Regarding the April 29 Outlook article “When a diagnosis does more harm than good”:
Paula J. Caplan contended that many people are “arbitrarily slapped with a psychiatric label,” which can “cost anyone their health insurance, job, custody,” etc. I find this argument troubling since overwhelming evidence demonstrates that stigma and misinformation about psychiatric illness prevent people from getting appropriate treatment.
Brain disorders are just as real as disorders of other organs in the body. The process of diagnosis is not an exact science but a scientifically informed one, and scientific understanding of brain disorders is advancing rapidly.
Many psychiatric conditions involve severe impairment in functioning, which is far more likely due to unrecognized or untreated illness than to receiving a diagnosis. A heartbreaking example is the escalating suicide rate in the military. It surely makes things worse for families whose lost loved ones had been reluctant to seek help for fear of being “labeled” with one of these illnesses.
John Oldham, Houston
The writer is president of the American Psychiatric Association.
By criticizing with too broad a brush, Paula J. Caplan distracted attention from a serious problem in psychiatry. Every week in my psychiatry practice, I see an adult or child diagnosed with bipolar disorder who has gotten no better with treatment. A re-diagnosis of depression and an antidepressant medicine usually help these patients.
Is it any coincidence that this is happening when most antidepressants have gone generic while most bipolar medicines are still expensive brand-name drugs? To me, the question is not whether popular diagnoses in the Diagnostic and Statistical Manual of Mental Disorders are harmful but whether they help psychiatrists correctly diagnose and treat their patients.
Edward Gogek, Prescott, Ariz.