Allen FrancesRecensioni

Author Allen Frances was chair of the task force who updated the APA's diagnostic and statistical manual for mental disorders (DSM) to its fourth edition in 1994. This book is largely his polemic against the diagnostic inflation that resulted since its release. Frances cautions about the lack of specificity with many diagnoses today. As the title suggests, fewer and fewer people are considered normal anymore and this poses a major problem. The eccentric, different, and unique can now be diagnosed from an ever-expanding list of new psychiatric disorders. The road back to saving psychiatry will be a long one he says, but is achievable.

If this book doesn't leave you feeling conflicted, perhaps you've been hanging around with the wrong sort of people.

Unlike a lot of the reviewers of this book, I didn't get it as a LibraryThing review copy. I bought it myself, because I'm involved in some of the controversy in psychiatry, and I wanted to see what Dr. Frances had to say. And certainly there is much that is good and valuable here. That the pharmaceutical industry is out to feather its own nest is obvious, and that they manipulate the research process seems pretty clear. That the creation of the DSM-5 was too secret is clear -- the result of that secret process was that one major section (personality disorders) was voted down after its completion; the DSM-5 still uses the DSM-IV-TR criteria for personality disorders. That there are some bogus, or at least unhelpful, diagnoses in DSM-5 is also pretty clear -- do we really need four different diagnoses for alcohol problems (Alcohol Use Disorder, Alcohol Intoxication, Alcohol Withdrawal, and Unspecified Alcohol-Related Disorder, plus a whole raft of diagnoses where alcohol makes something else worse), and similarly for cannabis, caffeine, phencyclidine, opioids, and more? Couldn't we just have "Drug intoxication," etc., and specify the drug? We'd even be ready, in that case, when new drugs come along.

And yet... Dr. Frances specifies three diagnoses he particularly regrets, as they have caused "epidemics": Autism, ADHD, and Bipolar II.

I will grant that the hypomania of Bipolar II does not need treatment in itself -- indeed, it often results in brilliant work, and it's sad to have to control it. On the other hand, if there is no Bipolar II diagnosis, then a person who suffers only hypomania and depression isn't left with any possible diagnosis except major depressive order -- and will get put on an antidepressant, and there is strong albeit anecdotal evidence that antidepressants turn hypomania into full-blown mania. So there needs to be some way to say that these people can't just be treated as ordinary depressives.

As for ADHD -- well, I know someone who has it, and she really does need her Adderall to function properly. She's been on it for a decade, and she hasn't increased her dose, and she's dangerous without it. It's not as if she wants the stuff -- she tells me it's great to not have to take it. But she can't get any work done, and has lousy impulse control. Are there people getting drugs who don't really have ADHD? Maybe. But for the ones who need it, Dr. Frances, they need it.

And then there is Autism. This is the one I know best. This one doesn't really fit Dr. Frances's model, because autism hasn't really been over-pharmaceuticalized. (Oh, there are a couple of companies pushing drugs -- Risperidone and Aripiprazole, AKA Risperdal and Abilify -- for autism, and this is truly immoral because those drugs are anti-psychotics, and dangerous, and most of the time they don't work. But there are no drugs approved for autism in general, and no signs of any coming down the pipeline.) And guess what: I have autism, and I can tell you that it's real. Oh, "my" autism may not be the same as the non-verbal kid in the corner who is constantly pounding his head against the wall. That's a different question. But I have a condition that makes it effectively impossible for me to live a "normal" life despite having high intelligence. I suppose you could call it Avoidant Personality Disorder plus Social Anxiety Disorder plus Executive Function Disorder plus Sensory Processing Disorder plus Pragmatic Social Disorder plus only Dr. Frances knows what else. But autism is a lot simpler than five or six different diagnoses that, in any case, don't have any more treatment than autism!

