Allen Frances Is Preoccupied With “Saving Normal”

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 explains one of his main concerns to Michael MechanicMother Jones:

There’s been a rapid diagnostic inflation over the course of the last 35 years, turning problems of everyday life into mental disorders resulting in excessive treatment with medication. Pretty soon everyone’s going to have a mental disorder or two or three, and it’s time we reconsider how we want to define this and whether the definitions should be in the hands of the drug companies, which is very much what’s happened in recent years…

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 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 at http://www.cdc.gov/nchs/icd/icd9cm.htm.” (The latter is the International Classification of Diseases.)

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.

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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