The function of ‘functional’: a mixed methods investigation, 2012, Kanaan et al.

[Chandelier]

The function of ‘functional’: a mixed methods investigation | Journal of Neurology, Neurosurgery & Psychiatry

Authors: Richard A Kanaan, David Armstrong, Simon C Wessely

Abstract​

Objective The term ‘functional’ has a distinguished history, embodying a number of physiological concepts, but has increasingly come to mean ‘hysterical’. The DSM-V working group proposes to use ‘functional’ as the official diagnostic term for medically unexplained neurological symptoms (currently known as ‘conversion disorder’). This study aimed to explore the current neurological meanings of the term and to understand its resilience.
Design Mixed methods were used, first interviewing the neurologists in a large UK region and then surveying all neurologists in the UK on their use of the term.
Results The interviews revealed four dominant uses—‘not organic’, a physical disability, a brain disorder and a psychiatric problem—as well as considerable ambiguity. Although there was much dissatisfaction with the term, the ambiguity was also seen as useful when engaging with patients. The survey confirmed these findings, with a majority adhering to a strict interpretation of ‘functional’ to mean only ‘not organic’, but a minority employing it to mean different things in different contexts - and endorsing the view that ‘functional’ would one day be a neurological construct again.
Conclusions ‘Functional’ embodies real divisions in neurologists' conceptualisation of unexplained symptoms and, perhaps, between those of patients and neurologists: its diversity of meanings allows it to be a common term while meaning different things to different people, or at different times, and thus conceal some of the conflict in a particularly contentious area. This flexibility may help explain the term's longevity.

 

[Utsikt]

its diversity of meanings allows it to be a common term while meaning different things to different people, or at different times, and thus conceal some of the conflict in a particularly contentious area. This flexibility may help explain the term's longevity.

«This term is very convenient for dealing with patients we don’t want to deal with, and it helps us gaslight them more efficiently.»

 

[Jonathan Edwards]

I wonder what 'not organic' is supposed to mean?
Supernatural?

 

[bobbler]

Useful reference to have saved as it seems to show there is no confusion and those pushing certain terms know what they are doing.

 

[Utsikt]

I wonder what 'not organic' is supposed to mean?
Supernatural?

The non-dualist mind in the mind-body, of course! It’s amusing when they say the quiet part out loud.

 

[wabi-sabi]

The non-dualist mind in the mind-body, of course!

These people don't even understand what dualism is. They say they are getting rid of it, while instead they create it.

 

[wabi-sabi]

Here is the correct explanation(s) of dualism, if anyone wants it:
From the Stanford Encyclopedia of Philosophy

Dualism (Stanford Encyclopedia of Philosophy)

 

[Jonathan Edwards]

It's a bit like selling an old used copy of a sewing pattern for the Emperor's new underwear on Ebay really.

 

[wabi-sabi]

I wonder what 'not organic' is supposed to mean?
Supernatural?

Well, according to Aristotle, yes, or to say, that the intellect is part of the soul. Aristotle believed that some faculties like sight and hearing have corresponding bodily organs: eyes and ears. The intellect (the rational part of our mind) is different. it does not have a corresponding organ in the body!

There is some mushiness going on here between the meaning of mind and soul that I don't really understand- I can't read Greek! But it looks to me that at this point in our history the concepts of mind and soul were not completely differentiated. The rationale goes something like: concepts are immaterial (not made of matter), so therefore the part of us that can grasp concepts must also be immaterial. It's built on Plato's concept of the Forms, the first differentiation between form and substance in Western philosophy. I'm not sure how these ideas might show up in Buddhist philosophy.

It makes me think of something a high school math teacher told us once, when trying to explain numbers and their abstraction. "you'll never see a three go walking down the street". You can see three people, or three dogs, or three birds, but you'll never see a three itself. That's because three is an abstract idea that humans have created to explain our world and let us count our sheep and balance our checkbooks, but it's not physically real. Aristotle's forms are a bit like the abstract idea of three. We can see it made manifest in material objects, but we can't grasp it directly in our hands. Only our rational souls can grasp the idea of three, and this goes to show that our rational souls (or in modern, secular terms our minds) are also abstract and non material things.

Wessely et al. don't seem to have advanced their scientific understanding of the world past Aristotle.

 

[SNT Gatchaman]

The use of euphemisms or codes is extremely common in conversion disorder — three quarters of neurologists do so at least some of the time — but there is also a divergence between the terms neurologists use medically and with laypeople.

One advantage of ‘functional’ may thus be as a simplifying euphemism, allowing neurologists to use the same term to mean one thing to colleagues and another to patients. It may be precisely this ambiguity which has allowed the construct to survive despite the uncertainty and conflicts underpinning its meaning at any point in time.