The point is, just because we see an explosion of cases as soon as a new type of diagnosis is announced doesn't mean that the diagnosis shouldn't exist. There is a sort of excluded middle here: Dr. Frances seems to think that everything in the DSM-5 is in there so that we can force treatment on people. I would view it a different way. The diagnoses in the DSM-5 exist to tell us what sorts of supports people will need if they need support at all. If they don't, fine. You can diagnose something without treating it -- just as you can say "that person has brown hair" without saying "we have to convince her to dye it purple."

Also, I have to note, Dr. Frances is sometimes a little too willing to supply false history (e.g. how he knows so much about the shamans of prehistory is beyond me -- we call it "prehistory" because nobody knows what happened!).

Ultimately, one of the problems of psychiatry is that there are researchers, and there are clinicians, and their needs aren't the same. Dr. Frances is a researcher, and he produced a researcher's book (referring to the DSM-IV, which he edited, not this book). His general critique is good and valid. Psychiatry needs better diagnostic tools, and we need better ways to figure out what will help actual individuals. The DSM-5 was a very mixed bag in this regard. Big Pharma is no help. But pretending that everyone is normal is no help, either.

Het boek begint met twintig vragen die de meeste psychiatrische problemen dekken. De hoofdstukken die daarop volgen, gaan op deze twintig problemen in.

I was disappointed. Frances is criticizing "out of control psychiatric diagnoses" from within the system, so the findings feel bland and non-actionable. I'm more of a fan of the style of The Emperor's New Drugs by Irving Kirsch, who gets to the heart of the problem and proposes solutions.

Also, from Frances's title "Saving Normal," I wanted and expected a more philosophical discussion than I got, about the value of accepting human differences, vs. what we have now, a runaway proclivity in American culture to exclude minority cultures of all kinds, by labeling deviant behaviors as sick or bad. It's a great topic and I hope another smart person comes along to tackle it for real.

This is an interesting and much-needed commentary on the excessive prescription of medications and misuse of psychiatric diagnoses. The guilt throughout this book is palpable; the author, sharing responsibility for the production of DSM-IV, didn't prevent the misuse of medications and diagnoses. While this book does say that everyone is different and that's fine, the message gets lost, as there is an inconsistency of audience. A slightly better organization of the book (perhaps one section aimed with a message for individuals, medical professionals, Big Pharma and legislation) might help solidify the message.

In this century, we live in an instant gratification culture. You can have just about anything shipped to you in two-days or less after ordering from the internet. So, why, then, should it not be possible to instantaneously "fix" your mood or behaviors. It becomes easier for an individual to blame an inherent condition that needs medication to control than it is to develop new coping mechanisms or deal with life's miseries. And society tells the individual this is acceptable.

Six-word review: Well-documented indictment of medical profiteering.

Extended review:

When you put a profit motive behind finding as much as possible wrong with as many people as possible, suddenly and frighteningly a lot of people have something wrong. And nothing lends itself better to free-wheeling commercialization than people's emotional states. Because not everybody has a sore foot or hearing loss, but everybody has troubles sometimes and everybody feels bad sometimes. And when people feel bad, they want to feel better.

And the pharmaceutical industry is right there with its hand out.

Two hands, in fact: one to dispense from a bottomless barrel of meds for every describable ailment, and one to rake in obscenely huge profits from true believers and cynics alike.

Diagnostic inflation and overmedication are the two dominant themes of Allen Frances' book. Dr. Frances, the psychiatrist who headed the DSM-IV (1994) team, doesn't limit his discussion to psychotropic medications, but they are a primary target.

The DSM is the Diagnostic and Statistical Manual of Mental Disorders, now in its fifth edition (DSM-5, 2013). A revenue-generating publication of the American Psychiatric Association, it was until its third edition in 1980 a relatively obscure document intended as an aid to professional diagnosis, initially in a military context. It was never meant to be a "bible" or to govern the relationships between therapists and clients, never mind furnishing criteria for insurance claims. With the upsurge in psychiatric research and practice in the 1970s and the explosion of psychotropic medications in the 1980s, the detailed classification of mental conditions became dramatically relevant.

And suddenly so did the DSM.

