Thursday, March 13, 2014

Allen Frances & Samuel Sewell (an Update)

Several years ago, I read one or two articles by Allen Frances and suggested that he might be a constructive force for reforming the cruel, corrupt and inhuman field of "mental health". Little did I know at the time I wrote that blog article that he would soon be considered a leading critic of American-style, "label-'em-&-drug-'em" psychiatry.

Dr. Frances recently published a curious little book: Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5 (NY: The Guilford Press, 2013). I just got a copy from Amazon of the revised edition (published only four months after the original -- no idea why such a quick revision was necessary & I am curious about that).

On one hand, the book is replete with cautionary statements about various DSM-5 "diagnoses", and Frances does consistently suggest that labeling people with psychiatric disorders is a dicey business.

But on the other hand this is a clear, opportunistic attempt by the erstwhile most-powerful-psychiatrist-in-America to maintain some vestige of his remunerative franchise as a famous diagnostician despite replacement of his very own DSM-IV last May.

I initially found it disappointing and ironic that Dr. Frances is now making money by ostentatiously piggy-backing on the sale of the APA's new DSM-5.  His book even looks exactly like the DSM (albeit smaller), with the same typefaces and formatting.  With the exception of a 16-page introductory chapter, it follows the DSM outline chapter-by-chapter and diagnostic-code-by-diagnostic-code. It is, effectively, a DSM-5 supplement. Minor omissions of individual diagnoses and an altered sequence of disorders are insignificant changes. If I were the APA, I might consider some sort of intellectual property claim...

Under a very thin guise of criticism, it sure seems that Allen Frances is actually supporting the psych status quo. He just wants to continue making money from it like he used to when DSM-IV was king of the hill. Frances has never repudiated the central idea, that unwanted human emotion and bad behavior must be essentially brain disease, treatable according to the medical model. He merely hopes psychs will be more conservative in asserting their philosophy and a bit more careful about damaging people, so the profession can avoid calamitous bad PR.

But there is another interpretation and a more optimistic view. We probably don't need dramatic, road-to-Damascus conversions, or even Judge Sewell apologies, to end specific psychiatric evils in the world and bring a new, freer day of human dignity. Little by little, the culture is changing. It might get much better pretty soon, and in future decades history might credit Allen Frances for some sort of personal mea culpa leading to positive changes, even if he himself never intended any such thing.

The real changes will never come from correcting such middling problems as Frances sees with DSM-5. They will come from total elimination of the one thing which Frances never addresses directly, although his arguments all hint around about it and point toward it: legal coercion of "treatment".

In fact, psychiatric "diagnosis" is not done for any purpose of finding useful treatment, it's done to justify "treatment" which is useful mainly to people other than the patient. The patient arrives, directly or indirectly, because the police bring him in.

And for the moment at least, Dr. Frances is still in the business.