Allen Frances And The DSM-5

Allen Frances, Duke University psychiatry professor emeritus, isn’t so much a critic of the Diagnostic and Statistical Manual of Mental Disorders as he is a critic of the DSM revision process. Apparently he has a love/hate relationship with the manual itself. He doesn’t object to the DSM, psychiatry’s label bible, so much as he objects to what he sees as a rushed and flawed job that could result in a shoddy product. He objects to a process that he thinks will produce a lower quality product than a more thorough going process would produce.

He himself was one of the architects of the DSM-IV. The DSM-IV was notorious for raising the “mental illness” rate throughout the world. The DSM-5 is expected to smooth out a few more of the wrinkles in the DSM-IV. Although current criticism of the DSM revision process may make the DSM-5 less of an open Pandora’s Box, or contagion zone, than no criticism whatsoever would, the publication of the DSM-5 is expected to raise the rate of mental illness around the world substantially again. Make no mistake about it; what is going on here, with the hoopla surrounding the revision and publication of this manual, is the selling of “mental illness”!

His latest jabs at this process on his Huffington Post blog have been aimed at the price tag. A recent blog post of his bore the title, DSM-5 Costs $25 Million, Putting APA in a Financial Hole. The DSM-5 has cost 5x the amount already that the DSM-IV cost. The APA is in the hole right now because of this price tag.

The American Psychiatric Association just reported a surprisingly large yearly deficit of $350,000. This was caused by reduced publishing profits, poor attendance at its annual meeting, rapidly declining membership, and wasteful spending on DSM-5. APA reserves are now below “the recommended amount for a non-profit (reserves equal to a year’s operating expenses).”

$350,000 in the hole to be exact because of a multi-million dollar revision process owing in part to the objections of critics such as Allen Frances.

APA has already spent an astounding $25 million on DSM-5. I can’t imagine where all that money went. As I recall it, DSM-IV cost about $5 million, and more than half of this came from outside research grants. Even if the DSM-5 product were made of gold instead of lead, $25 million would be wildly out of proportion. The rampant disorganization of DSM-5 must have caused colossal waste. One obvious example is the $3 million spent on the useless DSM-5 field trial, with its irrelevant questions, poorly conceived design, and embarrassing results.

The DSM-5 was due to be published in 2012. Because of the objections of many psychologists and the likes of Allen Frances publication was suspended for a year. The revisers of the DSM-5 are also going out of their way to get input from interested parties. Actually, and to be more precise, the revisers are busy at damage controll by giving the appearance of giving an ear to critics for public relations purposes. The upper echelon of the APA don’t want democracy. Dialogue is not what coming up with “mental disorder” labels is all about. There is, for example, no No Mental Disorder Not Otherwise Specified category in the manual.

If stage one were field testing, stage two is quality control. Stage one a disaster, in his view; he sees quality control as the issue in a more recent post, Follow The Money, on these monetary difficulties lost to the DSM-5 revision process.

APA was faced with 2 choices: 1) go ahead with Stage 2 to clean up the mess; or 2) declare Stage 2 unnecessary and publish a poorly edited, unreliable, and untested DSM-5. APA chose the second option and is rushing toward a forced, premature birth of DSM-5.

Actually, as pointed out above, publication had been suspended earlier, and so this would entail suspending publication yet again. This suspension proposed by Allen Frances also begs the issue of the rising tab and the debt. If the DSM-5 revision has cost $25,000,000 already, continuing to haggle over the minutae and specifics of “mental disorder” labels is not going to bring this tab down.

Since there is no pressing need to publish the DSM-5 quickly, let’s follow the money. The APA budget depends heavily on the huge publishing profits generated by its DSM monopoly. APA needs the money badly. It is losing paying members; other sources of funding are also on a downward trend; and its budget projections require a big May 2013 injection of DSM-5 cash.

Is there a pressing need to publish the DSM-5 at all? Oh, yeah! The money! The patients? Well, they’re going to rot anyway, and so we might as well take advantage of them and their plight. What can they do?

As someone with a history of activism in the psychiatric survivor movement, I have objections to the DSM-I through 5. Our problem stems precisely from the fact that these psychiatrists, with their medical degrees, and their drug company ties, are putting professional interests ahead of their patients’ health. These medical doctors are putting their own standing above the health of their patients to the detriment of their patients’ health. Allen Frances, the retired psychiatry professor, is as guilty as any of them.

