Psychiatry, like all other professions, has its upside and its downside. Psychiatry is one of the latest specialties in health care to emerge and, therefore, it is not far removed from its more "imprecise" period. Every health care specialty has had an "imprecise" period. In that sense, there is no argument against the fact that psychiatry and psychiatrists should pay close attention to the conflicts in their field and note how much their field is like cardiology before cardiologists could do procedures like electrocardiograms, open-heart surgery, angiograms, and ultrasound.

I don't think there is any organ more complex than the brain. Since brain structure and physiology are so complex, the understanding of its circuitry and biology are in its infancy. Dr. Hoeller wants us to believe that because "the precise causes (etiology) of mental disorders are not known" that we should wait before we try to assist people with less precise concepts and strategies. (Italics mine). If any other health-related science or profession had proceeded in such a manner, just think where the treatment of heart disease or diabetes would not be today. The history of health care science is riddled with imprecision while the precision was being developed.

Dr. Hoeller would have us believe, for instance, that the symptoms of Dementia of the Alzheimer's Type, a mental disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), cannot be ascribed to any biological, physical, or genetic origin. The DSM-IV has its upside and its downside. But, by dismissing all diagnoses found in the DSM-IV, Dr. Hoeller does a disservice to his community of scholars. The DSM-IV is not just a product of psychiatrists, but a product of a task force which included many psychologists and other professionals and is endorsed by the American Psychological Association.

Dr. Hoeller and his colleagues appear to be exploiting the semantic weakness of the term "mental illness." Illness is defined as a "disease of body or mind." Can you really have a disease of the mind? In my opinion, it is a fundamental flaw to define mental illness as a disease of the mind. The mind is not a physical entity, so how can it have a disease? The DSM might do better with a name such as "The Official List of Mental and Emotional Conditions." Some conditions will clearly be illnesses or disorders; many of them will not.

Dr. Hoeller notes that eight MindFreedom members began their Fast for Freedom to "demand that the mental health industry produce even one study proving the common industry claim that 'mental illness is biologically-based.' " It is difficult to view this behavior as anything other than grandstanding. Dr. Hoeller and his colleagues on the "expert panel for the strikers" have access to all the scientific literature and can determine on their own the answer to the question. The fact that they have ignored conclusive findings about brain structure and related cognitive and behavioral problems means that he and his colleagues are exploiting the weakness of the term "mental illness" to exclude all well-known brain-structure-related cognitive and behavioral abnormalities.

"Psychiatric survivors," for the most part, have been the victims of what I would call "over-treatment" based largely on the politics of control-freaks, and the impreciseness of behavioral science. The founders and movers of the National Alliance for the Mentally Ill, for the most part, are responding to situations where they or their loved-ones have been the victims of "under-treatment" based largely on the politics of free-will activists, and the over-cautiousness of scared providers. Both groups of advocates are looking for a balanced and humane approach to complex behavioral and cognitive problems. They both deserve respect and admiration for their missions.

Because psychiatry and psychology deal with some of the most intimate and sensitive issues in our lives, all mental health care professionals need to pay very close attention to the conflicts and limitations in our current understanding of brain function and dysfunction. To say that we know most of the answers to cognitive and behavioral problems or to get intellectually lazy would be just as dangerous as Dr. Hoeller's suggestion that a science that is in its childhood should be relegated to the ranks of astrology and phrenology.

• Seattle P-I guest column posted August 29, 2003 -- No proof mental illness rooted in biology.

• Seattle P-I guest column posted September 9, 2003 -- Focus discussion on the mentally ill.

• Seattle P-I guest column September 9, 2003 -- Hoeller does disservice to professionals.

• Seattle P-I follow-up Letters -- Letters to the Editor, September 12, 2003.