A DOSE OF SANITY

An incisive attack on the American Psychiatric Association that cuts to the quick. Walker (Help for the Hyperactive Child, 1978), a neurologist as well as a psychiatrist, contends that few psychiatrists perform the medical detective work necessary to evaluate their patients, but instead assign them a label from the Diagnostic and Statistical Manual (DSM), a catalog of disorders and symptoms published by the American Psychiatric Association (APA). The DSM, which has undergone increasing scrutiny and controversy in recent years, is not the result of careful scientific research, Walker says, but a constantly changing political document reflecting its APA panel members' personal biases and beliefs. Most psychiatrists, he asserts, do not like the hands-on practice of medicine and are more comfortable assigning a DSM label to a patient's symptoms and then writing a prescription or recommending psychotherapy. They have, in his words, ``replaced the science of diagnosis with the pseudoscience of labeling.'' Psychiatrists who rely on DSM labeling overlook symptoms of actual brain dysfunction that may respond to proper medical treatment, Walker asserts, and he includes numerous examples of patients with brain tumors, Tourette's syndrome, lead poisoning, and other medical problems whose disorders were misdiagnosed and consequently mistreated before they came to him. Besides the harm they do to their patients, he contends, DSM-reliant psychiatrists fall behind the progress being made in other areas of medicine such as genetics, molecular biology, and immunology. Walker blames the APA, which sets the standards for psychiatric training, as well as insurers, psychiatric hospitals, and the pharmaceutical industry for fostering a situation in which psychiatrists are not truly acting as doctors, and patients are misdiagnosed and unnecessarily drugged. While urging his colleagues to rebel against the DSM, he offers advice to patients on how to demand proper care. A dose of strong medicine for the psychiatric profession.