Abstract：
The functional-organic distinction attempts to differentiate disorders with diagnosable biological causes from those without and is a central axis on which diagnoses, medical specialities and services are organised. Previous studies report poor agreement between clinicians regarding the meanings of the terms and the conditions to which they apply, as well as noting value-laden implications of relevant diagnoses. Consequently, we aimed to understand how clinicians working in psychiatry and neurology services navigate the functional-organic distinction in their work. Twenty clinicians (10 physicians, 10 psychologists) working in psychiatry and neurology services participated in semistructured interviews that were analysed applying a constructivist grounded theory approach. The distinction was described as often incongruent with how clinicians conceptualise patients\' problems. Organic factors were considered to be objective, unambiguously identifiable and clearly causative, whereas functional causes were invisible and to be hypothesised through thinking and conversation. Contextual factors-including cultural assumptions, service demands, patient needs and colleagues\' views-were key in how the distinction was deployed in practice. The distinction was considered theoretically unsatisfactory, eventually to be superseded, but clinical decision making required it to be used strategically. These uses included helping communicate medical problems, navigating services, hiding meaning by making psychological explanations more palatable, tackling stigma, giving hope, and giving access to illness identity. Clinicians cited moral issues at both individual and societal levels as integral to the conceptual basis and deployment of the functional-organic distinction and described actively navigating these as part of their work. There was a considerable distance between the status of the functional-organic distinction as a sound theoretical concept generalisable across conditions and its role as a gatekeeping tool within the structures of healthcare. Ambiguity and contradictions were considered as both obstacles and benefits when deployed in practice and strategic considerations were important in deciding which to lean on.
摘要：
功能-有机区别试图将具有可诊断生物学原因的疾病与没有诊断的疾病区分开来，并且是诊断的中心轴，组织医疗专业和服务。以前的研究报告说，临床医生之间关于术语的含义和它们适用的条件的一致性很差，以及注意到相关诊断的高价值含义。因此,我们的目的是了解在精神病学和神经病学服务部门工作的临床医生如何在他们的工作中驾驭功能-有机的区别.20名临床医生(10名医生，10名心理学家）在精神病学和神经病学服务中工作，参加了半结构化访谈，并采用建构主义的基础理论方法进行了分析。这种区别通常被描述为与临床医生如何概念化患者问题不一致。有机因素被认为是客观的，明确可识别和明确的因果关系，而功能性原因是看不见的，可以通过思考和对话来假设。语境因素-包括文化假设，服务需求,患者的需求和同事的观点是如何在实践中进行区分的关键。这种区别在理论上被认为是不令人满意的，最终被取代，但是临床决策需要战略性地使用它。这些用途包括帮助沟通医疗问题，导航服务，通过使心理学解释更可口来隐藏意义，解决耻辱，给予希望，并提供疾病身份。临床医生将个人和社会层面的道德问题作为功能有机区别的概念基础和部署的组成部分，并将积极引导这些问题作为其工作的一部分。功能有机区别作为可在不同条件下推广的合理理论概念的地位与其在医疗保健结构中作为把关工具的作用之间存在相当大的距离。在实际部署时，歧义和矛盾被认为是障碍和好处，战略考虑在决定依靠哪个方面很重要。
