by Norman Jay Gersabeck M.D.

[Editor's note - this article is the follow-up to Are Tens of Thousands of the Mentally Ill Being Misdiagnosed?] 

Since the preceding article was written about seven months ago, I think it is now appropriate to update the status of my efforts to officially establish the diagnosis of substance dependency-induced psychosis (SDIP). I didn’t make any further progress with it until a few months ago (the second week of 1/01). I had made some futile attempts to get a response from medical schools, addiction and schizophrenia societies, and various federal agencies. I finally got a good response from the Surgeon General, Dr. David Satcher. His action of forwarding my letter about the diagnosis to the NIMH Director of Psychotic Disorders Research Program was of critical importance. The latter sent me a letter in which he offered to assist in the application of federal funding for a vitally needed clinical trial on the SDIP diagnosis. 

This response encouraged me to initiate another round of mailings to all of the U.S. medical schools, which included a copy of the NIMH letter. I got one meaningful and positive response. All of the letters had been addressed to the psychiatric chairperson, because I was well aware of the problem of the diagnosis tending to “fall between the cracks” in regards to the psychiatric department sections of addiction and psychotic disorders. The letter was from the chairperson of a prominent eastern medical school, and he spoke of intending to consult with other members of his department about doing research on the diagnosis. He ended the letter with the statement: “I am thankful of your bringing this to my attention and, hopefully, there will be a practical result.” 

But history then repeated itself, as his consultation with his staff must have been a negative one. The Chief of the Addiction Section did send me a very brief email in which he spoke of the diagnosis as being a “valuable concept.” But he gave no indication of wanting to actively deal with it in any fashion. (Interestingly, he was probably sincere in his opinion.) I then attempted to contact the Chairperson of the Department, but he apparently didn’t feel free to discuss the matter any further. Again, no response was seen as the “safest response.” The very real metaphorical truth of the “academic stonewall” against the “too theoretically controversial” SDIP diagnosis was being proven yet again- and in a particularly convincing manner. 

I then felt that I had no other option in my quest to establish the diagnosis but to again attempt to get media coverage on the diagnosis. More than ever, the public deserves to know about the diagnosis. The resulting public pressure from such knowledge would very likely soon result in a medical school organizing a clinical trial. But there has been no response to my recent mailings. Despite the impressive amount of support (both direct and indirect) for the diagnosis, the various media organizations still don’t want to report on a diagnosis with the opposition this one has. 

Obviously, it was the mere fact of its opposition, rather than the merit of the diagnosis which has been the deciding factor here. Yet its newsworthiness and public value are obvious. That newsworthiness is likely doubled by the very fact of the strong and unreasonable opposition that it has encountered. It is not only the Detroit Free Press which is aware of the “political/ academic incorrectness” of the diagnosis. Apparently, the media in general thinks that the act of reporting on the diagnosis would be regarded as “being too unfriendly” to the psychiatric community. The action of the California Mental Health Department to distribute information about the diagnosis to its psychiatrists wasn’t a sufficient antidote to this attitude- even for the California media. 

I think that an important factor in this attitude is the media’s not wanting to disillusion the American public about the quality and nature of its health care. This would be in regards to the process of making basic advancements in medical knowledge. Page Smith is an American historian who has used the problematic concept of “academic fundamentalism.” It is about the very human tendency for academics to frequently and almost automatically resist new ideas. A good example of this in the medical area is the only relatively recent general acceptance of the bacterial etiology for peptic ulcers. There was very compelling evidence for this causal relationship for years before the medical community finally accepted it. Ironically, it was the publication of an article about it in “National Enquirer” which finally sparked its general acceptance. In comparison with this causal relationship, the SDIP diagnosis has many, and more powerful “threatened sacred cows” associated with it.