Talk:Psychosis

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These really don't have anything to do with psychosis


  • The Problem of Defining Sanity for a discussion of the problems of defining reality in this context. This article, however, is fatally flawed in that sanity is a legal term and not a medical one
  • see the works of the science fiction author Philip K. Dick for a view from inside (Dick suffered from psychotic syptoms throughout his later life)

Readded line distinguishing bipolar and schizophrenia. It's rare for someone with schizophrenia to appear completely normal between psychotic episodes unless they are medicated. It's rather common for this to happen with people with bipolar disorder.

Was Joan of Arc psychotic, according to the article's definition? Shall we mention this in the article?

I suspect this question was written a couple of years ago, but to answer for the current editors - there was a school of scholarship in the twentieth century that proposed various psychological explanations for Joan of Arc's religious visions. This view was by no means universal among historians. Significantly, the people who met her during her lifetime often marveled at her mental acuity. It wouldn't be possible to maintain NPOV in this article with a short mention and an adequate treatment would probably be too digressive for an page devoted to psychosis. Durova 21:44, 2 March 2006 (UTC)
We could include a number of other prophets in this question Fred Bauder 13:25, 3 March 2006 (UTC)

Could someone include a citation for this and include the fact that this view is not generally accepted by psychiatrists?


Traditionally, psychosis was seen as arising exclusively from severe mental disturbance, however more recent evidence has shown that psychotic phenomena may be normally distributed throughout the population. It is usually only when someone becomes significantly distressed, or distresses others that psychotic experiences are considered as medical problems and become labelled as psychosis.

Yep, for example:

Johns LC, van Os J. (2001) The continuity of psychotic experiences in the general population. Clinical Psychology Review, 21(8), 1125-41
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11702510&dopt=Abstract

Verdoux H, van Os J. (2002) Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophrenia Research, 54(1-2), 59-65.
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11853979&dopt=Abstract

Changed info on link between cannabis use and psychosis in light of recent review and additional studies publishes in January 2003 edition of Psychological Medicine.

Of particular interest is the editorial which reviews the evidence for such a link:

Degenhardt, L. (2003) Editorial: The link between cannabis use and psychosis: furthering the debate. Psychological Medicine, 33, 3-6.

Also reworded info on amphetamines / hallucinogens and psychosis at top of article as it was a little ambiguous and could be interpreted as saying that LSD / mescaline caused psychosis by nature of their effect. The LSD / etc experience is not considered psychotic in itself, but psychosis may arise as an unwanted long term side effect in certain individuals -- Vaughan

Could someone explain why those two paragraphs were removed? They contained useful information and I don't see anything objectable (or even controversial) in them.

No idea. Thanks for putting them back in.

"Psychosis is a psychiatric classification for a mental state in which the perception of reality is distorted." This is an all-time champion in the field of question-begging! Who is saying what reality is? --141.219.44.80

Trust me, if you'd ever had a psychotic episode and recovered, you wouldn't be asking that question. "What is reality" is a good and important question, but I can tell you that part of the answer is "it's not psychosis" Aaargh

I am one who has been perceived as psychotic (by a psychiatrist) and to me the statement is very question-begging! (Please dont try telling me that my own perception of the statement is distorted). Laurel Bush 12:00, 31 Mar 2005 (UTC).

Just noticed that the psychosis article got added to the Brilliant Prose page. Well done to all who have contributed. Top teamwork.

Contents

[edit] Begin NPOV dispute discussion

I've removed the following, I don't think it's worth trotting out Szasz's views in quite such detail in every entry on mental illness, as this is done in more detail in Thomas Szasz, schizophrenia and anti-psychiatry.

However, not everyone agrees. Dr. Thomas Szasz (author, The Manufacture of Madness) is perhaps the leading critic of the psychiatric profession. He says, "The term 'mental illness' refers to the undesirable thoughts, feelings, and behaviors of persons. Classifying thoughts, feelings, and behaviors as diseases is a logical and semantic error, like classifying the whale as a fish. ... The classification of misbehavior as illness provides an ideological justification for state-sponsored social control as medical treatment." This view can be seen as congruent with the work of Chomsky, whose works Necessary Illusions and Manufacturing Consent address thought control in democratic societies, but via propaganda instead of psychiatric treatment.

