An Interview with Allen Frances M.D.: Making the DSM-5 WORSE?
1) Dr. Frances, briefly, what has been your role in the DSM (Diagnostic and Statistical Manual ) over the past few years?
First, I tried to warn the people doing DSM 5 and the leadership of the American Psychiatric Association that they were going badly off track. Now, I am warning clinicians and the public that DSM 5 will likely cause a massive mislabeling of normality and an excessive prescription of unnecessary and potentially harmful drugs.
2) I know you are busy, so I will keep this brief- Has the recent DSM-5 turned temper tantrums into a mental disorder?
Yes- and on the basis of the work of just one research group done for six years. The DSM 5 goal is to reduce the fad diagnosis of childhood bipolar disorder, but they are doing it in a strange and reckless way. The appropriate step would be to warn everyone how difficult it is to diagnose kids and that medicines have been often been used casually and without clear indications. It doesn’t make any sense to add a new and untested diagnosis that could easily start yet a new fad and increase medication use even more.
3) Dr. Frances, you and I have both had to deal with death- our parents, perhaps our siblings, loved ones etc. And we have both had to deal with loss- perhaps a pet or a dog or cat. Has this normal grief now become a (and I capitalize here for emphasis) A MAJOR DEPRESSIVE DISORDER?
Yes, this is another idea lacking in simple common sense. You lose someone you love and have two weeks of sadness, loss of interest, and reduced sleep, appetite, and energy. This seems human and entirely normal to me- but DSM 5 would label it mental disorder.
4) I teach at a University- some students are tired, fatigued, burned out, stressed out–will this now become ADULT ATTENTION DEFICIT DISORDER?
The slightest claimed distractibility in your students will likely score them a prescription of stimulant drugs . Thirty percent of college and ten percent of high school students already get illegal stimulants through purchase from the large secondary market of diverted prescribed drugs and then use them for performance enhancement or recreation. This illegal market will now thrive even more, courtesy of DSM 5.
5) The holidays are upon us, and I enjoy turkey, some ham, some peas and carrots, and oh boy, pumpkin pie—Have I contracted BINGE EATING DISORDER ?
I don’t know about you, but I qualify. . One pig out at holiday time is not enough- you have to binge at least once a week for twelve weeks. But this is not hard to do for many of us and should be considered a mental illness.
6) I have been following the data on autism for YEARS…and everything I have ever seen tells me that it is INCREASING…..yet what has the DSM done?
Rates have increased by more than twenty fold in the past twenty years. Some of this makes sense, but about half is due to loose diagnosis related to the need to have the diagnosis in order to qualify for enhanced school services. The changes in DSM 5 may actually lead to more accurate diagnosis and markedly reduced rates, but the effect on services has not been addressed forthrightly by the DSM 5 work group. The best solution would be to base eligibility for school services on actual educational need, not on a fallible diagnosis of autism developed for use in clinical, not educational settings.
7) Maybe someone will do a little pot and not inhale (like someone else I know ) –will they then be lumped with HEROIN and OXYCOTIN users? Or abusers?
DSM 5 lumps people who have early abuse substance abuse problems with those who have end stage addictions- despite their very different prognosis and treatment needs and the stigma it will cause.
8) I got bills to pay, appointments to keep, gotta gas up the car, running late, wolfing down a burger for lunch, too much to do and too little time—do I have Generalized Anxiety Disorder?
The boundary between normal worries and anxiety disorder is fuzzy and far too many people already take Xanax type anti-anxiety drugs that are addicting and do a great deal of harm and little good.
9) Now, I DO know some of these kids that are on the Internet 8, 9, 10 , 12 hours a day—Are they addicted ? Is this a mental disorder or a manifestation of some deeper problem?
Fortunately, internet addiction didn’t make it into DSM 5 but could become a new fad even without official recognition.
10) Final question, I do think the world has become more problematic, more stressful, more anxiety provoking, and I do believe there are a great many individuals who are not psychotic or schizophrenic, but who could benefit from an empathic ear-. Am I off on this?
Would you rather live now or at any other time in the past, in the US or anywhere else? Our stress is small potatoes compared to what our ancestors survived or to day to day life in most of the world. And I don’t worry about harm being done by empathic ears- my concern is that medication is given casually to people who don’t need it while we terribly shortchange psychiatric services for those with real mental disorders who do need and can greatly benefit from our help. Psychiatry does great good when done within its competence.