Descartes is still sowing confusion on the hospital ward. Neurologist Adam Zeman believes it is time to transcend the mind-body distinctionby Adam Zeman / February 20, 1996 / Leave a comment
A young woman in her 20s-call her Jane-is admitted to our neurology ward because she has become weak down one side of her body. Like many such patients she has had some professional contact with medicine: Jane works as an assistant in a nursing home. Diagnoses of stroke, brain tumour and multiple sclerosis have been considered by the first few doctors she has seen. They have also been mooted with her. Anxiety runs high.
As she meets progressively more experienced specialists things fail to add up. Features which would be anticipated in paralysis are absent: Jane’s reflexes, for instances, are normal. A sophisticated brain scan reveals nothing amiss. When troubles at home comes to light, suspicion grows that Jane does not have a neurological disorder at all.
Diagnoses of varying psychiatric sophistication are proposed: Jane is a) nuts, b) malingering, c) hysterical, d) displaying abnormal illness behaviour or e) suffering from a somatisation disorder. Most suggestions are at the less technical end of the spectrum: the training of physicians, curiously, tends to discourage psychiatric expertise. But on one point, at least, her doctors agree. Jane has a “functional” rather than an “organic” disorder.
Organic conditions are the real ones in neurological terms. All the conditions considered by Jane’s first relay of doctors were organic. They have a specific anatomical and physiological basis. Something is amiss down the microscope. By contrast, functional disorders are pure disruptions of normal working: the organism itself remains intact. The distinction is attractive and, like my colleagues, I find it coming readily to my lips. On closer inspection it falls apart completely.
We usually mean one of three things when we wield this F-word. The first is the least reputable. “Functional” in this sense simply means incomprehensible. Faced with an unfamiliar symptom there is a temptation to suspect some sort of trickery. This can be dangerous. Few doctors have an encyclopaedic knowledge of their subject and new diseases are being described every week. Functional patients who turn out to have dire diseases are all too familiar to the negligence courts. With growing knowledge of the brain, a procession of peculiar “functional” disorders-from wry neck to writer’s cramp-have come to be regarded as “organic.”
The second sense of functional at least does more than dignify our ignorance. It is the proposition that functional disorders are ones which lack an anatomical or physiological basis. But it is…