Functional Neurological Disorder (FND)

Functional Neurological Disorder (FND) is a complex condition that affects how the brain and body communicate. Here’s a breakdown of what it entails:

Definition: FND describes a problem with how the brain receives and sends information to the rest of the body. Unlike traditional neurological disorders, FND does not stem from structural damage to the nervous system but rather from changes in how brain networks function.

Symptoms: Individuals with FND may experience a variety of neurological symptoms, which can include:

• Weakness or paralysis: Difficulty moving limbs or parts of the body.
• Tremors: Involuntary shaking or trembling.
• Numbness: Loss of sensation in certain areas.
• Blackouts or seizures: Episodes that resemble seizures but do not have a neurological basis.

Causes: The exact cause of FND is not fully understood, but it is believed to be related to psychological factors, stress, or trauma that affect the brain’s functioning.

Diagnosis: Diagnosing FND can be challenging, as it often requires ruling out other neurological conditions. Healthcare professionals typically conduct a thorough medical history, physical examination, and sometimes additional tests.

Treatment: Treatment for FND often involves a multidisciplinary approach, including:

• Physical therapy: To help regain movement and function.
• cognitive behavioural therapy (CBT): To address any underlying psychological factors.
• Medication: In some cases, medications may be prescribed to manage symptoms.

Psychological Underpinnings

The relationship between psychological factors and physical symptoms in FND is complex and can be interpreted in various ways.

Many experts believe that FND can be linked to psychological stressors, trauma, or emotional conflicts. This doesn’t mean that the symptoms are “made up” or that the individual is consciously choosing to have them; rather, the brain may be responding to unresolved psychological issues in a way that manifests as physical symptoms.

Inner Conflict: The of an “unspoken inner war” resonates with some theories surrounding FND. It suggests that there may be deep-seated emotions or conflicts that the individual is not fully aware of or able to express. This can lead to a disconnect between the mind and body, where the nervous system reacts in ways that are not aligned with conscious thought.

Conscious vs. Unconscious Responses: While it might seem like a conscious decision, many individuals with FND do not have control over their symptoms. The brain’s response can be automatic, influenced by past experiences or stress, rather than a deliberate choice. This highlights the complex interplay between psychological and neurological processes.

Variability of Symptoms: Symptoms can vary widely from person to person, and what triggers them can also differ. Some may have a history of trauma, while others might experience symptoms without any identifiable psychological stressor. This variability makes FND a particularly challenging condition to understand and treat.

Treatment Approaches: Addressing the psychological aspects through therapies like cognitive behavioural therapy (CBT) combined with psychotherapy can be beneficial. These approaches aim to help individuals process their emotions and experiences, potentially alleviating some of the physical symptoms.

Uncertainty of Diagnosis

A critical point to understand is with regard to the limitations of current neuroimaging techniques when it comes to Functional Neurological Disorder (FND):

Dynamic Brain: The human brain is incredibly complex and constantly changing. Its neural pathways are not static, but rather adapt and rewire themselves in response to experiences, learning, and even stress. This dynamic nature makes it challenging to pinpoint the exact source of a problem through static imaging.

Similar Scan Results: Both FND and other neurological disorders can sometimes present with similar brain activity patterns on scans. This is because the brain is often trying to compensate for a dysfunction, whether it’s a psychological or structural issue.

Beyond Structure: Traditional neuroimaging techniques like MRI and CT scans primarily focus on structural abnormalities. They can detect tumours, strokes, or other physical changes in the brain. However, FND is often characterized by functional changes in how the brain communicates, not structural damage.

Functional Neuroimaging: While traditional neuroimaging has limitations, newer techniques like functional MRI (fMRI) and magnetoencephalography (MEG) offer insights into brain activity and connectivity. These techniques can reveal subtle changes in neural networks that might not be visible on structural scans.

The Need for a Holistic Approach: Diagnosing FND often requires a multidisciplinary approach that goes beyond imaging. It involves a thorough medical history, physical examination, psychological assessment, and careful observation of symptoms.

This understanding of the dynamic nature of the brain and the limitations of current neuroimaging techniques is crucial for comprehending the complexities of FND. It’s a reminder that understanding the brain requires looking beyond just the physical structure and considering the interplay of psychological, emotional, and neurological factors.

