From: jgnassi@athena.mit.edu (John Angelo Gnassi)
Subject: Re: Peter Breggin, _Toxic Psychiatry_ (Q)
Organization: Massachusetts General Hospital - Lab of Computer Science
Date: Wed, 16 Dec 1992 15:05:09 GMT

In article <BzB93G.JtL@unx.sas.com> sasghm@theseus.unx.sas.com (Gary Merrill) writes:
>
>In article <1992Dec15.155632.21024@athena.mit.edu>, jgnassi@hstbme.mit.edu (John Angelo Gnassi) writes:
>|> >to imply a certain degree of coercion.)  If you will assure me that I
>|> >can terminate my psychiatric treatment under the same conditions and
>|> >with the same freedoms that I can terminate my cancer treatment,
>|> >I withdraw any complaint.
>|> 
>|> Time to start withdrawing.
>
>Not quite yet.  The operative phrase was "under the same conditions and
>with the same freedoms".  Another (apparently knowledgeable) poster
>has already denied this.

I gave some criteria for these, showing that under the same conditions
a patient can and should be held against their will in a hospital, despite
whether the underlying cause is "medical" or "psychiatric".  That is
"same conditions" and "same freedoms".

>|> If a patient with a psychiatric disorder is lucid, evidences
>|> understanding of the situation, is not in immediate danger of harming
>|> self or others, they can walk out AMA - Against Medical Advice.
>
>"Evidences ..." to *whom*?  Who decides?  In the case of my cancer,
>*I* decide.  Does a jury of my peers decide?  Or does some psychiatrist
>or group of psychiatrists decide?  There are important distinctions
>here.

Oh, so you think a patient with unclear thinking, poor understanding,
and in danger of harming self or others should decide?  "Or does
some psychiatrist or group of psychiatrists decide?"  Clearly, I choose
the latter.  For severe disease, as someone else pointed out, you
don't need psychiatrists because you can identify these people
a block away.  Go downtown in any large US city and look.

>Oh, but it is *very* relevant.  A major motivation for the disease
>model of mental illness is to attain for the diagnosis and treatment
>of mental illness the respect accorded to the diagnosis and treatment
>of disease by the medical community.  If you want these (well earned)
>trappings of respect, you need to do better than simply *calling*
>something a disease.

Oh, there's no systematic way of describing psychiatric disease,
or evaluating treatment?  If you believe that, then I don't think
it's possible to convince you of the efficacy of psychiatric therapy.

>The question, of course, is whether underlying the set of symptoms there
>*is* a disease.

This is a definitional question which could be applied to any set
of symptoms.  I don't care whether you call schizophrenia a disease
or a syndrome; it clearly results in suffering for the patient and
society.  From a more philosophical perspective, diseases are very
culture-dependent; I don't propose a new system of context-independent
disease modelling.

--
     John Angelo Gnassi                 Lab of Computer Science
   jgnassi@hstbme.mit.edu               Massachusetts General Hospital
     "Eternal Student"                  Boston, Massachusetts, USA
     "The Earth be spanned, connected by a Network" - Walt Whitman