As Dr. Frances documents in disturbing detail, it was the vastly profitable pharmaceutical industry that stood to gain the most from those developments.

The selling of health to moneyed interests compromises everything from the integrity of practitioners to the well-being of the patients, many too young, too old, or too impaired to make their own choices.

A primary casualty of this seismic shift in the medical and pharmaceutical landscape is the concept of normality. By loosening diagnostic criteria, the therapeutic community's chief reference work ends up classifying anything outside of a narrow range as a disorder. The result is the medicalizing of life's ordinary ups and especially downs. Too much energy or too little, a spell of sadness, a display of eccentricity: diagnosis by checklist will give it a name, and then off you go to your pharmacy, hoping for a small copayment and instant relief.

Frances' courageous book calls his peers and colleagues to account, faulting them not for their lack of integrity but for their lack of judgment (page 288). He shows no mercy to Big Pharma, however, for capitalizing on people's natural desire to cope with their problems and grasp at easy remedies--and, what's worse, for manufacturing crises in mental and physical healthcare for its own gain.

Even more harmful than turning the vicissitudes of life into illnesses and relatively healthy people into patients is creating false epidemics of disorders such as ADHD, autism, and PTSD. Once attached, those labels adhere like leeches and can compromise for a lifetime a person's self-confidence, employability, access to healthcare and coverage, and quality of life. Dr. Frances relates several harrowing accounts of patients whose iatrogenic conditions might well have sunk them. Anyone who feels anything strongly or does anything passionately becomes a candidate for therapeutic intervention. And once plugged into the system, many become captives of it. "We have to address the fact," says Frances, "that the misuse of legal drugs has now become a bigger public health problem than street drugs. It is unacceptable that 7 percent of our population is addicted to prescription drugs and that fatal overdoses with them now exceed those caused by illegal drugs" (page 211).

Frances reserves special attention for the well-known placebo effect: "Modern drug companies have made big bucks capitalizing on the power and ubiquity of the placebo response. The best way to get great results with a pill is to treat people who don't really need it--the highest placebo response rates occur in those who would get better naturally and on their own" (page 99).

Does Dr. Frances have solutions to propose? He does, although without expressing much optimism. It must begin, he says, with the political will to do what must be done, and that means that public servants must wean themselves from the creamy persuasion of Big Pharma's virtually unlimited financial resources. A section called "Dismantling the Marketing Machine" lists fourteen policy changes that would act to curb the powers wielded in the interests of corporate greed. The media have an enormous role to play as well: once seduced by the magic of promised cures, they are now wising up and showing some well-placed skepticism. Doctors and patients themselves also figure in the picture, and Frances outlines action steps for them.

A key part in the process of trend reversal belongs to the DSM, and the author calls for its drastic revision as well as a reduction in reliance on it throughout the medical, educational, and legal systems.

As a layperson, I'm not qualified to evaluate this book with respect to the healthcare industry. However, it seems like an important book to me, and the author's passion for his subject is unmistakable. Saving Normal has significantly heightened my awareness of some issues that I'd already been paying attention to and opened my eyes to others. Assuming that the author's credentials are as represented and his documentation reliable, I think it has to be taken seriously. I don't know if most people would want to learn something from this book, but most people could.

The extent to which I engaged with it shows in my pencil work. In general, I regard a nonfiction book as a dialogue, and my side of the exchange takes the form of underscores, ticks in the margin, and annotations, sometimes extensive. I read this one hard; scarcely a page is unmarked. I found plenty here to think about and plenty to come back to.

Nonetheless, I do have a few quibbles with it. The book needed at least one more thorough, sentence-shaking, word-wrangling line edit. (Every time an author makes a change, remember, what you have is unedited text. The number of errors introduced in the course of incorporating changes is potentially limitless.) At several points, I wrote in the margin, "Naptime for editors." There is unexplained insider jargon. There is inconsistent use of abbreviations and failure to expand at first occurrence. There are shifts in audience focus: sometimes the author seems to be addressing the public, sometimes fellow medical professionals, and sometimes people he knows personally. There are egregious sentences such as this: "The value of early intervention to prevent psychosis rests on three fundamental and necessary pillars--diagnosing only the right people, having a treatment that is effective, and also safe" (page 198). There is a lot of trouble with parallel structure, especially with correlatives. There are instances of illogical order of presentation and downright ambiguity. There's a Bible misquote on page 170--and no excuse for it, either, since it's so readily checked.

