Keep calm and carry on: Mental disorder is not more “organic” than any other medical condition

J.A. Micoulaud-Franchi, C. Quiles, M. Masson
L'Encéphale. 2017-10-01; 43(5): 491-494
DOI: 10.1016/j.encep.2017.02.003

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1. Encephale. 2017 Oct;43(5):491-494. doi: 10.1016/j.encep.2017.02.003. Epub 2017
Mar 24.

Keep calm and carry on: Mental disorder is not more « organic » than any other
medical condition.

Micoulaud-Franchi JA(1), Quiles C(2), Masson M(3).

Author information:
(1)Services d’explorations fonctionnelles du système nerveux, clinique du
sommeil, CHU de Bordeaux, place Amélie-Raba-Leon, 33076 Bordeaux, France; USR
CNRS 3413 SANPSY, CHU Pellegrin, université de Bordeaux, 33000 Bordeaux, France.
Electronic address: .
(2)Pôle universitaire de psychiatrie adulte, centre hospitalier Charles-Perrens,
121, rue de la Béchade, 33076 Bordeaux cedex, France; Université Bordeaux
Segalen, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France.
(3)Nightingale hospitals Paris, clinique du Château-de-Garches, 92380 Paris,
France; Service hospitalo-universitaire, centre hospitalier Sainte-Anne, 75015
Paris, France.

Psychiatry as a discipline should no longer be grounded in the dualistic
opposition between organic and mental disorders. This non-dualistic position
refusing the partition along functional versus organic lines is in line with Jean
Delay, and with Robert Spitzer who wanted to include in the definition of mental
disorder discussed by the DSM-III task force the statement that « mental disorders
are a subset of medical disorders ». However, it is interesting to note that
Spitzer and colleagues ingeniously introduced the definition of « mental disorder »
in the DSM-III in the following statement: « there is no satisfactory definition
that specifies precise boundaries for the concept « mental disorder » (also true
for such concepts as physical disorder and mental and physical health) ». Indeed,
as for « mental disorders », it is as difficult to define what they are as it is to
define what constitutes a « physical disorder ». The problem is not the words
« mental » or « organic » but the word « disorder ». In this line, Wakefield has
proposed a useful « harmful dysfunction » analysis of mental disorder. They raise
the issue of the dualistic opposition between organic and mental disorders, and
situate the debate rather between the biological/physiological and the social.
The paper provides a brief analysis of this shift on the question of what is a
mental disorder, and demonstrates that a mental disorder is not more « organic »
than any other medical condition. While establishing a dichotomy between organic
and psychiatry is no longer intellectually tenable, the solution is not to reduce
psychiatric and non-psychiatric disorders to the level of « organic disorders » but
rather to continue to adopt both a critical and clinically pertinent approach to
what constitutes a « disorder » in medicine.

Copyright © 2017 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights

DOI: 10.1016/j.encep.2017.02.003
PMID: 28347522 [Indexed for MEDLINE]

Auteurs Bordeaux Neurocampus