“Saving Normal” by Allen Frances: DSM-5 Issues

My advice – the best protection against wild over-diagnosis is to ignore DSM 5. It is not official. It is not well done. It is not safe. Don’t buy it. Don’t use it. Don’t teach it. Allen Frances, MD, Saving Normal (Psychology Today blog)

But what does Allen Frances, MD, know anyway?

Well, for starters, he chaired the DSM-IV task force. Two, he’s a psychiatrist, educator, and researcher who’s intensely interested in this subject and has been writing prolifically about it. He has a whole blog called DSM5 in Distress and another called Saving Normal, the title of his brand new book. Three, besides the just released Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life, by the end of May his Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5 will also be available. 

Allen Frances stated to Michael MechanicMother Jones, that one of his main concerns is the increasing diagnoses of everyday problems and their treatment with drugs. “The drug companies have marketed heavily to primary-care doctors, who now prescribe 80 percent of psychiatric medication. That is amazing. Most psychiatric diagnosis is being done in seven-minute sessions with doctors who are not very interested or well trained in psychiatry.”

In a post on his Saving Normal blog, Frances advises therapists to stay away from the DSM V—just keep using the DSM-IV—if we don’t like the changes. Or, he adds, “buy one of many alternative guides to psychiatric diagnosis that will be available (COI disclosure- I have written one of these myself). Or…download the ICD-9-CM codes completely for free…” via the CDC.

What Frances wants all consumers of mental health services to know: “Don’t lose faith in psychiatry, but don’t accept psychiatric diagnosis or treatment on faith — particularly if it is given after a brief visit with someone who barely knows you. Be informed. Ask lots of questions. Expect reasonable answers. If you don’t get them, seek second, third, even fourth opinions until you do.”

He adds the following conclusion:

A psychiatric diagnosis is a milestone in a person’s life. Done well, an accurate diagnosis is the beginning of increased self understanding and a launch to effective treatment and a better future. Done poorly it can be a lingering disaster. Getting it right deserves the kind of care and patience exercised in choosing a spouse or a house.

Remember that psychiatry is neither all good or all bad. Like most of medicine, it all depends on how well it is done.

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