Keep calm: Psychiatric disorders are organic! The power of words in medicine

To the Editor

For a long time, psychiatric disorders were defined by the absence of an ‘organic’ lesion (Insel and Quirion, 2005). One vestige of this definition is the extremely frequent opposition of ‘organic’ or ‘somatic’ (‘soma’ means body in Greek) with ‘psychiatric’ disorders, not only in the international scientific literature but also in clinical practice as well as in medical teaching (for daily examples of this distinction, see Table 1). Such a dualism maintains an outdated distinction that contributes to confusion by distinguishing between ‘real organic disorders’, based on a failing body or ‘soma’, and psychiatric disorders that, by extension, would be disorders of the soul or mind.

Table 1.

Examples of the daily use of the organic/psychiatric opposition.

International scientific literature	‘Patients were excluded if they had an organic disorder’.
Clinical practice	From the psychiatrist: ‘We will accept the patient in our unit if he doesn’t present any organic disorder’.
	From the non psychiatrist: ‘Can you admit this patient into your unit? He doesn’t present with any organic disorder’.
Medical teaching	‘Always exclude organic causes of psychiatric symptoms’.

Interestingly, in recent years, high-quality research has highlighted that the brain (an organ!), whether in its cognitive, perceptual, motivational or social functions, is involved across a range of psychiatric disorders. A highly evocative example is the work showing the neural basis of hallucinations, a classical psychiatric symptom. Functional magnetic resonance imaging (fMRI), at an individual level, shows that hallucinations of schizophrenia patients are associated with sensory cortex hyperactivation that corresponds to their symptoms (Jardri et al., 2013). Anatomically, even in the absence of no obvious macroscopic changes, structural MRI data, using machine learning methods, can differentiate psychiatric disorders (Schnack et al., 2014). Furthermore, a plethora of strong evidence has highlighted the role of susceptibility genes across a range of psychiatric disorders.

Within the perspective that such data provide, all medical disorders, including psychiatric, are organic or somatic and thus medical language must be updated, across international literature, medical teaching and clinical practice. Consequently, we propose that, when possible, the known specific etiologies should be listed, such as metabolic, cardiovascular, traumatic or infectious causes, rather than the collective term organic. If a dichotomy is to be maintained, the terms ‘psychiatric disorder’ and ‘non-psychiatric disorder’ would be preferable.

Psychiatric disorders are as organic as any other medical conditions and should be considered as such. The use of an organic/psychiatric dichotomy suggests that psychiatric disorders are not biologically ‘real’, with consequences that contribute to the maintenance of the stigmatization and discrimination faced by people living with psychiatric conditions. Given the power of words in medicine and the evidence of current research, the maintenance of such a dichotomy is no longer intellectually tolerable nor clinically useful for patients and their families.