However, I think it's important to mention the general point, so I've replaced it with the following summary and included a little about R. D. Laing's criticisms as these are specific to psychosis.

Psychosis has been of particular interest to critics of mainstream psychiatric practice who argue that it may simply be another way of constructing reality and is not necessarily a sign of illness. For example, R. D. Laing has argued that psychosis is a symbolic way of expressing concerns in situations where such views may be unwelcome or uncomfortable to the recipients. Thomas Szasz has focused on the social implications of labelling people as psychotic, a label which he argues unjustly medicalises different views of reality so such unorthdox people can be controlled by society.

- Vaughan 09:54, 8 Jan 2004 (UTC)

Some people may make that claim but they would be in essence saying that the entire field of psychology is wrong. There are clear medical features of these mental illnesses. Although psychology, like any science, is not and cannot be 100% correct (since perfection is denied to humans and their creations) none the less it is difficult for a doctor to waive her hand over someone and pronounce them as psychotic without proof and rational backing her diagonsis up.

I am going to put 'inability to cope in ' back in. If we were smart we would get a copy of the DSM-4 (Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR) and quote them on their definition of psychosis is. Anyone diagnosed with mental illness must be done in accordance with this book. --ShaunMacPherson 15:47, 3 Mar 2004 (UTC)

I just noticed my secton on Szasz was removed. While I agree that a lengthy section is probably not warranted on every page on Psychiatry, I do not consider one paragraph to be excessive. Also, while I appreciate your inclusion of a Szasz link further down, your commentary is rather weak. To say he "has focused on the social implications" is secondary to the fact that he considers most aspects of Psychiatry fraudulent, IMHO. I think for NPOV reasons, something in the introduction should indicate that this branch of science is dubious.

Bhuston 10:00, 9 Jan 2004 (UTC)

Hi Bhuston
My problem is not with the content, but it just seems a little too much detail in the psychosis article as Szasz's arguments don't apply to psychosis specifically, but are general to all of what others call mental illness. Since his arguments are covered more fully on other pages, I'm not sure of the value of including them in such detail here. The same with mentioning the opinion that psychiatry may be dubious. Surely the place for that is on the psychiatry or anti-psychiatry pages, rather than on every page about psychopathology ? However, I certainly think that the point is important, perhaps it might be worth including a bit mentioning that these arguments are better covered on his personal page (for example) ? - Vaughan 10:20, 9 Jan 2004 (UTC)

Hi Vaughan,

In answer to the above, I disagree, as even the notion of "psychopathology" is considered by some (including me), BAD SCIENCE.


I'm adding the NPOV dispute tag until the following can be resolved:

  1. General tone that psychiatry in general, and specifically this topic, are foregone conclusions based on sound science, which they are not. Simple thought experiments can show that axioms of psychiatry are opinion and not demonstratable scientific fact
  2. weak mention of Szasz
  3. "Psychosis has been of particular interest to critics of mainstream psychiatric practice who argue that it may simply be another way of constructing reality and is not necessarily a sign of illness." The premise here again is that "psychosis" is a scientifically valid concept, even amongst the anti-psychiatric people, which it is not.
  4. The following argument is presented:
    1. psychosis is a symptom of extreme mental illness
    2. psychosis is a distorted view of reality
    3. psychosis can be induced with LSD, mescaline, and marijuana
    4. conclusion: LSD, mescaline and marijuana induce (symptoms of) mental illness
    This is one possible interpretation, but not the only valid one, such as the interpreatation that hallucinogenic substances produce transcendental, entheogenic, shamanistic visions, or other mystical or religous states, which are quite valid and not to be thought of as "disease"
  5. references to United States government sources supporting such "halucinogenic plants produce mental disease", which is really WOD propaganda

Really, I am of the anti-psychiatric camp. I've seen too many people, good friends of mine, forced into barbaric treatment, electrochocked, placed into restraints, removed from their homes, forced to take psychotropic drugs, etc. and worse, all against their will. These people were not threats. The laws are barbaric, and this is based on the bad scienctific premise that there is such a thing as "normal mental states", and that such things can be defined. I will not advocate removal of the NPOV dispute until these topics are addressed in a significant fashion.

