Diagnosis, Therapy, and Evidence

Contents

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pp. vii-

Preface

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pp. ix-x

Americans are besieged by advice about the efficacy of medical therapies and drugs as well as behavioral and dietary modifi cations that will presumably prevent disease, promote health, and extend longevity. Scarcely a day passes without revelations about new medical breakthroughs that will presumably...

Abbreviations

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pp. xi-

Chapter 1: Rhetoric and Reality in Modern American Medicine

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pp. 1-32

Most Americans believe that their health care system is the best in the world. Yet they do not recognize the extent to which many claims about the causes of disease, therapeutic practices, and even diagnoses are shaped by beliefs that are unscientific, unproven, or completely wrong. To so argue is not to...

Chapter 2: Medical Rivalry and Etiological Speculation: The Case of Peptic Ulcer

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pp. 33-56

In the early twentieth century peptic ulcer aroused the attention of physicians and, especially, surgeons, many of whom believed that its incidence was on the rise. Initially, surgery became the cutting-edge therapy. But it was quickly followed by claims that diet or psychological intervention could best...

Chapter 3: How Theory Makes Bad Practice: The Case of Tonsillectomy

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pp. 57-83

For much of the twentieth century tonsillectomy (generally with adenoidectomy) was the most frequently performed surgical procedure in the United States. Despite the fact that relatively little was known at that time about the precise function played by this organ, theoretical speculation served as a justification for...

Chapter 4: How Science Tries to Explain Deadly Diseases: Coronary Heart Disease and Cancer

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pp. 84-110

In contemporary America cancer and coronary heart disease are the two leading causes of mortality. They arouse fear and anxiety among many, and there are perennial calls for “wars” to conquer them. A variety of groups— physicians, scientists, epidemiologists, and others—provide bewildering and...

Chapter 5: Transforming Amorphous Stress in Discrete Disorders: The Case of Anxiety

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pp. 111-140

Psychiatry has always helped set many of the most important social boundaries. These include distinctions between abnormality and normality, disease and deviance, symptoms of illness and natural feelings, and states deserving of sympathy or of stigma. During the last half of the nineteenth...

Chapter 6: Depression: Creating Consensus from Diagnostic Confusion

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pp. 141-163

Major Depressive Disorder (MDD) has become fi rmly entrenched in psychiatric research, treatment, and teaching; the mental health and health care systems; media reports about the condition; pharmaceutical advertisements for anti-depressants; and patient self-conceptions. It is so taken-for-granted and...

Chapter 7: Post-Traumatic Stress Disorder: The Result of Abnormal Environments or Abnormal Individuals?

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pp. 164-191

Post-traumatic stress disorder and its historical antecedents have always been problematic diagnoses for psychiatry. Their basic tenet—that some traumatic event in the external environment can lead to lasting psychopathological consequences in previously normal people—does not easily fit the...

Epilogue: Where Do We Go From Here?

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pp. 192-197

The “lessons” of history are far less clear and often obscure and contradictory. Indeed, history suggests that there is a price to be paid for implementing ideology ungrounded in empirical reality and for making exaggerated rhetorical claims. In this volume we have employed both historical and...

Notes

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pp. 199-241

Index

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pp. 243-253