Allen Frances

Last updated
Allen J. Frances
Born (1942-10-02) October 2, 1942 (age 81)
New York City, New York, US
NationalityAmerican
Alma mater Columbia College (1963)
SUNY Downstate College of Medicine (1967)
Occupationpsychiatrist

Allen J. Frances (born 2 October 1942) is an American psychiatrist. He is currently Professor and Chairman Emeritus of the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. He is best known for serving as chair of the American Psychiatric Association task force overseeing the development and revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Frances is the founding editor of two well-known psychiatric journals: the Journal of Personality Disorders and the Journal of Psychiatric Practice .

Contents

During the development of the current diagnostic manual, DSM-5, Frances became critical of the expanding boundaries of psychiatry and the medicalization of normal human behavior, problems he contends are leading to the overdiagnosis and overtreatment of the "worried well" and the gross undertreatment of the severely ill. In recent years, Frances has become a vocal advocate for improved treatment and societal conditions for the seriously mentally ill, the appropriate use of electroconvulsive therapy in severe cases of mental disorder, and an integrated, biopsychosocial approach to psychiatry.

Frances is the author or co-author of multiple books within the fields of psychiatry and psychology, including: Differential Therapeutics (1984), [1] Your Mental Health (1999), [2] Saving Normal (2013), [3] Essentials of Psychiatric Diagnosis (2013), [4] and Twilight of American Sanity (2017). [5] [6] [7]

Education and career

Education

Frances was born and raised in New York City, US. [8] He received his bachelor's degree from Columbia College in 1963 and his medical degree in 1967 from SUNY Downstate College of Medicine. [9] [10] [11] He graduated from the psychiatry residency training program at the New York State Psychiatric Institute in 1971 and received a certificate in psychoanalytic medicine from Columbia University Center for Psychoanalytic Training and Research in 1978. [12] His research in the fields of psychiatry and behavioral sciences focused on schizophrenia, personality disorders, anxiety disorders, mood disorders, and clinical treatment of psychiatric patients. [10]

Career

Frances' early career was spent at Cornell University Medical College, where he rose to the rank of professor, headed the outpatient department, saw patients, taught, established a brief therapy program, and developed research specialty clinics for schizophrenia, depression, anxiety disorders, and AIDS. Throughout his academic career, Frances was an active investigator and prolific author in a surprisingly wide range of clinical areas including personality disorders, chronic depression, anxiety disorders, schizophrenia, AIDS, and psychotherapy. In 1991, he became chairman of the Department of Psychiatry at Duke University School of Medicine, where he helped to expand the research, training, and clinical programs that had been initiated by his predecessor as chair, Dr. Bernard Carroll. [10] [13] [14]

Research

Frances had originally viewed himself as a teacher and clinician but his administrative posts—National Institute of Mental Health and published extensively on personality disorders, chronic depression, schizophrenia, anxiety disorders, the psychiatric aspects of AIDS, and various aspects of psychiatric diagnosis. He also mentored the careers of many other researchers.

Publications

Frances' book on Differential Therapeutics (1984) tried to bring specificity and evidence to decisions on how best to match patient and treatment. [1] His recognition of therapeutic limits resulted in the 1981 paper No Treatment as the Prescription of Choice. [15] Frances was the founding editor of two journals that have become standards: The Journal of Personality Disorders and the Journal of Psychiatric Practice. [14]

In 2013, Allen Frances wrote a paper entitled "The New Crisis of Confidence in Psychiatric Diagnosis", which said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests". [16] [17] Frances was also concerned about "unpredictable overdiagnosis". [16]

The Diagnostic and Statistical Manual of Mental Disorders

DSM-III

Robert Spitzer, later the major force behind DSM-III, was one of Frances' teachers during his psychiatric residency at Columbia University and attempted to recruit him to participate in his research developing standardized criteria for mental disorders and interviewing instruments for diagnostic assessment. Frances declined the offer because he felt psychiatric treatment was much more interesting than psychiatric classification. Ten years later, in 1977, Spitzer attempted to recruit Frances again, this time to join his work on DSM-III. Frances accepted and was given three roles. He wrote the final draft of the personality disorders section of DSM-III; served as DSM-III liaison to the American Psychoanalytic Association and the Academy of Psychoanalysts; and he was a member of the team that delivered DSM-III educational conferences across the country. He wrote a number of papers on the uses and misuses of DSM-III and predicted DSM would eventually adopt a dimensional model of personality disorder diagnosis.

