Functional disorder

“ It is true a large proportion of them do have organic disorders in connection with their neuroses. We find that most of them do have functional disorders originating purely in their mind, or because of some constitutional nervous defect and that the real fundamental condition from which they are suffering is not an organic condition but is nervous or mental and must be approached along lines of psycho-therapy. ”

“ Undoubtedly they have been, and are continually, efficient in relieving, and even curing, many functional disorders which have resisted ordinary medical treatment—and it must be remembered that many functional derangements are as serious, subjectively, as grave organic disease—and consequently it is undeniable that Christian Science often does good. ”

“ Its causes lie in conditions, usually obscure, which lower the tone of the general health, including hereditary weaknesses, or depress the vitality of the brain either by physical wear or mental worry, and the exhausting influence of functional disorders or of organic diseases which may not be discovered before the autopsy. Disappointment, bad habits, want of proper mental occupation are often at fault. ”

“ Lastly, the cases in which the sufferings of the patient are due chiefly to a morbid action of his or her imagination, are a small percentage of the total of the ills which come before us for relief. But, even of this small percentage, only a very few are in perfect or even reasonably good physical health. A large majority of even these neurasthenics, psychasthenics, imaginary invalids, and bodily or mental neurotics, have some physical disturbance, organic or functional, which is the chief cause of their troubles. ”

“ Instead of assuming that some hereditary disposition, or a toxaemia, gives rise directly to organic processes of disease, I incline to the view that upon the basis of predisposition, whose nature is at present unknown to us, there arises a non-adaptable psychological function which can proceed to develop into manifest mental disorder; this may secondarily determine organic degeneration with its own train of symptoms. ”

“ When these physical diseases put the physical counterparts of sense-organs into disorder, it confuses the mind when it finds that its channels of outward communication, the senses, can no longer work through them. ”

“ We of a later day who deal with this disease on the whole are inclined to the belief that some internal factor of a physical kind is responsible, some neuronic shift, or some strange, visceral endocrinal disorder. ”

“ For these troubles are just those which most often puzzle the physician, leading him to change his diagnosis and the patient to change his doctor very frequently. Again, it is just these functional nervous disorders which, affecting as they do every part of the body and every organ, give rise to the false idea of “many diseases”—an idea based on the patient’s multitudinous sufferings.
Organic disease often runs its course accompanied by very little suffering, or with a very definite localization of the malady in one part of the body. ”

“ And if we ascend to the nervous system, we find how many so-called functional diseases seem to keep themselves going simply because they happen to have once begun; and how the forcible cutting short by medicine of a few attacks is often sufficient to enable the physiological forces to get possession of the field again, and to bring the organs back to functions of health. ”

“ We meet with the preponderance of nervous diseases in the refined and cultivated classes, where, by premature and stimulating processes of education, there has been forced an elaboration of brain-structure, hastening the functional activity of the brain, with no due regard to the law of evolutional precedence. Normal growth and development will give us healthy minds, while a structurally degraded centric nervous system, or an altered quality of blood, and secondary disturbance of nerve-function, will antagonize healthy mental manifestation. ”

“ The reaction from this doctrine, beginning in that higher respect for matter which modern science inculcates, professes to base itself upon the results of physiology and pathology, and propounds the view that mental disorder is in all cases simply a bodily or brain disease. ”

“ He dwells upon the remarkable power exerted by the mind "upon any organ or tissue to which the attention is directed, to the exclusion of other ideas, the mind gradually passing into a state in which, at the desire of the operator, portions of the nervous system can be exalted in a remarkable degree, and others proportionately depressed; and thus the vascularity, innervation and function of an organ or tissue can be regulated and modified according to the locality and nature of the disorder. ”

“ Of course, in real life, things are seldom as clear-cut as they are in books, and so it happens that often there is a combination of organic and functional disease that is puzzling even to a skilled diagnostician. The first essential is a diagnosis as to whether it be an organic disease, with accompanying nervous symptoms, or a functional disturbance complicated by some minor organic trouble. If the main cause is organic, only physical means can cure it, but if the trouble is functional, no amount of medicine or surgery, diet or rest, will touch it ”

“ But it is none the less true that always some disorder results from excess or defect, that it influences every function, bodily and mental, and that it constitutes a lowering of the life for the time being. ”

“ Disease may be caused by physical or by psychic forces. A "nervous" disorder is not a physical but a psychic disease. It is caused not by lack of energy but by misdirected energy; not by overwork or nerve-depletion, but by misconception, emotional conflict, repressed instincts, and buried memories. Seventy-five per cent. of all cases of ill-health are due to psychic causes, to disjointed thinking rather than to a disjointed spine. ”

“ The so-called functional diseases have a close relation with diseases of the nervous system, for they chiefly concern the reactions of nerve tissue. Disease expressing itself in disturbance of function only, does not seem to fit in with the conceptions of disease which have been expressed, nor can we imagine a disturbance of function which does not depend upon a change of material. Living matter does not differ intrinsically from any other sort of matter ”

“ When local action has been long continued, however, the highly morbid condition of a limited portion of tissue may in time find sympathy in adjoining parts, and so by degrees the whole system become involved in a chronic disorder. ”

“ The voluntary muscles indicate their participation in this energy, and, indeed, the whole organism is exalted by the influence of the mental faculties. They oppose the tendencies of Feebleness, Relaxation, and Derangement, and modify their proclivities to Disease. The will is the servant of the intellect, emotions, and propensities, and the executive agent of all the faculties. When the volitive faculties are in excess, they may overdo the other functions, prematurely break down the bodily organs, and, by overtaxing the system, subject it to pain and disorder. ”

