Psychiatry

We appreciate The Times' focus on psychiatry (Column One, "Window on Psyche of L.A.," April 27). However, what was left unsaid may be more important than what was said. Modern psychiatry is part of medicine, and has no relationship to "spiritual" therapies. While psychiatry brings a welcome humanistic viewpoint that emphasizes emotional as well as physical health, it is based on sound scientific principles. The specialty has been transformed by biochemical insights, sophisticated technologies and breakthrough drugs.

Is there room for a novel about Baruch Spinoza in a publishing market crowded with supernatural creatures and kinky romance? Irvin D. Yalom thinks so. In fact, there's plenty of room to describe the life of the 17th century Jewish philosopher, which is the focus of his most recent novel, “The Spinoza Problem” (Basic Books: $25.99). Yalom's career contains many professions - professor of psychiatry (emeritus, Stanford University), psychiatrist in private practice, best-selling author - yet they're all connected.

The recent article entitled "Prevention Becomes 4th Revolution in Psychiatry" and subtitled "Mental Health: Preventive" (by Lynn Simross, Sept. 17) should actually have read "Mental Health: Prevention of." By its own statistics, psychiatry does not work. Psychiatrists admit that mental illness has reached "epidemic proportions." Small wonder for a "science" which has absolutely no basis in fact whatsoever, and relies upon the use of such barbaric practices as electric shock "therapy" and on brain-destroying chemicals to effect "cures" for diseases to which they cannot even name a cause.

April Dunlap was 17 and weighed 165 pounds when she began a diet and exercise regimen. After three months, the 5-foot-5 teen had lost the 20 pounds she had hoped to shed. But she kept going. "It was like a drug," she said. "I always wanted to lose a little more. " When she hit 120 pounds, Dunlap's mother worried that April was losing too much weight. The family's doctor agreed. Four months after Dunlap's diet began, she found herself in a treatment program for anorexia nervosa. After only 10 days, she had gained enough weight to be discharged from the hospital.

To retired Beverly Hills pediatrician Simon Wile, mental illness in the United States has reached epidemic proportions. "With any other disease, it would be called an epidemic," Wile said, mentioning the staggering but generally accepted statistics that 19% of American adults have a diagnosable mental illness, and one out of seven U.S. children has a significant mental or emotional disorder.

In the early 1980s, a profound shift in psychiatry set the stage for the growth of psychiatric diagnoses in kids. In a third revision of the manual often called the profession's bible (the Diagnostic and Statistical Manual of Mental Disorders, or DSM), the American Psychiatric Assn. began adding descriptions of newly recognized anxiety disorders. The new entries set forth symptoms of extreme shyness, worry or fear.

I have been licensed as a medical doctor in the state of California since 1962 and have been in the practice of adult psychiatry and psychoanalysis since 1965. The article ("High Anxiety: Psychiatrists See Drop in Status as Roles Shift," June 18), presents a dismal picture of what is emerging for those of us in the practice of adult psychiatry and what future psychiatrists might anticipate. It also is upsetting for our patients to imagine that future generations may not be able to visit with a psychiatrist.

The red-and-black splashes on the card are bustling with images: bad-tempered crows, a butterfly in a belly and even a couple of blood-stained kidneys -- if it isn't a pair of monkeys contemplating their rears. You, however, would see other things, for this card and nine others in the world-famous Rorschach test have strange powers and are said to reveal much about a person's mind when a skillful seer interprets them. The cards have another uncanny power: to really, really tick people off.

Kate Millett, the feminist author and maverick intellect, sips her coffee in the plush hotel bar and considers a question: Were you truly insane? "No," she said. "I think I've had unusual experiences, happy and unhappy ones. But I was not mad. Madness is manufactured when psychiatry intervenes." Millett's new book, "The Loony-Bin Trip" (Simon & Schuster), is a dramatic account of her little-known fights against hospitalization for manic depression, a diagnosis she denies.

In recent years, a national debate flared over Ritalin, a drug used for more than three decades to treat hyperactivity in children. Across the country, multimillion-dollar lawsuits were filed by parents who contended that their children had been harmed by the drug. Major news organizations--including The Times--devoted extensive coverage to whether youngsters were being turned into emotionally disturbed addicts by psychiatrists and pediatricians who prescribed Ritalin.