DSM-IV

Frances was appointed Chair of the DSM-IV Task Force in 1987. His selection followed his role as one of the major advisors for DSM-IIIR and reflected concerns within the American Psychiatric Association that new disorders were being added without sufficient evidence and that definitions of existing disorders were too loose. Frances was known as a diagnostic conservative who would promote stability in the system and discourage its rapid expansion across the fuzzy boundary into normality. He introduced a thorough three-stage vetting system to discourage diagnostic exuberance in DSM-IV: 1.) a thorough review of the existing literature had to produce compelling evidence in support of the suggested change; 2.) funding from the MacArthur Foundation allowed dozens of reanalyses of unpublished data sets to help answer questions pertinent to DSM-IV changes; and 3.) NIMH funding allowed for 11 field trials assessing how proposed changes would translate into clinical practice. The conservatism seemed to work. Of the 94 new diagnoses suggested for DSM-IV, only two were accepted: Asperger's syndrome and bipolar II disorder. Both had good supporting literature and both had performed well in field trials. However, Frances argued that any change in DSM-IV that could be misused, would be misused, and both changes led to unfortunate fads of wild overdiagnosis. [18] Frances argues that there was also a fad of attention deficit/hyperactivity disorder partly due to loosened diagnostic criteria but mostly due to pharmaceutical company marketing. [18]

DSM-5

The next revision DSM-5 was initiated with a 2002 book (A Research Agenda for DSM-V [19] ) questioning the utility of the atheoretical, descriptive paradigm and suggesting a neuroscience research agenda aiming to develop a pathophysiologically based classification. After a series of symposiums, the task force began to work on the manual itself. In June 2008, Dr. Robert Spitzer who chaired the DSM-III and DSM-IIIR revisions had begun to write about the secrecy of the DSM-V Task Force (DSM-V: Open and Transparent? [20] ). Frances initially declined to join Spitzer's criticism, but after learning about the changes being considered, [21] he wrote an article in July 2009 (A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences [22] ) expressing multiple concerns including the unsupported paradigm shift, a failure to specify the level of empirical support needed for changes, their lack of openness, their ignoring the negative consequences of their proposals, a failure to meet timelines, and anticipate the coming time pressures. The APA/DSM-V Task Force response dismissed his complaints. [23]

In March 2010, Frances began a weekly blog in Psychology Today , DSM-5 in Distress: The DSM's impact on mental health practice and research, [24] often cross-posted in the Psychiatric Times [25] and the Huffington Post. [26] While many of his blog posts were about the DSM-5 Task Force lowering the thresholds for diagnosing existing disorders (attention deficit disorder, autism, addictions, personality disorders, bipolar II disorder), he was also disturbed by the addition of new speculative disorders (Attenuated Psychosis Syndrome, Disruptive Mood Dysregulation Disorder, Somatic Symptom Disorder). He has argued that the diagnosis attenuated psychosis syndrome promoted by advocates of early intervention for psychosis, such as Australian psychiatrist Patrick McGorry, is risky because of a high rate of inaccuracy, the potential to stigmatize young people given this label, the lack of any effective treatment, and the risk of children and adolescents being given dangerous antipsychotic medication. [27] The elimination of the bereavement exclusion from the diagnosis of major depressive disorder was another particular concern, threatening to label normal grief as a mental illness.

So while the task force was focusing on early detection and treatment, Frances cautioned about diagnostic inflation, overmedication, and crossing the boundary of normality. Besides the original complaint that the DSM-5 Task Force was a closed process, Frances pointed out that they were behind schedule and even with a one-year postponement, they had to drop a follow-up quality control step. He recommended further postponement and advocated asking an outside body to review their work to make suggestions. While the American Psychiatric Association did have an internal review, they rejected his suggestion of an external consultation. When the field testing for inter-rater reliability was released in May 2012, several of the more contested disorders were eliminated as unreliable [28] (attenuated psychosis syndrome, mixed anxiety depression) and the reliabilities were generally disappointing. The APA Board of Trustees eliminated a complex "Cross-Cutting" Dimensional System, but many of the contested areas remained when the document was approved for printing in December 2012 for a scheduled release in May 2013. There were widespread threats of a boycott. [29]

Frances's writings were joined by a general criticism of the DSM-5 revision, ultimately resulting in a petition calling for outside review signed by 14,000 and sponsored by 56 mental health organizations. In the course of almost three years of blogging, Frances became a voice for more than just the specifics of the DSM-5. He spoke out against the overuse of psychiatric medications—particularly in children; a general trend towards global diagnostic inflation—pathologizing normality; the intrusion of the pharmaceutical industry into psychiatric practice; and a premature attempt to move psychiatry to an exclusively biological paradigm without scientific justification. Along the way, he wrote two books: Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (2013), and Essentials of Psychiatric Diagnosis (2013), meant to guide clinicians and to help curb unwarranted diagnostic exuberance. [3] [4] He has decided to continue writing on a new Psychology Today blog called Saving Normal. [30]

