From: geb@cs.pitt.edu (Gordon Banks)
Newsgroups: sci.med
Subject: Re: Peter Breggin, _Toxic Psychiatry_ (Q)
Date: 24 Dec 92 15:31:38 GMT
Reply-To: geb@cs.pitt.edu (Gordon Banks)
Organization: Univ. of Pittsburgh Computer Science

In article <Bz9Kr3.H04@unx.sas.com> sasghm@theseus.unx.sas.com (Gary Merrill) writes:
>
>It is possible to make a mistake in initial diagnosis for something
>like scarlet fever based on the gross symptoms.  But subsequent tests
>yield the appropriate diagnosis.  Are you saying that the same is
>true for schizophrenia?  What is the analog of the blood test and
>the identification of the micro-organism?
>
There are many diseases for which there is no pathognomonic laboratory
test.  Even an autopsy can't always settle it.  There is nothing
magical about schizophrenia or other mental illness that differentiates
it from many other diseases of the brain or other parts of the body.
There are many diseases of the brain such as generalized dystonia,
narcolepsy, and others which have very clear and stereotypical
characteristics, can be proven to be hereditary, respond to the
medications, and yet on autopsy have normal structure of their
brains.  We know there is a neurochemical problem, but our technology
can not yet detect the cellular abnormalities in life and after
death and there is no animal model.  Study more about medicine
and you will realize that it is not nearly so simple as some
litmus paper test for diagnosing diseases, as the layman often
has the impression.

>If I decide to terminate my chemotherapy for cancer, I can simply
>do so and walk away from the hospital (suffering whatever consequences
>there may be).  If I am committed to a state psychiatric institute,
>am I free to leave when I decide (for whatever reason) to terminate
>my treatment?  (Notice that the very concept of "committed" seems
>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.

I recall treating a fellow who had been struck by a car and had
a subdural hematoma.  He regained consciousness on the gurney,
announced he was leaving, got up and started to walk out, trailing
his foley catheter and IV behind him, stark naked.  Did we let
him leave?  You'd better believe we didn't.  Schizophrenia and
psychiatric disorders are not the only ones for which we do not
allow the patient to make their own decisions.  There are many
patients that receive medical care against their wishes because
of acute or chronic conditions of the brain, ranging from high
fever, toxicity from a drug, head injury, etc., etc.  The dichomotmy
you imagine does not exist.  The question is whether the patient
is competent or not.  If not, the patient will not be allowed
to make their medical decisions without some questioning.  Incompetence
alone is not sufficient to override.  If, for example, you were
a patient terminally ill and you told me that you did not wish
to go onto artificial ventilation or be resuscitated when you
had cardiac arrest, and then you subsequently went into a coma
and your relatives told me to put you on the machine, they'd need
a court order to do so.  Ethical doctors will respect a patient's
autonomous wishes, provided they feel that the patient is capable
of expressing their autonomous wishes.  Similarly, a schizophrenic
should not be forced to undergo life sustaining treatments for
a terminal illness such as cancer if they don't want them.  Of
course, these areas can get into thorny dilemmas.  

-- 
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Gordon Banks  N3JXP      | "I have given you an argument; I am not obliged
geb@cadre.dsl.pitt.edu   |  to supply you with an understanding." -S.Johnson
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Newsgroups: sci.med