Bhuston 19:11, 14 Jan 2004 (UTC)

--

There seems to be a difference between the field of psychology as a science, and the practice of psychology by scientists (psychologists, etc.).
Psychosis seems to be a well defined collection of symptoms (behavioural, chemical, and neurological). However, problems arise when trying to measure these symptoms in people and then assigning a diagnosis to them. Putting in a section on the practice of psychology and how these professionals incorrectly diagnosis and (abuse patients in the process of this incorrect diagnosis) with well backed up information / stats is useful.--ShaunMacPherson 16:03, 3 Mar 2004 (UTC)

--


Hi Buston
I think your points are good ones, but they apply to the classification of ALL MENTAL ILLNESS by psychiatrists, not just psychosis. I think this objection is quite fundamental when we are discussing where your points should go.
The premise here again is that "psychosis" is a scientifically valid concept, even amongst the anti-psychiatric people, which it is not.
I don't think anyone has ever argued that the classification of psychosis is based on science and the article certainly doesn't, as the classification of anything is a pre-scientific concept. In other words, to classify anything you have to set your criteria before-hand and then use science to see if things fit into your classification. So this is not a problem with psychosis per se, but with all types of classification, and especially with the classification of any type of human behaviour. For example, the classification of what consititutes remembering and therefore what is classified as amnesia is subject to exactly the same objection.
Psychosis is a concept (not a 'scientific fact' - i.e. the result of a tested hypothesis), and even anti-psychiatry advocates understand what is meant by it, even if they don't agree with the implications of its use.
Since it is the psychiatric implications you disagree with, rather than (I presume) the classifying human behaviour, I would argue that this is not the place for your original comments.
However, I think you've raised an important point mentioning hallucinogenic drugs, as this case shows some of the shortcomings of the article in describing the psychiatric concept. Experiences caused by such drugs are not considered to be a sign of psychosis because they are short term and abate when the body metabolises the drug out of the bloodstream. I think it should be mentioned in the article that psychosis is considered to be a a reaction beyond the immediate psychotropic influence of any drug and is in some way impairing or distressing.
references to United States government sources supporting such "halucinogenic plants produce mental disease", which is really WOD propaganda
 ? - I see no references to any government sources in the article.
- Vaughan 21:31, 14 Jan 2004 (UTC)

I'd like to removed the The neutrality of this article is disputed notice. Since it was added I think the points of contention have been addressed, however perhaps any objections can be voiced here. If none are made, I'll remove the notice during the next few weeks. - Vaughan 20:43, 6 Feb 2004 (UTC)

I've reverted the following additions to the introductory paragraph:

"there is extensive disorder of the personality"
"and an inability to effectively cope in society"

This is the traditional psychaitric view and is considered increasingly outdated. For example, see the Johns and van OS (2001) paper (reference 10), Bentall's work and the work by Fromme and Escher with the 'Hearing Voices Network'. i.e. Many people may fulfill the diagnostic criteria for a psychotic illness despite functioning perfectly well and maintaining an integrated personality.

- Vaughan 13:34, 27 Feb 2004 (UTC)

There is a reason why many psychotic people are in mental institutions: they cannot cope in society. To pretend that they could is disingenuous.

If you prefer (after citing a scientific webpage that shows what % of psychotic paitents are able to cope so we can use the correct adjective) I'd have no objections to it being changed to '*sometimes accompanied* with an inability to cope in society' if a majority of people diagnosed with a psychotic illness can indeed function in society. --ShaunMacPherson 16:12, 3 Mar 2004 (UTC)

Hi there Shaun,
The DSM entry for psychosis is here. Specific diagnostic criteria is not outlined in the DSM because it is not a diagnosis in itself. It is a feature of, or a reaction to other conditions such as schizophrenia, or for example stress (in the case of brief reactive psychosis) and so on.
As for percentages, if we define psychosis as including hallucinations or delusions (as per the DSM, although it is not the final world in diagnosis, there are many other diagnostic systems used throughout the world), a study by Ohayon (2000) showed that 39% of people in the general population reported hallucinations. A study measuring delusional ideation in the general population by Peters et al (1999) reported that "The ranges of scores between the normal and deluded groups (i.e. inpatients) overlapped considerably".
The disintegration of personality and inability to cope in society is part of the diagnostic criteria for schizophrenia (see criteria B of the DSM-IV-TR criteria here) but psychosis can exist without these features and they do not define it in any way.

