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International Bestseller
A deeply fascinating and urgently important critique of the widespread medicalization of normality
Anyone living a full, rich life experiences ups and downs, stresses, disappointments, sorrows, and setbacks. Today, however, millions of people who are really no more than "worried well" are being diagnosed as having a mental disorder and receiving unnecessary treatment. In Saving Normal, Allen Frances, one of the world's most influential psychiatrists, explains why stigmatizing a healthy person as mentally ill leads to unnecessary, harmful medications, the narrowing of horizons, the misallocation of medical resources, and the draining of the budgets of families and the nation. We also shift responsibility for our mental well-being away from our own naturally resilient brains and into the hands of "Big Pharma," who are reaping multi-billion-dollar profits. Frances cautions that the newest edition of the "bible of psychiatry," the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), is turning our current diagnostic inflation into hyperinflation by converting millions of "normal" people into "mental patients." Saving Normal is a call to all of us to reclaim the full measure of our humanity.
- Sales Rank: #27545 in Books
- Brand: William Morrow Company
- Published on: 2014-08-12
- Released on: 2014-08-12
- Original language: English
- Number of items: 1
- Dimensions: 8.00" h x .79" w x 5.31" l, .0 pounds
- Binding: Paperback
- 352 pages
- William Morrow Company
From Booklist
*Starred Review* 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 diagnoses—much 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. --Tony Miksanek
Review
“Frances delves deeply into the history of mental illness, makes his arguements crisply, and has good personal stories to tell. He’s articulate and learned. ... He’s in favor of not medicating, and thus muffling, all the offbeat pain and beauty out of existance. ... [A] piece of intellectual skywriting.” (Dwight Garner, New York Times)
“An extraordinarily candid and important book. Allen Frances has written a fascinating account of the apparent explosion in psychiatric disorders in the United States. (MARCIA ANGELL, M. D., Senior Lecturer in Social Medicine at Harvard Medical School, and former Editor-in-Chief, New England Journal of Medicine)
“Saving Normal is a riveting and important book, written with great flair and precise passion. This is a book every psychiatrist, every general practitioner, every student swallowing meds--in fact everyone--needs to read.” (Dr. LISA APPIGNANESI, Chair of the Freud Museum, London, and author of Mad, Bad and Sad)
“Frances is largely credited with spearheading the anti-DSM-5 efforts.” (CNN.com)
“Saving Normal is a clear, convincing, and essential discussion of the twin epidemics facing modern psychiatry: under-treatment of the truly ill and overtreatment of the basically well. It holds immense potential to improve patients’ lives.” (JOSH BAZELL, M.D., New York Times bestselling author of Beat the Reaper: A Novel)
“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.” (Publishers Weekly)
“With Solomon-like wisdom, Frances justly doles out blame and offers reasonable remedies. His decree: don’t medicalize human difference; celebrate it.” (Booklist (starred review))
“A valuable assessment. ... A no-holds-barred critique.” (Kirkus Reviews)
“An indispensable guide for professional and lay readers” (Library Journal)
“Allen Frances’s book is fascinating. ... Entertaining.” (Metapsychology)
“Authoritative. ... Valuable. ... This is a detailed, nicely constructed account by a highly qualified and well-connected psychiatrist with intimate knowledge of the process. The book is clearly written and surprisingly easy reading.” (The Royal Australian and New Zealand College of Psychiatrists)
About the Author
Allen Frances, M.D., was the chair-man of the DSM-IV Task Force and part of the leadership group for DSM-III and DSM-III-R. He is professor emeritus and former chair of the Department of Psychiatry and Behavioral Science at Duke University School of Medicine.
Most helpful customer reviews
3 of 3 people found the following review helpful.
A PROFESSIONAL SPEAKS WITH COMMON SENSE AND HEART.
By R L Phares
Common sense and psychiatry seem an oxymoron though this book addresses some of the hijinx of a field prostituted to the Insurance companies.
