|Basic InformationLatest NewsLinksBook Reviews|10 Minute Solution: Butt Lift10 Minute Solution: High Intensity Interval Training101 Ways to Meditate29 Gifts3-In-1 Total Body Fitness with Desi Bartlett30 Minute Ab & Butt Blaster5 Day Fit Yoga5 Mega Miles with Toning Band7 Weeks to 100 Push-Ups8 Keys to Body Brain Balance8 Keys to Practicing MindfulnessA Journey Into Yin YogaA Philosophy for the Science of Well-BeingA.M. EnergyAccessible Yoga for Every Body DVDAfter the Ecstasy, the LaundryAge-Proof Your MindAgeless Mobility: Pain-Free Wellness For LongevityAlmost MeatlessAM/PM YogaAnd BreatheAnswers for AristotleAnywhere, Anytime, Any Body YogaAthlete's Guide to YogaAuthentic HappinessAwakening Self-EsteemBack in Action: Yoga for a Healthy BackBack To Basics: Fitness with Charlotte OrdBalanced AssetsBedroom Body: Booty Burner, Core & Pelvic Floor WorkoutBeginners Meditation & Mindful StretchingBeginners Yoga DVDBeginning YogaBellyFit ElementsBetter Sex Through YogaBeyond the SelfBody By BethennyBody Mindful YogaBorn to Balance - Balance BasicsBOSH!Breath-Centered YogaBreathingBrightening Our Inner SkiesBuddhist Boot CampCalm Body Clear MindCalm EnergyCalm Focus JoyChakra MeditationsChoosing CivilityClassical Pilates Technique DVDComplementary and Alternative Therapies ResearchCore Fusion - Pilates PlusCore Fusion - Pure Abs & ArmsCore Fusion - Thighs & GlutesCore Fusion Body SculptCore Fusion Lean & TonedCore Fusion Power SculptCore Strength PilatesCore Strength Vinyasa Yoga Power Hour with Sadie NardiniCore YogaCreative Core AbsCreative Writing In Health And Social CareDance Off the Inches: Cardio Hip Hop PartyDance the Chakras Yoga WorkoutDeep ListeningDeep Stretch / Yin YogaDetox YogaDr. Andrew Weil's Guide to Eating WellDr. Andrew Weil's Guide to Optimum HealthDr. Andrew Weil's Mindbody ToolkitEastern Body, Western MindEasy YogaElement: Barre ConditioningElement: Targeted Toning Pilates for BeginnersElement: Yoga for Stress Relief & FlexibilityElements of Yoga, Earth FoundationsElements of Yoga, Fire DynamicElements of Yoga: Air & WaterEmotional Chaos to ClarityEmotions, Stress, and HealthEvamarie Pilipuf's Yoga Express DVDEvery Day Yoga for Every Body DVDEveryday GreensEveryday Workout for the Everyday WomanEveryday Yoga for Stress Release Everything VeganExercise-Based Interventions for Mental IllnessExhale Core Fusion 30 Day SculptFamily ForagingFamily YogaFast Food for the SoulFat and FuriousFear and Other Uninvited GuestsFit Family Fun CircuitFit in 5 DVDFlat Abs PilatesFlow and YinFlow YogaFluid Power Vinyasa Flow YogaFood You Can ForageForgiveness is Really StrangeFully PresentGaiam Pilates Slide and Sculpt Kit with DVDGaiam Pilates Total Toning KitGaiam Yoga For Weight Loss KitGet Ripped & ChiseledGet RIPPED! 1000 #3Get RIPPED! and Jacked - The Boomer WorkoutGood MedicineGoodbye, ThingsHandbook of MindfulnessHealing the Heart and Mind with MindfulnessHealing Through Movement: Pilates Head to ToeHealthy AgingHealthy Sexy Beautiful Kundalini YogaHemalayaa's Yoga for Young Bodies DVDHemalayaa: Bollywood BootyHot Body Cool Mind - Level 1Hot Body Cool Mind: Waking Energy How to Be a PatientHow to Be a StoicHow to Cook Everything VegetarianHow Would Buddha Act?I Contain MultitudesI'd Rather LaughIn Defense of FoodInsight Yoga Earth: Balancing Yin EnergyInsight Yoga Heaven: Balancing YangInsight Yoga with Sarah PowersIntegrated YogaIntegrative MedicineInternational Perspectives on Reminiscence, Life Review and Life Story WorkIntroduction to Ashtanga Yoga DVDIntroduction to Qi YogaIntroduction to Yoga DVDIt's Up to YouJanis Saffell Beverly Hills YogaKids Teach Yoga - Flying EagleKidYogi - Yoga for ChildrenKnowing the Nature of FearKripalu YogaKripalu Yoga Dynamic DVDKripalu Yoga Gentle DVDKundalini Yoga : DVDKundalini