https://www.bmj.com/content/380/bmj.p221
Richard Smith
Richard Smith
About a third of patients attending neurological and gastrointestinal, or almost every outpatient clinic—have functional disorders, meaning that they do not have a physical cause that can be detected with a microscope, scanners, or blood or genetic tests. These are patients whom medicine has failed more than almost any other group.
Language, as always, is part of the problem. Functional disorder is perhaps the best term for these conditions, but psychosomatic, psychogenic, conversion disorder, and in the past hysteria have all been used. Hysteria, with its association with women, is clearly unacceptable, and the prefix “psycho” is unhelpful. As O’Sullivan writes “Every medical problem is a combination of the biological, the psychological, and the social. It is only the weighting of each that changes.” Medicine was cursed when René Descartes divided the mind from the body.
Our understanding of how people develop these symptoms is poor, but the starting point is distress of some kind. “Embodied cognition” is the theory that sensory and motor systems are integrated with cognitive processing. As O’Sullivan writes: “The body is awash with white noise, so symptoms can always be found if a person looks hard enough.”