LETTERS TO THE EDITOR

Drug Abuse as a Coping Mechanism psychiatric profile of President Nixon.

Psychiatric profiles are often justifiable for historical reasons
SIR: For the past three years I have been involved in training when they are performed on deceased persons or in an attempt
the personnel of crisis centers, hotbines, and emergency psychi- to solve a crime when no other methods ofobtaining vital infor-
atric services in handling drug abuse cases. The one part of my mation are available. However, we feel that psychiatric profiles
presentations that has brought me the most flack has gone done on living political figures without examining the person or
something like this: examining the psychiatric evaluations done on the person by
others is in fact character assassination and sets a dangerous
When a parent comes to you with his drug-abusing teen- precedent. If this activity continues it is foreseeable that in fu-
age son or daughter, it is the parent, not the child, that is tune elections competing politicians could use psychiatrists to
most likely to be in a state ofcnisis and in need of immedi- create psychiatric profiles on their opponents indiscriminately.
ate intervention. The child probably feels considerable This would not only be unethical but such “profiles” would lack
stress in the confrontation with his parent but is probably any scientific validity.
not in as serious a state of disequilibrium as the parent. We feel strongly that it is unprofessional and unethical to
The child was in a crisis, but he has found a coping mecha- publish psychiatric opinions on any person without examining
nism-drugs. When the pressure is too great, the depres- the person or, at the very least, examining confidential psychiat-
sion too deep, the anxiety too severe, relief is only a couple nc records done by other professionals. The Parade “psychiat-
of pills or an injection away. The drug-dependent person is nc profile” is in our opinion similar to actions taken against
engaging in self-medication. If he weren’t strung out on Barry Goldwater during his election campaign against Lyndon
dope, he would be neurotic, psychotic, violent, deviant, or Johnson, which were widely condemned at that time. We there-
whatever he is defending against. Take the drug away and fore recommend that on behalf of its members the American
you just have the other hidden problem. You have to deal Psychiatric Association adopt a policy of declaring this kind of
with both. Change the medicine or teach the abuser to live behavior to be unethical.
without psychopharmacological aid, but don’t treat the
drug as the problem or even as the symptom because in WILLIAM R. KAMMERER, M.D.
most cases it is really the self-applied Band-Aid. RICHARD A. SLAWSON, M.D.
National City. Ca/if
Frankly, that little talk and the discussion that followed used
to get me into conflict with an unbelievable number of mental
health professionals, legal professionals, and other profes- The Adult Hyperkinetic
sionals and nonprofessionals. Dave Wellisch pointed me to a
little supportive documentation in his paper on the psychotic SIR: My epidemiological studies on behavior disorders and
heroin addict ( 1 ), and I also found some support from Zimmer- learning disabilities ( I , 2) have led me to speculate about the
ing and associates in their study ofthe relationship ofheroin ad- adult hyperkinetic patient. Over ten years ago, in desperation, I
diction to problems of adolescence as a critical period in devel- treated one adult diagnosed as schizophrenic who had a rather
opment (2). Ann Singer’s recent article on the mothering typical childhood history of hyperkinesis with amphetamine-
practices characteristically found in addicts’ backgrounds also with surprisingly good alleviation of his most bothersome
seems compatible with such an interpretation (3). symptoms of impulsivity and emotional overreaction. Last
Despite this smattering of supportive documentation, I felt summer I began looking in earnest for such patients. In my
that I had little hope of getting any substantial acceptance of work as consultant at Spring Lake Ranch, a therapeutic corn-
my wild idea that drug abuse was a coping mechanism even if I munity, I was surprised to find many young adults who had
finally got it in print. Now I find that not only am I not alone in been through prominent psychiatric institutions, had come to
this idea but that the A merican )ournal ofPsychiatry is willing the ranch with the diagnosis of schizophrenia, but who showed
to publish this theory in the article by Drs. Khantzian, Mack, few evidences of primary symptoms of schizophrenia and who
and Schatzberg on “Heroin Use as an Attempt to Cope: Clini- had responded poorly to phenothiazines. These patients did
cal Observations” (February 1974 issue). I no longer feel alien- show typical childhood histories of hyperkinesis. I have begun
ated and anomie. Thank you for publishing what must be as treating these patients with imipramine hydrochloride
controversial a concept elsewhere as it is in Texas. (Tofr#{228}nil), since this minimizes the potential ofdrug abuse, and
have seen definite reduction of impulsivity and emotional over-
REFERENCES
reaction.
I. Wellisch DK, Gay GR, Wesson DR. et al: The psychotic drug ad-
Some rather wild extrapolations from existing epidemiobogi-
dict. Journal of Psychedelic Drugs 4(l):46-49, 1971
cal work lead one to speculate that one out of every nine people
2. Zimmering P. Toolan J, Safrin R, et al: Drug addiction in relation identified as hyperkinetic in early childhood will be totally psy-
to problems of adolescence. Am J Psychiatry 109:272-279, 1952 chiatnically disabled as an adult, and perhaps another two will
3. Singer A: Mothering practices and heroin addiction. Am J Nurs be seriously handicapped (3). To what extent this outcome can
74:77-82, 1974 be ameliorated by pharmacotherapy instituted in adult life is
unknown. I believe it warrants careful exploration. In a recent
DAVID F. DUNCAN, M.A. NIMH workshop on drug treatment Dr. Leon Oettinger re-
Houston. Tex. ported on some hyperkinetic children he has maintained on
medication into adulthood (4), and Dr. L. Eugene Arnold and
associates also recently reported such a case (5). Since the drugs
The Ethics of “Psychiatric Profiles” most commonly used for children-amphetamines, methyl-
phenidate, and imipramine-are not interchangeable, the same
SIR: In the January 13, 1974, issue of Parade magazine, a may be true for adults. At this point I could not speculate on
supplement to many national newspapers, there appeared an ar- optimal dosage. However, I have been able to obtain a notice-
ticle based on a book by Dr. Eli Chesen that was alleged to be a able response with only 50 to 75 mg. of imipramine a day or 20

724 Am)Psychiatry 131:6.)une /974