I'm sure we are all aware of the cunning and manipulation beneath the word 'real' when used by the medical profession. The word 'real' when applied to symptoms is normally understood by the patient to mean the symptom is biological, it has a biological, organic reality whether or not the limited kinds of tests the health service runs picks anything up. However the word 'real' to the doctor means 'psychological', the patient is genuinely deluded into thinking they have something wrong, at best, isn't faking. I've watched this cause chaos in court, for example also in an inquest - the doctors were responding the coroner's questions - yes of course we understood M's symptoms to be 'real'. The lay audience is then misled into thinking the doctors meant the patient had a biomedical condition. The doctors meant 'they were really convinced there was something wrong', it was 'really psychological', 'real to them'. (The coroner, bizarrely, was then satisfied that the patient had not been treated as though the condition didn't exist when in fact that was the entire approach of the team treating her. ) NEVER use the word 'real' when questioning doctors or in discussion, it's a red flag for manipulation to try to get the patient's 'on side'.

What utter nonsense, resorting to blaming those naughty, naughty patients for being ill and that they dare to question the appallingly weakly evidenced theory of 'FND'. I mean how dare they? Oh but wait, asking the AIs to grade the evidence base for 'FND' according to the GRADE system used by NICE gives a result that the evidence for 'FND' is 'very poor or poor' , which is substantially worse than for example the grading of the biological evidence for ME/CFS, some of which is groundbreakingly high. OMG, if patients were to realise that they wouldn't be able to take the 'faith healing' hype approach and BELIEVE in 'FND' which we are told is needed for the talking therapy to work! Snake oil, anyone? And unprepared to face both the fact that talking therapies have almost zero effect, and that we have absolutely no reason to think the biological explanation is unlikely to be adequate on its own. I'm left speechless by the sheer absurdity of talking about 'cognitive processing' approaches to labour pain - as if that has even the tiniest possible impact on pain once strong labour sets in. Anyone out there volunteering to try it? I mean why not remove dental anaesthesia as well and give patients talking therapy instead while they're waiting in the waiting room?

Anyone telling people they have to 'believe' in a treatment for it to work lights up my BS detectors like a firework display. That's simply not how medicine, or science, works.

The problem is you are assuming you understand everything there is to know about the 'mechanical' body and how it operates. Setting aside the bizarreness of FND claiming to get rid of the dichotomy between mind and body and in the next breath talking about hardware v software, lol, I see a far more complex picture. (For clarity I'm not arguing there is no such thing as a psychosomatic symptom, just that FND is a meaningless construct and is wildly overdiagnosed and inappropriately applied to large numbers of patients.) For example, ME/CFS is a proven biological disease - nobody with any credibility in biomedical research is even asking that question any more. There's mountains of published research, billions going into furthering the research - which may not have all the answers but is no longer at an early stage - and we know the disease impacts the whole body, and multiple systems. Researchers have so far identified in lab research116 differences in blood tests between those with ME and healthy controls (having matched for sedentary lifestyle). Some can correctly distinguish in lab tests between those with ME of different types and those who do have and do not have fibromyalgia. There are identified genes emerging as culprits with the second stage of the research under way to confirm the specific addresses, they are all associated with neuro and immune systems. The research is increasingly converging between teams and AI's applying NICE's GRADE analysis evaluate much of it as medium and some as potentially high and very significant - streets ahead of it's analysis of the scientific underpinnings of FND which are rated poor and very poor. Allocating ME/CFS to 'FND' is completely inappropriate. Similarly assuming epilepsy is FND until an (increasingly rare and brief) EEG captures a seizure to prove it's epilepsy is cruel, harmful and has done many patients devastating damage. We have real concerns. You can take a patient and with the same patient examined, same history, same symptoms, same test results and they will be diagnosed with ME/CFS by an ME specialist and as having FND by a neurologist - this isn't acceptable. It's undermining all the science behind ME. You stand a physio who specialises in neurology at the end of the ward and let them watch a patient walk normally from bed to bathroom, and then on the way back start to walk uncertainly - I've overheard the physio then saying look, he can walk normally if he's distracted, it's clearly FND. No it's not, it's the muscles running out of energy in ME. You can show them the patient walking uncertainly down a corridor, but then the phone by the bed rings and they walk normally to the phone to pick it up. The neuro is saying look the patient is distracted, they have FND. The ME specialist is saying look, the patient is taking time and care not to fall because they know their legs can give way, but when the phone goes it's more important to catch the call so they take the risk of walking faster (which they can do for a brief time before the energy in the muscles runs out). This isn't FND it's normal and rational behaviour in a patient who knows they have frequent falls. It's common sense, not a 'clinical sign'. An ME specialist shows his team training videos of doctors training doctors to diagnose FND and they are laughing at the patients on the video for being fooled by a name that makes it sound as though there's something wrong, when, ha ha ha, we all know there's nothing wrong, it's just in their imagination. It's all out there. The name has been invented to fool patients. You don't actually have a clue what's happening or what's causing it to the vast majority of these patients, but rather than admit it, you have invented something that makes life easier for you. It's the classic situation - the doctor looks seriously and kindly (because research has found you can manipulate people more easily if you are kind to them) and says 'I know your symptoms are real'. The patient hears 'your symptoms have a physical explanation'. The doctor means 'your symptoms are really psychosomatic'. Patients are being manipulated into taking a route into therapy which in the vast majority of patients has absolutely dire results.