Psychiatry - July 2008 - (Page 65)

a history of “chronic schizophrenia,” which is noted to be a cause of “nonsensical speech.” In the same text, we are told that “overactivity of the mesolimbic [dopamine] pathway is thought to be important in the ‘positive’ symptoms of schizophrenia.” Similarly, in Prezbindowski’s Study Guide to Accompany Porth’s Pathophysiology,20 we find five test questions on schizophrenia, including one that discusses atrophy of brain tissue and enlargement of cerebral ventricles. Strikingly, this textbook also includes several questions on bipolar and unipolar depressive disorders, as well as on anxiety disorders. individuals who struggle bravely with these all-too-real diseases. 12. ACKNOWLEDGMENT I wish to thank Mr. Darren Waters for prompting my investigation of this issue. I also wish to express appreciation for the groundbreaking work of Ahmed Aboraya, MD, on validity and reliability in psychiatry. 13. REFERENCES 1. Pies R. How “objective” are psychiatric diagnoses? (guess again). Psychiatry (Edgemont). 2007;4(10):18–22. Pies R. Beyond reliability: biomarkers and validity in psychiatry. Psychiatry (Edgemont). 2008;5(1):48–52. Wigney T, Parker G. Medical student observations on a career in psychiatry. Aust N Z J Psychiatry 2007;41:726–731. Szasz T. Insanity: The Idea and Its Consequences. Hoboken NJ: John Wiley & Sons, 1987. Schaler J. Mental-health parity [Letter to the editor]. Philadelphia Inquirer. August 22, 1998:A12. Debate: Is Depression a Disease? Produced by Warren Steibel. Taped March 31, 1998, New York City. http://www.szasz.com/isdepressionad iseasetranscript.html. Access date: July 9, 2008. Schaler J. Mental illness: philosophy masquerading as medicine. Br J Psychiatry. September 6, 2007. http://currentideas.blogspot.com/ and http://bjp.rcpsych.org/cgi/eletters/191 /3/271. Accessed July 9, 2008. Pies R. On myths and countermyths: more on Szaszian fallacies. Arch Gen Psychiatry. 1979;36(2):139–144. Virchow R. In: Rather LJ (ed). Disease, Life and Man: Selected Essays by Rudolf Virchow. Stanford, CA: Stanford University Press, 1958. Pies R. Moving beyond the myth of mental ilness. In: Schaler JA (ed). Szasz Under Fire. Chicago, IL: Open Court, 2004:327–553. Kendall RE: The myth of mental illness. In: Schaler JA (ed). Szasz 14. 15. 2. CONCLUSIONS The notion that, among physicians, only psychiatrists consider schizophrenia a real disease can easily be laid to rest with an hour’s work in a good medical library. The textbook examples provided in this commentary are by no means exhaustive; others are provided in my chapter in Dr. Schaler’s book.10 A failure to call the critics of psychiatry on their false claims regarding medical texts further marginalizes psychiatry and reinforces pejorative myths about psychiatric diagnosis. It also makes it more difficult to present psychiatry in a convincing way to medical students. Of course, the presence or absence of printed words in a textbook does not impinge on the “ultimate reality” of conditions like schizophrenia—any more than the sudden omission of the term cancer from pathology texts would mean that the disease has disappeared. We must continue to refine our diagnostic criteria and greatly intensify our search for valid biomarkers in schizophrenia, mood disorders, and other psychiatric conditions.2,21 Nonetheless, false claims that schizophrenia and related disorders are not recognized as diseases outside of psychiatry damage both our profession and those whom we treat—the 65 3. 16. 4. 5. 17. 6. 18. 19. 7. 20. 21. 8. 9. Under Fire. Chicago, IL: Open Court, 2004:29–48. Cotran RS, Kumar V, Robbins SL. Robbins’ Pathologic Basis of Disease, Fifth Edition.. Philadelphia, PA: W.B. Saunders, 1994. Sheldon H. Boyd’s Introduction to the Study of Disease, Eleventh Edition. Philadelphia, PA: Lea & Febiger,1992. Phillips J, Murray PG Kirk P (eds). Biology of Disease, Second Edition. Hoboken, NJ: WileyBlackwell, 2001. Wittgenstein L. The Blue and Brown Books: Preliminary Studies for the Philosophical Investigations. New York, NY: Harper Torch Books, 1965. Talmud PJ, Humphries S. Molecular genetic analysis of coronary artery disease. In: McGee JO, Isaacson PG, Wright NA, Dick HM. Oxford Textbook of Pathology, Volume 1: Principles of Pathology. Oxford Medical Publications, 1992. Esri MM, Morris JH (eds). The Neuropathology of Dementia. Cambridge: Cambridge University Press, 1997. DiMaio VJM, DiMaio D. Forensic Pathology, Second Edition. Boca Raton, FL: CRC Press, 2001. Blumenfeld H. Neuroanatomy Through Clinical Cases. Sunderland, MA: Sinauer Associates, 2002. Prezbindowski’s Study Guide to Accompany Porth’s Pathophysiology, Seventh Edition. Philadelphia, PA: Lippincott, Williams & Wilkins, 2005. Aboraya A, Rankin E, France C, et al. The reliability of psychiatric diagnosis revisited: the clinician’s guide to improve the reliability of psychiatric diagnosis. Psychiatry (Edgemont). 2006;3(1):41–50. 10. 11. [JULY] Psychiatry 2008 65 http://www.szasz.com/isdepressionadiseasetranscript.html http://www.szasz.com/isdepressionadiseasetranscript.html http://currentideas.blogspot.com/ http://bjp.rcpsych.org/cgi/eletters/191/3/271

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Psychiatry - July 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Reliability of Diagnoses: Do Psychiatrists Use Structured Interviews In Real Clinical Settings? Trend Watch: Use of Atypical Antipsychotics in the Elderly Review: The Struggle for Mental Healthcare in New Orleans-One Case at a Time Psychotherapy Rounds: Psychotherapeutic and Adjuntive Pharmacologic Approaches to Treating Posttraumatic Stress Disorder Original Research: Baseline Dissociation and Prospective Success in Special Forces Assessment and Selection Commentary: Performance-Enhancing Drugs: Where Should the Line Be Drawn and By Whom? Commentary: Psychiatric Diagnosis and the Pathlogist's View of Schizophrenia Journal Watch Classified Advertising Information for Authors

Psychiatry - July 2008

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