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Meaning and role of functional-organic distinction: a study of clinicians in psychiatry and neurology services
  1. Alice Chesterfield1,
  2. Jordan Harvey1,
  3. Callum Hendrie2,
  4. Sam Wilkinson3,
  5. Norha Vera San Juan1,
  6. Vaughan Bell1,4
  1. 1 Clinical, Educational and Health Psychology, University College London, London, UK
  2. 2 Community Support Work Service, Headway East London, London, UK
  3. 3 Dept of Sociology, Philosophy and Anthropology, Exeter University, London, UK
  4. 4 Department of Neuropsychiatry, South London and Maudsley NHS Foundation Trust, London, UK
  1. Correspondence to Dr Vaughan Bell, Clinical, Educational and Health Psychology, University College London, London, WC1E 6BT, UK; vaughan.bell{at}ucl.ac.uk

Abstract

The functional-organic distinction attempts to differentiate disorders with diagnosable biological causes from those without and is a central axis on which diagnoses, medical specialities and services are organised. Previous studies report poor agreement between clinicians regarding the meanings of the terms and the conditions to which they apply, as well as noting value-laden implications of relevant diagnoses. Consequently, we aimed to understand how clinicians working in psychiatry and neurology services navigate the functional-organic distinction in their work. Twenty clinicians (10 physicians, 10 psychologists) working in psychiatry and neurology services participated in semistructured interviews that were analysed applying a constructivist grounded theory approach. The distinction was described as often incongruent with how clinicians conceptualise patients’ problems. Organic factors were considered to be objective, unambiguously identifiable and clearly causative, whereas functional causes were invisible and to be hypothesised through thinking and conversation. Contextual factors—including cultural assumptions, service demands, patient needs and colleagues’ views—were key in how the distinction was deployed in practice. The distinction was considered theoretically unsatisfactory, eventually to be superseded, but clinical decision making required it to be used strategically. These uses included helping communicate medical problems, navigating services, hiding meaning by making psychological explanations more palatable, tackling stigma, giving hope, and giving access to illness identity. Clinicians cited moral issues at both individual and societal levels as integral to the conceptual basis and deployment of the functional-organic distinction and described actively navigating these as part of their work. There was a considerable distance between the status of the functional-organic distinction as a sound theoretical concept generalisable across conditions and its role as a gatekeeping tool within the structures of healthcare. Ambiguity and contradictions were considered as both obstacles and benefits when deployed in practice and strategic considerations were important in deciding which to lean on.

  • psychiatry
  • Neurology
  • philosophy of medicine/health care

Data availability statement

No data are available. The data used in this study are qualitative interview data and therefore it is difficult to ensure raw data are fully anonymised. Ethical approval and participant consent was given on the basis that data would not be shared outside the research team.

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Data availability statement

No data are available. The data used in this study are qualitative interview data and therefore it is difficult to ensure raw data are fully anonymised. Ethical approval and participant consent was given on the basis that data would not be shared outside the research team.

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Footnotes

  • Twitter @vaughanbell

  • Contributors AC, JH, CH and VB conceived and planned the study. AC, JH and VB collected the data. AC, JH, CH, NVSJ and VB were involved in the analysis of data. All authors were involved in the interpretation of results. AC drafted the manuscript. All authors were involved in revising and finalising the submitted manuscript and revising it for resubmission. The guarantor (VB) accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.