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<p>Functional disorders index the phenomenon in which someone is seriously ill—seizures, paralysis, complex pain—and yet no pathophysiological cause can be found. Traditionally, psychiatry has approached these disorders as instances of psychic distress manifesting through the body; however, multiple explanations currently compete within North American biomedicine and profound uncertainties, in diagnosis, treatment, and prognosis remain. Based on ethnographic fieldwork with clinicians and patients with&#xa0;suspected functional disorders at a Canadian neuropsychiatric clinic, this paper approaches medicine as an epistemological, psychic, and affective space. Focusing specifically on the role of fluctuation in these disorders, I explore how transience becomes a problem in the clinic, sticking to patients and instigating both ethical and epistemological crises. Following the anxieties and desires of both patients and clinicians, I argue that, in the unease surrounding functional disorders, a cultural fantasy of medicine as a space of certainty emerges. I describe this fantasy as a collective imagination of medicine as a place that can, and should, provide access to objective answers and stable truths. Despite the inescapable uncertainties of medicine, I suggest that this fantasy haunts the clinic, fundamentally shaping the conditions of possibility for affliction and care, especially for patients with contested illnesses.</p>

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The Place Where the Ground Gives Way: On Functional Disorders, Uncertainty, and Fantasies of Medicine

  • 期刊论文

  • 发表日期：

    2026年5月7日

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  • Daisy Couture

摘要

Functional disorders index the phenomenon in which someone is seriously ill—seizures, paralysis, complex pain—and yet no pathophysiological cause can be found. Traditionally, psychiatry has approached these disorders as instances of psychic distress manifesting through the body; however, multiple explanations currently compete within North American biomedicine and profound uncertainties, in diagnosis, treatment, and prognosis remain. Based on ethnographic fieldwork with clinicians and patients with suspected functional disorders at a Canadian neuropsychiatric clinic, this paper approaches medicine as an epistemological, psychic, and affective space. Focusing specifically on the role of fluctuation in these disorders, I explore how transience becomes a problem in the clinic, sticking to patients and instigating both ethical and epistemological crises. Following the anxieties and desires of both patients and clinicians, I argue that, in the unease surrounding functional disorders, a cultural fantasy of medicine as a space of certainty emerges. I describe this fantasy as a collective imagination of medicine as a place that can, and should, provide access to objective answers and stable truths. Despite the inescapable uncertainties of medicine, I suggest that this fantasy haunts the clinic, fundamentally shaping the conditions of possibility for affliction and care, especially for patients with contested illnesses.