SAVING NORMAL

Frances weighs in with a no-holds-barred critique of the newly revised Diagnostic and Statistical Manual of Mental Disorders.

As the DSM IV Task Force leader, the author does not duck responsibility for the problematic nature of the manual, which he describes as a “cultural icon” and “perennial best seller.” Not anticipating the diagnostic creep, “we failed to predict or prevent three new false epidemics of mental disorder in children—Autism, Attention Deficit Disorder, and Childhood Bipolar Disorder.” In the author's view, too often clinicians adopt labels from the manual to cover up their own sloppy and even faddish diagnoses. He predicts that the situation will worsen with the new edition. Once considered a rare disease, “CBD [childhood bipolar disorder] has become the most inflated bubble in all psychiatric diagnosis.” Frances anticipates that the DSM V’s inclusion of Asperger's in the autism spectrum will cause problems, possibly leading to a reduction of special school programs that help students with Asperger’s at one end of the spectrum, and disability benefits for the extremely disabled at the other. While accepting his own and fellow psychiatrists’ failure to predict the problem of label creep, the author ascribes most responsibility to pharmaceutical companies, which have “hijacked the medical profession” and created “a feeding frenzy of over-diagnosis, over-testing, and over-treatment.” He attributes the current obesity epidemic to side effects of modern antipsychotics, and he charges drug companies with complicity in promiscuously pushing antipsychotics on patients with “garden-variety” anxiety or shyness and broadening the definition of childhood bipolar disease to encompass temper tantrums and moodiness. In a partial effort of exculpation and mea culpa, Frances explains that his team began work in the “pre-Prozac days of 1987.”

A valuable assessment for clinicians and potential patients.