I worked in the mental health field for many years and found the labeling of human spirit and soul seachers a task worthy only of those who are
responsible with their "forecasting". Self-fullfiling prophecies can be damaging if not life altering. This author raises questions and creates thought provoking suggestions as to how we might rely less on labeling for the sake of payment, and more on common sense and creative planning for wellness.
12 of 13 people found the following review helpful.
The World According to Allen Frances
By Anonymous
In Saving Normal, Allen Frances mentions how "expert opinion" tends to play an important role in the DSM revision process, and how he sought to limit its role in DSM-IV by requiring extensive hard data before making any important changes. Saving Normal is itself a summary of Allen Frances' own "expert opinion," and it is very light on data or references to empirical research in general. Of course, Allen Frances *is* a valuable expert to consult about these issues, and I generally agree with his overarching points. But if one is looking for a scholarly introduction to these broader debates, I would look elsewhere, as Frances does not place his views firmly within the the large body of scholarship on these topics.
The strongest chapters of this book are, in my opinion, "Diagnostic Inflation," "Fads of the Present," and "Taming Diagnostic Inflation." In particular, I found his comprehensive list of proposals for limiting diagnostic inflation to be very valuable reading. There are several chapters which feel somewhat unnecessary - the anecdotes about the benefits and costs of diagnosis at the end and Frances' cursory, loosely cited review of the history of psychiatry pre-DSM-III, especially.
While Frances provides a valuable perspective and many of his critiques generally feel worth reading, there is a certain lack of nuance to his portrayal of the issues. Diagnostic inflation is a very complex topic with many different likely causes, and I wish Frances had done more to ground his viewpoint in the empirical literature connected to each diagnostic category he addressed. (For example, he mentions a very interesting study about ADHD diagnosis and the month a child was born in, and I wish he had included more evidence along those lines for the other categories he discusses.) It's easy to point to prevalence rates and label them as ludicrous on their face, but I wish he had gone farther.
For example, Frances talks at length about the expansion of adult bipolar diagnosis, and how it has spawned a boom in the prescription of antipsychotic medications, which have a variety of serious side effects. However, he does not put this clearly in context -- primarily, that the expansion of bipolar diagnosis was meant to address the fact that many patients who appear to have unipolar depression experience dangerous manic symptoms when given antidepressant medications. (Indeed, several of Frances' anecodotes describing the perils of misdiagnosis feature this exact problem!) These serious negative side effects can lead to suicide, and, just like with the antipsychotic medications, Big Pharma was sued for downplaying them. The boundary between bipolarity and unipolar depression is a very complex, nuanced issue, and Frances does not sufficiently discuss the difficult cost/benefit analysis needed here.
Finally, Saving Normal focuses so much on psychiatry as an institution, but at many points Frances hints that psychiatry is used to solve problems that are best solved in other ways. I wish he had gone into more detail on this, zooming out to touch on how school funding could be allocated differently, how sexually violent predator laws could be improved, etc.
In the end, I think Saving Normal is an important book that I might suggest to a lay person who had very little knowledge about the DSM and the problem of overdiagnosis. And as a source for understanding "The World According to Allen Frances," it is also valuable. I would not, however, recommend this book to an undergraduate studying this topic, and I would not probably not assign it as reading for an undergraduate course (at least not more than a chapter or two). Most of the important content of this book can also be gathered from reading Frances' blog posts on these topics.
5 of 5 people found the following review helpful.
What ever happened to normal mini-breakdowns/recovery in the ups and downs of life?
By Clint Souligny
Great book about the overreaching, overselling and overmedicating of the label bipolar from one of the guys at the very top of the psych field. Very enlightening how fads and mega pharmaceutical lobbying and marketing impact diagnosis and treatment. Frances is just trying to rein it in a little. He's a lone voice in the wilderness. Worth reading to better serve those in your sphere of influence.
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