Customer Reviews

A Dose of Sanity: Mind, Medicine, and Misdiagnosis

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This is not the first book I've read that is critical of psychiatry. But compared to Caplan, Breggin, and Szasz, this is the most sensible critique I've seen. Usually, in the anti-psychiatry literature one finds inexcusible nonsequiturs. For example: "Psychiatrists often don't realize that the medication is causing the disorder (good point). Therefore, biological psychatry is unsound (bad point)." Or "Psychiatric illnesses are voted on by committee (good point), therefore there is no such thing as mental illness (bad point)." Walker avoids making such obvious nonsequiturs. Far from being against biological psychiatry, Walker argues that current psychiatry is not biological enough. It appeals to highly hypothetical conditions (such as neurotransmitter disorders) while ignoring known conditions (such as pin worms or hypothyroidism). Some might think that this is all that Walker is saying, but his general point seems to be that since psychiatrists are taught to run through symptoms lists instead of being medical detectives, there a lot of unknown conditions which they are failing to discover.

Dr. Walker's book is a stern indictment of the contemporary medical profession and the mental health field in particular. He charges the majority of psychiatrists of ignoring the true needs of their patients and instead practicing and arbitrary pseudo-science of labeling. They seem to have given up on the idea (fundamental to the philosophy of science)that all events have a cause and that to understand something we must understand the process of cause and effect that brought it into being. Most modern psychiatrists are not interested in finding out what is wrong through careful methodology. They are divided into two camps. The psychoanalytic types deny a medical cause for abnormal feelings and behaviour altogether (however, they still want the prestige that comes with being a medical doctor!). They look everything from a bad childhood to alien abductions to explain such things as psychosis and manic depression, even though no scientific study has ever proven the theories on which their claims are based. The next group, the standard issue biopsychiatrists are a little more up to date. They would admit the obvious scientific truth that someone who hears voices or is immobilized by a deep depression is psysically ill. However, they drop the ball as well. Most biologically based psychiatrists give very vague answers about the causes of mental illness, and rely on a few biological treatments which are tried on the patient almost randomly until one seems to "work". For instance, a depressed person will be given one antidepressant drug after another without the doctor even stopping to consider that the deprssion may result from anemia, a thyroid imbalance, poor nutrition or a host of other causes. Many psyciatric patients today are not even given a blood test, an EEG or any other genuine medical test before traetment is prescribed. Walker points out that until people are given a battery of tests, we will never really know what is wrong with them. Prozac or tranquilizers may make the! m feel better temporatily, but they could be literally dying. He also attacks the concepts of hypochodndria and facetious disorder. For the most part, he argues, these are destructive labels used to protect doctors and stigmatized patients ("if I can't figure out what is wrong with you then it is all in you're head and/or you are just making it up") While I don't agree with all his points (for instance, his extreme anti-prozac position) I must say that this book is must reading for anyone in need of mental health care.

I was very impressed with A Dose of Sanity because so many books critical of psychiatry remind me of Breggin which claim that there is something "spiritual" missing in the patient, and the author ignores the bioligical problems inherent in the behavioral or mood disorder.

However, I as I made my way through the book I was concerned that Dr. Walker was not going to address what to do if you have been diagnosed with a serious mood disorder, but were unable to find a physical cause (like a boy that was ADHD but had cardiac problems). I was right. He never said what to do if you have been diagnosed with manic depression (or any of the other hard to treat mood disorders). He did not address lithium or other non-antidepressant therapies for mood disorders. I agree that these treatments are probably only treating the symptoms of some underlying brain dysfunction that science has not yet named, but what does the patient do until science has figured this out? Remain psychotic? Lithium therapy may be some band-aid solution for a cellular dysfunction of our brain matter, but is a patient supposed to discontinue this medication because science can only offer this treatment to help the symptoms of the disorder? I wish Walker had offered an opinion and information on this issue.

Also, along the same line, he didn't say what patients should do once they had gone through exstensive medical testing to determine their problem and nothing physically wrong was found. (Nevermind the fact that he did't give specific tests to ask for - just blood and urinalysis in addition to what else?) If you know that you don't suffer from pin worms, syphillis, typhus, cardiac problems or whatever else, but your symptoms only seem to match typical manic symptoms that only lithium helps, should you throw in the towel and accept the psychotropic medication?

I do think that Dr. Walker is truly concerned about patients who have fallen victim to DSM "diagnosis", and this book could be very helpful for a patient who has received psychiatric care, but did not have a full medical work-up before taking psychotropic medications. I only wish this book had touched on the issues that I mentioned above.

Finally, the most important message of this book is never stop learning about what you have been told your disorder is, and never take the word of your doctor as law. As Walker says himself, there is no way that one doctor can know everthing about medicine.

Walker's book rests on two main themes. One is that the DSM, in spite of its name, is not a diagnostic manual at all, but a catalogue of descriptive labels that serve as an excuse for abandoning further medical investigation. He calls the DSM "a cookbook listing of symptoms that has replaced the science of differential diagnosis."

The other theme divides into two parts. The minor one is that many people who are slapped with DSM labels and prescribed psychotropic drugs have nothing at all medically wrong with them.

