BMJ JNN&P: Neuropsychiatry: The function of ‘functional’: a mixed methods investigation

[Firestormm]

The function of ‘functional’: a mixed methods investigation

Richard A Kanaan1, David Armstrong2, Simon C Wessely1

Contributors: RK designed the study, collected the data, analysed the data, drafted the manuscript and acts as guarantor; DA designed the study, cleaned the data, analysed the data and edited the manuscript; SW designed the study and edited the manuscript. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

Received 18 July 2011 Revised 12 October 2011 Accepted 19 October 2011

Published Online First 16 January 2012
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.

 

[SilverbladeTE]

in otherwords
You can say any shit you like about any shit, long as it sounds nice and nonspecific so no one can check up on you!
It's a ROGUES CHARTER!

yeah business as f'ing usual in Rip Off Britain: land O' the Rising Scum! :/

 

[orion]

Disgusting. Anybody who still believes that Wessely has significantly changed his position (after having read his recent correspondence with Lady mar) needs to read this paper.

 

[Sasha]

'[...]the ambiguity was also seen as useful when engaging with patients.'

Great. Just what patients want. To be deliberately kept in the dark about what's really being said.

 

[peggy-sue]

Adhering to the Red Queen's philosphy of a word meaning exactly what she wants it to!

No better than philosophy; the true functionality of words is to decieve.

 

[user9876]

The abstract doesn't actually say what the authors opinions are but report the results of surveying neurologists. However the way they write about it you may make inferences.

To me science should include clear and concise definitions so I find it intersting that they seem unworried by the confusion for the term and even seem to infer that it might be helpful. To me they should conclude that a common term meaning different things to different people is unacceptable within a scientific or diagnostic context.

 

[Firestormm]

I still need to read this one through properly, as you say it is the result of a survey, so it represents the opinions expressed in the data. Ask a group of monkeys what they think 'functional' means and you'd get a different pile of pooh from each one.

Ha!

Sorry. Funny mood. I need to read the paper through but my impression was that at least it helped quantify the situation. And I did think it helpful in that respect. Be interested to read the survey results - wonder what the received the highest score... No. No. Don't tell me...

 

[SilverbladeTE]

Just in case cultural differences obscured my meaning

ROGUE'S CHARTER

It's a term for any legislation or rules that - deliberately or accidentally - are set up in a way that makes corrupt behaviour easy

usually reffered to when say the government or a leadership puts in laws that are obviously "Bent" to let them do what they want

this item shows these psychiatrists create not just "wiggle room", but complete non-specifity so they can come up with ANY bullshit, abuse or even out right harmful crap, and *get away with it later* by claiming or showing there was no specifics "Oh I didn't know it would result in harm!" etc etc

 

[Firestormm]

Just in case cultural differences obscured my meaning

ROGUE'S CHARTER

usually reffered to when say the government or a leadership puts in laws that are obviously "Bent" to let them do what they want

this item shows these psychiatrists create not just "wiggle room", but complete non-specifity so they can come up with ANY bullshit, abuse or even out right harmful crap, and *get away with it later* by claiming or showing there was no specifics "Oh I didn't know it would result in harm!" etc etc

Except they were neurologists who answered the survey, Silverblade and not psychiatrists:

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.

 

[alex3619]

Adhering to the Red Queen's philosphy of a word meaning exactly what she wants it to!

No better than philosophy; the true functionality of words is to decieve.

Which is the principle of language also used in cons, spin, propaganda and lies, but not science. Isn't medicine supposed to be scientific?

 

[Little Bluestem]

For those who are more interested in Merriam-Webster’s opinion than the Red Queen’s:

Definition of Functional
1 a : of, connected with, or being a function

b : affecting physiological or psychological functions but not organic structure <functional heart disease>

Definition of Function
3 : any of a group of related actions contributing to a larger action; especially : the normal and specific contribution of a bodily part to the economy of a living organism

 

[Valentijn]

b : affecting physiological or psychological functions but not organic structure <functional heart disease>

I got the impression that this is the definition favored by the article:

There is a view among neurologists that their diagnostic obligation ends with the diagnosis—or exclusion—of neuropathology: once they have established that a problem is not ‘with the wiring’ they should properly remain ‘agnostic’ about what it otherwise is.12 14 Those who adopt the ‘non-organic’ use for ‘functional’ can be seen as taking that line, refusing to be drawn into speculation about the nature of the disorder.

But I think they are incorrect in asserting that "non-organic" is not speculative itself. Indeed, it's making an assertion that is not proven, and really never can be proven. Rather, that would seem to be the very essence of speculation!

Hence I think the authors are not simply relating what neurologists think, but are proclaiming that a functional disorder is necessarily non-organic.

 

[peggy-sue]

Medicine is supposed to be scientific, yes. But medics are not scientists and they are not taught science or how to be scientists. They only socialise with each other at uni - they are kept apart from other students.
They are stuffed with medical information that is most likely to be around 10-20 years out of date.

Subjects such as anatomy shouldn't change too much and should have no excuse for being out of date;
but it is interesting to note that it took a feminist to pay to have the female genitalia properly dissected and the results published privately. I do not think that official anatomy books have caught up with getting that correct yet.

It takes about 5 -10 years for any "new" science to get incorporated into any text books - and the active life of a research paper is only about 5 years, at most.

 

[alex3619]

Hi peggy-sue, I mostly agree, the question about medicine and science I posed was rhetorical. Clearly much of medicine is not scientific (as in being adequately science based), and just as clearly many if not most doctors doing medical research are not trained research scientists (although this is not always true). Indeed, most doctors trained now (in Australia) have a science degree before they start their medical degree, though this is typically a Bachelor, not a research science degree like M.Sc. or Ph.D..

New medical students coming out of places like Stanford and Harvard Medical Schools are claimed by the deans to be five years out of date. Thats the research gap in a medical school. A study a few years ago showed that average doctor is 17 years out of date, though this probably varies by topic. However consider that the 17 years includes both new graduates and specialists. Doctors cannot keep up to date, and the information support services they have are failing them. Doctors are typically up to date on common problems that are well reviewed in journals and through information from sources like pharmacological companies. Uncommon, rare or misunderstood problems are a major issue though.

 

[Snow Leopard]

So basically, "functional" is often used as doublespeak.

 

[peggy-sue]

And in that context, it is a very functional word indeed!

 

[alex3619]

So basically, "functional" is often used as doublespeak.

Yes, but the real worry is that these "experts" think that double speak is necessary. There goes the whole idea of informed consent. There goes honesty and scientific accuracy. There goes medicine as we hoped it might be.

This issue of names being out of favour is one reason why psychiatric labels keep changing. The old labels go out of favour, so they slap a new label on an almost identical diagnosis, and abra cadabra, a new DSM is born.

 

[peggy-sue]

I have (effectively) one leg about an inch shorter than the other and it's been causing sciatica.
I've been to a podiatrist, who tells me my legs are the same length.

So, I have been diagnosed with a "functional" disorder - the functioning of my legs is such than one appears to be an inch shorter than the other. Nobody has suggested to me that it might thus be imaginary. I am being referred for physiotherapy.
Frankly, I'd like some sort of scan of my hips and back to find out where that inch has gone.
I used to have it.