Very good then "an inability to cope in society" should be in the introduction since schizophrenia is a significant fraction of people with psychosis. As i've already stated if you want to add "sometimes/often/in the case of many disorders/etc. accompanied by...an inability to cope in society" then that is fine with me.

For example, delusional disorder is a psychotic disorder (see its DSM entry under 'Schizophrenia and Other Psychotic Disorders' here) but specifically states that general functioning should not be impaired.

Is delusional disorder a significant fraction of the psychosis patients like schizophrenia (~25%) is? I hope you are not using the exception to prove the rule.

In fact, there are even moves to remove the signs and symptoms of psychosis from the diagnostic criteria for schizophrenia, in favour of specific neurocognitive deficits. This is discussed at length in a recent article by Tsuang et al's and in Green's recent book Schizophrenia Revealed (ISBN 0393703347).

Yes, so?

Just because there are some people with psychosis who can't cope in society, doesn't mean that it is necessarily a defining feature of it. -

Vaughan 17:10, 3 Mar 2004 (UTC)

Just because some people with psychosis can cope in society doesn't mean it isn't necessarily a defining feature of it. --ShaunMacPherson 11:21, 11 Mar 2004 (UTC)


Additionally, I found a study which found that suggests that the minority of people who fulfill the criteria for psychosis are clinically impaired in any way. Abstract here.
I propose removing the "disorder of the personality" and "inability to cope in society" description from the introductory paragraph as is seems neither supported by the DSM nor recent research. However, I think these are interesting points and would like to suggest a section titled "Is psychosis an illness ?" (or similar) where these points can be discussed, alongside the bits elsewhere in the article about Laing and Szasz's view of psychosis and Jfdwolff's suggestion incorporating non-psychiatric aetiologies into the article.
I'll make a start shortly, so please voice any objections here or edit once it's in place. - Vaughan 16:22, 8 Mar 2004 (UTC)

Secondary psychosis I've introduced a small list of diseases that can induce psychosis, e.g. Lupus Erythematosus and Sarcoidosis. I did not have the time to find a more complete list, but I felt this belonged here. Jfdwolff 08:57, 1 Mar 2004 (UTC)

Unfortunately, the list would be very long indeed as psychosis has been reported to occur in association with almost every form of disease known, including ones traditionally thought to be relatively benign and not usually associated with neurotoxicity, such as flu, mumps and rickets. In fact, almost any combination of 'psychosis' and another randomly selected disease will bring up a case on PubMed.
I'm also a little uncomfortable about the use of the term 'Somatic diseases' as it suggests that mental illnesses aren't located in the body which seems to smack of dualism for me.
So, I'm not entirely sure such a list would be useful. However, perhaps some others could give their views here ? - Vaughan 09:26, 1 Mar 2004 (UTC)

Thanks Vaughan, I'll be more specific. Of course any disease can also luxate psychosis (there's a seperate DSM code for this phenomenon). There are, however, some diseases which are very prone to cause psychosis. Up to 25% of all Lupus patients have a psychosis at some point through their disease, which is very high indeed. Most 'flu' patients do not get psychosis :-).

The use of the word "somatic" is entirely because this is the way psychiatrists talk. Allright, the brain is also an organ, but psychiatry has benefitted immensely from the distinction of "psychiatric" and "somatic". The third axis in DSM diagnosis is reserved for so-called "somatic" diagnoses.

Hope this clarifies my contributions. Jfdwolff 20:05, 1 Mar 2004 (UTC)

Hi again Jfdwolff,
Good point. Perhaps it would be better to have a 'top 10' or similar of conditions most associated with psychosis, rather than an open list as I fear it may simply be continuously added to over time and become increasingly useless as the list becomes excessively large and, like you say, full of rare cases.
Unfortunately, after a quick literature search has brought up nothing of obvious relevant that might provide this information, however I will continue looking both on and offline and see what I find. If you know of any such sources, please post them !
As to your second point, although psychiatry may have benefitted from the distinction between 'somatic' and 'psychiatric' in the past, I would argue it is becoming increasingly redundant. More importantly I don't think a wikipedia should simply uncritically reproduce psychiatric definitions, especially where they are confusing. Perhaps a note on 'secondary psychoses' and a mention of Tsuang et al's influential paper on etiology of psychosis might be informative on this issue ? - Vaughan 21:08, 1 Mar 2004 (UTC)

