The diagnosis of Functional Neurological Disorder (FND) requires differentiation from other neurologic diseases/syndromes, and from the comparatively rare diagnosis of feigning (Malingering and Factitious Disorder). Analyzing the process of diagnosing FND reveals a necessary element of presumption, which I propose underlies some of the uncertainty, discomfort, and stigma associated with this diagnosis. A conflict between the neurologist’s natural social cognition and professional judgement (cognitive dissonance) can be understood by applying a framework originally designed for the determination of moral responsibility. Understanding (...) the source of this cognitive dissonance may effect its alleviation, and in turn, allow more compassionate treatment of patients with FND. (shrink)

Biomedical diagnostic science is a great deal less successful than we've been willing to acknowledge in bioethics, and this fact has far-reaching ethical implications. In this article I consider the surprising prevalence of medically unexplained symptoms, and the term's ambiguous meaning. Then I frame central questions that remain answered in this context with respect to informed consent, autonomy, and truth-telling. Finally, I show that while considerable attention in this area is given to making sure not to provide biological care to (...) patients without a need, comparatively little is given to the competing, ethically central task of making sure never to obstruct access to biological care for those with diagnostically confusing biological conditions. I suggest this problem arises from confusion about the philosophical value of vagueness when it comes to the line between biological and psychosocial needs. (shrink)

Kanaan (2010) should be commended for revisiting, and bringing to the attention of his fellow colleagues, the complexity of hysteria. His article reminds us of the difficulties doctors have encount...

Hysteria is thought to involve the unconscious production of symptoms that resemble neurological disorders. However, it is not usually possible to distinguish this from deception, leading some authors to advocate dropping the distinction. In this paper, I argue that deception is not a unitary concept, so that hysteria may indeed involve a form of deception without necessarily the ethical implications of lying. The evidence for and against deception in hysteria is considered, and a taxonomy of deception outlined. The evidence is (...) argued to support deception as a sufficient model for hysteria, though not necessarily in the form of lying, and not such as to exclude other models for much of their behavior. An appreciation of the distinct forms of deception may help clinicians to clarify their relationships with their patients with hysteria, and clarify the distinction from malingering. (shrink)