The major theme, however, and the main theme of the book next to criticism of the DSM, is that almost all cases of serious aberrations of feelings or behavior stem from physical causes such as genetic disease, hormonal imbalances, toxins, infection, parasites, and tumors. The DSM encourages psychiatrists to be lazy and overlook these causes, he says. Psychotropic drugs only mask them, and do more harm than good. Psychotherapy, including psychoanalysis, are totally useless for these conditions. Psychiatry should return to its true mission as practiced (according to Walker) by Emil Kraepelin and Benjamin Rush, namely to identify and treat the physical causes of insanity.

I agree with Walker that cases of grossly aberrant behavior (as opposed to responses to stress) are probably due to unidentified physical causes. However, not identifying these causes is the failure of somatic medicine, not psychiatry. Psychiatry's mission has always been to sweep up after somatic medicine, and to sweep away society's rejects while it's at it.

Walker maintains that there is a legitimate use of psychotropic drugs, but only in those extremely rare cases that the physical cause cannot be identified, or no curative treatment exists. My opposition to this contention is that far from being extremely rare, those are exactly all cases with which psychiatry deals. One of Walker's examples of physical disease which psychiatrists frequently fail to identify and treat is Tourette Syndrome, which he calls genetic. In spite of his own insistence that the causes of conditions should be scientifically sought, he fails to provide any evidence that TS is genetic in origin. Even if he had such evidence, since when does identifying conditions as genetic make them curable? On the other hand, Walker overlooks compelling evidence that TS is caused by brain damage: it is common in people whose brains have been damaged by psychotropic drugs. He doesn't mention how he thinks TS should be treated. In fact, the only "treatment" that exists, whether effective or not, is Haldol, the very type of treatment he claims to oppose except in those extremely rare cases, whichever they are.

While correctly calling into question the efficacy and safety of psychiatric practice, Walker highly overrates somatic medicine. He attaches great diagnostic significance to gene mapping and brain scanning, whereas in reality such toys have as yet benefited no one but the doctors who employ them for research.

One of Walker's more bombastic claims for successful treatment of aberrant behavior is ... surgically cleaning cholesterol out of a patient's brain arteries! (Who would be so gullible as to believe that?)

Interesting to note are Walker's views on two of the greats among opponents to psychiatry, Peter Breggin and Thomas Szasz.

Walker duly credits Breggin with having called attention to the horrific harm done by psychiatric drugs. Unfortunately, according to Walker (and I agree with him on this) the flip side to Breggin is blaming serious dysfunctional behavior on "bad parenting." No, not such obvious bad parenting as battering children or trading them for cocaine, but vague failures that only Breggin himself can identify, like paying insufficient attention to children. Walker might have added that those parents who are likely to seek psychiatric services, not to mention pay big bucks for them (a subject on which Breggin never touches), are the very parents who are deeply devoted to their children. Walker also criticizes Breggin for blaming schools, though schools are very much known to contribute to the ill-being of children.

Contrary to his position on Breggin, Walker showers praise on Szasz, particularly for having been the first and the most relentless critic of DSM fake diagnoses. However, he feels Szasz goes too far in denying there is ever a physical origin for dysfunctional behavior, and by suggesting that such people are actually "incompetent, lazy, or bad." He presumes that Szasz would leave them to die in the streets and in jails, overlooking the fact that Szasz is the only writer in the field who has suggested a practical solution for dealing with such people, namely the non-medical asylum, or as Szasz nicknames it, the "adult orphanage."

Those of you who are interested in "alternative psychiatry" may be interested in Walker's views on such treatments. He does not reject the idea outright, though he considers most of them quackery and downright silly. Acupuncture he calls effective in treating pain - but not curing the cause of pain. Orthomolecular medicine can treat nutritional deficiency, but nothing else, he says.

Walker further criticizes judges' reliance on psychiatric expertise. He says nothing about it that Szasz hasn't said before him. He does not mention involuntary commitment anywhere in the book.

Finally, Walker calls on us, potential psychiatric patients, to take responsibility for our own health care. That's fine advice, but limited by the fact that responsibility can be carried out only in freedom. Massive state intervention in medicine means that much of his otherwise excellent advice is impossible to follow.

All in all, this book's power is the author's ability to state in layman's language why the DSM is a fraud.

Copyright © MeTZelf

Dr.Walker has written a unique,and compassionate book. It has,indeed,saved my sanity! Dr.Walker's treats his patients with tremendous sensitivity,and,with a non-judgemental insight,far beyond any other doctor that I know! I think,and believe,that Dr.Walker is a medical giant,of our time.

This book should be required reading by all psychiatrists. There is still so much to learn from this maverick psychiatrist. Dr.Sydney Walker 111 was an unforgettable and unique and towering giant,we will not find another Dr.Sydney Walker again!! The closest thing to another Dr.Walker in Canada might be the ill-fated Dr.Ed Pakes,a brilliant pioneer bereavement psychiatrist. There is also Dr.Robin Brooks-Hill. Then there is an aloof South African "Shrink",and his son,who wrote some book called "Freud". (Obviously that isn't really the correct title,but it is a free country) Besides,why see Dr.Aloof Shrink when you can watch Meryl Streep films on Video. Bouchard is no longer a power,Richler is dead,Where is Trudeau or Lon Chaney Jr when we need him?