The pain of losing a loved one can be a searing, gut-wrenching hurt and a long-lasting blow to a person's mood, concentration and ability to function. But is grief the same as depression? That's a lively debate right now, as the psychiatric profession considers a key change in the forthcoming rewrite of its diagnostic "Bible. " That proposed modification -- one of many -- would allow mental health providers to label the psychic pain of bereavement a mood disorder and act quickly to treat it, in some cases, with medication.

The sunny fact that Americans are living longer, more productive lives has a dark side: More of us than ever live with chronic illnesses that are not only a drag on sufferers' time and energy, but on the nation's pocketbook. The Institute of Medicine on Tuesday put a dollar figure on the cost of caring for chronic illness in the United States--$1.5 trillion yearly, fully three-fourths of annual healthcare spending. A panel of experts called on policymakers to do more to prevent and track the big nine chronic diseases that most drain the nation's wallet.

Eighteen months after they have returned from a war zone, soldiers bear an unmistakable sign of emotional trauma deep inside their brains. But in most, a key node of the brain's fear circuitry returns to normal, perhaps keeping mental illness such as post-traumatic stress disorder ( PTSD ) from developing, says a new study published Tuesday in the journal Molecular Psychiatry. The study, a follow-up to an earlier brain-imaging study conducted by Dutch researchers, put two groups of Dutch soldiers into a brain scanner called a functional Magnetic Resonance Imaging scanner, and had them look at pictures of people expressing anger or fear.

Several types of personality disorders will be dropped from the next edition of the Diagnostic and Statistical Manual of Mental Disorders. But one disorder previously proposed for elimination -- narcissistic personality disorder -- will likely remain in the text. The American Psychiatric Assn. announced Thursday that the framework for personality disorders in DSM-5 will be a "hybrid" model that is substantially different from how personality disorders are diagnosed currently. Under the new system, personality disorders will be aligned with particular personality traits and levels of impairment.

People with a diagnosis of obsessive-compulsive disorder can often shake their family tree and find a relative who has also contended with obsessive thoughts, hoarding, repetitive hand-washing, behavior in which locks and stove burners are checked over and over again or elaborate rituals must be followed for daily life to proceed. The disorder seems to have some genetic component. But even related people with obsessive-compulsive disorder often exhibit different behavioral symptoms from one another, suggesting that some of the disorder behaviors are learned.

The American Psychiatric Assn. , which labored to bring forth a revision of psychiatry's “Bible” earlier this year, has just released a more modest opus likely to generate much discussion among mental health professionals. With the release on Friday of its “Practice Guideline for Treatment of Patients with Major Depressive Disorder,” the nation's leading psychiatric association makes a number of subtle adjustments to its past treatises on depression and its treatment. The new guideline is the first comprehensive update of the organization's guidelines for depression treatment since 2000.

Katie's middle child "has always had a lot going on in her head," says her mother. And much of it has been a mystery to Katie, who has coped with her daughter's escalating tantrums, combative behavior, bouts of fearfulness and just-plain-oddity since the 11-year-old was a toddler. A month ago, Katie, a 38-year-old L.A.-area mother of three, brought the child to a psychiatrist.

At 8:43 a.m. March 28, 1991, two UCLA campus police officers responding to an emergency call found a burly young man lying face down outside of Boelter Hall. He had jumped from the roof of the nine-story classroom building; at 9:23 he was pronounced dead at UCLA Medical Center. His name was Tony Lamadrid. A coroner's report included this notation: "This 23-year-old male with a history of depression and schizophrenia was being treated for same at UCLA Medical Center Psychiatric Department . . .

As chairman of the task force that created the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which came out in 1994, I learned from painful experience how small changes in the definition of mental disorders can create huge, unintended consequences. Our panel tried hard to be conservative and careful but inadvertently contributed to three false "epidemics" -- attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many "patients" who might have been far better off never entering the mental health system.

The DSM story DSM-I Published in 1952 Directed by William C. Menninger, a psychiatrist and brigadier general. The focus was on treatment of soldiers. Listed 106 disorders. DSM-II 1968 Listed 182 disorders. Many conditions were seen as abnormal reactions to life situations. A revision, in 1974, dropped homosexuality as a disorder. DSM-III 1980 Terms were made consistent with disorders classified by the World Health Organization.