Major contentions

Neglecting severe mental illness

Frances contends that while the deinstitutionalization movement was needed due to hospital overcrowding, frequent civil liberties violations, and poor conditions for hospitalized psychiatric patients, its implementation in the United States was an utter failure. In 2018, he wrote,

The money saved from closing the custodial state hospitals was often misallocated to tax cuts and prison construction—depriving the mentally ill of adequate community treatment and housing. The result has been a broken American mental health "non-system" that overtreats the worried well and vastly undertreats the seriously mentally ill. Instead of 600,000 in state hospitals, we now have 350,000 mentally ill in prison and 250,000 homeless—because the vast majority is unable to obtain decent housing and access to treatment. [31]

Frances asserts that psychiatry itself has contributed to the neglect of the severely ill by diverting limited resources away from the community treatment of these patients and focusing instead on genetics research, neuroscience research, and the treatment of the mildly ill. He is particularly critical of NIMH spending excesses in the field of neuroscience, which he says have not helped a single patient in actual life. [32] [33] He is a proponent of a community psychiatry approach.

He argues for the limited and safeguarded use of involuntary psychiatric hospitalization, writing that it is far preferable to the all-too-common alternatives: homelessness and imprisonment. [31]

Overtreating the worried well

Frances argues that with the gradual expansion of the DSM diagnostic system, psychiatry's attention has shifted away from the severely mentally ill and towards the treatment of the mildly ill or "worried well." This has led to several "false epidemics" of mental disorder, including autism and childhood bipolar disorder. [18] He writes extensively about the pathologization of normal human behavior in his book Saving Normal, and provides guidance to clinicians to avoid these pitfalls in Essentials of Psychiatric Diagnosis. During the DSM-5 revision process, he was particularly critical of the concepts of psychosis risk syndrome, binge eating disorder, and mild neurocognitive disorder.

Controversial treatments

Frances is a proponent of the safe and appropriate use of electroconvulsive therapy in severe and treatment-resistant cases of mental disorder; the use of lithium therapy for bipolar disorder; and the use of clozapine for schizophrenia. [34] Regarding electroconvulsive therapy, Frances argues that the treatment can be lifesaving in cases of severe, unrelenting depression and in some other psychiatric disorders, such as malignant, or lethal, catatonia. He has repeatedly asserted that if he were severely depressed, he would agree to electroconvulsive treatment. [35] [36]

Frances has expressed his belief that both lithium carbonate and clozapine are underutilized in the treatment of bipolar disorder and schizophrenia, [34] respectively, often in favor of newer, more profitable second-generation antipsychotic drugs. [37] The current consensus in global psychiatry is that both lithium and clozapine remain the most effective agents in the treatment of their respective conditions; among academic psychiatrists, their underutilization is widely recognized. [38] [39]

Frances has expressed skepticism over the use of ketamine in the treatment of clinical depression, writing that even if it is narrowly indicated in treatment-resistant mood disorder, "ketamine promotionals will encourage many people to start using it as self-medication for distress–a practice that is filled with risk and falls far outside any possible reasonable use of ketamine." [40]

Binding advance directives

Frances has advocated for the widespread use of binding advanced directives allowing patients to determine when they are well what treatments they would like to receive should they have a psychotic relapse. Most psychiatric patients are competent to decide whether or not they want treatment and to pick which treatments they prefer from the available alternatives—but patients with acute psychotic disorders often temporarily lose this capacity and refuse desperately needed treatment to help prevent imprisonment or homelessness. Studies show that most patients with bipolar disorder, once recovered, realize their judgment was dangerously impaired during past acute episodes and welcome the chance to plan advanced directives for involuntary treatment, should this be needed during future episodes. [41] Giving others permission in advance to impose treatment, should it become necessary, takes away much of the anger, mistrust, helplessness, and humiliation patients feel when they have no say in their fate.

Frances argues that advanced directives are perhaps the only intervention in psychiatry that is without a downside. Relapses are much shorter and less harmful when treated promptly. Accepting that future relapses can occur provides patients with the strongest possible incentive to reduce their probability by participating fully in preventive disease management. And ideological and legal controversies about the role of coercion in psychiatry usually dissolve in the cooperation forged by jointly facing clinical reality.

Frances contends that advanced directives make sense for patients who have previously required involuntary treatment. Discussion of advanced directives might help restore a fractured therapeutic relationship by explaining why the coercion seemed necessary in the past and suggesting how it can be avoided in the future. It is more of a case-by-case decision whether to discuss directives with patients who have never before opposed treatment—directives most indicated for those whose acute episodes are severe, dangerous, frequent, and prolonged. The best time to begin discussing advanced directives is soon after insight returns following an acute episode and it is almost always helpful to include family in the discussion.