Yes, I know it isn't easy to get all this stuff right. That's why people hire professional editors. And when one is too familiar, too close to the material, or just worn out, maybe you need another one.

A notable drawback to utility is the fact that the ample chapter notes are headed by chapter numbers, without page references; but the running heads in the chapters give title only and not chapter number, so that when you want to look up a note, you first have to page back in the chapter to find out the number of the chapter you're in. This is something that a fresh editorial eye ought to have spotted in page proofs right away.

A book that aspires to making a difference--indeed, becoming an agent for major change--deserves every measure of care that can be lavished on it. An extra two months' attention before press time might have been just the prescription it needed.

Dr. Allen Frances has written a provocative book, Saving Normal, about the way we treat mental illness in the United States. He centers the book on the DSM-IV and DSM-V, the Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatry, in its fourth and fifth iteration. He believes that the broadening of the definitions of many mental disorders has led and will further lead to the labeling of millions of normal people as “mental patients”. He concludes that too many people are being given drugs who don’t need them, primary care doctors are administering drugs they don’t understand, drug companies are preying on consumers and doctors in order to make big profits and that the limited psychiatric resources are not going to those who really do need help.
Dr. Frances is a psychiatrist and professor emeritus and former chair of the Department of Psychiatry and Behavioral Science at Duke University School of Medicine. He chaired the Task Force that wrote the DSM-IV and worked with the group that wrote DSM-III and DSM-IIIR so he really does know what he is writing about. He doesn’t shy away from taking some of the blame for redefinitions that came about in DSM-IV that have caused an increase in diagnoses of autism, ADHD and bipolar disorder. He uses that experience to highlight how important it is to anticipate the unintended consequences of the revisions of this manual. If you are interested in the issue of mental illness, this is a must read.

This is an interesting book. Dr. Allen was a member of the groups that developed - and later revised - DSM III (Diagnostics and Statistical Manual for Behavioral Science, 3rd Edition), and chaired the committee that developed DSM IV. Saving Normal is a reflection on developments in psychiatry after DSM III, the way DSM IV was an effort to preempt efforts by pharmaceutical companies to increase diagnoses of psychiatric illnesses, and how the recently completed DSM 5 has the potential of making it easier for psychiatrists to find some mental illness in just about anyone.

The result of the process is a loss of grasp on the concept of "normalcy," and millions of people ending up on useless drugs to treat "illnesses" that really exist only in the mind of the psychiatrist and the pharmaceutical companies. Dr. Allen tries to make the case that this process is a result of poorly structured DSMs that make it possible for psychiatrists to find illness in just about anything that deviates from a poorly defined concept of normalcy.

It is educational to find out the role drug companies have played in the proliferation of mental-illness diagnoses, and how they have managed to make billions of dollars per year developing (what Dr. Allen contends are) virtually useless drugs that serve little purpose other than to make people dependent on them.

At root, I believe this book is an attempt on Dr. Allen's part to absolve himself of blame for a process that - arguably - he was part of, and even led. He admits complicity in the process, but I get the impression he doesn't own up to the extent to which he contributed to the problem.

As a chair of the DSM-IV task force, Dr. Frances has a unique and expert viewpoint of the psychiatric diagnosis process. In this book he examines how psychiatry has gotten away from the psychiatrist and now lays at the hands of big pharmaceutical companies and general practitioners. The results being that many "worried-well" are being overly treated with anti-anxiety and anti-depressants that they do not need while the truly sick fall through the cracks. I think this is an important book that addresses issues seen not just in psychiatry but also in the general field of medicine. This became a bit dry at times and even repetitive which made for slow reading, but the author definitely realizes a huge problem and wrote this book in order to make an important argument that may not reach the widest audience. Overall, this is an informative yet depressing look at how medical decisions are made and medicines are marketed. I received this book through a LibraryThing giveaway.

