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• ‘Organic’ and ‘non-organic’
  JMS Pearce
  Published on: 27 September 2017

• Published on: 27 September 2017

  ‘Organic’ and ‘non-organic’

  • JMS Pearce, emeritus -

  Stone and Carson(1) say:
  ‘Non-organic refers to things unrelated to living matter,… This is a word that cannot be used to describe conditions suffered by living human beings.’ They refer ‘to the OED sense: “something characterised by structural or other pathological change in an organ or organs”. They acknowledge it was useful ‘in the 19th century when neurologists first saw the pathology of multiple sclerosis or motor neurone disease. But what about genetic generalised epilepsy or migraine—pathological, but not necessarily structural, or at least no more so than, for example, unipolar depression where there is quite substantial evidence for structural changes. ’(2)

  They are right to point out the difficulties in separating ‘functional and non-organic’ disorders from those with structural or ultrastructural abnormalities but they should not be ‘blackballed from the club of legitimate conditions because of the difficulty in establishing their veracity.’

  Most of us understand that epilepsy, migraine and spasmodic torticollis, for example, have underlying structural or other subtle abnormalities; the fact that modern techniques don't always disclose the organic basis does not mean they are psychogenic, do not exist, or are illegitimate.

  Functional was originally the result of altered function (rather than structure) of an organ, system, etc.; but its meaning confusingly changed to a psychological cause as opposed to a physical one. The term...

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  Stone and Carson(1) say:
  ‘Non-organic refers to things unrelated to living matter,… This is a word that cannot be used to describe conditions suffered by living human beings.’ They refer ‘to the OED sense: “something characterised by structural or other pathological change in an organ or organs”. They acknowledge it was useful ‘in the 19th century when neurologists first saw the pathology of multiple sclerosis or motor neurone disease. But what about genetic generalised epilepsy or migraine—pathological, but not necessarily structural, or at least no more so than, for example, unipolar depression where there is quite substantial evidence for structural changes. ’(2)

  They are right to point out the difficulties in separating ‘functional and non-organic’ disorders from those with structural or ultrastructural abnormalities but they should not be ‘blackballed from the club of legitimate conditions because of the difficulty in establishing their veracity.’

  Most of us understand that epilepsy, migraine and spasmodic torticollis, for example, have underlying structural or other subtle abnormalities; the fact that modern techniques don't always disclose the organic basis does not mean they are psychogenic, do not exist, or are illegitimate.

  Functional was originally the result of altered function (rather than structure) of an organ, system, etc.; but its meaning confusingly changed to a psychological cause as opposed to a physical one. The term functional, which approximates to non-organic, should be confined to conditions such as migraine or asthma in which there is evidence of a disordered function or biophysiology. Non-organic has the merits of indicating simply the dearth of evidence of a structural, genetic or biochemical basis capable of demonstration using available technology. It should not imply that the patient harbours a definable psychological illness, nor that symptoms are faked.

  Stone and Carson say ‘the word “organic” and its evil twin “non-organic”… deserve their place in the hall of neuromythology.’ Like the term angina (Greek ankhone "a strangling") they are simply metaphors. Many physicians still find these terms useful and practical for purposes of communication, and because when correctly applied they may influence the extent of investigation and treatment.

  Not for room 101 in my humble opinion.

  References
  1 Jon Stone, Alan Carson. ‘Organic’ and ‘non-organic’: a tale of two turnips
  http://dx.doi.org/10.1136/practneurol-2017-001660

  2 Arnone D , McIntosh AM , Ebmeier KP , et al . Magnetic resonance imaging studies in unipolar depression: systematic review and meta-regression analyses. Eur Neuropsychopharmacol 2012;22:1–16.doi:10.1016/j.euroneuro.2011.05.003

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  Conflict of Interest:
  None declared.

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