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Sociosomatics Gives Insights Into Functional Disorders

Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC 27599-7160

The special series on the sociosomatic understanding of illnesses in Psychosomatic Medicine (July-August, 1998) casts new light on the shadowed domain of functional disorder. Taken together with systems theory and the long-established openness of psychosomatic theory and practice, perhaps the following new definition may be offered:

Functional disorder: an illness for which the clinician has not found an explanation using his/her own frame of reference.

The Western medical diagnostic system is an oddly crafted net that catches many sign and symptom complexes and gives them a name, thus making them "real diseases." Other sign/symptom patterns slip through the net without a label. This creates some embarrassment in clinicians causing them to label the illness as "functional" or "psychosomatic," and to assign a demeaning label to the nonconforming patient. Consider how many of the culture-specific syndromes, named and "understood" in the international reports in the "Special Issue," would have been called hypochondriacal or "merely functional" by typical American or European clinicians?

Each new medical era is ushered in by the crafting of a new nomological net, which either patches an incomplete sector of the old net or expands the net outward. The netting is constructed with the help of new technologies for diagnosis and treatment; such as microbiology, lipid chemistry, brain imaging, or chemotherapy. The substance of the netting is new diagnostic labels for conditions, and ultimately, the most sacred emblem, a number complete with decimals in the Diagnostic and Statistical Manual.

Thus it has been through history. The functional disorders of history, like apoplexy, depression, or many others are now caught in modern anatomical and neurochemical nets. And that will no doubt continue to happen as long as there are future times from which we can look back.

With this thinking, we should not shun the patient for having a disease we cannot treat. Nor should we criticize ourselves for a lack of knowledge. We should blame ourselves only for not knowing that we do not know.

Biomedical, psychosocial, psychosomatic, and sociosomatic networks of knowledge will be made finer, extended further, and soon supplemented by some other way of thinking, so sufficiently beyond us that we do not even know its name. But for now, we can advance both research and the healing arts by acknowledging openly that today’s functional disorders are simply the ones we do not as yet understand.

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