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Lee Schacter, MD, PhD
Case Western Reserve School of Medicine Veterans Administration Medical Center Cleveland

JAMA. 1983;250(6):728.

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To the Editor.—

There is nothing, it is said, that will so concentrate the mind as ascending the gallows. In this context, the observations of Derogatis et al (1983;249:751) are neither surprising nor instructive. One would be surprised if patients with cancer were not depressed or anxious. Labeling patients as having a "psychiatric disorder" because they fit the criteria of the DSM-III is a bit like calling a bat a bird because it has wings. The authors do not seem to consider the possibility that depression and anxiety are appropriate in a group of patients with potentially lethal diseases.

Many of us who treat cancer patients find few instances of inappropriate behavior by patients considering the severe stresses in their lives. Indeed, one of the positive features of an oncology practice is the lack of psychosomatic complaints. Having ascended the gallows, most patients focus on their real problems.

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