Allen Frances – Misuses of Psychiatric Diagnosis

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Allen Frances – Misuses of Psychiatric Diagnosis




Dr. Allen Frances presented his views on the problems brought by the latest update of the Diagnostic and Statistical Manual of Mental Disorders (DSM). He also presented the real concerns evidenced by his fellow professionals and the members of the public at large. The lecture that he delivered in the lecture theater of Robert Dean Institute was attended by many people (, 2015).  Dr. Frances concerns were on the increasing misuse of the psychiatry diagnosis that ends up putting healthy people at risk due to the side effects of psychiatric medications (Frances, 2012). He said that anyone living a normal life must experience ups and downs, stresses, disappointments, setbacks, and sorrows. These challenges are a normal part of human life, and psychiatrists should stop classifying normal behaviors as psychiatric conditions (, 2015).  Today, millions of people who are just but worried are being diagnosed as having mental disorders, and they are receiving unnecessary treatments.

Dr Frances traced the antecedent of psychiatry from the Sharmans, Hippocrates, Christianity, Galen, Priest and gods, Arabs enlightenment, Sydenham, Pinel, Linnaeus, Freud, Kraeplin, Spitzer and the DSM (Frances, 2012).  The common thread was to associate deviant behavior with the interest of certainty so as to take good care of people with various problems and those who were behaving badly. It ranged from the interpretation of which spirit was angry and what was necessary to appease it. The management of mentally disturbed people moved from the aggressive interventions to a focus on what was wrong with the affected individual and how well the person could be treated (, 2015).

The notion of personality was introduced during the Galen’s time. The first classification of temperament and the idea of understanding the person both well, and the sick came from the four theories of humor (Frances, 2009). Christianity brought the concept of war between good and evil, and this led to a period of severe reactions to those who deviated as it was seen as a sign of possession (Frances, 2012). The Arabs in this period were very civilized, and they didn’t demonstrate any problem accepting mental illness. People with mental illness were not harshly judged, but there was a restriction of funds from the family with a person who was suffering from mental illness. Arabs doctors lived together with their patients, and it’s believed that they were among the earliest culture to begin classifying diseases (Frances & Widiger, 2012).

The taxonomist Linnaeus had a formative influence on the classification. He had traveled widely, and this enabled him to come across very many species (, 2015).  Pinel came after Linnaeus, and he is referred to as the father of modern psychiatry. He developed a more humane approach to psychiatric treatment (Frances, 2009). Sydenham also hailed around this time, and he introduced the notion of syndromes. Kraeplin took the concept of disease classification to a higher notch by arguing that it’s good to have a classification system and then attempt to follow this with an explanatory model (Frances, 2012). Freud was a neurologist, but he saw that there was the need to develop theories that explained the concept of the unconscious mind.

Pre-World War 2 there was a growing necessity for the US to collect statistics about mental disorders that were uniform (Frances, 2009). The need for uniformity led to the development of a new psychiatric manual after the war that was used to categorize mental disorders. It was formalized into the first DSM-1. International Classification of Diseases (ICD) also had their section of mental disorders. By around 1980s, there was an increasing risk of the psychiatric classification becoming irrelevant because each diagnostic category’s reliability was very low. This problem was addressed by the DSM task force that led to the introduction of DSM-III (Frances & Widiger, 2012). DSM-III was a more precise diagnostic criterion, a multiaxial system and it used a descriptive approach that was neutral to etiological theories. Development of DSM-III coupled with the emergence of semi-structured interviews helped professionals to read from the same page (Frances, 2012).

Despite the development of the DSM classification, people continued to misuse this classification as they used it as a bible rather than a guidebook (Frances, 2009). Psychiatrists conceptualized the entities in it, and the patients were in danger if their symptoms were not apparent in the symptom checklist (Frances, 2012).  The more complex the category was, the less reliable the diagnosis was. Despite the advances in genetics and imaging over the last thirty years, it has not helped in the advancement of psychiatric pathology. It’s easy to understand the normal, but very difficult to comprehend processes in individuals when things go wrong. The understanding of the mechanisms of the brain has remained elusive despite the increase research findings in this area (Frances & Widiger, 2012). It is evidenced by the fact that even today there is no firm definition of mental disorder.

The main problem with psychiatric classification is the fact that definitions in the DSM are only theoretical in nature and also open to multiple interpretations (, 2015).  For the manual to be useful, it has to identify which disorders have enough evidence to be listed. If the sick person happens to be in the boundary how can the clinician involved figure out how to treat that patient. Unlike the past, when DSM systematization promoted research, it’s now withholding it back because there are no advances in psychiatric diagnosis (Frances &Widiger, 2012). For instance, after a period of 30 years in this research, there are still no identified biological tests for psychiatric pathologies. The psychiatrist can give a precise diagnosis if the there is a disorder that is clearly defined, but even in this case they must work within their competence (Frances, 2009).  When there are unwarranted assumptions about the diagnosis of a psychiatric condition, the clinician can bring more harm than good.

Frances warns that mislabeling everyday problem as mental disease has a shocking implication of the individuals and the society (Frances, 2012).  People must learn to differentiate between normal and real mental conditions. He argues that stigmatizing a healthy individual as suffering from mental disorders makes such a person be subjected to taking psychiatric medications that have harmful side effects (, 2015). Frances caution that the new edition of the psychiatric bible the DSM-5 will turn millions of healthy people into mental patients. Frances argues that the real mentally ill patient will be neglected while the many “worried well” will be given the bulk of all psychiatric medications. He continues to argue that the DSM-5 will benefit pharmaceutical companies that will reap big profits from the sale of psychiatric drugs (Frances & Widiger, 2012).

There is some area of concerns in the use of DSM-5. They include the use of subsyndromal disorders, the confusion of whether to focus on a particular behavioror symptoms, the misuse of the manual itself and the judgment in the forensic area (Frances, 2012).  Inflation of diagnostic inflation with an unprecedented number of children and adults being treated for diagnosing disorders is also noted. This inflation is thought to be brought by the increased number of possible diagnostic disorders (Frances, 2009).  The pains and aches of everyday life are being pathologised with consequent over-diagnosis and over-medication. Research shows that half of the children diagnosed with autism grow out of it. In addition to the probable damage to the developing brain, there are also dangerous side effects associated.............

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