From: sasghm@theseus.unx.sas.com (Gary Merrill)
Subject: Re: Peter Breggin, _Toxic Psychiatry_ (Q)
Originator: sasghm@theseus.unx.sas.com
Date: Tue, 15 Dec 1992 19:52:44 GMT
Organization: SAS Institute Inc.


In article <2279@hsdndev.UUCP>, rind@binoc.bih.harvard.edu (David Rind) writes:
|> In article <BzB0IB.89F@unx.sas.com> sasghm@theseus.unx.sas.com
|>  (Gary Merrill) writes:
|> >Yeah.  Naturally when you take a child to the pediatrician and the child
|> >presents with classic symptoms of scarlet fever the pediatrician
|> >cultures the skin.  Who are you trying to kid?  It is these kinds of
|> >misdirected and specious responses that weaken your own position.
|> 
|> Gee, as I recall, I gave that example because you were claiming that
|> scarlet fever (unlike schizophrenia) could be proven by some culture
|> or test.  Now, when I point out that there is no simple test that
|> makes the distinction, you say basically that it's a clinical
|> diagnosis (I'm assuming that line about culturing the skin was

Please re-read a little more carefully.  What, exactly, *is* the
point of doing the classic throat culture if not to give certainty
to the initial diagnosis made clinically?

Here, again, put perhaps another way, is the point.  Suppose a kid
is brought to you presenting with the usual symptoms of scarlet
fever.  This generally is not a hard diagnosis.  With a little experience
I've even done it myself.  So you say, "Well, it looks like scarlet
fever.  Let's start him on X (I forget the preferred antibiotic)."
And the very *next* thing you say is, "We'll need to get a throat
culture.  We'll call you if it's not scarlet fever."

Similarly, if someone comes in with a lump in the neck, generalized
itching, and night sweats, you say, "Well, this sure looks like
Hodgekin's Disease."  And the next thing you say is, "We'll need
a biopsy to be sure."

So some questions:

	1. Why the *second* step in each of these (and all the
	   similar usual) cases?  What happens if you leave out
	   this step?  Wouldn't most physicians (not to mention
	   most lawyers -- who are best *not* mentioned) regard
	   such an omission as malpractice?

	2. What is the *corresponding* step in the diagnosis
	   of mental disease (schizophrenia, for example)?
	   What corresponds to doing the throat culture and,
	   *on that basis* deciding that the diagnosis was correct
	   and the treatment appropriate?  What corresponds to
	   getting the pathologist's report about the biopsy?
	   What would count as malpractice in erroneously diagnosing
	   (or failing to diagnose) schizophrenia?

The point is that you can be wrong on the basis of the clinical
signs, but there *is* something that tells you whether you treat
for strep, whether you treat for HD or perhaps consider the grimmer
alternatives for metastatic carcinoma.  What corresponds to this
"something" in the case of mental "disease"?

|> 
|> I think you should re-read the above.  I didn't suggest that it is
|> hard to find people held against their will (that's why there are
|> locked state psychiatric facilities.)  Rather that you might
|> change your understanding of why they are being held against their
|> will if you actually met some such people.

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.
-- 
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