Hi Vaughan. Unfortunately I lack the time to compile an authoritive list of disorders associated with psychosis. Cerebral Lupus and Sarcoid definitely belong here, though. In order to meet with your objections, the header could be changed to read: "Non-psychiatric disease associated with psychosis" (to eliminate the "somatic" bit). Tsuang et al seem to focus mainly on the classification of schizophrenia, which - although the most important - is only one of the causes of psychosis. I would agree that this is an important reference, but more properly in the Schizophrenia entry. Jfdwolff 16:41, 3 Mar 2004 (UTC)


Hi Jfdwolff,
Excellent suggestion. I am in the process of compiling a list and will certainly add your information and perhaps you can check it over once completed? The Tsuang article is focused on the classification of schizophrenia but makes wider points about the separation of psychosis and schizophrenia. - Vaughan 17:11, 3 Mar 2004 (UTC)

Vaughan, I'm embarrassed to say that I've not properly read the Tsuang article, and I beg to understand what light it might shed on secondary psychosis. I've personally never heard of secondary schizophrenia, nor does it sound plausible. I'm very interested about your list! Jfdwolff 15:26, 5 Mar 2004 (UTC)


Hi, It gives a suggestion for hearing voices - internal voices that are mislabeled. I've had a possible idea about that. You know when you leave on the microphone on voice recognition software, and it tries to make words out of background noise. The software makes sure it generates gramatically correct sentences. What if that is happening in real life? An over sensitive recognition system, combined with hearing what you think you should hear. I know this is offtopic, sorry about that. Does anyone know if this has been suggested, and is it a theory? Could this idea be added in someway? Thank you for your time. JohnFlux 19:22, 24 Apr 2004 (GMT)

What's the deal with the PC treatment? Is it taboo to call psychosis a disease/disorder/ailment?

[edit] Psychotic experience

An anon user deleted the following:

Although usually distressing and regarded as an illness process, some people who experience psychosis find beneficial aspects and value the experience or revelations that stem from it.

I have not personally heard of anyone saying this but someone has added this to the article and I believe that should be respected and thus reinstated. How does everyone else feel about this? --CloudSurfer 03:18, 20 Oct 2004 (UTC)

Hi CloudSurfer,
I've reinstated it, as it is plainly clear from the work of people like R. D. Laing and others (whatever you think of his theories) that some people do find beneficial aspects to psychosis. I've personally met many patients who found insights they gained from the experiences were positive, even if the majority of their psychotic experience was distressing or impairing. - 131.251.37.132 07:13, 20 Oct 2004 (UTC)

Requesting that someone add "ICU psychosis" to the article.

Hi SueNami,
I think 'ICU psychosis' is a bit of a misnomer (albeit a commonly used one) as it usually refers to a state of delirium. Nevertheless, it might be useful to add a section on the more esoteric uses of the term 'psychosis' in the medical literature (such as so-called 'airport psychosis') and a note on the fact that the term may be used more loosely in these situations.
- Vaughan 21:17, 9 November 2005 (UTC)

The article is lovely!

Is there a cure, I can't be bothered to read the above paragraphs to find out

According to R.D. Laing, psychosis itself could be the cure.

[edit] Removed 'Hearing voices' section

I removed the following section that was recently added, as it seems to be someone's personal experience of psychosis. However, it reminded me that the article doesn't particularly address the magical thinking / apophenia aspect (see connections everywhere) very well, which probably needs a bit more elaboration. - Vaughan 07:49, 17 July 2006 (UTC)