A minority of neurologists, for example, take a functional model for conversion disorder seriously. That is to say, the vision articulated by Charcot where ‘more powerful microscopes’ will reveal the subtle physiological alterations underlying hysteria is seen to be a real possibility with the advent of functional neuroimaging. The functional/structural dichotomy may have broken down as the distinction between psychiatry and neurology, but some clearly see the result of that being functional, psychiatric illness welcomed back into the neurological fold.

The variability of meanings identified across and within neurologists attests to the vibrancy of the construct, despitedor more likely because ofdits ambiguity. Its proposed use in DSM-V indicates that in certain clinical areas ambiguity has its own function.

 

[rvallee]

These people don't even understand what dualism is. They say they are getting rid of it, while instead they create it.

Oh they understand it very well. They're just lying about it, it's even part of the lie to lie about lying about it. Power without responsibility leads to stuff like this all the time. Humans don't do the right thing just for the sake of it or learn lessons from mistakes, we learn when there are consequences for mistakes.

And here the mistakes, the intentional destruction of millions of lives, have led to ample rewards, incentivizing them has led to a state of systemic dishonor. Funny how that doesn't work.

In the text they seem to refer to euphemisms. The proper term is dog whistle: the only ones who hear are the ones they are whistling for. Except of course for the fact that we do hear it, they know it, but they don't have to care because without power over us they don't have to care one bit. Here's them making it clear, because they don't even have to hide it.

One advantage of ‘functional’ may thus be as a simplifying euphemism, allowing neurologists to use the same term to mean one thing to colleagues and another to patients. It may be precisely this ambiguity which has allowed the construct to survive despite the uncertainty and conflicts underpinning its meaning at any point in time.

There's a famous quote from, IIRC, the movie The smartest guys in the room, about the collapse of Enron: "they're not confessing, they're bragging". If I ever get to make mine, or write about it, it will instead be: "it's worse in context, and the more context you add, the worse it is". They know. They don't care.

 

[Sean]

And here the mistakes, the intentional destruction of millions of lives, have led to ample rewards, incentivizing them has led to a state of systemic dishonor.

The gold standard for perverse incentives. Par excellence, one might even say.

There's a famous quote from, IIRC, the movie The smartest guys in the room, about the collapse of Enron: "they're not confessing, they're bragging".

It's from The Big Short, about the corruption in the US housing market and its eventual collapse in 2008, and how little accountability there was for it.

There are two other movies about that human-made disaster, Margin Call and Too Big To Fail, and all three are very good, and very depressing.

 

[FicaR94]

I always thought the ambiguity of "functional" was the point. It's vague enough to use without committing to a clear organic or psychiatric label, which is probably why it's stuck around this long

 

[Alinda]

I often feel the only reason that  most pwME don't see themself as having a functional problem is because treatment of functional problems (mostly CBT, from what I have seen) often actively makes us more ill.

It always makes me a bit sad when pwME think their problems are properly explained by being "functional". Personally I still barely understand what it is even supposed to understand, because no one seems to properly know.

 

[wabi-sabi]

I always thought the ambiguity of "functional" was the point.

Indeed it is. The philosopher Diane O'Leary has given a talk about this to an EDS group.

 

[Jesse]

I always thought the ambiguity of "functional" was the point. It's vague enough to use without committing to a clear organic or psychiatric label, which is probably why it's stuck around this long

Funny you say that because that's literally the last sentence of the abstract:

its diversity of meanings allows it to be a common term while meaning different things to different people, or at different times, and thus conceal some of the conflict in a particularly contentious area. This flexibility may help explain the term's longevity.

 

[bobbler]

I'm guessing I'm doing a granny sucks eggs but just for the record of anyone reading through this one day...

But of course at the same time there is currently another thread: https://www.s4me.info/threads/trust...-symptoms-2024-lewis-et-al.40879/#post-645398

Which is a current-day supposedly 'new', but old wine in new bottles, article basically using just this instruction manual - and how many have we read before.


Of course I find this whole thing very 'meta' where there is this whole literature that is basically on propaganda/marketing (except of course it is selling dishonesty so it crosses the line there if it were under business regs?) pretending it is mental health charading under physical health

And really when put together it is actually an interesting literature on the psychology of the people who feel the need to use, research, market people doing this.

It never really feels that it has to draw that line between the dots as to why these people feel it is either important to be dishonest and lie or why it might be helpful or a good thing to do. Another 'between the lines' nod and wink hidden 'you know if you've been trained into it' (although normally to themselves they think 'had to work in a hospital'/met these people etc I suspect) secret policy and communication thing.

I've noticed a lot in medicine seems to be actually learned not through the overt critical thinking process but by enforcing habits into people by the day to day and then post-hoc giving them a story as to why they are already habitually doing it that way to leave no gap for cognitive dissonance.

But for people who feel compelled to stoke it by writing these sorts of papers and who really push these suggestions as needed/necessary then boy would I be intrigued to get the fly on the wall honesty behind it.