Faulty reasoning signals

• Ambiguity (Equivocation) - 26.8%
• Appeal to Authority - 24%
• Negativity Bias - 20.8%

Article text

Debates over what it means when someone who was born a girl claims to be a boy, or vice versa, have raged in recent years. Many activists and some experts assert that internally felt gender identity is determinative and indisputable, like the fact that water makes you wet. At the other end of the spectrum are those who regard claims of gender nonconformity as false and harmful beliefs. There is another condition in which the reliability of self-definition fails, one that intersects with transgender identification and gender nonconformity in interesting ways, but has much less notoriety. This is a condition I encounter regularly in my practice as a neurologist: Functional Neurological Disorder (FND), the current medical term of art for psychosomatic illness. It refers to a condition where someone experiences neurological symptoms that originate not in any physical damage to their nervous system, but in the subconscious mind. Psychosomatic illness, once known as hysteria, may sound like a vestigial branch of medicine, a condescending label used to explain away symptoms earlier generations of doctors couldn’t understand given their limited science. That is not the case. The concept of psychosomatic illness is alive and well, updated under the framework of FND. It is common and routinely diagnosed in clinics and hospitals. I estimate that between 5 and 10 percent of my new referrals are for patients with FND, and the literature suggests this rises to a quarter of patients at tertiary referral centers. Psychosomatic neurological illness is incredibly diverse and can manifest as shaking, migrating weakness, random body jerks, attacks of fainting or convulsions, pseudo tics, cognitive blocks, abnormal walking, facial contortions, and language disruptions, among other varieties. Its repertoire is nearly as broad as that of organic neurological illness. The current framework of FND has greatly sharpened the diagnostic accuracy of psychosomatic illness. Diagnosis rests on two pillars: first, determining that a patient’s symptoms are internally inconsistent, meaning they change or can be manipulated in ways that are not consistent with the structure of the nervous system, in particular changing when the patient is distracted; second, verifying that the symptoms are incongruent with known patterns of neuropathology. This framework is a powerful tool in the hands of a skilled clinician. “Many of my most interesting patients have FND.”