Hearing Voices - Explained
Individuals that "Hear Voices", contrary to what's listed above, very rarely hear ACTUAL voices inside their head. More often than not, the term 'hearing voices' is used to explain a phenomena un-explainable by current medical knowledge; When going through a period of Mania, or Depression, it's common when experiencing psychosis to have a feeling of 'a greater power' controlling the things in daily reality. Things such as lights flickering, television reception, etc. When a person experiencing psychosis has racing thoughts (thoughts moving much faster than normal), often co-incedances are sought after as everything is believed to have meaning to a greater purpose. When certain things happen, such as say a poster comes loose from a wall and falls to the floor, it's believed by the psychotic person that 'the higher power', whatever it may be, caused the poster to fall, which then causes the attention of the psychotic person to start paying close attention to all their senses, looking for signs that the higher power is trying to tell them something. If for example they are wondering if they should go and get a drink of water because they are thirsty but are indecisive as they are currently engaged in an activity, the poster falling off the wall depending on where it is hung would be the determining factor on them getting a drink. If the poster was hung close to a sink or next to the fridge, it would be a 'sign' that they should get a drink. If it was opposite them, it would be perceived to continue their activity and ignore their bodies request for fluid.
Combine all external stimuli, from fans going on and off in an office space, to the volume level of a television program in between commercials, people experiencing psychotic symptoms often portray these stimuli as something/someone trying to communicate with them - hence being spoken to, aka, hearing voices.

[edit] Reference format

Hello all. I'm a newcomer to this article and thought it would be good to give references in the way I've been doing in the etymology section; can get back to the main text after clicking on the reference link. I haven't had time to sift through the references yet. The page Wikipedia:Citation templates may be useful. Thanks. I've made a start at this. Will come back to finish it off (unless someone else wants to). MP (talk) 12:56, 19 August 2006 (UTC)

[edit] Recent reference additions

Just a note for people adding new references to the article. Most are fantastic, but please read them through to get an idea of their signficance, as some are a bit outside of the mainstream literature for the point being referenced.

For example, the article "Chronic phencyclidine administration induces schizophrenia-like changes in N-acetylaspartate and N-acetylaspartylglutamate in rat brain" is not great evidence that PCP is linked to psychosis. PMID 6725621 is a much better reference to support this claim (actually describes cases of people with phencyclidine-induced psychosis).

Other than that, it's looking good and I'll sift through the article myself shortly.

- Vaughan 06:47, 29 September 2006 (UTC)

[edit] Neurotoxicity?

In the section "Brain function", following is written:
"Findings such as these have led to debate about whether psychosis is itself neurotoxic and whether potentially damaging changes to the brain are related to the length of psychotic episode."
Use of term "neurotoxic" as such is inappropriate here; neurotoxicity, or toxicity in general applies only to a substance i.e. a poison/toxin/venom. Toxicity is a characteristic of a substance, it can not be used to describe a condition. That means, that patological processes can't be described as "-toxic" unless they are caused by a poison/toxin. Thus, I suggest to change this term with "neurodegenerative", which, in my opinion, describes the situation related to psychosis better/more accurate than "neurotoxicity".--Spiperon 21:00, 25 October 2006 (UTC)


Hi there,
The progression of conditions can be described as neurotoxic when a toxin is theorised (even if it has not been identified) and there is an ongoing debate in the psychosis literature about whether psychosis is neurotoxic or not. e.g. see this review article. - Vaughan 06:41, 26 October 2006 (UTC)


Even in the quoted article abstract, it is stated that "...Synaptic plasticity, not neurotoxicity, appears to be the mediating process.". Neurotoxicity as such necessarily implies an action of a poison, not hypothesis about it. Neurodegeneration, in turn, may be an effect of neurotoxicity as well as other causes, and is therefore more appropriate, in my opinion.--Spiperon 07:17, 28 October 2006 (UTC)
Hi there,
As I mentioned before it is possible to talk about a condition being neurotoxic, if one suspects an unknown neurotoxin at work. The reason the article says "Synaptic plasticity, not neurotoxicity, appears to be the mediating process" is not because you can't talk about neurotixicity in this instance (if that were the case, how could you write a review article in a scientific journal using this exact terminology?) but because it argues that there is no evidence for neurotoxicity.
Neurodegenerative is not appropriate because the debate about whether idiopathic psychosis is neurodegenerative has been largely rejected (e.g. when Bleuler changed the named from dementia praecox to schizophrenia exactly because there was no evidence of neurodegeneration).
The sentence in the article "Findings such as these have led to debate about whether psychosis is itself neurotoxic and whether potentially damaging changes to the brain are related to the length of psychotic episode" is accurate because it accurately describes the debate in the medical literature. If you don't agree with how the term is being used, this doesn't change the fact that it is being used in that way.
- Vaughan 10:02, 29 October 2006 (UTC)
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