The function of ‘functional’: a mixed methods investigationHonestly, who doesn't love it when psychologists mislead patients, and lie to them?
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.
HIIILARIOUUUUS, I tell you.
"First do no harm?" Hippocrates, shmoppocrates.
Trust us!If the psychologist does not understand what is wrong with the patient, the first order is to blame the patient and the second order is to lie to him. And then put the patient on anti-depressents, or even better anti-psychotics, for good measure – that'll teach those unruly patients, foolishly seeking help for their medical problems at a psychologist.
Give up your anti-psychological attitude!
We mean you no harm!
Now do as I say and calmly take your pills for your *cough* functional *cough* disorder.
Informed consent, to god-damned hell with informed consent!
We don't use informed consent. In fact, we don't need informed consent.
We treat patients without any stinking informed consent, you god-damned cabrón and chinga tu madre!