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.  The absence of objective diagnostic tools in psychiatry is one of the greatest obstacles facing the field today.  Yet the suffering of psychiatric patients is real, and we have to diagnose and treat them to the best of our abilities with the means currently available, no matter how imperfect.  

Psychiatry is hardly the only medical field that is heavily influenced by the pharmaceutical industry.  Criteria for treating elevated cholesterol, blood pressure, and blood sugar are becoming increasingly more stringent, with combination drug therapy being the rule rather than the exception of treatment, even for mild cases that could and should be managed with lifestyle changes alone.  It is an oversight to target the psychopharmaceutical industry as “a kind of legal drug cartel” because the same companies that manufacture antidepressant medications also make expensive nonpsychiatric drugs designed to correct “chemical imbalances,” albeit of a different kind.  The expansion of the illness model to include borderline and possibly normal cases is happening across medical disciplines, because most medical research is mar-ket-driven.  

So far as ADHD is concerned, hardly anyone ever wonders about the possible environmental contributions to what is undoubtedly a pattern of increasing distractibility, hyperactivity, and behavioral instability in today’s children.  The jury is still out as to whether ADHD is a “disease” and whether it is associated with brain abnormalities.  The real question is whether this is a condition that is produced in susceptible children by early and excessive exposure to television and other visual media that condition the growing brain into developing a short attention span and a drive for constant novelty.  In our society, it is much easier just to “treat” this disorder with drugs, since, this way, the market wins, and no one has to make any difficult choices about how to rear children.  

        —Boris Vatel, M.D.
Evansville, IN

Dr. Baughman Replies:

Dr. Vatel, a psychiatrist, adheres to a belief system that holds that all psychiatric, emotional, and behavioral problems are “diseases” or “chemical imbalances” of the brain.  Where have these “chemical imbalances” come from?  I have been a neurologist since 1964.  I have discovered real brain and genetic diseases.  I am not aware that a single psychiatric, emotional, or behavioral condition has been proved to be a brain abnormality or disease.

In 1948, neurology and psychiatry were formally split by the American Board of Psychiatry and Neurology—neurology was to deal with organic disease of the nervous system; psychiatry, with emotional and behavioral problems in the neurologically/physically normal.  It wasn’t until the 60’s, when psychiatric drugs began to be marketed, that Big Pharma and psychiatry merged and declared that all emotional and behavioral problems could be solved by pills.

Not a single psychiatric “disease” has been validated by proof of a confirming abnormality (e.g., elevated blood sugar in diabetes, malignant cells in cancer); all of their “research” is done on subjects who are physically and medically normal, although labeled with one or more of psychiatry’s 347 subjective “disease” labels.

A young father testified in hearings on Ritalin in Nashville, Tennessee, in December 1997: “My ten-year-old’s psychiatrist said the Ritalin was for his ‘chemical imbalance.’  I asked him for the lab results.  He stuttered, and stammered, then ‘lost it,’ confessed he had no such records, and banished us from his office.”

Such is the nature of “biological” psychiatry.