What is the Functional / Organic Distinction Actually Doing in Psychiatry and Neurology? (Preprint, 2020) Bell, Greco et al

No time to read this today and apologies if already posted in another thread:

https://psyarxiv.com/bwa6m/

What is the Functional / Organic Distinction Actually Doing in Psychiatry and Neurology?


Authors:
Vaughan Bell, Sam Wilkinson, Monica Greco, Callum Hendrie, Ben Mills, Quinton Deeley

Pre-print
PDF: https://psyarxiv.com/bwa6m/download


Abstract

The functional-organic distinction aims to distinguish symptoms, signs, and syndromes that can be explained by diagnosable biological changes, from those that cannot. The distinction is central to clinical practice and is a key organising principle in diagnostic systems. Following a pragmatist approach that examines meaning through use, we examine how the functional-organic distinction is deployed and conceptualised in psychiatry and neurology. We note that the conceptual scope of the terms 'functional' and 'organic' varies considerably by context.

Techniques for differentially diagnosing 'functional' and 'organic' diverge in the strength of evidence they produce as a necessary function of the syndrome in question. Clinicians do not agree on the meaning of the terms and report using them strategically. The distinction often relies on an implied model of 'zero sum' causality and encourages classification of syndromes into discrete ‘functional’ and ‘organic’ versions. Although this clearly applies in some instances, this is often in contrast to our best scientific understanding of neuropsychiatric disorders as arising from a dynamic interaction between personal, social and neuropathological factors. We also note 'functional' and 'organic' have loaded social meanings, creating the potential for social disempowerment and epistemic injustice. Given this, we argue for a better understanding of how strategic simplification and complex scientific reality limit each other. We also note that the contribution of people who experience the interaction between 'functional' and 'organic' factors has rarely informed the validity of this distinction and the dilemmas arising from it, and we highlight this as a research priority.

 

What a confused mess. I'm sure there's an argument in there somewhere but I can't find it. It's completely detached from real life and the consequences of waffling over pseudo-philosophical nonsense, there's simply zero consideration that this "debate" is about the lives of tens of millions of people, a debate that only exists because of people who swing this argument around as if it were relevant.

Psychiatry is frankly in a state of disarray, trying to worm its way outside of its own borders based solely on that hysteria of the gaps and despite having nothing useful to offer on those issues beyond a pathological insistence that it must be involved at all cost. This isn't really unscientific so much as ascientific, a natural extension of the people who rejected the germ theory of disease at the time, prefering what they feel is right to the rigorous and thankless pursuit of figuring out what is actually true.

 

Are you suggesting that it's a little 'goopy'?

 

This is pure plagiarism. I am sure it was in a Monty Python sketch in 1977 with John Cleese as Monica Streeb-Grebeling.

 

Comedy gold

 

it seems like half a dozen people decided after multiple bottle of whatever beverage of choice decided to write about the deceitful nature of some medical professionals /academics and where obviously to drunk for a rational discussion . hence the waffle . what an extremely low bar there is for publishing .

 

I thought the paper wasn't that bad. It mostly explains how the term 'functional' has different meanings

They give the example of tic disorders, to show that functional sometimes means psychogenic

I think I remember a paper by Wessely's group where they argue that the ambiguity of "functional" is precisely the reason for its succes (doctors can tell each other that they think symptoms are psychogenic without offending the patient).