Re: "Psychiatric Diagnoses"

To the editor,

As a psychiatrist and psychoanalyst, I applaud Ronald Pies' highlighting underlying societal and psychological determinants that contribute to negative attitudes about psychiatric diagnoses (3/20/13 NYT, 'Psychiatric Diagnoses).  But the fact that some medical diagnoses are made on a similar phenomenological basis as psychiatric diagnoses conceals the fact that psychiatry, as a branch of medicine, remains at a very primitive level with regard to understanding etiology and pathophysiology. This is not reason to abandon diagnoses or to embrace therapeutic nihilism. The brain is a complex organ. But it is reason to exercise caution precisely because diagnosis does inform treatment, as Pies notes, and there can be a risk of over-diagnosing and over-treating. In my experience, young adults who come to see me have often come with diagnoses of 'bipolar spectrum illness' or 'borderline personality' with multiple unsuccessful medication trials when what is indicated is psychotherapy. Baumeister, in a study published last year, estimated that 1.2% of the American population was receiving antidepressant treatment for either mild or subsyndromal Major Depression; i.e., conditions that are not believed to be responsive or in need of medication. These findings do not make psychiatric diagnoses inherently problematic, but the public should be aware of the unintended consequences being given diagnoses in addition to the problems noted by Pies.

Respectfully submitted

Larry Sandberg MD