Organic mental illnesses are outlawed: farewell to Karl Bonhoeffer

Abstract

The article analyzes the reasons for the deletion of the section “Organic mental disorders” from the psychiatric classifications (ICD-11, DSM-5) and its replacement by the sections “Neurocognitive disorders” and “Secondary mental and behavioral disorders associated with disorders and diseases classified in other chapters”. It is argued that at the present stage of development of psychiatry it has become clear that not only organic mental disorders are associated with impaired brain function, but also all others, e.g. the disorders of the schizophrenic spectrum. This leads to the conclusion that the term “organic” has become an anachronism and no longer reflects the essence of psychogenesis. As a result, changes in terminology in modern psychiatric classifications should be recognized as justified. However, the term “organic disorders” did not have a stigmatizing character, unlike, for example, “psychopathy”, “oligophrenia”, “hysteria” or “manic-depressive psychosis”. It undoubtedly had an indeterminate character, as it interpreted pathological changes in the brain broadly and was opposed to the concept of “functional disorders”. At the current stage of development of psychoneurology, organic causes are often found behind the functional. Exclusion of the term “organic” from the psychiatric lexicon, rejection of the Bonhoeffer approach, the Walter-Buell triad and the psychoorganic syndrome can be considered superfluous, since the introduction of the concept of “secondary mental disorders” in their place does not alter the process of understanding the nature of psychogenesis. It is concluded that the division of mental disorders into so-called primary and secondary disorders is no better than the opposition of functional and organic disorders, and that the “outdated” approach can be used in the training of young psychiatrists, emphasizing that the term “organic” can also be extended to mental disorders that used to be called endogenous.