Yoga for Beginners & BeyondKUNDALINI YOGA for Your Week - MONDAYKUNDALINI YOGA for Your Week - TUESDAY - CoreKundalini Yoga Meditation for Beginners & BeyondKundalini Yoga Meditation for Complex Psychiatric DisordersKundalini Yoga on the BallKundalini Yoga Solar Power All-In-One WorkoutKundalini Yoga to Detox and Destress DVDKundalini Yoga Transformer All-In-One WorkoutKundalini Yoga: Green Energy of the HeartLife MakeoversLifeForce Yoga to Beat the Blues--Level 1LifeForce Yoga to Beat the Blues: Level 2Living BeautifullyLiving Room Yoga DVDLiving Room Yoga: Twist and BendLiving Your Best LifeLiving Your DreamLunar Flow YogaMadhur Jaffrey's World VegetarianMake It Fast, Cook It SlowManage Your Depression Through ExerciseMaui PilatesMayo Clinic Wellness Solutions for Back PainMayo Clinic Wellness Solutions for IBSMayo Clinic Wellness Solutions for InsomniaMean GenesMeditation in a New York MinuteMeditations for BeginnersMeditations on Self-Discipline and FailureMind GamesMindful AmericaMindful AngerMindfulnessMindfulness for BeginnersMindfulness-Based Treatment Approaches: Clinician's Guide to Evidence Base and ApplicationsMisadventures of a Garden State YogiMozart's Brain and the Fighter PilotNamaste Yoga: Season 3 Part 1NeuroLogicNever Home AloneNew York PilatesNext-Level PilatesNutrition Essentials for Mental HealthOn Being an Introvert or Highly Sensitive PersonPassionate VegetarianPerfect in Ten AbsPerfect in Ten: PilatesPerfect in Ten: StretchPerfect in Ten: YogaPilates AnatomyPilates for BeginnersPilates for MenPortraits of ResiliencePositivityPower to the Peaceful YogaPower YogaPower YogaPower YogaPower Yoga for HappinessPower Yoga: Core PowerPower Yoga: Fat BurnerPrenatal FlowPrescriptive StretchingPresence Through Movement: Yin YogaPsychology Moment by MomentPure and Simple YogaPure SculptPure Yoga Pilates with Kerry BestwickQi Gong Fire & Water With Matthew CohenQi Gong Flow for BeginnersQi Gong for Low Back PainQi Gong for Upper Back and Neck PainQi Gong for Weight LossQi Workout AM/PMQiGong for Healthy Joints & BonesQiGong IllustratedQuick Blast MethodReach - Upbeat Toning & Flexibility for a Dancer's BodyRed Lotus YogaResistance Stretching With Dara TorresRestorative Yoga PracticeSara Ivanhoe's Taste DVDSaving NormalSelf-CompassionSeven Challenges To Change Your Life DVDSleep BetterSolar Flow Yoga DVDSoupsSparkSpontaneous HappinessSports Hypnosis in PracticeStep By Step Strength TrainingStep by Step Tai ChiStrength & SpiritStrength, Grace, HealingStress ReliefStrong & SculptedStrong Body, Ageless BodySun SalutationsSuper Natural CookingSuper Seniors: Box, Balance, & Lift SuperhumanSupersurvivorsSurf Yoga SoulSybel's Yoga For Sports & FitnessSybel's Yoga For Sports & Fitness Vol 2Tai Chi for Beginners with Grandmaster William C. C. ChenTaming Your Inner BratTeach Yourself MeditationTeen YogaTeenYogi DVDTen Minutes to RelaxThe Accidental VeganThe Angelica Home KitchenThe Art and Science of MindfulnessThe Athlete's Guide to YogaThe Beginner's Guide to Healthy EatingThe Best Things You Can EatThe Booty Barre -Total New BodyThe Breathing FieldThe Cafe Brenda CookbookThe Complete Book of Raw FoodThe Complete Vegetarian HandbookThe Easy Yoga WorkbookThe Feeling Good HandbookThe Five Things We Cannot Change ...The Good LifeThe Happiness of PursuitThe Harvard Medical School Guide to YogaThe Healing Remedies SourcebookThe Healing Remedies SourcebookThe Health Psychology HandbookThe Healthy KitchenThe Heart of YogaThe Indian VegetarianThe Jewel Tree of TibetThe Joy of MeditatingThe Kettlebell BoomerThe Little Book of Healthy TeasThe Little Soy BookThe Little Yoga BookThe Mood CureThe Mozart EffectThe Myth of Freedom and the Way of MeditationThe Nature FixThe Origins of HappinessThe Perfect ExerciseThe Pilates Workout