IT IS TIME TO BE CLEAR:
PSYCHIATRY IS NEITHER NEUROLOGICAL NOR BIOLOGICAL
by
Fred A. Baughman Jr., MD, Fellow
American Academy of Neurology
June 19, 2001
What is Leon Eisenberg's ["Is it Time to Integrate Neurology and
Psychiatry," Neurology Today, May, 2002, p. 4] suggestion that
neurology and psychiatry integrate, doing in a publication of the
American Academy of Neurology?
Eisenberg, a psychiatrist, writes: " Psychiatry has changed from
brain-averse to brain-responsive." What is that supposed to mean? He
continues: "In the first edition of the American Psychiatric
Association Diagnostic and Statistical Manual (1952), affective
disorders and schizophrenia were classified as psychotic disorders 'of
psychogenic origin without clearly defined structural change of the
brain.' The second edition of the manual in 1968 continued to
distinguish both affective disorders and schizophrenia 'from organic
brain syndromes.' The fourth edition in 1994 disavowed the term
organic brain disorder 'because it implies that 'non-organic' mental
disorders do not have a biological basis.'" Saying this, like the
authors of the DSM-IV themselves, Eisenberg offer no example of a
psychiatric diagnose /condition that has been validated as bona fide
disease by virtue of the discovery of an objective abnormality.
He continues: "Today, most psychiatrists believe that schizophrenia is
a brain disorder; neurologists, never doubted it." Is this statement
supposed to carry some scientific weight? Who is he to say what
neurologists believe or doubt. And what does that matter anyway. All
that matters is whether or not an objective abnormality exists in
schizophrenia, during life, or, at autopsy, at death. There is no such
proof in the medical science literature.
Eisenberg continues: "Imaging studies regularly reveal striking
correlations between mental events and brain activity, whether those
events are cognitive, affective, or pathological. Whether the brain
changes are caused by the mental activity or cause that activity
remains uncertain, but it is indisputable that there is no mind
without brain." Also "Those who deal with structural abnormalities and
those who deal with behavioral abnormalities are coming closer together."
There has been a burgeoning neuro-biological vocabulary within
psychiatry since the advent of psychopharmacology in the fifties, but
nary a psychiatric "disease" has been validated. All of this talk
about of things "neuro-biological" and about "chemical imbalances of
the brain" is about selling drugs-- "chemical balancers", which are,
in fact, the first and only chemical imbalance in the previously
normal, psychiatric patients' brain.
In science, if not in the practice and business of medicine, the
divide between psychiatry on the one hand and neurology and medicine
on the other, is wholly intact.
In 1994, when the DSM committee of the APA disavowed the term organic
brain disorder 'because it implies that 'non-organic' mental disorders
do not have a biological basis,'
Houston psychiatrist, Theodore Pearlman [letter to the editor,
Clinical Psychiatric News, December, 1994] wrote: "I take issue with
Dr. Harold Alan Pincus' (of the Diagnostic and Statistical Manual
Committee of the American Psychiatric Association) assertion that
elimination of the term "organic" in the DSM-IV has served a useful
purpose for psychiatry...Far from being of value to psychiatry, the
elimination of the term "organic" conveys the impression that
psychiatry wishes to conceal the nonorganic character of many
behavioral problems that were, in previous DSM publications, clearly
differentiated from known central nervous system diseases.
Baughman [letter to the editor, Clinical Psychiatric News, December,
1994] wrote: "to contend that something is a disease when that has not
been established is to fail to provide the patient with information
sufficient to make an informed decision. In fact, the essential first
step in all diagnosis, even in the diagnosis of psychiatric disorders,
is to make the fundamental "Is it a disease or isn't it?"
determination. This determination is usually made by physicians other
than psychiatrists; usually by those referring patients to the
psychiatrist (or psychologist, or other mental health professional).
What psychiatrists do from that point on, is nothing, more or less,
than, semantic classification, based upon subjective symptoms, alone,
in patients already-proved to have no disease.
The primary duty of neurologists remains to determine whether or not
organic disease of the nervous system is present, and, if so, which
one. Psychiatrists, have no such duty and have no biological tests to
apply for the simple reason that there are no biological abnormalities
in psychiatry to which to apply them. Those, who for marketing and
financial reasons seek to portray the physically normal as
abnormal/diseased to make "patients" of them should not be allowed to
pervert any aspect of the scientific practice of medicine.
###
|