This book should be judged not so much by how well it is written but just by the fact of who wrote it. There is a lot of weight to be given to former chair of DSM-4 (Diagnostic and Statistical manual) when he talks about 'diagnostic inflation' in mental health. He recognizes the unfortunate role DSM-4 played in that terrible process but also identifies the other factors that together contributed in such massive 'medicalization' in psychiatry. He describes the recently issued DSM-5, which, unfortunately, provides foundation for further expansion of diagnostic inflation. He writes about role played by big pharmas, consumer advocates, media, psychiatric association, etc. Although the author does describe the steps necessary to reign in mental diagnosis proliferation they seem to be not very realistic. The author himself is quite pessimistic regarding short term resolution. But somebody has to step up and this book is one small step in this direction.

An excellent book. The hardcover version, released in 2013, was named a Top 10 Science and Health Book by Booklist. In Saving Normal, author Dr. Allen Frances researches why we're seeing so many more cases of mental disorders being diagnosed in the U.S.

Dr. Frances chaired the DSM-IV Task Force (DSM is the Diagnostic and Statistical Manual of Mental Disorders) and helped led the DSM-III and DSM-III-R groups, so he's an insider when it comes to this issue. He believes that literally millions of us are being labeled with mental problems when we're really no more than the average "worried well" person who must cope with the stresses of everyday life.

He puts most of the responsibility (blame) for this diagnostic trend on the big pharmaceutical companies, who make a profit from developing and selling drugs that may or may not even affect the psychiatric conditions we supposedly suffer.

The author does not question at all the very real mental issues some patients face, and their need for medical help and prescribed medication. He's simply saying that we need to look closely at why these diagnoses are rising; who is making these judgment calls; and what we are putting into our bodies, or the bodies of our families, when we take these prescribed drugs.

This book raises many important points. I received it through the LIbraryThing giveaway, but this has not influenced my opinion. I highly recommend it.

The author, who worked on DSM-III and edited DSM-IV, discusses how psychiatric diagnoses have expanded to the point where all emotional turmoil may now qualify for a DSM-IV diagnosis, and thus (likely) psychotropic medication. DSM-5 is will only make the situation worse. This critique of psychiatry applies equally to all of current US clinical medicine, where the initial treatment response is a prescription, rather than lifestyle modification or other non-medicinal option.

Also up for blame is the medical-industrial complex, the FDA, direct-to-consumer advertising, and the expectation of patients that whatever their complaint, they will leave with a prescription for something.

An essential read for anyone interested in the current state of psychiatry (specifically) and American medicine (in general).

Thank you, Dr. Frances!

Brilliant! This is an outstanding book about the dangers of the psychiatric community overpathologizing mental illnesses. I have been concerned about this for sometime especially with the alarming rate of children on psychiatric medicines. This book reminded me of previous sentiments echoed by Dr. William Glasser.

The premise of this fascinating book is that behaviors and conditions that used to be considered normal variations in human personality have come to be considered mental illnesses. This has happened through a vast expansion of the list of diagnoses in the "DSM," which is considered the bible of psychiatric diagnosis, followed by the commercial exploitation of this expansion by the drug companies. The author is clearly an expert in this area, as a former chairman of the Duke University Medical School Department of Psychiatry and an editor of a previous edition of the DSM. However, this book is written for a general audience, in a lively, engaging style, and is free of technical jargon. It includes a history of mental illnesses and their treatment throughout history, a description of how mental illnesses are recognized and described via grouping of symptoms, and a description of "fad" mental illness diagnoses of the past and present. The author is no extremist; he reiterates that psychiatry and psychiatric drugs have helped and continue to help many people who need them. What he is opposed to is the medicalization of what is essentially normal behavior, and labeling of people who aren't really ill, so that they can be sold drugs to cure their "condition." I would highly recommend this book, both for those who have an interest in this subject, and for the general reader who is interested in how science tries, sometimes well and sometimes not so well, to categorize and describe human behavior.