JournalThe Playful BrainThe Quest for Peace, Love, and a 24'' WaistThe Road to Calm WorkbookThe Self-Compassion Skills WorkbookThe Spa DeckThe Spirit of Buddhist MeditationThe Stoic Art of LivingThe Ultimate BALLET YOGAThe Ultra MindsetThe Way of StretchingThe Weight of the NationThe Well-Tuned BrainThe Will to Live and Other MysteriesThe Wisdom of FrugalityThe Yin Yoga KitThink SmartTotal AstangaTotal Health the Chinese WayTotal PilatesTotal-Body ToningTransform Yourself with Jivamukti YogaTransformative YogaTrudie Styler's Warrior YogaV-Core WorkoutVegan ExpressVegan for LifeVegan Recipes from the Middle EastVegetarian Turkish CookingVegetarianoViva Vegan!Walk It Off in 30 DaysWalk to the HITS Radio RemixesWalkingWalking a Literary LabyrinthWatch Me Do YogaWeight Loss Cardio KickWellbeingWhat We Say MattersWhen Things Fall ApartWriting in FlowYin and Yang YogaYin Yoga DVDYogaYogaYogaYoga & Pilates Workouts for DummiesYoga 4 TeensYoga : Beginners Flow for EveryoneYoga AnatomyYoga and PsychologyYoga as MedicineYoga Beauty BodyYoga Bliss HipsYoga Body : Lean & Defined Total Body WorkoutYoga By Teens DVDYoga Emergency DVD: Arms & ShouldersYoga Emergency DVD: BackYoga Emergency DVD: Full Leg StretchYoga Emergency DVD: HipsYoga Flow DVDYoga for AnxietyYoga for AthletesYoga for Back CareYoga for BeginnersYoga for Energy & Stress ReliefYoga for EveryoneYoga for MeditatorsYoga for OsteoporosisYoga for Pain ReliefYoga for Regular GuysYoga for Strength & EnergyYoga for Strength & FlexibilityYoga for the Young at HeartYoga for Your WeekYoga In BedYoga in BedYoga Inside Out: Go DeeperYoga Inside Out: The Healing WayYoga Journal's Yoga for StressYoga Journal: Yoga for Strength and Toning DVDYoga Link: Core IntegrationYoga Link: Hip HelpersYoga Link: Shoulder Shape-UpYoga Nidra for Complete Relaxation and Stress ReliefYoga on DemandYoga Quick FixesYoga SanctuaryYoga SculptYoga ShaktiYoga TherapyYoga TherapyYoga Therapy for Back PainYoga Therapy Prescriptions - 60 Health Restorative SequencesYoga To Go's Yoga Quick Fixes DVDYoga to the Rescue - Feel Good from Head to ToeYoga to the Rescue for Back PainYoga to the Rescue for Neck & ShouldersYoga to the Rescue for Pain-Free Back, Neck & ShouldersYoga Weight Loss for DummiesYoga: Freedom from Back PainYoga: Relief from Neck and Shoulder PainYoga: Spirit of Vinyasa FlowYogabodyYogawomanYou Can Think Yourself ThinYou'll See It When You Believe ItYour Body Breakthru - Your Best Body Circuit DVDYour Brain on FoodYour Brain on Food: How Chemicals Control Your Thoughts and Feelings,Your Miracle BrainZen Encounters with Loneliness
by Allen Frances
William Morrow, 2013
Review by Christian Perring on Jun 4th 2013
Reading Saving Normal, Allen Frances's book about DSM-5 is fascinating because it is so rare for members of the psychiatric establishment to be quite so frank about the arguments and policies that led to the formulation of our current psychiatric diagnostic categories. For example, there has been a great deal of discussion of the process that led to the vote for the removal of homosexual tendencies from the DSM in 1973, but the psychiatrists talked about it in scientific terms saying little about the personal events that led to their decisions. It was only in the last decade that the fuller back story began to emerge about Robert Spitzer, such as in a New Yorker article The Dictionary of Disorder. But here we have Frances, who was chairman of the DSM-IV Task Force, talking about his experiences in creating the DSM-IV, his take on the work of Robert Spitzer being the controlling force behind DSM-III and DSM-III-R, and his analysis of the errors in those who have put together DSM-5. If he has pulled any punches, it is hard to guess where. He seems to be giving his considered but unedited opinion.
