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Functional neurological disorder (FND) is a condition characterised by neurological symptoms without identifiable pathology. Evolving from historical diagnoses such as ‘hysteria’, FND represents a transformative shift in diagnostic understanding. FND is common, accounting for 5-15% of neurology patients, with an incidence of 12 per 100,000 per year - around 8,000 new diagnoses yearly in the UK.This study assessed diagnostic rates at a large neurological centre without a dedicated FND service. Inpatient episodes, outpatient appointments, and emergency department attendances between 1 January 2018 and 30 June 2024 were analysed. Accuracy of coding was assessed by reviewing 9,698 patient medical records and a survey of practicing neurologists examined perceptions of FND in the centre. These findings were then contextualised within historical understandings of functional disorders.Over the six year period, FND was diagnosed in 19 inpatients, with diagnosis rates of 0.0135% in outpatient appointments and 0.0145% in emergency department attendances. Clinical attitudes and treatment decisions were shaped by stigmas, outdated perceptions, and insufficient institutional investment.Historical stigmas and structural underinvestment continue to marginalise FND, creating a self-perpetuating cycle of low diagnosis rates and limited care. Breaking this cycle requires addressing cultural and institutional barriers, alongside systemic belief in and investment in the condition to achieve meaningful reform.edward.nicholas555@btinternet.com