Saving Normal takes a deep look at the newest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is generally regarded as the bible of psychiatry. It's used by primary care doctors, psychiatrists, psychologists, social workers, etc. to diagnose mental illness in their patients. The newest revision, known as DSM-5, has stirred up an awful lot of controversy. This book takes a look at that controversy and explores what the impacts could be in the US. Allen Frances explains the possibilities and impacts of over-diagnosing mental illness in the general population, arguing that many of the revisions take "normal" (whatever that means) life experiences into the realm of mental illness.

However, the author remains very positive about psychiatry in general, and does a lot to explain how the field is helpful for many people. Many people do suffer from mental illness, and having a proper diagnosis leads to life-saving treatment. I really like that about this book, because other critical reviews of the DSM-5 (namely "The Book of Woe" by Gary Greenberg) take down the profession of psychiatry as a whole.

What I don't like about this book is how poorly edited it is. The author uses a lot of complicated and technical language and concepts without explaining them; if you don't have a good knowledge of what the DSM is and what psychiatrists do, you might be totally lost reading this book. He uses a lot of acronyms without explaining them until much later in the book, if at all.

Also, I really disliked the language of this book, which made the author come across as totally ensconced in cisgendered,-straight-white-man-privilege world. He uses the term "man" to mean humanity. He only uses the pronoun "he" in the book. Actually, he uses "she" maybe three times, only making it all the more obvious that he views the world through a man-lens. He makes no critical analysis of mental illness used as a tool to oppress women in his critique of psychiatry throughout the ages.

In addition, I can live without the evo-psych. Nothing makes me take a book less seriously than conjectures about why humans act the way they do based on what we suppose our distant ancestors did before the invention of fire. Things only get weeded out in evolution if they kill people BEFORE they can reproduce. Many people tend to forget that, including this author. Suicidality couldn't and can't (and didn't) get weeded out of our gene pool because many people commit suicide after reproducing, if suicidality is even genetic to begin with (which has not been proven). Also, evo-psych looks at the world in a severely male-centric, heteronormative way.

I think the most useful part of this book was chapter 8, which gives practical advice to patients who have a mental illness or think they may have one. It's good to know what kind of information to have on hand when seeing a somebody in the mental health field, and how to take a critical look at options regarding diagnoses and medications. So if you skim through the rest of this book, I recommend waking up a bit when you get to the end!½

Saving Normal was somewhat eye-opening, and also confirmed a lot of suspicions about the mental health industry (and yes, it is an industry, not healthcare).

Dr. Allen Frances was the chair of the DSM-IV task force, so he has the inside scoop on how the psychiatric community categorized and defined mental illnesses and disorders, neuroses and psychoses. The way that every human behavior can now be attributed to a psychological disease is astonishing. I think many of us have had the experience of seeing our doctor and being offered an antidepressant, apropos of nearly nothing. "I take mine every day: it's like a vitamin," boasted a physician's assistant to me as she prescribed me amitriptyline (which, being a tricyclic, is easy to OD on -- in large quantities, it can stop your heart).

A lot of psychology is guesswork; we all know that. What's frightening is that something like the DSM becomes a "bible" for diagnosing mental illness, when it's not a Rosetta Stone for personality disorders, schizophrenia, mood disorders, etc. It's simply a book, a compilation of ideas and opinions designed and written by a group of professionals who apply their own human bias to their work.

My friends and I used to like to sit around my dining room table, drinking vodka and diagnosing each other out of the DSM-IV. It was a great drinking game.

I wanted to buy the DSM-V, expensive as it is, just to have it for reference. But after reading Saving Normal, it seems like a waste.

I definitely recommend this book to anyone who has been diagnosed with mental illness, whether it be depression, personality disorder, or psychosis. Be aware of what your doctor/therapist/psychiatrist is basing his/her decisions on.

