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Leonard R. Derogatis, PhD
The Johns Hopkins Hospital Baltimore

JAMA. 1983;250(6):728-729.

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In Reply.—

It was somewhat disappointing to learn that our recent research on the prevalence of psychiatric disorders among cancer patients was not found to be instructive by Dr Schacter; however, on reading his letter, I believe the reasons for this pedagogic failure are rather clear.

The fundamental problem seems to reside with the fact that Dr Schacter does not assign the process of diagnosis the same pivotal status in psychiatric disorders that he presumably does in medicine in general. Taking depression as an example, he fails to discriminate between depression as a normal mood state, a symptom, a clinical syndrome, or a disease entity. Although it may be perfectly "appropriate" and understandable to react to the news of a cancer diagnosis with depressed mood, it is another matter to experience a major affective disorder (depression) concomitantly with cancer. This is particularly true since optimal treatments for the two conditions . . . [Full Text PDF of this Article]

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