I happen to know this guy who knows a lot about mental-health policy. And, well, okay, he happens to be my father. So my ears perked up recently when my dad mentioned that the DSM-5, the latest in a series of diagnostic manuals soon to be published by the American Psychiatric Association, is something of a disaster.
Indeed, at the end of April, the National Institute of Mental Health (the branch of the NIH that funds mental-health research) took the drastic step of renouncing the latest DSM (short for Diagnostic and Statistical Manual of Mental Disorders) in advance of its publication—renouncing the whole DSM system, really—and replacing it with something called Research Domain Criteria. (Read more…)
“Basically, they said they would no longer use it as a main test in grant requests,” explains psychiatrist Allen Frances, who chaired the task force that produced the prior version, DSM-IV (past editions used roman numerals) during the 1990s. “They made it sound like DSM-5 and all the DSMs were invalid, and that we should wait for the new discoveries that were going to come from scientific endeavors.”
Frances considers the NIMH’s move misguided, but he’s no fan of the DSM either. That much is clear from his new book, Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. (The New York Times reviews it here.) Given the current upheaval in psychiatry, and the impending release of the new diagnostic manual, Frances seemed like the man to bring us up to speed on how the DSM got so bloated, and why so many Americans are popping uppers and antidepressants that we don’t need.
Mother Jones: What you mean by “saving normal”?
Allen Frances: 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.
MJ: To what degree has this trend accelerated lately?