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July 10, 1994

Regarding "Rewriting the Dictionary of Madness" (by Ann Japenga, June 5):

As a psychiatrist, I must point out that there is a vast body of world literature on the biological elements of many mental disorders, including Alzheimer's Dementia, alcoholic encephalopathy and numerous organic brain syndromes, all included in the Diagnostic and Statistical Manual of Mental Disorders, as well as schizophrenia and affective disorders. One wonders how anyone could possibly conclude that "a bunch of guys just made this stuff up."

This literature, recognized as scientific by every major university in the world, has involved decades of work by many thousands of researchers and has contributed to the development of highly successful treatment for many mental disorders.

Anyone wishing to examine this evidence can consult any standard textbook of psychiatry or any one of dozens of scientific journals and then would be in a position to make arguments in terms of flaws in research design, of statistical errors or on any other scientific basis. Critics of psychiatry as "unscientific" never seem to do this.

DR. ROBERT D. ROSENBERG

Woodland Hills

Examples of downright falsehood abound in Japenga's article. A sample: ". . . no one has ever been able to prove that mental illnesses--such as depression, panic disorder and even schizophrenia--are biological conditions." Granted, this is a quotation from Peter Breggin, a maverick psychiatrist who plans to bring out a book soon, but why would an ethical journalist quote him in such detail as an authority on a subject that deeply affects so many families in our communities? And why this all-out sideswiping of psychiatry?

The DSM-IV is a manual. If no one attacks the manuals that computer engineers and architects prepare to do their work, the reason is quite clear. These manuals are not about human beings and their sufferings.

As psychiatry moves into the future, there will be further editions of the DSM. It is hoped that the future also will include universal coverage in the National Health Plan of the biological brain diseases--schizophrenia, bipolar disorder and major depression--along with other physical illnesses, as well as support for research in these areas.

FLORENCE E. FITZGERALD

ALLIANCE FOR THE MENTALLY ILL--WHITTIER

Japenga's refreshingly accurate article on DSM-IV actually quoted both proponents and opponents. So often "the other side of the story" is ignored in articles about psychiatry, a field in which experts are deified. I was quoted several times as coordinator of our 28-group Support Coalition International. Thank you for treating our members as human beings whose views are actually worth hearing.

No doubt you'll hear typical complaints from the psychiatric establishment, which is used to its power being unquestioned.

DAVID OAKS

Eugene, Ore.

When my son, now 25, was 18, he called me from the patient telephone at UCLA's Neuropsychiatric Institute and Hospital. He was there for his second "evaluation." Tearfully, he said: "This is the happiest day of my life. I found out it's not my fault."

What was not his fault was the "weird" collection of behaviors, skills, deficits and interpersonal failures he suffered from all his life. It was his brain, the doctors said, that was to blame--brain damage of an amorphous kind that had caused lifelong loneliness, brought about unrelenting teasing and triggered an "allergic reaction" on the part of others when he entered the room.

Unlike the case of Margaret Jensvold, my son's initial label provided the illumination that allowed him and his loved ones to seek the appropriate treatment. It took another seven years for the diagnosis of "Asperger's" to find its way onto the pages of the DSM-IV--"Autism: Asperger's Type," replete with a list of criteria. Who can guess what course my son's life might have taken if only one of his many doctors, therapists or teachers had come across that label when he was 5, even 8 years old?

One thing, however, is certain: He and his parents would have grieved sooner, and advocated earlier, freed as they would have been from the blame, guilt and mystification borne by an unlabeled, yet painfully real, disorder.

BARBARA A. LA SALLE

PSYCHOTHERAPIST

North Hollywood

Japenga has omitted the primary reason for DSM categories--that is, "third-party" dollars for mental health treatment. Insurers pay only when providers use the DSM diagnoses as evidence that the prescribed treatment is justified.

Margaret Jensvold proves that she does not suffer from "self-empowering personality" by her self-destructive attempts to deny not only such money for herself but for all women who could benefit from mental health treatment.

TONI WARD

Marina del Rey

I was encouraged to read about the controversies surrounding the DSM, a professional manual that has bothered me for years.

As a therapist working with emotionally disturbed children and their families in a school setting, I have been struck with the extraordinarily unscientific approach to treatment that this publication affords a mental health worker. I have watched too many children affected at age 4 or 5 by one of a variety of diagnostic labels that in effect promote resistance to growth or instill a lack of hope for change.

Diagnosing a child inadvertently allows the entire family to be focused for years on the problems of the "identified patient," rather than looking at the crucial, broader family

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