A leg will not move, though nothing is wrong with the nerves or muscles. An arm shakes. A person has seizures, but the brain’s electrical activity is normal. These are the symptoms of functional neurological disorder, or FND, one of the commonest reasons people see a neurologist.
The history of hypnosis is bound up with this condition. It was in patients like these that Charcot, Freud and the doctors of the First World War saw what suggestion could do.
What FND is
FND is a problem with how the nervous system functions, not with its structure. A common comparison is with a computer: the hardware is intact, but the software is not running properly. Signals between brain and body are not being sent or received in the normal way.
Symptoms include:
- Weakness or paralysis of a limb
- Tremor, jerks or abnormal postures
- Problems with walking
- Seizures that resemble epilepsy
- Loss of sensation, or problems with vision or speech
Three points are essential.
The symptoms are real and involuntary. People with FND are not pretending and cannot simply stop.
It is a positive diagnosis. Neurologists identify it from characteristic signs on examination, not just by ruling other things out.
It is not “all in the mind.” Stress or trauma are present for some people and absent for many. FND often starts after a physical injury or illness.
It used to be called conversion disorder or hysteria, terms that carried a good deal of stigma.
Why hypnosis seems relevant
There is a curious parallel. Hypnotic suggestion can produce, in healthy volunteers, temporary paralysis, loss of sensation or involuntary movement that closely resembles FND. Brain imaging of suggested paralysis and of functional paralysis shows overlapping patterns.
That suggests the two may share mechanisms involving attention, expectation and the sense of control over movement. If suggestion can produce such symptoms, perhaps it can also help reverse them. People with FND have also been found, on average, to be somewhat more hypnotizable than others.
What the evidence shows
A randomised trial. In a Dutch study published in 2003, 49 people with motor-type conversion disorder, mostly women, with symptoms lasting an average of nearly four years, were randomly assigned to hypnosis-based treatment or to a waiting list. Treatment was weekly as an outpatient. Motor performance was rated by assessors who did not know which group patients were in.
The treated group improved relative to the waiting list. The authors noted that the study was small.
The wider literature. A review found more than 35 studies using hypnosis or suggestion for FND, including five randomised controlled trials. All reported improvement. But many are old, small or uncontrolled, and a Cochrane review of psychological treatments for these conditions has judged the overall evidence to be limited.
So hypnosis looks helpful, on a thin evidence base.
Where it fits in modern treatment
Treatment of FND has improved a great deal. The recommended approach now usually includes:
- A clear, sympathetic explanation of the diagnosis. For many people, understanding what is happening is itself the start of recovery.
- Specialist physiotherapy, which retrains movement by shifting attention away from the affected limb. It has the best evidence for motor symptoms.
- Psychological therapy, often CBT, especially for functional seizures.
- Occupational therapy and help with pacing, fatigue and pain.
Hypnosis is not a standard part of this, but it is used by some specialist teams, and it fits naturally with the principle that attention and expectation are central.
How it is used
- Explaining hypnosis as a way of practising control over attention and movement
- Relaxation, since tension and anxiety worsen symptoms
- Suggestions for normal function: a limb feeling lighter, warmer, easier to move
- Imagery of movement, rehearsing walking or using a hand
- Demonstrating reversibility. Under hypnosis a symptom may ease, showing the person that change is possible.
- Self-hypnosis for practice between sessions
- For functional seizures: learning to recognise early warning signs and interrupt them
Important cautions
- Diagnosis first. FND must be diagnosed by a neurologist. Many serious conditions cause weakness, tremor and seizures.
- Specialist delivery. This is not work for a general hypnotherapist. It needs a clinician who understands FND, working with the neurology or rehabilitation team.
- No hunting for hidden causes. Old ideas that FND always stems from buried trauma are wrong and harmful. Hypnosis should not be used to search for memories.
- No implication of faking. If a symptom improves under hypnosis, that does not mean it was put on.
- Dissociation. Some people with FND dissociate readily. Sessions should be short and grounding.
- Not instead of physiotherapy.
If you have FND
- Ask your neurologist for a clear explanation and a referral for specialist therapy.
- Reliable patient-led information is available from FND charities and from neurologist-written websites.
- Ask whether the team uses hypnosis or relaxation techniques.
- Self-hypnosis for relaxation and sleep is reasonable alongside your treatment.
- Be wary of any practitioner who promises a quick cure or who suggests the cause must be psychological.
For families
Believe the symptoms. Avoid both doing everything for the person and telling them to try harder. Encourage them to follow the therapy plan, and celebrate small gains.
The bottom line
Functional neurological disorder is real, common and treatable. Hypnosis has a long association with it and some trial support, but the evidence is limited. Its place is as one tool within specialist care, alongside a good explanation and physiotherapy, never as a search for a hidden cause.
Next in the series: Self-Hypnosis for Children’s Migraine: The Study That Beat a Drug
This article is for general information and is not medical advice.