Saving Normal by Allen Frances is an exploration of the major diagnostic inflation currently occurring in the field of psychiatry. Frances, a prominent and accomplished psychiatrist, is best known for being chair on the task force in the production of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), often considered the “bible of psychiatry”. Being an insider, Frances has extensive knowledge of the causes of diagnostic inflation and exactly how the psychiatry field has faced difficulties. In Saving Normal, Frances delves into the history of diagnosis, presents the negative effects of its increase, and considers solutions to this rapid rise. Asserting that the the increase in diagnosis is out of control, …show more content…
He explains that following World War II, psychiatric care finally took off, yet diagnoses were “a quiet and insignificant backwater completely ignored” (61). This is powerful passage because it shows shows how mental problems were successfully treated without a diagnosis. Frances’ intent is to focus psychiatric treatment on those who need it. By only treating symptoms rather than a diagnosis, only those who actually require treatment will receive it. It wasn’t until the late 1970s when the third edition of the DSM (DSM-III) started being created. A group of psychiatric experts hashed out the details of the manual through plenty of arguing and little consensus. Frances writes how “there seemed no way of choosing among their various suggestions,” and because of the haphazard way it was created, the DSM-III ignored the context of many symptoms and made minor conditions into mental disorders (64). This evidence is very effective in Frances’ argument. By exposing the DSM-III, one of the main factors behind modern diagnosis, as poorly developed and justified, he leads the reader to question the validity of the current system. Frances’ inclusion of a light but comprehensive history of psychiatry is an example of his effective style: namely, writing a book that an …show more content…
Before he begins, however, he immediately explains the counter argument, that today’s society is more stressful than the ever, leading to more people developing mental disorders. He approaches this argument with logic and writes that among the many “who have ever walked this earth, we are undoubtedly the luckiest (81). He elaborates that while there are day to day pressures, we rarely have to worry about predators or our next meal (81). This argument is rather effective in reasoning, considering there are few if any scientific studies that can compare modern levels of stress to ancient ones. Next, Frances provides his main evidence for the harm of diagnostic inflation through a series of examples. The most effective example he uses is how the most recent DSM made temper tantrums a mental disorder (disruptive mood dysregulation disorder), which has lead dangerous antipsychotics to be prescribed to children as young as two (177). He poses that there is an “ambition to label as mental disorder every inconvenient or distressing aspect of childhood” (177). This example is especially effective because reveals the absurdity of modern diagnoses and may strikes a chord with parents worried about the safety of their children. Later on, Frances includes series of stories, each detailing an instance where overdiagnosis had negative effects. One of these is the story of Todd, a boy who at
A physician has an unenviable position; he is closest to man approaching a god-like stature. And despite the demise of 'doctor knows best', we still need to trust his diagnosis-something that is increasingly difficult in a world where information is widely available, and Google substitutes for a doctor. In the case of psychiatry the issue of trust is amplified since diagnosis is based on a patient's expressed thoughts and overt behaviours rather than solely on biological phenomena. And these thoughts and behaviours are influenced by the patient's environment-a mix of his social, cultural and technological experiences.
In the book “The Mad Among Us-A History of the Care of American’s Mentally Ill,” the author Gerald Grob, tells a very detailed accounting of how our mental health system in the United States has struggled to understand and treat the mentally ill population. It covers the many different approaches that leaders in the field of mental health at the time used but reading it was like trying to read a food label. It is regurgitated in a manner that while all of the facts are there, it lacks any sense humanity. While this may be more of a comment on the author or the style of the author, it also is telling of the method in which much of the policy and practice has come to be. It is hard to put together without some sense of a story to support the action.
The disorder which is being treated is actually strengthened to the point of a serious mental illness. Similarly, in today’s society, medical and psychological advice may have the same effect. Medical technology and practice have progressed considerably since the time of the “Yellow Wallpaper.” This is not to say that today’s physicians are infallible. Perhaps some of today’s treatments are the “Yellow Wallpaper” of the future.
Madness: A History, a film by the Films Media Group, is the final installment of a five part series, Kill or Cure: A History of Medical Treatment. It presents a history of the medical science community and it’s relationship with those who suffer from mental illness. The program uses original manuscripts, photos, testimonials, and video footage from medical archives, detailing the historical progression of doctors and scientists’ understanding and treatment of mental illness. The film compares and contrasts the techniques utilized today, with the methods of the past. The film offers an often grim and disturbing recounting of the road we’ve taken from madness to illness.
