Polemics & Exchanges

On Attention Deficits

Dr. Baughman’s implied argument (in “Making a Killing,”?Vital Signs, June, cowritten by B.K. Eakman) that, if there is no objective means of diagnosing a disease, then there is no need for medical treatment, is akin to throwing the baby out with the bathwater.  Up until relatively recently, medicine relied on clinical criteria (the combination of the patient’s self-report and the physician’s subjective observation) in making a diagnosis of disease or health.  Many nonpsychiatric diagnoses, including acute appendicitis and multiple sclerosis, are still made on largely clinical grounds, with scant or conflicting laboratory or imaging evidence.  Psychiatry relies on the clinical method exclusively because no one really knows yet what causes psychiatric illness.  The inability to confirm a diagnosis by technical means, however, should not cause us to doubt the existence of a disorder when one is apparent.  There are and always have been unfortunate individuals who hallucinate, experience delusions, or become profoundly disabled as a result of a severe mood disturbance.  Sometimes, the cause of these symptoms is physical and measurable.  Most of the time, these patients are either physically “normal” or have physical abnormalities that are apparently unrelated to their psychiatric disturbance. ...

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