DSM5 in Distress

The DSM's impact on mental health practice and research

Allen J Frances M.D.

Balancing Patient Freedom With Safety And Well Being

We need a common sense approach to balance the important value of patient freedom with the equally important value of personal and public safety.

"Please empathize with me, Doctor!”

The doctor/patient relationship has been the central instrument of healing throughout the history of medicine, but has become a lost art. We have to teach doctors to better understand their patients so that they can become better healing instruments.

A Checklist To Stop Misuse Of Psychiatric Medication In Kids

The exponential growth in the use of psycho-stimulants, anti-depressants, and anti-psychotic drugs often harms children more than helps them. This Checklist to help clinicians think through the necessary steps before prescribing medicines.

School Refusal and Severe Social Withdrawal

A kid not going to school is a crisis for family and school. Parents and teachers often feel helpless and perplexed. The kid may quickly spiral down into increased anxiety, avoidance, despair, and gaming. Starting treatment early reduces the risks the child will develop severe school refusal and become completely homebound.

Think Twice Before Getting Knee Surgery

Accumulating evidence now proves that much of arthroscopic (keyhole) knee surgery may be unnecessary because the results are no better than placebo. This is an especially startling finding because this is the second most common surgical procedure in the world (after cataract surgery).

Life Is Not a Premortality Condition

Western medical science has changed life into a premortality condition and death into a failure of treatment.

Dying Well Means Dying At Home

There is no worse death than a hospital death. Dying well means dying at home. This requires preparation and preparation requires recognizing that dying is a necessary, and indeed desirable, part of life. Preparing for a good death may be one of the best decisions you will ever make in your life.

What's in a Name?

Diagnosis and empathy are necessary partners in any therapeutic relationship, fully complementary and in no way incompatible.

Don't Give Up on the Difficult Patient

The most difficult patients often eventually form the deepest relationships and have the most satisfying outcomes. We are most important and make the biggest difference in the lives of the people who need us most, even if the day to day is not always smooth. With redirection, what was once the power to destroy can now become the power to heal and create.

Falls End Lives; Good Balance Saves Them

Falling is a major cause of disability and death. Physical exercise and specific balance tasks greatly reduce the risks. People who don't change their behavior to prevent falls are almost sure to have them.

Buying And Selling Binge Eating Disorder

In Greek myth, Cassandra was cursed with the gift of seeing the future without having any power to change it. I now know the feeling. What a mess.

Wilderness Programs for a Struggling Child

As a last resort for behaviorally disturbed kids, wilderness programs provide a new chapter and offer an opportunity for greater self-control, self-esteem, and wisdom. They are good for the kids, their families, the juvenile justice system, and society.

Psychotherapy Works But Not for Everyone

Treatments that work well for most don't work well for all. And even effective treatments have side effects and complications. This is true of medication and surgery—and it is also true of psychotherapy.

Welcoming the Mentally Ill Back into Our Community

It has been my life’s passion to help the victims of mental illness discover that they can again be loveable, loving, purposeful people with the ability no longer to be overwhelmed by their illness.

The Crisis of Confidence in Medical Research

Randomized placebo controlled studies have been the gold standard in medical research, but some believe they have been so corrupted by Pharma that they cannot be trusted.

There's No Back Pain Surgery Can't Make Worse

Surgeons are too quick to operate on back pain and doctors are to quick to prescribe dangerously addicting opioids. Much better bets are rehab exercises and mindfulness.

Having a Severe Mental Illness Means Dying Young

People diagnosed with serious mental illness-schizophrenia, bipolar disorder, or sever depression- die 20 years early because of a combination of lousy medical care, smoking, lack of exercise, complications of medication, suicide, and accidents. They are the most discriminated against and neglected group in the US, which has become probably the worst place in the developed

The Globalization Of Attention Deficit Disorder

Mental disorders have become a global commodity. A diagnostic fad heavily promoted first in the US now quickly spreads around the world. Parents must protect their kids from the drug company promoted flood of massive ADHD over diagnosis and over treatment.

Surviving Suicide: A Mother’s Search for Meaning

I have known dozens of mothers who have lost children to suicide. None ever really got over it. All remained intermittently haunted and forever felt a hollowness in life. But life must go on and a serving mother explains how she found new meaning and purpose.

Price Tags On Medical Procedures To Stimulate Competition

The Internet has reduced the price, and increased the convenience, of shopping for just every product in our economy- except medical care. Why not use comparative posted prices to empower consumers and reduce the monopoly power of providers.

Psychiatry and Recovery

Psychiatry and Recovery have compatible and complementary contributions to make in treating mental illness and in advocating for better funding and community care.

Back to Normal

We have become a dangerously pill popping society. I offer practical tips on how people can avoid being over-diagnosised and over-medicated.

Female Sexual Dysfunction and Disease Mongering

DSM 5 will give drug companies running room to continue their disease mongering of female sexual disorders- hyping questionable DSM ills as a means of pushing pills.

DSM 5 Confirms That Rape Is Crime, Not Mental Disorder

DSM-5 has rejected rape as a mental disorder. This should reduce the inaccurate use of psychiatric diagnosis to justify the longterm involuntary commitment of sexually violent predators who have already served their full prison sentence. Inappropriately using psychiatric diagnosis in the service of preventive detention is a slippery slope with disastrous consequences.

The Power of Sexual Selection

Sexual selection has powerfully influenced psychology and psychology has powerfully influenced evolution.

Who Was the Greatest Psychologist?

Darwin's evolutionary approach to human psychology is the foundation of all later developments.

A New Blog Title and a New Mission: 'Saving Normal'

Now that DSM 5 is in press, my new mission is saving normal.

Price Gouging: Why Will DSM-5 Cost $199 a Copy?

DSM-5 is pricing itself out of the market at $200 a copy. I explain the forces leading to this price gouging and why it won't work.

Bad News: DSM 5 Refuses to Correct Somatic Symptom Disorder

DSM 5 will inappropriately label as mentally ill 1 in 6 people with cancer and heart disease; 1 in 4 with irritable bowel and fibromyalgia; and 1 in 14 who are not even medically ill. DSM 5 rejected the simple wording changes I suggested that would have helped correct this problem.

Pragmatism In Psychiatric Diagnosis

This is a response to Dr Ghaemi's claim that DSM IV and DSM 5 both suffer from excessive pragmatism. Psychiatric diagnosis must be pragmatic. DSM 5 suffers from not being pragmatic enough.

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