It is also surprising to have a prominent psychiatrist who was such a pillar of the psychiatric establishment be so forthright in his condemnation of the pharmaceutical industry and the widespread use of psychiatric medication. While Frances defends the judicious use of medication for serious mental illness, he argues that the bulk of the pharmacological treatment of the worried well is unhelpful and inappropriate. He further argues that there needs to be a massive overhaul of prescription practices of potentially addictive medications, which would solve what is now the biggest substance abuse problem that the USA faces. His suspicion of Big Pharma was always there, but he explains how his opinion of them got worse as he saw them promote profits over patient welfare for decades; he writes at one point "The pharmaceutical industry will do its best to mislead you.". Often, his views are surprisingly close to the most trenchant critics of psychiatry.
Frances explains that although he attempted to be very careful in putting together DSM-IV and keep it guided by scientific principles, the changes that went through allowed three main errors in the diagnostic criteria, allowing explosions in the diagnosis of autism, attention deficit, and childhood bipolar disorder. He is very clear that these are not real rises of mental illness, but are cases of normal young people being treated as if they have a mental disorder. While many parents have mixed feelings about their children receiving these diagnoses, some welcome them because their children then qualify for special education, and presumably the parents are under subtle or not-so-subtle pressure to authorize medication for their children's difficult behavior.
Both in his Saving Normal blog and in this book, Frances has been highly critical of many proposals for DSM-5. He argues that the team that put the manual together has less experience in the dangers than he did when he was put in charge of DSM-IV, and that their inexperience shows in poorly formulated diagnostic criteria which will very likely open the floodgates to new categories of "so called" mental illness. He devotes 3 chapters to psychiatric fads of the past, present and future, putting his criticism in historical context.
Yet although his approach is comprehensive, it is not scholarly. His surveys of science, history, sociology, and philosophy are brief and eclectic. Sometimes they are entertaining, and at other times they seem so idiosyncratic as to be easily dismissible. For example, in Part I of the book, Frances provides 3 chapters on the notion of what counts as normal, and he covers the problems of some of the standard approaches, such as using statistics and lab-tests. But he says with a few pages that philosophy, sociology and anthropology have no answers to the question. He mentions a few figures and ideas, but he completely ignores all the current literature on the nature of normality in these fields. His conclusion is that no definition of normality is useful for psychiatry. His final position is therefore hard to define, but it seems to be that mental disorders are real, treatment should aim to help patients, and diagnostic categories should facilitate treatment. He does say that normal is a fuzzy concept, so there is no clear division between normal and abnormal. He looks to the history of psychiatry as a guide to avoiding the mistakes that have been made previously. So his position seems to be that the overdiagnosis of autism, for example, is a scientific mistake, making factually incorrect assumptions about what counts as autism. But when we ask how do we know what the limits of normality should be?, his answer seems to be that we should let experience and history be our guide. That isn't enough to justify the view that it is factual or scientific rather than a fundamentally normative issue. On the other hand, his idea that is helpful to look to the past and see the abuses of over-treating people or mislabeling them as being ill as a way of controlling them is certainly plausible -- we would want those formulating the DSM to be very much aware of that history.
Theoretical and methodological questions run all through the book, underlying Frances's central claims about the difficulties of ordinary life and our emotional reaction to them being normal. At the same time, there is indication that the issues are practical and empirical: people are resilient and recover on their own from life's difficulties, and treating them with medication introduces risks and interferes with the process of learning life's skills. Frances does not produce much in the way of scientific evidence for this, but he seems to assume it is an empirical question. He is not against the use of psychotherapy as a way to get through difficult times, but psychiatrists do not need to be involved in that treatment.
Much of the rest of Saving Normal is devoted to setting out what counts as good psychiatric diagnosis and treatment, and what problems occur when it is done badly. Only a few chapters are directly about the problems with DSM-5, and readers can find those criticisms on Frances's Saving Normal blog and his other published writings in the last few years.
Are his fears that we will move to an age of massive diagnosis and overtreatment of psychiatric disorders well justified? Is his suspicion of the pharmaceutical companies reasonable? Will DSM-5 be the disaster that Frances predicts? Are practicing psychiatrists trained so badly or so under the influence of Big Pharma that they will over medicate their patients even more than they do now? Lay readers are as always placed in a difficult position when seeing disputes between different experts. Before writing off DSM-5, it would be good to see what those who have actually put together the manual have to say for themselves. Frances has certainly made a strong case and has given readers enough reason to be very careful when seeking psychiatric help.
© 2013 Christian Perring
Christian Perring, Professor of Philosophy, Dowling College, New York