Deep Denials Often Stem from the Need to Hide Self-Blame and Shame.

If we are talking deep denials, it is likely that the individual may well have false memories hiding a trauma induced and entirely false, self-blame. Often the abused child, in their infant logic will blame itself for the actions of its caregiver, and will dissociate that part of itself that it decided to take the blame. But also, had the need to hide this blame from itself, and so invented a story, a false memory, that allowed it to rationalise the continued need to isolate that self-aspect and avoid that painful memory.

This is a profound and complex understanding of how trauma, self-blame, and dissociation can intertwine, particularly in the context of childhood experiences.

False Memories and trauma:

False Memories: Research indicates that individuals with a history of trauma, such as those with PTSD, are at risk for developing false memories. These memories can be distorted or entirely fabricated, often as a coping mechanism to deal with overwhelming emotions or experiences.

Self-Blame: It’s common for trauma victims, especially children, to internalize blame for their circumstances. This self-blame can stem from a child’s limited understanding of complex situations, leading them to believe they are at fault for their caregiver’s actions.

Infant Logic and dissociation:

• Infant Logic: Children often interpret events through a simplistic lens, which can lead to misguided beliefs about their role in traumatic situations. This “infant logic” can result in a child believing they are responsible for negative outcomes, even when they are not.
• dissociation: To cope with the emotional pain of self-blame, a child may dissociate, effectively separating themselves from the part of their identity that feels responsible. This dissociation can manifest as a protective mechanism, allowing the child to function despite the trauma.

Inventing Narratives:

• Rationalization: In order to cope with the conflicting feelings of blame and helplessness, individuals may create narratives that justify their feelings. These stories can serve to rationalize the need to isolate certain aspects of themselves, allowing them to maintain a semblance of control over their identity and experiences.
• Hiding from Self: The process of hiding from the self that feels blame can lead to a fragmented sense of identity, where different parts of the self are not fully integrated. This fragmentation can complicate healing and recovery, as individuals may struggle to reconcile these disparate parts.

The Limitations and Uses of CBT

With false memories, CBT can be used to provide a short-term coping solution. and it would be dangerous to suggest otherwise. But, it could very well help stabilise the client in order for deeper psychoanalytic treatments to explore the clients psychology more deeply. Personally, I would suggest a Jungian or parts-working therapeutic approach as the core methodology.

CBT’s Limitations:

• Short-Term Focus: CBT is often effective for addressing specific thought patterns and behaviours, but it might not be sufficient for fully processing deeply ingrained trauma and false memories. CBT typically focuses on present-day challenges, while the root of the problem might lie in past experiences.
• cognitive Restructuring: While CBT can help individuals challenge negative thought patterns, it may not be able to address the underlying emotional and psychological processes that contribute to false memories.

Dangers of Oversimplification:

• False Hope: Suggesting that CBT alone can solve complex trauma-related issues can be misleading and potentially harmful. Individuals may feel pressured to “fix” themselves quickly, leading to frustration and disappointment if they don’t experience immediate results.
• Re-Traumatization: Without addressing the underlying trauma, attempts to change thought patterns or behaviours could inadvertently trigger further distress and re-traumatization.

The Need for Deeper Exploration:

• Jungian Approach: Jungian psychology emphasizes the importance of exploring the unconscious mind, archetypes, and the integration of different aspects of the self. This approach can be particularly helpful in understanding how trauma impacts the psyche and how to reconcile conflicting parts of the personality.
• Parts-Work Therapy: This approach focuses on identifying and working with different parts of the self, including those that hold trauma and those that are trying to cope with it. It aims to understand how these parts interact and to create a more integrated sense of self.

Stabilization and integration:

• CBT as a Bridge: You’re right to suggest that CBT can play a valuable role in stabilizing the client before engaging in deeper therapeutic work. It can help manage anxiety, improve coping skills, and create a safe space for exploring more challenging material.
• Long-Term Healing: The goal of deeper therapies like Jungian or parts-work approaches is to facilitate a more profound and lasting integration of the self, leading to healing and resilience.