On psychotherapy and psychoanalysis

Trained as a psychoanalyst, Frances taught the Freud course at the Columbia Psychoanalytic Center for a decade starting in the late 1970s. He has said that his "favorite work activity throughout [his] career was doing and teaching psychodynamic psychotherapy." [12] Some of his early work was on the study and treatment of personality disorder.

Frances contends that guild wars within psychotherapy have hurt the profession and those it treats; like Marvin Goldfried, he is a proponent of psychotherapy integration. He has said that the biggest mistake made by American psychoanalysis was their rejection of Aaron Beck's cognitive behavior therapy. Regarding Freud, Frances has said that Freud was "overvalued in his day and is now undervalued in ours." [12]

Biopsychosocial model

Frances is a proponent of George Engel's biopsychosocial model of mental disorder, writing that the "biopsychosocial model of mental illness and mental health care created a conceptual underpinning of psychiatric practice." [42] Frances is critical of reductionistic theories in psychiatry and psychology; in any mental disorder, biological, psychological, and social factors are working in tandem to create and maintain dysfunction.

No treatment as a treatment of choice

During his residency training, Frances became dismayed at the long length of hospital stays and overtreatment with psychiatric drugs. Later, as head of the outpatient department at Cornell, Frances noted that many patients failed to benefit from treatment, and some seemed to be harmed by it. This led to his 1982 paper, "No Treatment as the Prescription of Choice," [43] and his career-long efforts to warn clinicians against overdiagnosis and overtreatment.

On antipsychiatry

Frances has much in common with critics of psychiatry who oppose overdiagnosis and overtreatment, but is much opposed to those who preach that psychiatric treatment is always harmful and never necessary. He frequently debated antipsychiatrists at conferences and in print, arguing that treatments overvalued to the many were essential to the few. The five percent of the population with severe mental illness do not do well without medication and often wind up in jail or living on the streets unless treatment is provided. [18] He believes that antipsychiatry is a useful check against psychiatric overreach but that it is extremely harmful when it discourages patients from getting the treatment they need.

Psychotherapy

Throughout his career, Frances has maintained that psychotherapy represents a core, foundational skill in the practice of clinical psychiatry. He counts, among others, Silvano Arieti, Sherv Frazier, Nathan Ackerman, Lawrence Kolb, John Talbott, Leon Salzman, Howard Hunt, Harold Searles, Aaron Beck, and Marsha Linehan as his greatest mentors on psychotherapy. [44] While initially trained in psychoanalysis, Frances gained exposure to a variety of therapeutic models and techniques and has said that his proudest career activity was serving on the NIMH committee that in the 1980s funded the early studies on cognitive behavioral therapy and dialectical behavioral therapy. He has argued that this research has helped many more millions of people than much of the fascinating but clinically useless biological research undertaken by NIMH in recent decades. [18]

Although Frances was trained as a psychoanalyst and taught a course on Freudian theory for a decade, he is an enthusiastic supporter of brief psychotherapy as the treatment of choice for most patients. Partly this is informed by a public health concern that everyone who needs help should have quick and easy access to treatment. Partly this comes from the experience that brief therapy is effective for most milder problems and is what most patients prefer. Partly it is partly based on the utilitarian dictum of the greatest good for the greatest number. And finally, Frances feels that brief therapy is a wonderful training device allowing acquisition of cognitive, behavioral, psychodynamic, and family systems techniques.

In a 2023 interview on his career as a psychotherapist, Frances stressed the importance of differential diagnosis in psychotherapy; the importance of theoretical pluralism and technical flexibility; the healing power of the therapeutic relationship; and the value of clinical supervision and personal psychotherapy. He advised early-career therapists to treat patients across the psychiatric diagnostic spectrum, including severely ill patients; to learn the basics of psychopharmacology, including its limitations; and to gain life experience in a variety of ways, including reading literature, falling in love, and traveling, in order to become a more well-rounded therapist. [44] Frances says that his patients were his best teachers and he is grateful to them not only for making him a better therapist but also a better person. [45]

Since 2022, he has co-hosted with psychologist Marvin Goldfried a podcast titled Talking Therapy, which covers a wide range of topics on psychotherapy and is available on Youtube.

