From: sasghm@theseus.unx.sas.com (Gary Merrill)
Subject: Re: Peter Breggin, _Toxic Psychiatry_ (Q)
Originator: sasghm@theseus.unx.sas.com
Date: Wed, 16 Dec 1992 18:09:53 GMT
Organization: SAS Institute Inc.


In article <2285@hsdndev.UUCP>, rind@binoc.bih.harvard.edu (David Rind) writes:

|> Ok, let's try once more.  Strep (like the kind that causes strep
|> throats) can cause scarlet fever.  It also can cause another
|> serious illness that produces a rash, streptococcal toxic shock
|> syndrome (a much rarer illness).  In both cases the throat
|> culture will show Group A beta-hemolytic Streptococcus pyogenes if
|> the source of the strep is from a strep throat.
|> 
|> The throat culture does *not* make the distinction.  Neither does
|> any other routinely performed laboratory test.  The diagnostic
|> distinction is a clinical one.

Yes, and you have put your finger precisely on the fundamental issue.
It *doesn't matter* in such a case precisely what the disease is.
There *is* a disease, and what is *important* is identifying the
*cause* since it is *this* that determines treatment.  You have
given an excellent example of a common cause to two distinct diseases.

Again, what is the *analog* for schizophrenia?  I still have no
answer to this.  The success of the disease model depends upon this.
And upon the disease model rests much of contemporary psychiatry.

|> >I understand perfectly why they are being held against their
|> >will.  It does not follow that the mechanism by which they initially
|> >are incarcerated nor the mechanism that allows for their continued
|> >incarceration is justified.
|> 
|> I don't think you do understand, and I am not debating the morality
|> of committing such patients.  You don't recognize that schizophrenia
|> is a "real" disease.  This is so obviously incorrect, that I suspect
|> that if you would actually take the time to meet some severe
|> schizophrenics you would recognize the error (I like to believe
|> that people aren't invincibly ignorant).  I realize that this
|> may not alter your view on the morality of "incarcerating" such
|> patients, but it would at least cause you to argue from a
|> position of knowledge rather than one of ignorance.

You are correct that the moral question is distinct from the issue
as to whether there is a disease here.  But they are intimately
related since the incarceration (as well as various legal issues
alluded to in other postings) are *justified* by appealing to the
disease model.  However, I would prefer to avoid debating the
moral question in this venue since it requires that one quickly
get down to fundamental issues in political and legal philosophy.

You are also correct that I do not recognize that schizophrenia
is a real disease.  This is *not* "obviously incorrect" since
in fact there is some long-standing dispute in the literature.
It *may* be incorrect, but I have seen no convincing evidence.
And observing an alleged schizophrenic patient (I have met
people with this diagnosis) will not help.  People used to get
"the vapors", but there was no corresponding disease.  Certain
diseases (distinct ones) may have afflicted *some* people so
diagnosed.  Others may have been subject to some environmental
problems.  Etc.  I wish I had a better example from the history
of medicine, but I don't at the moment have access to the
appropriate texts.  I think you get the point.

Frequently, if one denies the cogency of something like schizophrenia
one is taken to deny a number of other things:  that certain people
exhibit odd (and oddly similar) behavior, that certain identifiable
physical conditions (abnormal brain formation, for example) are
causally related to odd behavior, that administering certain drugs
alters the behavior and feelings of such people.  But I deny none
of these.  I deny only the cogency of the idea that there is a
single identifiable disease under which all of this can be subsumed.
Characterizing schizophrenia as a disease is not done by *subsuming*
it under the existing disease model, but rather by *extending* that
model intentionally to encompass a new domain.  We are free to do
this, but it results in changing what "disease" means and we must
beware of being misled by a model that doesn't fit very well.
There are several examples in the history of science where it is
plain that clinging to such an incorrect model misdirected research
and resulted in delaying advances.  And this is quite independent
of any moral issues that may be involved.

It is clear that you consider schizophrenia to be a disease.  I
wonder how you feel about such things as depression and attention
deficit disorder.  Are these diseases as well?

By the way, I don't mind your considering me ignorant.  And I do
appreciate the tone and overall reasonableness of your remarks.
-- 
Gary H. Merrill  [Principal Systems Developer, C Compiler Development]
SAS Institute Inc. / SAS Campus Dr. / Cary, NC  27513 / (919) 677-8000
sasghm@theseus.unx.sas.com ... !mcnc!sas!sasghm