1 Boring Old Man

Since I turned my attention to the invasion of psychiatry by commercial interests, there have been some new everyday blogs you all know, like Ed Silverman at Pharmalot and Jack Friday at Pharmagossip to mention a few. But there was one that was a surprise, DSM-5 In Distress, at Psychology Today [and sometimes at Psychiatric Times or Huffington Post] by Dr. Allen Frances. I say surprise, because he’s an "insider" – a former Chairman of Psychiatry at Duke, and the person who was in charge of the DSM-IV Revision of our diagnostic manual. The story of how he decided to come out of retirement to become an active critic of the DSM-5 of his successors is well told in Wired Magazine‘s, Inside the Battle to Define Mental Illness by Gary Greenberg:

DSM5 in Distress
^{The DSM’s impact on mental health practice and research}
Psychology Today
by Allen Frances, M.D.

A New Blog Title and a New Mission: ‘Saving Normal’

DSM 5 still in distress but now already in press
by Allen J. Frances, M.D.
February 7, 2013

^{DSM 5 is a done deal — the final proofs were just sent off for printing with a mid May publication date.}

^{I began writing this blog almost three years ago hoping to warn the people working on DSM 5 off their worst decisions. For the most part I failed. About one third of my targets were dropped, but DSM 5 remains a reckless and poorly written document that will worsen diagnostic inflation, increase inappropriate treatment, create stigma, and cause confusion among clinicians and the public. APA is betting cynically that, when the dust of controversy and opposition settles, DSM 5 will still have a captive audience forced to buy and use it. Some of my most knowledgeable friends think they are right and that I have mostly wasted my time on a fool’s errand. I don’t agree. My view is that DSM 5 has taken a fatal hit internationally and is greatly discredited in US. But I may be self deluded.}

^{My mission now changes. The people working on DSM 5 are no longer my primary audience and the DSM 5 changes are no longer my primary topic. My main job now is to alert the public and clinicians on ways to contain diagnostic exuberance and to fight back against excessive and misdirected treatment for people who are essentially normal. Equally important, I will be advocating that resources be redirected towards those who are really ill and who now are shamefully neglected.}

^{The blog will also pick up on larger themes in psychology and psychiatry. The new blog site has the same title as the book I have written for the general public—Saving Normal—and is located at:}

^{http://www.psychologytoday.com/blog/saving-normal}

^{All of the blogs in the DSM 5 in Distress series will remain online and readers will still be able to comment on them. I have also written another book for clinicians—Essentials of Psychiatric Diagnosis—that provides a convenient summary of how best to make accurate diagnoses and to avoid the DSM 5 pitfalls…}

His first topic, Saving Normal [also a book out today], is a direct extension of his writing about the DSM-5 that inappropriately extends diagnostic boundaries at a time when over-diagnosis and over-medication is rampant. His second topic is on the other end of the spectrum – modern psychiatrists and psychiatry focusing on treating the psychological aches and pains of life and ignoring the severely afflicted among us who really need psychiatric attention and resources. Like Dr. Marcie Wheeler, Allen Dr. Frances is also in the expert class – having lived through and been intimately involved with all the changes psychiatry and mental health care have been through in the last forty years. We’re lucky to have him weighing in on the state of play in these confusing times [he’s also become a twitter tweeter – @AllenFrancesMD]…