From: sasghm@theseus.unx.sas.com (Gary Merrill)
Subject: Re: "stigma" of psychiatric treatment, again
Originator: sasghm@theseus.unx.sas.com
Date: Fri, 18 Dec 1992 18:51:57 GMT
Organization: SAS Institute Inc.


In article <jimkent.724693496@well.sf.ca.us>, jimkent@well.sf.ca.us (Jim Kent) writes:
|> 
|> Please note, however, that the person in the PTSD example was not held
|> against his will, and other than psychiatrists made the "diagnosis."

There is more scary here than who makes the diagnosis, of course.  A question
I raised in an earlier posting (and was unanswered either because it is
so very difficult to answer or because it was simply skipped over as
relatively insignificant) is, I think, quite germane.  That is, what
counts as malpractice in areas of this sort?  If we are really talking
about diseases and criteria for diagnosing and classifying diseases, then
there should be pretty clear criteria for malpractice, as there are in
other areas of medicine (please don't take this to imply that malpractice
is always straightforward to establish -- I'm concentrating on the
conceptual issues here).

The case described briefly by Andrew Koenig appears to me to be a real
candidate for a malpractice claim.  It seems that an analogous case in
internal medicine or surgery (one in which I had suffered physically
or financially or by having my rights affected in some manner) would
be actionable *unless* it could be demonstrated that something like
"reasonable and customary practices" had been followed.  But in *this*
case if the claim is made that "reasonable and customary practices"
were followed, then something is dangerously wrong.  And it doesn't
*matter* whether the doctor in question is a resident or a board
certified psychiatrist.

What I am saying is that there is a cluster of concepts in medical
practice and medical science (involving disease, treatment, methodology,
responsibility, and others) that are closely related.  But it is not
obvious how closely related these are in psychiatry or how analogous
their employment and meanings in psychiatry are to their roles in other
areas of medicine.  Frequently, however, I have seen psychiatry made
an exception on the grounds that it is not as much a "hard science"
as are other areas of medicine.  But this smacks of seeking respectability
without responsibility, of milking an analogy while it works *for*
you, but choosing to abandon it when you will be stuck with unpleasant
consequences.  The issue of what counts as malpractice in the types
of cases in question cuts to the heart of how good a fit the "medical
model" is for psychiatry.  I don't claim to have a final answer to this,
but I do have some fundamental concerns about this fit.  And the goodness
of fit has rather sweeping consequences for the justification of practice.

Beyond this, the case described by Koenig illustrates a transfer and
abuse of power that is independent of whether psychiatry fits well into
the medical model.  When "due process" becomes some resident (or an
experienced board certified psychiatrist) calling a bureaucrat and
having my rights restricted, a travesty has occurred.



-- 
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