There are many important insights from psychoanalysis that continue to be valuable when thinking about functional neurological disorder (FND). There is also however a legacy of harm related to the implementation of psychoanalytic theory in FND over the last century. This includes the accentuation of a dualistic, purely psychological model; the replacement of nineteenth century multifactorial models with a superficially more simplistic view; and encouraging disbelief of patient’s own narrative accounts. Predictive processing models and a much larger scientific evidence base offer an opportunity to revisit and update psychoanalytic hierarchical accounts of FND while acknowledging past harms.