I have to be careful with this diagnosis of nonorganicity as physicians have a track record in the past of calling something they did not understand a psychogenic disorder. As new medical understanding comes along, an organic disorder may be discovered that accounts for the patient’s unusual problem. For example, prior to the 1980s, patients with vocal spasms interrupting their voice were sent to psychiatrists. Interestingly, most or all failed to improve with psychiatric treatment. With the advent of an induced nerve paralysis by Herbert Dedo, MD in one individual, patients with this condition, later called spasmodic dysphonia (see “Laryngeal dystonia”), found an effective treatment for their neurologic condition.
As new medical understanding comes along, an organic disorder may be discovered that accounts for the patient’s unusual problem. Nonorganicity should be a diagnosis of careful inclusion — not a label applied to patients who are difficult or confusing.
What You Learned
- Physicians have historically labeled poorly understood conditions as psychogenic — a label that can delay correct diagnosis for years or decades.
- Spasmodic dysphonia was once sent to psychiatrists; it was later revealed to have a neurologic basis (laryngeal dystonia) and found an effective treatment.
- Nonorganicity must be a diagnosis of careful inclusion, not a dismissal applied to patients who are puzzling or difficult.
- As medical knowledge advances, organic explanations continue to emerge for conditions previously attributed to psychology. Intellectual humility is essential.