Functional Neurological Disorder (FND) : a patient's guide
including Functional/Dissociative (non-epileptic) Seizures, Functional Movement Disorder and other functional symptoms
Psychology? I'm not crazy
So why don't you want to see a psychologist / psychiatrist?... ...
So why should I want to see a psychologist / psychiatrist?... ...
If you haven't read it yet,please look at the page 'Not imagined" before reading this. This will explain how, even though your symptoms are not 'all in the mind' it may be helpful to look at any psychological angles to treatment.
Psychologists and psychiatrists who are familiar with the area can have a lot to offer patients with functional and dissociative symptoms.
Psychologists working in general hospitals, rehabilitation, pain clinics or in a chronic fatigue service are likely to be familiar with this area. Liaison psychiatrists or Neuropsychiatrists will definitely be familiar with it.
There are a number of reasons why patients with FND may not want to see a psychologist / psychiatrist
1. "Im not crazy!"
For some people, being sent to see a psychologist / psychiatrist, carries an implication that their physical symptoms problem must be 'all in the mind', or that they are 'crazy/loopy/mad/nuts". There is more about this on the 'all in the mind" page.
2. "I'm not stressed"
One area where doctors and patients come unstuck with is the relationship between functional symptoms to stress. There is more about this on the 'Causes' pages.
The bottom line here is that many patients develop functional and dissociative symptoms without being stressed. The symptoms may have happened out of the blue or in relation to a physical injury, and the only thing thats stressful is having the symptoms!
There are also many people who develop functional symptoms at times of stress. But this does not mean the stress was the only factor or even the main one.
Of course life stresses makes everything worse, and it can be a major cause of functional symptoms, but in many people it is not that important. Stress about the symptoms is much more common and worth addressing.
3."I'm not the sort of person that sees a psychologist"
Do you really think that everyone who sees a psychologist/psychiatrist is crazy? Probably not. Many people understand why other people may need to see a psychologist / psychiatrist, but have trouble thinking of themselves as being someone that ever would. If you want to 'pull out all the stops' of treatment, you may have to leave aside your prejudices to do so.
4. "I don't want to be psychoanalysed"
Many people think that if they see a psychiatrist or a psychologist, the discussion and 'treatment' will be like old fashioned psychoanalysis. The classic, (and mistaken view) is that the psychiatrist says ' tell me about your childhood' , you spill the beans on every secret you've ever had and then the psychiatrists tells you how you've ended up this way.
Seeing a psychiatrists or psychologist is rarely like this. Most health professionals in this area will want to get to know you, but they will be more interested in the things that are stopping you getting better now, than the reasons in the past why this has happened.
As has been explained on the 'causes' page, it can be very difficult to pinpoint the reasons why people get functional and dissociative symptoms. Sometimes its enough just to say, 'You have a vulnerability to functional symptoms, lets try to work out how we can get you better'
Many people with functional symptoms do not need the extra assistance of a psychologist or psychiatrist. But your doctor may have suggested this and you may wonder why, when your problem is a neurological one like a weak leg or blackouts.
A common, and reasonable, question is, "How can talking about it actually help my symptoms?"
These are the common ways in which "talking about it" can help:
1. Being able to spend longer understanding the nature of your condition - eg that it is common, not your fault, not imagined, not due to disease but a potentially reversible problem with the function of your nervous system. It can take a long time to get your head around that, a psychologist can help you to do it
2. Talking about behaviours that might be getting in the way of your recovery - eg if you have chronic back pain and weak leg you may have pain which is worse on exercise. You may have been avoiding moving your back because you fear that you may be damaging your back further. By understanding you are making the pain temporarily worse but not damaging your back, this can help you experiment with moving your back more.
3. Talking about thoughts that are getting in the way of recovery - eg. someone with dissociative seizures may find that they become really worried about whether they are going to have another attack. The more they anticipate the attack, for example in a supermarket or walking down stairs, the more likely it is to occur.
4.Identifying feelings of low mood and worry. - eg your symptoms may have been going on for some time. You may have developed feelings of depression , anxiety or panic attacks. Less commonly other symptoms may be present like post-traumatic symptoms, obsessive thoughts or eating problems.
5. Problem solving - many of lifes problems don't have easy solutions. But some everyday hassles, like how to solve debt problems, or how to get help for a child who is being bullied may have solutions that you hadn't thought of. One less problem on the list can help things overall
If you put these all together then you may be surprised how helpful 'talking about it' can be.
Psychologists and psychiatrists vary a lot in their approach. You may need to talk to your family doctor or neurologist about who might be most helpful to see