Dose of Sanity

Mind, Medicine, and Misdiagnosis

Sydney Walker III, M.D.

reviewed by Mira de Vries

Walker’s book rests on two main themes. One is that the DSM, in spite of its name, is not a diagnostic manual at all, but a catalogue of descriptive labels that serve as an excuse for abandoning further medical investigation. He calls the DSM “a cookbook listing of symptoms that has replaced the science of differential diagnosis.”

The other theme divides into two parts. The minor one is that many people who are slapped with DSM labels and prescribed psychotropic drugs have nothing at all medically wrong with them.

The major theme, however, and the main theme of the book next to criticism of the DSM, is that almost all cases of serious aberrations of feelings or behavior stem from physical causes such as genetic disease, hormonal imbalances, toxins, infection, parasites, and tumors. The DSM encourages psychiatrists to be lazy and overlook these causes, he says. Psychotropic drugs only mask them, and do more harm than good. Psychotherapy, including psychoanalysis, are totally useless for these conditions. Psychiatry should return to its true mission as practiced (according to Walker) by Emil Kraepelin and Benjamin Rush, namely to identify and treat the physical causes of insanity.

I agree with Walker that cases of grossly aberrant behavior (as opposed to responses to stress) are probably due to unidentified physical causes. However, not identifying these causes is the failure of somatic medicine, not psychiatry. Psychiatry’s mission has always been to sweep up after somatic medicine, and to sweep away society’s rejects while it’s at it.

Walker maintains that there is a legitimate use of psychotropic drugs, but only in those extremely rare cases that the physical cause cannot be identified, or no curative treatment exists. My opposition to this contention is that far from being extremely rare, those are exactly all cases with which psychiatry deals. One of Walker’s examples of physical disease which psychiatrists frequently fail to identify and treat is Tourette Syndrome, which he calls genetic. In spite of his own insistence that the causes of conditions should be scientifically sought, he fails to provide any evidence that TS is genetic in origin. Even if he had such evidence, since when does identifying conditions as genetic make them curable? On the other hand, Walker overlooks compelling evidence that TS is caused by brain damage: it is common in people whose brains have been damaged by psychotropic drugs. He doesn’t mention how he thinks TS should be treated. In fact, the only “treatment” that exists, whether effective or not, is Haldol, the very type of treatment he claims to oppose except in those extremely rare cases, whichever they are.

While correctly calling into question the efficacy and safety of psychiatric practice, Walker highly overrates somatic medicine. He attaches great diagnostic significance to gene mapping and brain scanning, whereas in reality such toys have as yet benefited no one but the doctors who employ them for research.

One of Walker’s more bombastic claims for successful treatment of aberrant behavior is … surgically cleaning cholesterol out of a patient’s brain arteries! (Who would be so gullible as to believe that?)

Interesting to note are Walker’s views on two of the greats among opponents to psychiatry, Peter Breggin and Thomas Szasz.

Walker duly credits Breggin with having called attention to the horrific harm done by psychiatric drugs. Unfortunately, according to Walker (and I agree with him on this) the flip side to Breggin is blaming serious dysfunctional behavior on “bad parenting.” No, not such obvious bad parenting as battering children or trading them for cocaine, but vague failures that only Breggin himself can identify, like paying insufficient attention to children. Walker might have added that those parents who are likely to seek psychiatric services, not to mention pay big bucks for them (a subject on which Breggin never touches), are the very parents who are deeply devoted to their children. Walker also criticizes Breggin for blaming schools, though schools are very much known to contribute to the ill-being of children.

Contrary to his position on Breggin, Walker showers praise on Szasz, particularly for having been the first and the most relentless critic of DSM fake diagnoses. However, he feels Szasz goes too far in denying there is ever a physical origin for dysfunctional behavior, and by suggesting that such people are actually “incompetent, lazy, or bad.” He presumes that Szasz would leave them to die in the streets and in jails, overlooking the fact that Szasz is the only writer in the field who has suggested a practical solution for dealing with such people, namely the non-medical asylum, or as Szasz nicknames it, the “adult orphanage.”

Those of you who are interested in “alternative psychiatry” may be interested in Walker’s views on such treatments. He does not reject the idea outright, though he considers most of them quackery and downright silly. Acupuncture he calls effective in treating pain – but not curing the cause of pain. Orthomolecular medicine can treat nutritional deficiency, but nothing else, he says.

Walker further criticizes judges’ reliance on psychiatric expertise. He says nothing about it that Szasz hasn’t said before him. He does not mention involuntary commitment anywhere in the book.

Finally, Walker calls on us, potential psychiatric patients, to take responsibility for our own health care. That’s fine advice, but limited by the fact that responsibility can be carried out only in freedom. Massive state intervention in medicine means that much of his otherwise excellent advice is impossible to follow.

All in all, this book’s power is the author’s ability to state in layman’s language why the DSM is a fraud.

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