Allen Frances is playing a double game. If he has to settle for a shoddy product, to him it’s better than no product at all. This product could be “medicalizing normal”, as he puts it, right and left. This represents a glitch the next edition can potentially clear up. He can immediately start projecting his wishes onto a revision of the DSM-6. He may not be alive then, but his followers can continue to opt for a little more rigor in the revision efforts. I just don’t see how any amount of rigor is going to resolve the basic lack of real science you’ve got in the DSM. There is no real science involved in the selection of “disease” labels by committee.

We don’t really have a potentially bad edition of a good book going on here. We just have another bad edition of a bad book that was a bad idea to start with. The DSM should be scrapped altogether for other approaches that don’t owe so much to biological bias and drug industry profiteering. Lives are on the line, and as long as the current toxic paradigm, supported by the DSM, is in operation, more of those lives are going to be lost. The APA can find other ways to fund its nefarious activities. The DSM is basically fraud, but unfortunately it’s a fraud that it appears is going to continue for some time to come. Again, and emphatically, it should be scrapped entirely!

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9 Responses

  1. Freedom to be anything other than a state-sanctioned clone is at risk too.

    The APA is full of malignant narcissists and psychopaths by their own description. I cannot understand why their blatant conflicts of interest and clearly manufactured new disorders are not currently the catalysts for an official block on the publishing of the DSM-V. Unless..

    This on the “forfeited its right” link also by Allen Frances was better:

    http://www.nytimes.com/2012/05/12/opinion/break-up-the-psychiatric-monopoly.html

    • Don’t be fooled! Allen Frances is playing two ends against the middle. He’s pulling strings.

      Here he says the DSM-III was an improvement. He had something to do with the revising that lead to that edition of the manual. He also worked on the DSM-IV. He’s also another shrink that objects to psychoanalytic approaches. He is, in a word, bio-bio-bio-psychiatric. Consciousness, & the consciousness of shrinks, is kaput.

      The DSM-III raised the number of insults to throw at people from 185 (DSM-II) to 265. There are now (DSM-IV) 374 such labels to attach to people. These guys get together in committee, and vote “disease” labels into existence. We don’t need more people drawn into this business of name calling and “disease” fabrication. We need them to stop calling people names.

      Psychiatric labeling is harmful in itself. It is part and parcel of the Church of Biological Psychiatry’s strident demand for universal belief in “mental illness”. As soon as they come up with a label, don’t you know, some drug company will be developing a drug to use on it. What else would they be charging the insurance companies for? Now that shrinks don’t talk, they scribble on prescription pads. It’s as simple as ABC.

      Allen France’s concern is not going to produce a better product in the end. This book can only get worse. It should be scrapped altogether.

  2. Don’t worry, I am not.

    This is from:

    http://www.beforeyoutakethatpill.com/2009/6/Frances_DSM-5.pdf

    and bears out your comments regarding his bio-psychiatry leanings:

    “The work on DSM‐5 has, so far, displayed an unhappy combination of soaring ambition and remarkably weak methodology. First, let’s expose the absurdity of the DSM‐V claim that it will constitute a “paradigm shift” in psychiatric diagnosis and indicate the dangers inherent in pursuing this false goal. The simple truth is that descriptive psychiatric diagnosis does not need and cannot support a paradigm shift. There can be no dramatic improvements in psychiatric diagnosis until we make a fundamental leap in our understanding of what causes mental disorders. The incredible recent advances in neuroscience, molecular biology, and brain imaging that have taught us so much about normal brain functioning are still not relevant to the clinical practicalities of everyday psychiatric diagnosis. The clearest evidence supporting this disappointing fact is that not even one biological test is ready for inclusion in the criteria sets for DSM‐5.”

  3. In two parts due to a glitch:

    Biological methodology has merit but is dangerous insofar as it can be manipulated for profit and for social control. When it is introduced – which it will be – there is a need for stringent controls on its application.

    There is validity in many of Frances’s comments about the DSM-V but I see his protection of the earlier DSM publications.

    Belief in the DSM has set a dangerous precedent for judging others and finding them flawed in some way or another. This leads to separation and persecution. I agree that this overrated book ought to be scrapped.

    • I don’t agree with you about “biological methodology”. Most of this biological based research is predicated on fatalistic assumptions made about people it views as not normal. Most this research, given the fatalistic perspective behind it, is directed towards drug development and treatment. It is not recovery oriented, and it completely ignores the social and psychological factors involved in distressful situations.

