This is an interesting but controversial new book, written for the general public, on the current practice of psychiatry. The author takes an interesting position in that he believes that psychiatry has abandoned traditional medical practices in not thinking about and emphasizing differential diagnosis and physical diagnosis. Because psychiatrists rely too much on DSM-IV, they mistakenly and at times impulsively misdiagnose and mistreat patients. I generally have a problem with books like this in that rather than trying to present ideas through doing a research study or publishing a scientific article and attempting to change the field that way, the author wrote a book to the public. I believe many patients who are being properly treated will be scared by this book and discontinue their needed treatment. I do, to a large extent, agree with his general thesis regarding the lack of emphasis in psychiatry training of medical/ neurological differential diagnosis. The purpose is to show that there is an alternative to DSM psychiatry, and that many psychiatric disorders can be more accurately diagnosed and treated. The author intends constructive criticism of psychiatry. I generally agree with his goal. The intended audience is lay readers. Because patients will read this book and attempt to discuss this with their psychiatrist, psychiatrists need to read this book! The book features 260 pages containing nine chapters, a reference and index section, and a set of appendixes. This is an interesting and controversial new book that may stir debate that can only improve psychiatric practice.
Walker, director of Southern California's Neuropsychiatric Institute, here argues that clinicians should not rely exclusively on standard psychiatric labels. He contends that labels such as depression, hyperactivity, etc., often hide medically treatable disorders. He notes a trend in psychiatry to lump individuals under broad categorical labels, e.g., mental retardation, which often obscures the specific problems. Drawing upon 30 years of clinical experience, he cites cases illustrating the fallibility of psychiatric labeling. Walker writes that the current diagnostic system survives because of its support from the American Psychiatric Association, drug companies, and managed care providers. This thought-provoking book is an effective complement to Peter Kramer's Listening to Prozac (LJ 5/1/93). Recommended for public and academic libraries.-Dennis Glenn Twiggs, Winston-Salem, N.C.
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.
Reviewer: Michael Schrift, DO (University of Washington School of Medicine)
Description: This is an interesting but controversial new book, written for the general public, on the current practice of psychiatry. The author takes an interesting position in that he believes that psychiatry has abandoned traditional medical practices in not thinking about and emphasizing differential diagnosis and physical diagnosis. Because psychiatrists rely too much on DSM-IV, they mistakenly and at times impulsively misdiagnose and mistreat patients. I generally have a problem with books like this in that rather than trying to present ideas through doing a research study or publishing a scientific article and attempting to change the field that way, the author wrote a book to the public. I believe many patients who are being properly treated will be scared by this book and discontinue their needed treatment. I do, to a large extent, agree with his general thesis regarding the lack of emphasis in psychiatry training of medical/ neurological differential diagnosis.
Purpose: The purpose is to show that there is an alternative to "DSM psychiatry," and that many psychiatric disorders can be more accurately diagnosed and treated. The author intends constructive criticism of psychiatry. I generally agree with his goal.
Audience: The intended audience is lay readers. Because patients will read this book and attempt to discuss this with their psychiatrist, psychiatrists need to read this book!
Features: The book features 260 pages containing nine chapters, a reference and index section, and a set of appendixes.
Assessment: This is an interesting and controversial new book that may stir debate that can only improve psychiatric practice.
