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  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.


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