Should Psychiatrists Really Decide about Psychiatry? (with DSM-4 Chair Allen Frances‪)‬ What’s Next in Mental Health?

 About a decade ago, one of the most influential psychiatrists of our time, started speaking out against over-medicalization and vested interests corroding the diagnostic system in psychiatry - a system he had helped pioneer. Professor Emeritus Allen Frances points to systemic biases with specialists pushing to expand their own speciality. Dr. Frances has protested about the pharmaceutical industry capitalizing on this expansion and suggested that the exceptionally lucrative Diagnostic and Statistical Manual (DSM) be taken entirely out of the hands of the American Psychiatric Association. He also doesn’t see the World Health Organization’s corresponding system working any better.

In this episode, we discuss with Dr. Frances, how the field of mental health became so medicalized and how the two diagnostic systems are produced.  We look at why specialists can be problematic evaluators when it comes to their own speciality and why a broader, less vested set of shoulders can be more appropriate for setting diagnostic criteria and treatment guidelines.

Allen Frances chaired the task force that produced the fourth edition of the DSM (DSM-IV) and is Professor Emeritus at the Duke University School of Medicine where he chaired its department of Psychiatry and Behavioral Sciences. He is the author of the book Saving Normal: An Insider's Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life.


Timestamps:
0:00    Experts’ and Pharma’s interests in medicalization
7:30    Creating diagnostic systems and APA’s DSM publishing interests
9:54    Power balance between specialists vs. primary care
13:31 Compensating treatment and therapy before or after diagnosis?
17:00 Replacing APA as institution producing the diagnostic system
20:25 Role of DSM, symptoms and the quest for biological understanding
28:40 Becoming a public critic and witnessing the lack of progress for the severely ill



Related episodes on What's Next in Mental Health? 


The Elephant in the Clinic: The DSM has Fallen Behind. Here is How Psychiatric Diagnosis Might Work in the Future. (with Dr. Colin DeYoung)



Should We Stop Prescribing Antidepressants for Depression? (with Prof. Joanna Moncrieff)




Other related materials


Preventing Overdiagnosis: Winding back the harms of too much medicine (Allen Frances, talk at Dartmouth College, 2013)



Psychiatry & Big Pharma: Exposed (James Davies, lecture for The Weekend University, 2019)



Anatomy of an Epidemic (Robert Whitaker, book)