The function of 'functional': a mixed methods investigation.

Area of Science:

• Neurology
• Medical Semantics

Background:

• The term 'functional' has evolved, historically representing physiological concepts but now often implying 'hysterical'.
• The DSM-V proposes 'functional' for medically unexplained neurological symptoms, previously termed 'conversion disorder'.

Purpose of the Study:

• To explore the current meanings of 'functional' within neurology.
• To understand the resilience and varied interpretations of the term 'functional'.

Main Methods:

• Mixed-methods approach combining interviews with neurologists in a UK region.
• Nationwide survey of UK neurologists regarding their use of the term 'functional'.

Main Results:

• Interviews identified four primary uses: 'not organic', physical disability, brain disorder, and psychiatric problem, alongside significant ambiguity.
• While many neurologists expressed dissatisfaction, the ambiguity was perceived as beneficial in patient interactions.
• A UK-wide survey confirmed these findings, with most neurologists interpreting 'functional' strictly as 'not organic', while a minority used it flexibly and anticipated its future as a neurological construct.

Conclusions:

• The varied meanings of 'functional' reflect divisions in how neurologists conceptualize unexplained symptoms.
• The term's diverse interpretations allow it to serve as a common language, potentially masking conflicts between patient and neurologist perspectives.
• This semantic flexibility likely contributes to the enduring use of 'functional' in neurology.