently.
Isokinetic dynamometry is a highly accurate and validated metric in sports medicine for assessing load-dependent strength and fatigability. That is precisely why it was suggested as an additional objective tool.
With respect, can we avoid medical clericalism here?
The blog post clearly framed fatigable weakness from the start. It also explicitly states that the initial output of both legs looked normal at low demand. This means we are clearly not dealing with a positive Hoover sign. That is the whole point of the post.
I deliberately mentioned the wheelchair use in the post to illustrate how easily one can jump to conclusions based on incomplete assumptions. Ironically, that is exactly what happened here. The wheelchair was used for balance issues, not primary leg weakness. In the same way the clinician in the case did, you are assuming generic unilateral weakness without fully listening to the actual reported symptoms of demand-dependent fatigability. Treating the normal initial output as a contradiction would be incorrect, even according to your own analysis.
The post highlighted clear, reproducible, load-dependent patterns of fatigability from real performance data produced and interpreted by sport scientists. These patterns are the opposite of the inconsistent and variable patterns described in the 1985 Knutsson & Mårtensson study for functional weakness. They are straightforward and easily understood by anyone who has experienced fatigue under physical load. None of this is esoteric.
Thank you Kenneth, that means a lot! Appreciate you reading it.
Discussions started
2You can literally go onto https://fndconnect.org.uk/shop/product/fnd-connect-i-have-seizures-lanyard-and-card
And for £ 4.99 you can buy yourself a lanyard to inform bystanders to effectively discourage appropriate emergency care.
Someone may assume every episode is "just another functional seizure." But seizures can change, suffer a head injury, have a stroke,
low blood sugar, cardiac syncope, or another medical emergency.
3 replies
Looking back, was there a symptom(s) that should have prompted doctors to investigate further before diagnosis FND?