Saving Normal

March 18, 2013
Wary of liberties being taken by the psychiatric community with its definition of “normal,” Frances (Essentials of Psychiatric Diagnosis) goes on a sobering foray through mental disorders and the social institutions that have defined and redefined them. These recalibrations will be promulgated, most prominently, by the soon-to-be-published DSM-5. Frances, who served as the chairperson for DSM-IV, explains that the new version of the Diagnostic and Statistical Manual of Mental Disorders (widely known as the “bible of psychiatry”) has been recklessly expanded and rejiggered, to the point that nearly anything can now be pegged as an aberration. Such “diagnostic inflation” entails the obvious risks of unnecessary and/or excessive treatment, but perhaps even more pernicious is its grander effects on what society—not just specialists—deem normal. Despite Frances’s years of professional experience, his analysis is sometimes scattered with historical and cultural asides that, while interesting, do not clarify the trajectory and impact of the DSM. Still, few are as well-equipped as Frances to map the dynamic field of psychiatry, and his rendering of its shifting contours is timely, crucial, and insightful—as are his solutions for navigating it. Agent: Carrie Kania, Conville and Walsh Literary Agency (U.K.).

April 15, 2013

Frances (emeritus, former dept. chair of psychiatry & behavioral science, Duke Univ. Sch. of Medicine) reveals significant, pernicious deficiencies in the psychiatric diagnostic system in this critique of the Diagnostic and Statistical Manual (DSM), now entering its fifth iteration. According to Frances, this endeavor to standardize psychiatric diagnosis is doomed to failure because, in the end, the classification is a product of human biases. The author's authority as chair of the Task Force for the DSM-IV, as well as a leader in a subgroup for the DSM-III and DSM-III-R, adds credibility to his argument. Biases of committee members, coupled with the financial interests of Big Pharma, he contends, have generated diagnostic fads, such as multiple-personality disorder. Popular diagnoses such as ADD have been overgeneralized to benefit the profits of pharmaceutical companies as medication is dispensed more liberally. Frances argues that "normal" has vanished because everyone qualifies for a psychiatric diagnosis at some point in life. VERDICT An indispensable guide for professional and lay readers of Peter D. Kramer's Listening to Prozac. [See Prepub Alert, 11/25/12.]--Lynne Maxwell, Villanova Univ. Sch. of Law Lib., PA

Copyright 2013 Library Journal, LLC Used with permission.

Starred review from April 15, 2013
The Diagnostic and Statistical Manual (DSM), produced by the American Psychiatric Association, is considered the bible of psychiatry. It establishes the border between normalcy and mental disorder. Despite its usefulness, one prominent psychiatrist laments that the DSM has become too influential. The definition of normal seems to be steadily shrinking. Frances served as head of the task force that issued the fourth DSM. He worries that the new DSM-5 (which cost $25 million to produce) will further inflate psychiatric diagnosis, resulting in additional overmedication. Already, 20 percent of American adults take one drug or more for a psychiatric condition. About 11 percent of adults used antidepressants in 2010. And prescriptions for antipsychotic medicines have doubled in a decade. Frances frets that the DSM-5 will spawn faddish diagnosesmuch like its predecessor, which created false epidemics of attention deficit, autism, and childhood bipolar disorder. This time around, look out for Disruptive Mood Dysregulation Disorder, which morphs temper tantrums into a mental illness, and Minor Neurocognitive Disorder, which turns the forgetfulness of aging into a mental disorder. With Solomon-like wisdom, Frances justly doles out blame and offers reasonable remedies. His decree: don't medicalize human difference; celebrate it.(Reprinted with permission of Booklist, copyright 2013, American Library Association.)

March 1, 2013
Frances weighs in with a no-holds-barred critique of the newly revised Diagnostic and Statistical Manual of Mental Disorders. As the DSM IV Task Force leader, the author does not duck responsibility for the problematic nature of the manual, which he describes as a "cultural icon" and "perennial best seller." Not anticipating the diagnostic creep, "we failed to predict or prevent three new false epidemics of mental disorder in children--Autism, Attention Deficit Disorder, and Childhood Bipolar Disorder." In the author's view, too often clinicians adopt labels from the manual to cover up their own sloppy and even faddish diagnoses. He predicts that the situation will worsen with the new edition. Once considered a rare disease, "CBD [childhood bipolar disorder] has become the most inflated bubble in all psychiatric diagnosis." Frances anticipates that the DSM V's inclusion of Asperger's in the autism spectrum will cause problems, possibly leading to a reduction of special school programs that help students with Asperger's at one end of the spectrum, and disability benefits for the extremely disabled at the other. While accepting his own and fellow psychiatrists' failure to predict the problem of label creep, the author ascribes most responsibility to pharmaceutical companies, which have "hijacked the medical profession" and created "a feeding frenzy of over-diagnosis, over-testing, and over-treatment." He attributes the current obesity epidemic to side effects of modern antipsychotics, and he charges drug companies with complicity in promiscuously pushing antipsychotics on patients with "garden-variety" anxiety or shyness and broadening the definition of childhood bipolar disease to encompass temper tantrums and moodiness. In a partial effort of exculpation and mea culpa, Frances explains that his team began work in the "pre-Prozac days of 1987." A valuable assessment for clinicians and potential patients.

COPYRIGHT(2013) Kirkus Reviews, ALL RIGHTS RESERVED.