Book and statements on Donald Trump

Frances wrote a 2017 book, titled, Twilight of American Sanity, in which he asserts that Trump himself does not have a mental disease, but rather that the problem lies with the American people for selecting him as U.S. President. [7] [6] [5] Frances writes in the book: "Calling Trump crazy allows us to avoid confronting the craziness in our society." [5] The Washington Post found the arguments made by Frances in the book stray from medical to political in nature. [5] Publishers Weekly said the book contained factual errors and exaggeration. [7] Kirkus Reviews said the work "helps explain why and how the Trump presidency happened." [6]

In August 2019, Frances stated that "Trump is as destructive a person in this century, as Adolf Hitler, Joseph Stalin and Mao Zedong were in the last century. He may be responsible for many more million deaths than they were. He needs to be contained, but he needs to be contained by attacking his policies, not his person." [46] [47] [48] Frances posted a follow-up to Twitter in which he asserted his comments referred to the potential future impact of climate change. [46] In their analysis of his comments, Politifact reported that a 2011 calculation by Yale University history professor Timothy Snyder said Hitler killed over 11 million people, and the U.S. Holocaust Memorial Museum estimated about 17 million deaths attributed to Hitler. Politifact also cited author Ian Johnson, who found Mao Zedong responsible for approximately 42.5 million fatalities in his book The Souls of China: The Return of Religion After Mao. [46] Politifact concluded that: "Not only does Frances' comparison exaggerate the predicted climate change death toll compared to that of the dictators, he also lays the blame for potential future deaths at Trump's feet alone, which even experts critical of Trump consider wrongheaded," and rated his statement as "Pants on Fire". [46]

In a further clarification statement to Snopes, who analyzed his assertions, Frances reiterated that he was referring to the potential future impact of climate change, stating; "I think it is no exaggeration to worry that the policies that follow from Trump's reckless climate denial may wind up causing the death of hundreds of millions of people. Our species appears to be on a path to self-destruction, and Trump is enthusiastically leading the way." [47]

Related Research Articles

<i>Diagnostic and Statistical Manual of Mental Disorders</i> American psychiatric classification

The Diagnostic and Statistical Manual of Mental Disorders is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common language and standard criteria. It is the main book for the diagnosis and treatment of mental disorders in the United States and Australia, while in other countries it may be used in conjunction with other documents. The DSM-5 is considered one of the principal guides of psychiatry, along with the International Classification of Diseases (ICD), Chinese Classification of Mental Disorders (CCMD), and the Psychodynamic Diagnostic Manual. However, not all providers rely on the DSM-5 as a guide, since the ICD's mental disorder diagnoses are used around the world and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions.

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

Anti-psychiatry, sometimes spelled antipsychiatry without the hyphen, is a movement based on the view that psychiatric treatment is often more damaging than helpful to patients, highlighting controversies about psychiatry. Objections include the reliability of psychiatric diagnosis, the questionable effectiveness and harm associated with psychiatric medications, the failure of psychiatry to demonstrate any disease treatment mechanism for psychiatric medication effects, and legal concerns about equal human rights and civil freedom being nullified by the presence of diagnosis. Historical critiques of psychiatry came to light after focus on the extreme harms associated with electroconvulsive therapy or insulin shock therapy. The term "anti-psychiatry" is in dispute and often used to dismiss all critics of psychiatry, many of whom agree that a specialized role of helper for people in emotional distress may at times be appropriate, and allow for individual choice around treatment decisions.

<span class="mw-page-title-main">Borderline personality disorder</span> Personality disorder of emotional instability

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses. Individuals diagnosed with BPD frequently exhibit self-harming behaviours and engage in risky activities, primarily due to challenges in regulating emotional states to a healthy, stable baseline. Symptoms such as dissociation—a feeling of detachment from reality, a pervasive sense of emptiness, and an acute fear of abandonment are prevalent among those affected.

Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis requires symptoms of both schizophrenia and a mood disorder: either bipolar disorder or depression. The main criterion is the presence of psychotic symptoms for at least two weeks without any mood symptoms. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses.many people with schizoaffective disorder have other mental disorder such as anxiety disorder

<span class="mw-page-title-main">Delusional disorder</span> Mental illness featuring beliefs with inadequate grounding

Delusional disorder, traditionally synonymous with paranoia, is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect. Delusions are a specific symptom of psychosis. Delusions can be bizarre or non-bizarre in content; non-bizarre delusions are fixed false beliefs that involve situations that could occur in real life, such as being harmed or poisoned. Apart from their delusion or delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not necessarily seem odd. However, the preoccupation with delusional ideas can be disruptive to their overall lives.

Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment.

This article is a compiled timeline of psychotherapy. A more general description of the development of the subject of psychology can be found in the History of psychology article. For related overviews see the Timeline of psychology and Timeline of psychiatry articles.

