UK CMRC 2018 Conference - Rachel Hunter (health economist)

If an illness is "psychosomatic" then it is explained. A 'functional disorder' means people haven't done their jobs yet.

 

We have all been on these forums for a number of years now and shared all our experiences of useless doctors, scientists and academics. They are numerous and often seem to be the majority rather than the minority.

I simply don't trust the medical profession to diagnose anything now that needs any amount of examination, thought process or ability to read scans etc for things that are well established conditions and do have objective tests.

For this reason I am unconvinced that anyone can be trusted to deliver the diagnosis of functional disorder ever when you consider the amount of processes from GP to hospital to specialist to referral onwards to radiologists to administration to departmental and budget cuts.

Then add in dustbin diagnosis get outs via psychologists and psychiatrists and a monkey could see that the notion of a safe diagnosis of 'functional disorder' is most likely to be failure of process than anything to do with sound scientific process.

 

So 'functional disorder' means that for this patient the health service has ceased to function?

 

Pretty much.

 

Whenever "functional illness" and ME are mentioned in the same sentence I like to quote Rachel Jenkins:

HYSYERIA RECONSIDERED

As we have seen, right from the early epidemics, the question of hysteria was considered by observers, who nonetheless decided that the evidence pointed to an organic aetiology. However since the McEvedy and Beard papers were published, the standard psychiatric teaching, and indeed often the standard medical teaching, has been that ME is primarily a functional illness, namely hysteria. Before reassessing this viewpoint, it is important to establish precisely what we mean by hysteria. The term has been used in many different ways...……

She goes on to consider the question in some detail in the Introduction of Post-viral Fatigue Syndrome (Myalgic Encephalomyelitis) 1991 eds Rachel Jenkins and James Mowbray. She should have known what was taught. She was, or had been, a lecturer at the Institute of Psychiatry.

It looks as though those who consider the condition "functional" should be questioned as to which precise use of "hysteria" they intend.

 

"A functional disorder is a medical condition that impairs normal functioning of bodily processes that remains largely undetected under examination, dissection or even under a microscope."

That is a neat definition that says one thing but means another. It sounds like nothing can be found on careful examination but biochemical, subtle genetic or certain viral problems won't be found by dissection or microscopy. As for examination, the whole POINT about functional disease is that things are apparent on examination but are not believed to be associated with lesions. So patients have dystonia or epilepsy which can be observed by a doctor but does not match certain traditional findings so bring on the psychologist not the biochemist.

The idea of functional meaning serving a function in the life of the individual was prevalent what seems to me not long ago but is obviously being downplayed nowadays. It was said explicitly that people got a virus or whatever but being an invalid helped them with other areas in their lives so they stayed ill instead of facing their problems (unconsciously, of course!) CBT for ME was then to be used to help the patient deal with those issues in a better way.