A practice of speech for bodies that speak.
Functional Neurological Disorder (FND) describes a class of neurological symptoms — weakness, tremor, non-epileptic seizures, gait disturbance, disorders of speech or swallowing, sensory loss, functional vision changes — that arise without corresponding structural pathology. The investigations come back negative. The neurology is intact. The symptoms are not.
FND is among the most common presentations in neurology clinics, second only to headache and epilepsy. Many people with FND spend years being investigated, referred, doubted, or told the problem is ‘psychological’ — without being offered any adequate psychological treatment. This practice takes FND seriously as a clinical presentation. And as a problem that psychoanalysis has been thinking about, in one form or another, since the beginning.
The term Functional Neurological Disorder emerged from a deliberate effort to move away from earlier formulations — first hysteria, then conversion disorder — that implied a psychological aetiology. What was lost in the process is the name that actually says something. FND names what the disorder is not: not structural, not organic, not neurological in the conventional sense. It is a diagnosis of exclusion.
Describes what is absent — no structural lesion, no organic cause. A name for an absence. The neurology remains the frame, even where neurology cannot provide the explanation.
Names a mechanism — the transformation of something psychical, something that could not be spoken or carried in thought, into a somatic symptom. It says something about what is happening, not only about what is not.
The psychoanalytic tradition retains the word conversion not out of nostalgia but because precision matters in the clinic. The name holds open what the neurological frame closes down.
FND is not a new condition. It is, in a certain sense, the condition from which psychoanalysis emerged. Jean-Martin Charcot, working at the Salpêtrière in the 1880s, identified a class of symptoms he called hysteria: dramatic neurological presentations in the absence of any discernible lesion. A young Freud came to study with him in 1885–86 and found that the nervous system was not the whole story.
Freud returned to Vienna and, with Josef Breuer, described in the Studies on Hysteria (1895) what they came to call conversion: the process by which an incompatible psychical representation — something that could not be spoken, tolerated, or held in thought — found expression in a somatic symptom. The body took on what the mind could not carry. Anna O., Lucy R., Elisabeth von R.: each case showed a body speaking what words had failed to say.
“Hysterics suffer mainly from reminiscences.”
— Freud & Breuer, Studies on Hysteria (1895)
Freud’s most sustained analysis of conversion symptoms remains the Dora case (1905). The cough that persisted without organic cause, the aphonia that came and went in direct relation to the absence of an idealized figure: not deficits, but messages — addressed to an other who had not yet read them.
Hospital and multidisciplinary programs typically offer six to eight weeks of psychoeducation, physiotherapy, and CBT-based input — an evidence-based approach oriented toward reduced symptom severity and improved functioning. What they are not is treatment in the psychoanalytic sense. Psychoeducation names what is happening; analysis asks why.
Psychoanalysis does not offer a cure. This is the orientation of the work. When something changes in analysis, it changes because the subject has found a different relation to what they were carrying. That is not cure. It is Durcharbeitung — working-through.
This practice works in collaboration with Revive Neuro Physiotherapy for the bodily dimension of treatment. The analytic and physiotherapeutic registers are not alternatives — they address different dimensions of the same presentation. The inner work of analysis and the bodily work of physiotherapy each attend to what the other cannot reach. reviveneuro.com.au
Psychoanalysis is not a longer version of these programs. It operates in a different register — the symptom is not a problem to be managed but a formation to be heard.
Preliminary sessions begin where structured programs end: not with what the symptom is, but with what it may be saying — and for whom.
This practice is suited to adults and older adolescents carrying a diagnosis of FND or conversion disorder, or currently in neurological investigation. It may be particularly appropriate where:
You do not need to arrive with a clear account of the connection. The work begins before that account is available.