Robert Leopold Spitzer was a psychiatrist and professor of psychiatry at Columbia University in New York City. He was a major force in the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

A major depressive episode (MDE) is a period characterized by symptoms of major depressive disorder. Those affected primarily exhibit a depressive mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities. Other symptoms can include feelings of emptiness, hopelessness, anxiety, worthlessness, guilt, irritability, changes in appetite, difficulties in concentration, difficulties remembering details, making decisions, and thoughts of suicide. Insomnia or hypersomnia and aches, pains, or digestive problems that are resistant to treatment may also be present.

<span class="mw-page-title-main">Ego-dystonic sexual orientation</span> Psychiatric diagnosis

Ego-dystonic sexual orientation is a highly controversial mental health diagnosis that was included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) from 1980 to 1987 and in the World Health Organization's (WHO) International Classification of Diseases (ICD) from 1990 to 2019. Individuals could be diagnosed with ego-dystonic sexual orientation if their sexual orientation or attractions were at odds with their idealized self-image, causing anxiety and a desire to change their orientation or become more comfortable with it. It describes not innate sexual orientation itself, but a conflict between the sexual orientation a person wishes to have and their actual sexual orientation.

Medical model is the term coined by psychiatrist R. D. Laing in his The Politics of the Family and Other Essays (1971), for the "set of procedures in which all doctors are trained". It includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and prognosis with and without treatment.

<span class="mw-page-title-main">Bipolar disorder in children</span>

Bipolar disorder in children, or pediatric bipolar disorder (PBD), is a rare mental disorder in children and adolescents. The diagnosis of bipolar disorder in children has been heavily debated for many reasons including the potential harmful effects of adult bipolar medication use for children. PBD is similar to bipolar disorder (BD) in adults, and has been proposed as an explanation for periods of extreme shifts in mood called mood episodes. These shifts alternate between periods of depressed or irritable moods and periods of abnormally elevated moods called manic or hypomanic episodes. Mixed mood episodes can occur when a child or adolescent with PBD experiences depressive and manic symptoms simultaneously. Mood episodes of children and adolescents with PBD are different from general shifts in mood experienced by children and adolescents because mood episodes last for long periods of time and cause severe disruptions to an individual's life. There are three known forms of PBD: Bipolar I, Bipolar II, and Bipolar Not Otherwise Specified (NOS). The average age of onset of PBD remains unclear, but reported age of onset ranges from 5 years of age to 19 years of age. PBD is typically more severe and has a poorer prognosis than bipolar disorder with onset in late-adolescence or adulthood.

The classification of mental disorders, also known as psychiatric nosology or psychiatric taxonomy, is central to the practice of psychiatry and other mental health professions.

Child and adolescent psychiatry is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.

<span class="mw-page-title-main">Psychiatry</span> Branch of medicine devoted to mental disorders

Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of deleterious mental conditions. These include various matters related to mood, behaviour, cognition, and perceptions.

Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture. These patterns develop early, are inflexible, and are associated with significant distress or disability. The definitions vary by source and remain a matter of controversy. Official criteria for diagnosing personality disorders are listed in the sixth chapter of the International Classification of Diseases (ICD) and in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

<span class="mw-page-title-main">Melancholic depression</span> Medical condition

Melancholic depression, or depression with melancholic features, is a DSM-IV and DSM-5 specifier of depressive disorders. The specifier is used to distinguish clinically relevant subsets of causes and symptoms that have the potential to influence treatment.

<span class="mw-page-title-main">Disruptive mood dysregulation disorder</span> Medical condition

Disruptive mood dysregulation disorder (DMDD) is a mental disorder in children and adolescents characterized by a persistently irritable or angry mood and frequent temper outbursts that are disproportionate to the situation and significantly more severe than the typical reaction of same-aged peers. DMDD was added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) as a type of depressive disorder diagnosis for youths. The symptoms of DMDD resemble many other disorders, thus a differential includes attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), anxiety disorders, and childhood bipolar disorder, intermittent explosive disorder (IED), major depressive disorder (MDD), and conduct disorder.

Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis, the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent, the side effects of treatments such as electroconvulsive therapy, antipsychotics and historical procedures like the lobotomy and other forms of psychosurgery or insulin shock therapy, and the history of racism within the profession in the United States.