Saving Normal was somewhat eye-opening, and also confirmed a lot of suspicions about the mental health industry (and yes, it is an industry, not healthcare).

Dr. Allen Frances was the chair of the DSM-IV task force, so he has the inside scoop on how the psychiatric community categorized and defined mental illnesses and disorders, neuroses and psychoses. The way that every human behavior can now be attributed to a psychological disease is astonishing. I think many of us have had the experience of seeing our doctor and being offered an antidepressant, apropos of nearly nothing. "I take mine every day: it's like a vitamin," boasted a physician's assistant to me as she prescribed me amitriptyline (which, being a tricyclic, is easy to OD on -- in large quantities, it can stop your heart).

A lot of psychology is guesswork; we all know that. What's frightening is that something like the DSM becomes a "bible" for diagnosing mental illness, when it's not a Rosetta Stone for personality disorders, schizophrenia, mood disorders, etc. It's simply a book, a compilation of ideas and opinions designed and written by a group of professionals who apply their own human bias to their work.

My friends and I used to like to sit around my dining room table, drinking vodka and diagnosing each other out of the DSM-IV. It was a great drinking game.

I wanted to buy the DSM-V, expensive as it is, just to have it for reference. But after reading Saving Normal, it seems like a waste.

I definitely recommend this book to anyone who has been diagnosed with mental illness, whether it be depression, personality disorder, or psychosis. Be aware of what your doctor/therapist/psychiatrist is basing his/her decisions on.

Saving Normal was somewhat eye-opening, and also confirmed a lot of suspicions about the mental health industry (and yes, it is an industry, not healthcare).

Dr. Allen Frances was the chair of the DSM-IV task force, so he has the inside scoop on how the psychiatric community categorized and defined mental illnesses and disorders, neuroses and psychoses. The way that every human behavior can now be attributed to a psychological disease is astonishing. I think many of us have had the experience of seeing our doctor and being offered an antidepressant, apropos of nearly nothing. "I take mine every day: it's like a vitamin," boasted a physician's assistant to me as she prescribed me amitriptyline (which, being a tricyclic, is easy to OD on -- in large quantities, it can stop your heart).

A lot of psychology is guesswork; we all know that. What's frightening is that something like the DSM becomes a "bible" for diagnosing mental illness, when it's not a Rosetta Stone for personality disorders, schizophrenia, mood disorders, etc. It's simply a book, a compilation of ideas and opinions designed and written by a group of professionals who apply their own human bias to their work.

My friends and I used to like to sit around my dining room table, drinking vodka and diagnosing each other out of the DSM-IV. It was a great drinking game.

I wanted to buy the DSM-V, expensive as it is, just to have it for reference. But after reading Saving Normal, it seems like a waste.

I definitely recommend this book to anyone who has been diagnosed with mental illness, whether it be depression, personality disorder, or psychosis. Be aware of what your doctor/therapist/psychiatrist is basing his/her decisions on.

De Amerikaanse psychiater Allen Frances, ooit voorzitter van de DSM-IV Task Force, is tegenwoordig een van de meest gezaghebbende critici van de DSM-5, de nieuwe editie van het diagnostische handboek voor psychische stoornissen. Aan de hand van de geschiedenis van de psychiatrie beschrijft hij de excessen in de huidige psychiatrische diagnostiek. Frances waarschuwt voor 'diagnostische inflatie' en 'overmedicatie'. Volgens de professor verwarren snel gestelde diagnoses somatische klachten met psychische stoornissen waardoor de grens tussen 'normaal' en 'gestoord' in de DSM-5 radicaal verschuift. Hij vreest dat de maatschappelijke consequenties (onderwijs, rechtspraak,…) voor de behandeling van de zogeheten nieuwe 'patiënten' niet te overzien zijn.

A Layman's Guide to the Psychiatrist's Bible by Frances, Allen, M.D., Michael B. First, M.D.