As science has evolved, so have treatments for mental illnesses have over time. The medical model is described as the view that psychological disorders are medical diseases with a biological origin (King, 2010, pg. 413). Abnormal behavior that categorizes some disorders can be impacted by biological factors such as genes, psychological factors such as childhood experiences, and even sociocultural factors such as gender and race (King, 2010). Treatments such as psychosurgery (lobotomy) , drug therapy (pharmaceuticals), electroconclusive therapy, and psychoanalysis are used to treat a wide range of psychological disorders. Back then, the public’s negative views on mental illnesses also went as far to associate with the people who treated it; psychiatrists. “Nunnally (1961) found that the public evaluated professionals who treated mental disorders significantly more negatively than those who treat physical disorders,” (Phelan, Link, Stueve, & Pescosolido, 2000, pg. 189). People back then didn’t see the point in “paying to be told that they were crazy”. However, in today’s society, it is now acceptable to seek help from psychiatric professionals; we are seeing more and more people seek mental health treatment. “In terms of facility-based records of utilization (Manderscheid and Henderson 1998), the data suggest that the rate of utilization of professional mental health services has at least doubled and maybe tripled, between the 1950’s and today,” (Phelan, Link, Stueve, & Pescosolido, 2000, pg. 189). In the 1950’s, neuroleptic drugs like Thorazine were introduced to treat the symptoms of schizophrenia. These drugs block a neurotransmitter called dopamine from getting to the brain, which in turn reduce schizophrenic symptoms, however there are some side effects such as substantial twitching of the neck, arms, and legs, and even dysphoria or lack of pleasure. (King, 2010, pg.
Allen Frances spends his time concluding his thoughts about the DSM and diagnostic inflation in the third part of “Saving Normal”. Frances appears to be passionate about reducing over-diagnosing and unnecessary medication. Frances did a good job providing us with ways that can change the future of diagnosis. Having a complete culture change will be difficult, but we can begin by educating ourselves.
31. pp. 281-294. Weisman, M.M., Livingston, B.M., Leaf, P.J., Florio, L.P., Holzer, C. (1991). Psychiatric Disorders in America?
Stone, D. (2011, May 8). Psychological Musings: Historical Perspectives of Abnormal Psychology. Retrieved April 23, 2014, from http://psychological-musings.blogspot.com/2011/05/historical-perspectives-of-abnormal.html
Star,S.A.(1955). The public’s ideas about mental illness. Paper presented at the annual meeting of the National Association for Mental Health.
The knowledge of mental illness was very small. Doctors did not understand how to diagnosis or treat mental disorders. They did not understand how the brain functioned and what to expect from people in certain situations. Many symptoms of physical illness today were considered mental illness in the eighteenth century. The constant shaking due to Parkinson’s disease was misinterpreted as a mental condition and treated as such4. These patients were placed into...
Whitaker, Leighton C. "Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America." Ethical Human Psychology and Psychiatry 13.2 (2011): 169-71. Print.
When patients are labeled with a mental illness they start to believe they actually have that illness. In more severe cases, misdiagnosis can result in the patient’s death or simply taking their own life. According to Dr. Mercola “Diagnostic errors are just one type of error that occurs in the medical field, and you might be surprised at just how common errors occur. While the 1999 IOM report blamed 98,000 deaths a year on hospital errors, a 2013 study in the Journal of Patient Safety projected that medical errors now account for 210,000 to 440,000 US deaths annually”. To better understand the severity of misdiagnosis, imagine a close family member getting diagnosed with a mental disorder that he or she doesn’t have and from that they decide to take their own life due to unnecessary treatment that is harmful to their
Szasz, Thomas. Coercion as Cure: A Critical History of Psychiatry. New Brunswick, New Jersey: Transaction, 2007. Print. Braslow, Joel T. Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century. California: University of California, 1997. Print.
7. Roth, Martin. & Kroll, Jerome (1986) The Reality of Mental Illness. Cambridge University Press
Barlow, D., Durand, V., & Stewart, S. (2009). Abnormal psychology an integrative apporach. (2nd ed.). United States of America: Wadsworth