References

  1. 1 2 Siris, Samuel G. (August 1, 2006), "Differential Therapeutics in Psychiatry: The Art and Science of Treatment Selection—by Allen Frances, M.D., John Clarkin, Ph.D., and Samuel Perry, M.D.; Brunner/Mazel, New York, 1984, 395 pages, $30", Psychiatric Services , 36 (6): 669, doi:10.1176/ps.36.6.669
  2. ↑ "Your Mental Health: A Layman's Guide to the Psychiatrist's Bible", WorldCat , OCLC, 2019, OCLC   605729701
  3. 1 2 Guldberg, Helene (July 16, 2014), "Review: Saving Normal - A rebellion against the pathologisation of everyday life.", Psychology Today , retrieved August 27, 2019
  4. 1 2 Pierre, Joseph M. (June 27, 2014), "Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5", Psychiatric Times , Vol 31 No 6, 31 (6), retrieved August 27, 2019
  5. 1 2 3 4 Lozada, Carlos (September 22, 2017), "Book Party - Review - Is Trump mentally ill? Or is America? Psychiatrists weigh in.", The Washington Post , retrieved August 27, 2019
  6. 1 2 3 "Book Review - Twilight of American Sanity", Kirkus Reviews , August 7, 2017, retrieved August 27, 2019
  7. 1 2 3 "Nonfiction Book Review - Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump", Publishers Weekly , October 2017, retrieved August 27, 2019
  8. ↑ "Live Internet Talk Radio Shows Streaming On-line | Listen for Free". VoiceAmerica. Archived from the original on August 17, 2017. Retrieved August 17, 2017.
  9. ↑ "Bookshelf". Columbia College Today. Fall 2018. Archived from the original on December 20, 2018. Retrieved June 7, 2020.
  10. 1 2 3 Frances, Allen James, Duke University, Duke Psychiatry & Behavioral Sciences; Duke University School of Medicine, 2019, retrieved August 28, 2019
  11. ↑ "Allen Frances, MD '67 - 'Saving Normal: Over Treatment in Psychiatry'" (PDF), Alumni Reunion Brochure 2017, SUNY Downstate College of Medicine, 2017, retrieved August 28, 2019
  12. 1 2 3 "Allen Frances: Portrait of the Psychiatrist as a Young Man". Psychology Today. Retrieved April 12, 2021.
  13. ↑ "Allen Frances, M.D.", The Huffington Post , Verizon Media, 2019, retrieved August 28, 2019
  14. 1 2 Rubin, Lawrence (2019), "Allen Frances on the DSM-5, Mental Illness and Humane Treatment", Psychotherapy.net: Great Therapists Never Stop Learning, retrieved August 28, 2019
  15. ↑ Frances, Allen; Clarkin,JF (May 1981). "No Treatment as the Prescription of Choice". Arch Gen Psychiatry. 38 (5): 542–545. doi:10.1001/archpsyc.1980.01780300054006. PMID   7235855.
  16. 1 2 Frances, Allen (August 6, 2013). "The new crisis of confidence in psychiatric diagnosis". Annals of Internal Medicine. 159 (2): 221–222. doi:10.7326/0003-4819-159-3-201308060-00655. PMID   23685989.
  17. ↑ Frances, Allen (January 2013). "The past, present and future of psychiatric diagnosis". World Psychiatry . 12 (2): 111–112. doi:10.1002/wps.20027. PMC   3683254 . PMID   23737411.
  18. 1 2 3 4 5 Frances, Allen (2013). Saving Normal. HarperCollins.
  19. ↑ David J. Kupfer; Michael B. First; Darrel A. Regier, eds. (2002). A Research Agenda For DSM V A Research Agenda For DSM V. Arlington, VA: American Psychiatric Publishing. p. 336. ISBN   978-0-89042-292-2.
  20. ↑ Spitzer, Robert (June 18, 2008). "DSM-V: Open and Transparent?". Psychiatric News. Retrieved March 26, 2013.
  21. ↑ Greenberg, Gary. "Inside the Battle to Define Mental Illness". Wired. Retrieved March 26, 2013.
  22. ↑ Frances, Allen (June 26, 2009). "A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences". Psychiatric Times. Retrieved March 26, 2013.
  23. ↑ Schatzberg AF, Scully JH, Kupfer DJ, Regier DA (July 1, 2009). "Setting the Record Straight: A Response to Frances Commentary on DSM-V". Psychiatric Times. Retrieved March 26, 2013.
  24. ↑ Frances, Allen. "DSM5 in Distress: The DSM's impact on mental health practice and research". Psychology Today. Retrieved March 26, 2013.
  25. ↑ Frances, Allen. "Blog". Psychiatric Times. Retrieved March 26, 2013.
  26. ↑ Frances, Allen. "Blog". The Huffington Post. Retrieved March 26, 2013.
  27. ↑ "Frances A. Psychosis risk syndrome—far too risky". Aust N Z J Psychiatry. 2011 Oct;45(10):803-4.
