Functional disorders, Cartesian dualism and stigma: where does the dualism really lie?
- Correspondence to Professor Anthony S David, Professor of Cognitive Neuropsychiatry, PO Box 68, Institute of Psychiatry, King's College London, London SE5 8AF, UK;
- Accepted 25 April 2012
This is a timely reappraisal of one of Oliver Sacks' less well-known works. The authors argue that the sense of detachment from his leg that Sacks felt after his injury and surgery was ‘functional/psychogenic’.1 ,2 Stone and colleagues take Sacks' account at face value and are at pains to label it repeatedly as ‘genuine’. Their aim is to go beyond Cartesian dualism, a common aspiration but one hard to achieve in practice, such is the hold it has on our explanatory frameworks. Stone et al approach the ‘case’ like the good clinicians that they are and attempt to ‘get above the lesion’. There is no mind–brain divide but there is a hierarchy: from the peripheral nerves up through the neuraxis to the cortex. But that is as far as it goes: in the materialist world, there is nothing else. A disorder of will seems the best formulation and is made without implied criticism or facetiousness.
The review is used didactically to provide us …