It’s crucial to tailor treatment plans to the individual’s needs and to avoid simplistic solutions that might not address the root of the problem.

integration of a Physiotherapeutic Approach

As this is potentially a psychological illness with physical symptoms, the integration of physiotherapy is important. However, this means there is likely to be an additional resource that will increase the complexity and cost of the treatment. The physical approach therefore needs to be nuanced and led by the psychologist or therapist. They should therefore have suitable training, and should be able to test and record physical, as well as psychological responses and track improvements. In many cases, the client can be given physiotherapy to do themselves, as homework.

Importance of integration: The integration of physiotherapy is crucial for addressing the physical manifestations of psychological conditions. This holistic approach can help patients regain mobility and function while also addressing underlying psychological issues.

Complexity and Cost: Adding physiotherapy can increase both the complexity and cost of treatment. It requires careful coordination between healthcare providers to ensure that both psychological and physical aspects are addressed effectively.

Nuanced Psychological Approach: A nuanced approach led by a psychologist is essential. They should be trained to understand the interplay between psychological and physical symptoms, allowing for a more tailored treatment plan.

Training and Assessment: Psychologists involved in such treatments should have suitable training that includes:

• Understanding the biopsychosocial model of care is a crucial aspect of treatment for conditions like Functional Neurological Disorder (FND), where the remapping of neurons plays a significant role in restoring normal function. The biopsychosocial model provides a comprehensive framework for understanding this process.
• neuroplasticity: This is the brain’s ability to reorganize itself by forming new neural connections. Therapeutic interventions, such as physiotherapy and specific exercises, can promote neuroplasticity, helping to remap neurons and restore function.
• Physiological Responses: Understanding how physical symptoms manifest in the body can guide treatment. For instance, addressing muscle tension or coordination issues through targeted physical therapy can facilitate better neural communication.
• Skills to assess and record both physical and psychological responses.
• The ability to track improvements over time, ensuring that the treatment is effective and responsive to the patient’s needs.

Self-Directed Physiotherapy: Providing clients with physiotherapy exercises to do at home can empower them and enhance their recovery. This self-directed approach can help reinforce the physical aspects of their treatment while allowing them to take an active role in their healing process.

Collaboration Between Disciplines: Effective treatment often requires collaboration between psychologists, physiotherapists, and other healthcare professionals. This multidisciplinary approach can lead to more comprehensive care and better outcomes for patients.

Social Factors:

• Support Systems: The presence of a supportive environment can significantly impact recovery. Family and community support can enhance motivation and adherence to treatment plans, facilitating the remapping process.
• Socio-environmental Influences: Factors such as stress, lifestyle, and social interactions can affect both psychological well-being and physical health, influencing the effectiveness of treatment strategies.

The First dissociation

The first dissociation is usually the one that has most, if not all false, protective memories. This is often hidden behind a series of following dissociations, as the child ages, and the abuse continues. It can be thought of as the child protecting itself by hiding increasing layers of itself in the shadows on the unconscious mind.

The First dissociation: A Core Protection:

• The Foundation: The initial dissociation, often occurring in early childhood, serves as a primary defence mechanism against overwhelming trauma. This early separation of self is crucial for survival, allowing the child to compartmentalize the pain and continue functioning.
• False Memories and Distortion: The memories associated with this first dissociation are often deeply embedded in the unconscious mind and may be distorted or entirely fabricated. This distortion serves to protect the child from the full emotional impact of the trauma.

Layers of dissociation: A Growing Shadow:

• Escalating trauma: As the child ages and the abuse continues, additional layers of dissociation may emerge. These subsequent dissociations act as further shields, protecting the core self from the ever-increasing pain and threat.
• The Unconscious Mind: These layers of dissociation become increasingly embedded in the unconscious mind, creating a complex and often inaccessible network of fragmented memories and identities.

The Shadow Self:

Hidden and Untouched: The dissociated parts of the self, particularly those associated with the earliest trauma, are often referred to as the “shadow self.” This hidden aspect of the personality holds the most painful and often distorted memories, making it difficult to access and integrate.

The Need for integration: Healing from trauma requires a gradual and careful process of integrating these fragmented parts of the self. This process can be challenging and emotionally demanding, but it is essential for achieving lasting recovery.