  28. ↑ Carey, Benedict (May 8, 2012). "Psychiatry Manual Drafters Back Down on Diagnoses". New York Times. Retrieved March 27, 2013.
  29. ↑ Carney, Jack (February 5, 2013), "DSM-5 Boycott Launched!", Mad in America, retrieved August 27, 2019
  30. ↑ Frances, Allen. "Saving Normal: Mental health and what is normal". Psychology Today. Retrieved March 26, 2013.
  31. 1 2 Allen Frances, M. D. (July 3, 2018). "Mental Illness, Civil Liberty, and Common Sense". Psychiatric Times. Vol 35, Issue 7. 35 (7). Retrieved April 17, 2021.
  32. ↑ "The lure of 'cool' brain research is stifling psychotherapy – Allen Frances | Aeon Ideas". Aeon. Retrieved April 17, 2021.
  33. ↑ Frances, Allen (February 22, 2019). "30 yr search for biomarkers to explain/treat #mentalillness has cost $20 billion. Produced great hype & "cool papers", but so far hasn't helped a single patient. Quixotic NIMH head Tom Insel now seeks gold w #smartphone markers". Twitter. Retrieved April 17, 2021.
  34. 1 2 "Advice to Young Psychiatrists From a Very Old One". Psychiatric Times. October 4, 2019. Retrieved April 17, 2021.
  35. ↑ Frances, Allen (June 3, 2020). "ECT is only effective treatment for severe depression that hasn't responded to anything else. Would be my choice for me- one of best risk/benefit ratios in medicine". Twitter. Retrieved April 17, 2021.
  36. ↑ Frances, Allen (June 27, 2017). "Wrong. ECT works in severe/delusional depressions when all else fails. If I had severe depression, ECT would definitely be my 1st choice". Twitter. Retrieved April 17, 2021.
  37. ↑ Allen J. Frances on the overdiagnosis of mental illness , retrieved April 17, 2021
  38. ↑ Post, Robert M (April 2018). "The New News about Lithium: An Underutilized Treatment in the United States". Neuropsychopharmacology. 43 (5): 1174–1179. doi:10.1038/npp.2017.238. ISSN   0893-133X. PMC   5854802 . PMID   28976944.
  39. ↑ Bogers, Jan P. A. M.; Schulte, Peter F. J.; Van Dijk, Daniel; Bakker, Bert; Cohen, Dan (April 2016). "Clozapine Underutilization in the Treatment of Schizophrenia: How Can Clozapine Prescription Rates Be Improved?". Journal of Clinical Psychopharmacology. 36 (2): 109–111. doi:10.1097/JCP.0000000000000478. ISSN   0271-0749. PMID   26872120.
  40. ↑ "Is Ketamine Really a Miracle Drug for Depression?". Drug Rehab Options. Retrieved April 17, 2021.
  41. ↑ Stephenson, Lucy A.; Gergel, Tania; Gieselmann, Astrid; Scholten, Matthé; Keene, Alex Ruck; Rifkin, Larry; Owen, Gareth (October 16, 2020). "Advance Decision Making in Bipolar: A Systematic Review". Frontiers in Psychiatry. 11: 538107. doi: 10.3389/fpsyt.2020.538107 . ISSN   1664-0640. PMC   7596358 . PMID   33192654.
  42. ↑ Frances, Allen (December 1, 2014). "Resuscitating the biopsychosocial model". The Lancet Psychiatry. 1 (7): 496–497. doi:10.1016/S2215-0366(14)00058-3. ISSN   2215-0366. PMID   26361297.
  43. ↑ Frances, A.; Clarkin, J. F. (May 1981). "No treatment as the prescription of choice". Archives of General Psychiatry. 38 (5): 542–545. doi:10.1001/archpsyc.1980.01780300054006. ISSN   0003-990X. PMID   7235855.
  44. 1 2 "A Psychiatrist Reflects on Psychotherapy: An Interview with Allen Frances | CARLAT PUBLISHING". www.thecarlatreport.com. Retrieved October 6, 2023.
  45. ↑ Frances, Allen (September 15, 2023). "Psychotherapists are the luckiest people on earth. Many of the best hours of my life were spent doing therapy & many of my favorite people were patients. I couldn't be more grateful to them for teaching me so much about life & making me a better person". X (formerly Twitter). Retrieved October 6, 2023.
  46. 1 2 3 4 Jacobson, Louis (August 26, 2019). "Hitler, Stalin, Mao ... and Trump? No, Pants on Fire". Politifact . Poynter Institute . Retrieved August 27, 2019.
  47. 1 2 Palma, Bethania (August 27, 2019), "Did a Psychiatrist Say Trump May Cause More Deaths Than Hitler, Stalin, and Mao?", Snopes , retrieved August 27, 2019
  48. ↑ Givas, Nick (August 25, 2019). "Duke professor compares 'destructive' Trump to 'Hitler, Stalin and Mao' during CNN interview". FOX News. Retrieved August 26, 2019.
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