05/11/2021
Why We Still Use “Organic Causes”: Results From a Survey of Psychiatrists and Residents.
The diagnostic category of “organic disorders” was officially removed from the psychiatric nosology in DSM-IV, published in 1994. Despite this change, physicians continue to use the term “organic causes” to refer to medical and neurological causes of psychiatric symptoms, and it remains part of the ICD-10 classification. In the context of increasing integration of psychiatric disorders within a medical and neuroscientific framework, the reasons behind the ongoing use of this term (reminiscent of mind-body dualism) have to be clarified. The authors conducted a survey of 391 Canadian psychiatrists and psychiatric residents to understand attitudes and beliefs related to this terminology and then applied qualitative and quantitative analyses. Results showed that the terminology is used by the majority (55.9%) of psychiatrists and residents for two main reasons: out of a habit that begins in residency training and because of the belief that other specialties do not fully understand alternative terminology. The authors found that some psychiatrists are concerned that their patients will not receive adequate investigation unless it is made clear through the use of the “organic cause” term that other medical causes of psychiatric symptoms are suspected. The use of the “organic cause” term was predicted by being of younger age, performing emergency department calls, and finding alternative terminology difficult to use. These findings highlight the importance of reflecting on and discussing the effect of this terminology used in psychiatry.
When the first DSM was published in 1952, mental disorders were divided into two major groups: “disorders caused by or associated with impairment of brain tissue function,” and “disorders of the psychogenic origin or without clearly defined physical cause or structural change in the brain.” The first category, referred to as “organic syndromes,” included symptoms caused by infection, intoxication, or trauma; the second category included depression, personality disorders, and schizophrenia. As reviewed by Bürgy,1 these categorizations were in turn based on a tradition dating back to the work of Möbius, who made a distinction between “endogenous” and “exogenous” psychoses in 1892. This distinction was maintained by authors such as Kraepelin, Jaspers, and Bonhoeffer and then crystallized by “Burke's equation of exogenous and somatogenic.”