Therapeutic Implications:

• Uncovering the Layers: Therapy can help individuals identify and understand the layers of dissociation they have created. This process can involve working with memories, emotions, and different parts of the self, often through techniques like parts-work therapy or trauma-informed therapy.
• Reintegration and Healing: The goal of therapy is to help individuals reintegrate these fragmented parts of themselves, allowing them to reclaim their full sense of identity and heal from the trauma they have endured.

This understanding of the layered nature of dissociation powerfully illustrates how the mind protects itself from overwhelming experiences. It highlights the importance of understanding the complexities of trauma and the need for sensitive and skilled therapeutic interventions to facilitate healing and integration.

The Inner-Child as the First dissociation

This first dissociation is often called the Inner-Child, A Jungian approach, might take years to peel back all those layers, and this may well be the best approach as this is a very complex psychology and a slower, tentative approach is going to be required. The CBT “Quick Fix” emergency recovery concept works very well in such an approach.

This points to the need for a nuanced and long-term approach to healing from complex trauma and dissociation, especially when dealing with the “Inner Child” and the layers of protection it represents.

The Inner Child: A Core of Vulnerability:

• The First dissociation: As mentioned, the first dissociation often manifests as the “Inner Child,” representing the core self that was traumatized and sought protection. This “child” holds the most profound and often distorted memories, making it a central focus for healing.
• A Vulnerable and Fragile Part: The Inner Child is a vulnerable and fragile part of the self, needing careful attention and understanding. Reintegrating this part requires patience, empathy, and a gentle approach.

The Jungian perspective: A Journey of Depth:

• Unconscious Exploration: Jungian psychology emphasizes the importance of exploring the unconscious mind, where the Inner Child and its layers of protection reside. This journey into the depths of the psyche can be long and challenging, requiring a commitment to deep introspection and self-discovery.
• integration and Wholeness: The goal of a Jungian approach is to integrate the fragmented parts of the self, including the Inner Child, into a more whole and balanced personality. This process can take years of dedicated work and requires a skilled therapist who can guide the individual through the complexities of their unconscious.

CBT as a Stabilizing Force:

• Temporary Relief: CBT can be a valuable tool for providing temporary relief and stabilization during the initial stages of therapy. It can help manage anxiety, improve coping skills, and create a safe space for exploring more challenging material.
• A Bridge to Deeper Work: CBT can serve as a bridge, allowing the individual to build a foundation of stability and self-regulation before venturing into the deeper, more emotionally demanding work of addressing the Inner Child and its layers of protection.

The Importance of Patience and Tenderness:

• A Slow and Tentative Approach: Healing from complex trauma requires a slow and tentative approach, respecting the pace of the individual and the depth of their experiences. Rushing the process can lead to re-traumatization and hinder progress.
• A Gentle Touch: Working with the Inner Child requires a gentle touch, a willingness to listen, and a deep understanding of the pain and vulnerability this part of the self holds. Empathy and compassion are essential for creating a safe and nurturing environment for healing.

A Parts-Working Approach

As another option, parts-working therapies such as Internal Family Systems Therapy may well offer a quicker way of addressing this core aspect of the shadow self, as well as being able to deal with, to some extend that added complexity of those other dissociated parts.

However, for older people, this approach might get hung up on the sheer number of parts that might want to be involved in this fundamental change to the conceptual structure of self. On the other hand, younger clients will need to have a family therapy based approach, IFS is based on Family Therapy.

These are important considerations regarding Internal Family Systems (IFS) therapy and its application across different age groups. Let’s break down these observations and explore how IFS can be effectively utilized for both older and younger clients:

IFS and the Shadow Self

Quicker Access to the Shadow Self: IFS can indeed provide a more direct route to addressing the shadow self and the various dissociated parts. By fostering a dialogue between the Self and these parts, clients can begin to understand and integrate their experiences more rapidly.

Complexity of Parts: For older clients, the sheer number of parts that may emerge can be overwhelming. This complexity can lead to challenges in navigating the therapeutic process, as clients might feel lost among their many internal voices and identities.

Considerations for Older Clients

Navigating Multiple Parts: Older individuals may have developed numerous protective parts over the years, which can complicate the therapeutic journey. It’s essential for therapists to help clients prioritize which parts to engage with first, focusing on those that are most relevant to their current struggles.

