One of the few issues not thoroughly covered in Scott Calvert's well-researched, comprehensive articles on Baltimore Behavioral Health ("Hooked on treatment," Nov. 7 and "Sheltered addicts, strained recovery," Nov. 8) is why psychiatric diagnoses are particularly prone to misdiagnosis and overdiagnosis.
The reason is that psychiatric diagnosis is not based on pathological criteria. The closest the article comes to addressing this problem is the statement that "Even in the best clinical scenario, a psychiatric diagnosis is tricky, experts say; doctors have no X-rays to help apply the criteria defining a mental illness."
In fact a diagnosis can never be indisputably ruled in or ruled out in psychiatry. All we have is testimony by differing psychiatrists, psychologists and social workers. In somatic medicine there is an array of pathological tests which often permit much greater diagnostic certainty. A biopsy of a lump in the breast will almost always tell you whether it's benign or malignant.
The ability of professionals and patients to play the system financially and to exculpate addicts from responsibility will forever be aided by makeshift diagnoses which can neither be confirmed nor ruled out.
Richard E. Vatz, Towson
The writer is a professor of political rhetoric at Towson University.