The Persistence of the “Organic” Problem

To the Editor: As a resident in neurology, and according to the syllabus approved by the Spanish Ministry of Health, I had to complete a 2-month rotation in psychiatry, which is a compulsory component of our residency program. The first day of this rotation I was assigned to the psychiatric inpatient ward. Every Monday, Wednesday, and Friday, the medical team (physicians, nurses, psychologists, and social workers) met and discussed the diagnosis, treatment, evolution, and prognosis of every patient. In one of my first meetings, the wide use of the term “organic” to refer to any disease with a nonpsychiatric origin surprised me. Suffering from gastroenteritis, a urinary tract infection, or a meningioma denoted suffering from an “organic” disease while being diagnosed with depression, anorexia nervosa, or conversion disorder meant having a “nonorganic” or psychiatric condition; this term also allowed the treatment team to clearly separate their responsibilities from those of nonpsychiatric medical professionals.

I then found the term “organic” most disconcerting, especially when recent advances show that most (if not all) psychiatric conditions have underlying alterations demonstrable by molecular biology or molecular imaging techniques. In this case, the meaning of the term “organic” is unclear and denotes an obsolete functional-structural, psychological-biological, and mind-body dualism.¹

In 1994, following the claims of several groups of psychiatrists, the DSM committee of APA eliminated the term “organic” because it implied that “nonorganic” (or psychiatric) mental disorders do not have a biological basis.² The term “organic” was then dropped from DSM-IV in order to emphasize and recognize the neurobiological underpinnings of psychiatric disorders.

This problem seems to be solved, but the term “organic” has enjoyed a wide diffusion, and, despite its elimination from DSM, European psychiatrists still use it daily in a familiar way. The other reason why this term persists may be because the World Health Organization International Classification of Diseases (ICD-10) still includes it in a block titled “Organic, including symptomatic, mental disorders” (F00-F09).³ This block comprises a range of mental disorders grouped together based on a demonstrable etiology in cerebral disease leading to cerebral dysfunction. ICD-10 is the most widely used classification for psychiatric disorders by European and Australian psychiatrists. WHO is revising the classification of mental disorders as a part of the overall revision of ICD-10 and the development of ICD-11 (scheduled for 2015), and an International Advisory Group has been established to guide this process.⁴

In this context, I believe that most European and Australian physicians and researchers would appreciate an effort to consider a conceptual and terminological reorganization of ICD, according to the current knowledge of psychiatric conditions, and fully eliminate the confusing and obtrusive term “organic”.⁵