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

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.