Therapeutic Patience: A slower, more patient approach may be necessary to allow older clients to process their experiences without feeling rushed. This can help prevent feelings of being overwhelmed and facilitate a more meaningful exploration of their inner world.

Considerations for Younger Clients

Family Therapy integration: Younger clients often benefit from a family therapy-based approach within the IFS framework. Engaging family members can provide additional support and context, helping younger clients feel more secure as they explore their internal systems.

Engagement Techniques: IFS can be adapted for younger clients by using engaging activities that resonate with their developmental stage. This might include play therapy techniques or creative expression to help them identify and interact with their parts in a safe and supportive environment.

Benefits of IFS for Both Age Groups

• Empowerment: IFS empowers clients by helping them recognize that they are not defined by their parts but rather have a core Self that can lead the healing process.
• compassionate Framework: The model encourages a compassionate understanding of all parts, fostering a sense of acceptance and integration rather than judgment.

Further Reading

Here’s a curated reading list that covers the various topics we’ve discussed, including Functional Neurological Disorder (FND), Internal Family Systems (IFS) therapy, Jungian psychology, trauma, dissociation, and the Inner Child.

Functional Neurological Disorder (FND)

• A Clinician’s Guide to Functional Neurological Disorder: A Practical Manual
  This manual presents a ground-breaking model for understanding FND.
• Functional Neurological Disorder: An Issue of Neurologic Clinics
  A comprehensive overview of FND, edited by Carrie M. Hersh.
• Overcoming Functional Neurological Symptoms: A Five Areas Approach
  This book uses a CBT model to help individuals experiencing FND.
• A Patient’s Workbook for Functional Neurological Disorder: Helping You Understand and Manage Your Symptoms
  A self-help workbook designed for those coping with FND.

Internal Family Systems (IFS)

• Internal Family Systems Therapy by Dr. Richard C. Schwartz
  The foundational text on IFS therapy.
• Introduction to the Internal Family Systems Model by Dr. Richard C. Schwartz
  A great starting point for understanding the IFS model.
• Self-Therapy: A Step-By-Step Guide to IFS by Jay Earley
  A practical guide for individuals looking to apply IFS concepts in their own lives.
• Freedom from Your Inner Critic by Jay Earley
  Focuses on addressing internal criticism through IFS.

Jungian Psychology

• Memories, Dreams, Reflections by C.G. Jung
  Jung’s autobiography, offering insights into his thoughts and theories.
• Man and His Symbols by C.G. Jung
  An accessible introduction to Jungian concepts, particularly symbols and the unconscious.
• Re-Visioning Psychology by James Hillman
  Explores depth psychology and its implications for understanding the psyche.
• The archetypes and the collective unconscious by C.G. Jung
  A deeper dive into Jung’s theories on archetypes and their role in the human experience.

trauma

• The Body Keeps the Score by Bessel van der Kolk
  A seminal work on how trauma affects the body and mind.
• Healing trauma: A Pioneering Program for Restoring the wisdom of Your Body by Peter A. Levine
  Focuses on somatic experiencing as a method for healing trauma.
• Complex PTSD: From Surviving to Thriving by Pete Walker
  A guide for those dealing with complex trauma and its effects.

dissociation

• Coping with trauma-Related dissociation: Skills Training for Patients and Therapists by Onno van der Hart
  A practical guide for understanding and managing dissociation.
• dissociation Made Simple: A Stigma-Free Guide to Embracing Your Dissociative Mind by Faith G. Harper
  An accessible introduction to understanding dissociation.

Inner Child

• Homecoming: Reclaiming and Championing Your Inner Child by John Bradshaw
  A classic work on healing the inner child.
• Reconciliation: Healing the Inner Child by Thich Nhat Hanh
  A powerful guide to nurturing and healing the inner child.
• The Best 10 Books for Inner Child Healing
  A compilation of various resources focused on inner child work.

Biopsychosocial Model

• The Biopsychosocial Model of Health and Disease
  A systematic update on the philosophical and scientific foundations of the biopsychosocial model.

• A Biopsychosocial Approach to Health From Cell to Society
  This book offers an integrated perspective on health through the biopsychosocial lens.