“ At the same time we must admit the possibility of mixed forms, where the functional element is linked with primary or secondary organic disease, and perhaps their occurrence is more general than is ordinarily imagined. We repeat, however, that rigorous and lengthy investigation alike of the psychical and the somatic phases of the condition, embracing the state of the reflexes, will usually furnish sufficient information to facilitate the question of diagnosis and justify a positive statement. ”

“ It should not be thought, however, that the symptoms of functional and organic troubles are identical. Hysteria and neurasthenia closely simulate every imaginable physical disease, but they do not exactly parallel any one of them. It may take a skilled eye to discover the differences, but differences there are. Functional troubles usually show a near-picture of organic disease, with just enough contradictory or inconsistent features to furnish a clue as to their real nature. ”

“ To sum up: in round figures a quarter of our insane patients show more or less clearly extensive changes and destruction of the brain, while three-fourths have a brain which seems to be generally unimpaired or at most exhibit such changes as give no explanation of the psychological disturbance.
These figures offer the best possible proof that the purely morphological view-point of modern psychiatry leads only very indirectly, if at all, to the understanding of the mental disorder, which is our aim. ”

“ It cannot happen that it shall ever be extensively inflamed without a coincident exhibition of the greatest disorder in the functions of the nervous organs directly implicated in its structure, or possessing with it physiological relations that could not be safely disturbed. ”

“ To one case where positive illness is traceable to over-application, there are probably at least half-a-dozen cases where the evil is unobtrusive and slowly accumulating—cases where there is frequent derangement of the functions, attributed to this or that special cause, or to constitutional delicacy; cases where there is retardation and premature arrest of bodily growth; cases where a latent tendency to consumption is brought out and established; cases where a predisposition is given to that now common cerebral disorder brought on by the labour of adult life. ”

“ To draw an example from the more serious disorders, let us consider the hypochondriac, who harbors the insistent thought that he must be always perfectly well, that each of his sensations must conform to his ideal, and that each function must follow regulations imposed by himself. If he can learn to ignore this thought by realizing that an acute illness is preferable to life-long mental captivity; if he can learn to do what others do, and to concentrate his energies on outside affairs which shall displace the question of health ”

“ If the brain and nervous system are overworked, vitality is lowered, the resisting power of the body is diminished, disease is easily produced. If the brain and nervous system are underworked, the generation of nervous power is low and deficient, the vitality of the tissues becomes low in proportion, and disease is easily excited. ”

“ If, on the contrary, the new theory be true—the one to which the anatomical arrangement and the physiological experiments point—that each part of the brain has its own work to do, a limited area of disease will interfere with the work of the part diseased—will produce a loss or impairment of one function, and will not affect all the powers. ”

“ In such cases, the deficiency is either in the sensitive and conducting power of the nerves, or in some a loss of tone in the portion of the brain to which they immediately lead—at all events, a barrier is interposed between organic structure and the mind. ”

“ In the latter belong our doubts and fears and worries, as well as the other more easily controlled factors in the causation of these purely functional nervous disorders. But even in the case of heredity, it is more the unstable nervous equilibrium that is transmitted than the specific form in which it is manifested in any individual case; and this unstable equilibrium is capable, in no small degree, of being influenced by reeducation along the lines of which we have been speaking. ”

“ I believe that the patient has to accept his disorder as a given and work AROUND it rather than confront it directly. I believe that our disorders ARE adaptive and help us to function. Their removal may not always be wise or necessary to attain a full and satisfactory life. ”

“ Mental disease in its basis and causation is bodily disease, and the multitudinous forms of mental weakness, degeneracy, and aberration are to be studied as effects of corporeal infirmity or disease of the nerve-structure. The light thrown upon the science of mind through the manifestations of mental failure has been of great importance, and physiological investigation has now brought us to another and very significant aspect of the subject. ”

“ THE relation between physical and psychical states is so intimate, and the effects of the latter so nearly simulate disease, that physicians are often led into grave errors in diagnosis and treatment. Nor is this the worst mischief; the secondary stage of psychical excitement may be actual disease, for the nerve-force expended is so much withdrawn from the processes of nutrition and assimilation, and continued morbid action of any of the functions has a tendency to establish organic change. ”

“ As physiologists we have to deal with volition as a function of the supreme centres, following reflection, varying in quantity and quality as its cause varies, strengthened by education and exercise, enfeebled by disuse, decaying with decay of structure.... We have to deal with will not as a single undecomposable faculty unaffected by bodily conditions, but as a result of organic changes in the supreme centres, affected as certainly and as seriously by disorders of them as our motor faculties are by disorders of their centres. ”

“ All the elements in the disease point to the influence of the mind over it. The predisposition is caused by over-use of the mind at a time when many claims are being made on the nervous system because of the growth of muscles. There must, as a rule, be a pathological basis, natural or acquired, that is, something that tends to produce a defect in the circulation, but even without this certain children suffer from the affection. If the patient is an object of solicitude or of curiosity at home or at school, the symptoms rapidly become worse. ”

“ It is a law of the human system that the various organs become strong and maintain a high standard of health, only while under a considerable degree of activity, and this is especially true of the muscular and nervous systems. Inactivity and disuse tend toward degeneration, therefore, such circumstances and surroundings of life as will conduce to harmonious activity of these organs and parts, would, ceteris paribus, be most favorable to health. ”