If you were ever leery of journalists, now you’ve got even more reason to be leery of them. Retired psychiatry professor Allen Frances, critic of the DSM-5 revision process, just conducted a class for journalists. The article, in Scientific American of all places, bears the sensational heading, just the kind of thing Dr. Frances wants, “Is Anybody Sane Here”, Said the Psychiatrist to the Journalists.
Frances is a retired psychiatrist and you might know of him from his blogging or frequent media interviews. He chaired the committee that developed the DSM-4: the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders. And he’s a key leader in the charge of dismay about the next edition, DSM-5, that’s due to appear later this year. It will likely vastly expand the many ways you can get a mental illness label. You can read more about that at Scientific American and an important article on conflicts of interest in PLoS Medicine.
Okay, Dr. Frances was instrumental in developing the DSM-IV that ‘vastly expanded the many ways you can get a “mental illness” label’. Now he is posing as the chief critic of the effort by the DSM-5 revision team to ‘vastly expand the many ways you can get a “mental illness” label’. Hmmm. Curious indeed.
How big is the problem? Using DSM-4 criteria for mental disorders, almost half the people in the US are getting a diagnosis of a mental disorder in their lifetime – and other countries aren’t far behind. Frances fears that “the pool of normal is becoming a small puddle.”
This is the real issue, between people who are “normal” and people who are labeled “disordered”, where do you draw the line? Dr. Frances, after putting the line over there, wants to pull the line back over here. Okay, that might help, but you’ve still got a number of people pigeon-holed because of that line. For some of us the question is whether there should be a line drawn in the first place.
Frances called for “Saving Normal” (the title of his forthcoming book). Some of his prescriptions are radical. For example, not just fines for drug companies that misbehave, but reduction of patents. And an “FDA” to determine diagnoses rather than allowing specialist groups who are over-invested in their “pet” diagnoses to hold such sway: “If you’re an expert you love your diagnosis – it becomes your pet. It’s human nature.”
Dr. Frances thinks we need a better DSM. A DSM that is more scientifically valid. Some of us think the DSM IS the problem, there is no way for it to become scientifically sound, and that it should be canned altogether because it was a bad idea from the get go. Obviously, if it was a bad idea, growing to almost 400 “disorder” labels in length is an even worse idea. Now really, you’ve got all these doctors sitting around, inventing “diseases”, and filling this manual with ill health demons of their own fanciful imaginings. Get a person to believe his or her problems amount to a “disease” requiring specialists, pill bottles, and permanent disability payments, and boy oh boy, you’re in business big time.
Oops. Wouldn’t stifling some of this labeling of so called “normal” people poke a big hole in the national mental health industry pocket? “Mental disorder” labeling is still your big ace in the hole, Dr. Frances. We can get by on “truly disordered”. Sure, we can do that. They are, after all, “really” “disordered”. We, of the psychiatric profession, should know. We’ve been calling them crackers for centuries. We’ve got more than enough cracked cases to go around. The thing is, if you scrutinize some of those cases more closely, they aren’t so cracked after all. The only trial they get is the trial of expert opinion, and that expert opinion is known to be way way off. Take the DSM-I through etcetera, for starters, and examine how absolutely bonkers that document actually is in places.
Don’t get me wrong. I’m not saying Dr. Frances doesn’t have some good proposals, and that they shouldn’t be implemented. I’m just saying that it’s unlikely that any proposal Dr. Frances comes up with is likely to go far enough. Prevention is the goal, and right now, we’re still pretty much dealing with the causative factors in a contagion. Funny thing, we’re also dealing with “disease” that is only figuratively “disease”. Considering, you wouldn’t think prevention would be such a difficult feat to accomplish. Of course, that isn’t considering the corporate empire that thrives on “disease”, be it figurative or bacterial.