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Comments and Controversies

‘Shoebox’ diagnoses

Vol. 10, No. 01 / January 2011

I have always been a strong advocate of antipsychotic treatment, not only for major depressive disorder but also many anxiety disorders, such as posttraumatic stress disorder while in combat and obsessive–compulsive disorder, as well as hypochondriasis and some personality disorders (“Are some nonpsychotic psychiatric disorders actually psychotic?” From the Editor, Current Psychiatry, November 2010, p. 16-19).

Above all, do no harm, but our patients are suffering from severe, disturbing, restrictive, and hurtful illnesses that require any approach we have at hand. I have to admit, it’s not something I do comfortably regardless of the benefit to my patients. There is always a lawyer ready to knock at my door.

When I was practicing as a physician in New Zealand, a patient’s well being was never compromised by fear of being sued, yet I was able to obtain some much-needed relief for many of my patients.

I would like to share with you my thoughts about not forcing patients into a “shoebox” diagnosis that limits a specific treatment, as the DSM tends to do. Keep the government from dictating to doctors and keep doctors from being limited to only FDA-approved indications, when clinically we know which treatment is best, but may be subjected to legal risk. Finally, society as well as lawyers needs to stop expecting perfection, especially with illnesses where remission is not the rule and recurrence is part of the natural history of the disease.

Eduardo Lichi, MD
Major, Army Psychiatrist (Retired)
785th Medical Company, Combat Stress Control
Naples, FL

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