Functional neurological disorders: misunderstanding "Dualism".

Psychological and psychiatric explanations for Functional Neurological Disorders (FND) are routinely dismissed as embodying "dualism" or "mind-body dualism", strongly implying that any notion of psychogenicity should be rejected outright. This reflects a widespread misunderstanding. DSM5 nomenclature and recent mainstream literature emphasise neurobiological causation - framing FND as a "multi-network brain disorder" or "dysregulation of neural circuitry" - while downplaying psychological formulations, despite high rates of psychiatric symptomatology and the fact that the majority of clinicians worldwide continue to prefer psychogenic models and treatment with psychotherapy. The charge of dualism is misplaced: while Cartesian substance dualism has been correctly rejected by modern neuroscience, the term is now commonly misused to criticise any distinction between neurological and psychiatric causation. We argue that neuropsychiatric conditions exist on a clinically useful continuum from predominantly neurological to predominantly psychiatric/psychological disorders, while fully accepting that all are ultimately brain-based. Psychiatric symptomatology, clinician perspectives, and response to psychological approaches place FND firmly on the psychiatric/psychological side of this continuum. Framing FND as driven by psychological/psychiatric engines offers far greater clinical utility and therapeutic direction than reductionistic neurobiological models. We conclude that psychological/psychiatric conceptualisations remain the most valid and effective framework for understanding and managing FND.