      No theory has a comfortable freeway for exceptions to exit on. Many of the people snagged by the mental health system, I hesitate to say all, simply aren’t doomed by biology. If they are doomed, they are doomed by researchers looking for a biological excuse to view them fatalistically as non-recoverable subhumanity.

  4. I have given thought to what you have said on this matter before and concur that researchers have been looking for the potential to malfunction. However, I tend to think there is something to the biological model, so continue to research it.

    This is a an excerpt from:

    http://www.theatlantic.com/magazine/archive/2009/12/the-science-of-success/7761/1/

    “The team was also testing a radical new hypothesis about how genes shape behavior—a hypothesis that stands to revise our view of not only mental illness and behavioral dysfunction but also human evolution.

    Of special interest to the team was a new interpretation of one of the most important and influential ideas in recent psychiatric and personality research: that certain variants of key behavioral genes (most of which affect either brain development or the processing of the brain’s chemical messengers) make people more vulnerable to certain mood, psychiatric, or personality disorders. Bolstered over the past 15 years by numerous studies, this hypothesis, often called the “stress diathesis” or “genetic vulnerability” model, has come to saturate psychiatry and behavioral science. During that time, researchers have identified a dozen-odd gene variants that can increase a person’s susceptibility to depression, anxiety, attention-deficit hyperactivity disorder, heightened risk-taking, and antisocial, sociopathic, or violent behaviors, and other problems—if, and only if, the person carrying the variant suffers a traumatic or stressful childhood or faces particularly trying experiences later in life.

    This vulnerability hypothesis, as we can call it, has already changed our conception of many psychic and behavioral problems. It casts them as products not of nature or nurture but of complex “gene-environment interactions.” Your genes don’t doom you to these disorders. But if you have “bad” versions of certain genes and life treats you ill, you’re more prone to them.

    Recently, however, an alternate hypothesis has emerged from this one and is turning it inside out. This new model suggests that it’s a mistake to understand these “risk” genes only as liabilities. Yes, this new thinking goes, these bad genes can create dysfunction in unfavorable contexts—but they can also enhance function in favorable contexts. The genetic sensitivities to negative experience that the vulnerability hypothesis has identified, it follows, are just the downside of a bigger phenomenon: a heightened genetic sensitivity to all experience.

    The evidence for this view is mounting. Much of it has existed for years, in fact, but the focus on dysfunction in behavioral genetics has led most researchers to overlook it. This tunnel vision is easy to explain, according to Jay Belsky, a child-development psychologist at Birkbeck, University of London. “Most work in behavioral genetics has been done by mental-illness researchers who focus on vulnerability,” he told me recently. “They don’t see the upside, because they don’t look for it. It’s like dropping a dollar bill beneath a table. You look under the table, you see the dollar bill, and you grab it. But you completely miss the five that’s just beyond your feet.”

    Though this hypothesis is new to modern biological psychiatry, it can be found in folk wisdom, as the University of Arizona developmental psychologist Bruce Ellis and the University of British Columbia developmental pediatrician W. Thomas Boyce pointed out last year in the journal Current Directions in Psychological Science. The Swedes, Ellis and Boyce noted in an essay titled “Biological Sensitivity to Context,” have long spoken of “dandelion” children. These dandelion children—equivalent to our “normal” or “healthy” children, with “resilient” genes—do pretty well almost anywhere, whether raised in the equivalent of a sidewalk crack or a well-tended garden. Ellis and Boyce offer that there are also “orchid” children, who will wilt if ignored or maltreated but bloom spectacularly with greenhouse care.”

    This article and others like it make a lot of sense to me. Please have a read and let me know what you think.

    • I don’t think good parents of children in their terrible twos would give their kids over to researchers looking for bad genes. I really don’t think leaving child-rearing practices to mental health professionals the right thing to do either.

      “Dandelion” or “orchid”, children are children, and not vegetables, and they need to be given unconditional love if they are expected to grow and learn. I worry about all these leaps to judgment, and all this labeling, especially of toddlers.

      Statistically speaking, statistical speaking is not always the best kind of speaking to engage in. If transcending statistics is the way to go, maybe that is what we really ought to be looking at. What is going on with those kids who defy statistical analysis?

  5. I agree. What sticks out to me however is that despite the prevailing desire to find fault, there are scientists who have looked further and have found that the prevailing science is flawed.

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