Following our March 15 Infomail/ post, "Inside Psychiatry's Battle to Define Mental Illness," we received an e-mail from Dr. Allen Frances, objecting--in essence retracting his statements in an article in WIRED magazine by  Gary Greenverg.  Our response to Dr. Frances follows his communication. 

From: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it [mailto: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ]
Sent: Tuesday, March 22, 2011 6:20 PM
To: Manning; Vera Sharav

Subject: I was disturbed by your posting. You went way overboard and am forced to respond to it. I return next week. Will not post til you have chance to comment.

Defending Psychiatry From Reckless Attacks

   The Alliance for Human Research Protection is attempting to draft me as an unwilling soldier in its dangerous campaign to discredit psychiatry and to discourage psychiatric patients from staying in treatment and taking medication. In a posting titled  "Toxic Victims or Mentally Ill ? Re: Inside Psychiatry's Battle to Define Mental Illness"  there is the ludicrous claim that Dr Frances' "publicly expressed criticism of psychiatry's grandiose ambition--demonstrated by its ever expanding list of unvalidated disease designations and reliance on demonstrably harm-producing chemical interventions--essentially validates the criticism expressed by the Alliance for Human Research Protection for more than a dozen years."

   No. No. No. And a thousand times no. My views and the Associations do have a small degree of overlap- but at a fundamental level could not be more opposite. My critique of diagnostic inflation and overtreatment in psychiatry in no way "validates" the Association and its reckless rhetoric.

   Here is the difference. I believe psychiatry is a noble and extremely helpful profession. My concern is that it has strayed beyond its suitable boundaries- leading to too much diagnosis and treatment of people who are not really ill or too mildly ill to require an intervention. My goal is to  keep psychiatry doing what it does best and what only it can do really well- treating the clearly ill who definitely need help.

  The Association makes no distinction between this absolutely necessary role of psychiatry and its recent overshoot toward excessive treatment. It is vigorously engaged in a determined effort at throwing out the precious baby with the bath water. Psychiatry is a toxic evil and the Association is a crusader, protecting its victims. This is a wildly inaccurate and simply terrible message for the millions of people who desperately need psychiatric help. So no- I do not validate the Association in any way and would encourage patients to ignore its ill founded, strident and potentially dangerous criticisms of psychiatry and its medications.

  Psychiatry is imperfect, but essential. And it is not alone in its problems. All of American medicine is currently engaged in a frenzy of overdiagnoses, overtesting, and overtreatment. We spend twice as much on health care as other countries and have only mediocre outcomes to show for it. This does not, and should not, lead to cries that all of medicine is toxic and is best avoided. Medicine and psychiatry both stand greatly in need targeted reformation, not blind undiscriminating  attack. 

Sent from my Verizon Wireless BlackBerry

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-----Original Message-----
From: veracare [mailto: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ]
Sent: Tuesday, March 29, 2011 5:48 PM
To: ' This e-mail address is being protected from spam bots, you need JavaScript enabled to view it '

Subject: Response to your objection to the AHRP Infomail about the Greenberg article in WIRED

Alliance for Human Research Protection
A Catalyst for Debate
www.ahrp.org

In response to your objection to the AHRP Infomail, Inside Psychiatry's Battle to Define Mental Illness , the Alliance for Human Research Protection (AHRP) disseminates credible information as public service: our aim is to be a catalyst for open debate about ethics in medicine. Sometimes our Infomails are couched in non-academic terminology--the better to make our points come across clearly and unambiguously to everyone.

You state that "the [AHRP] is attempting to draft me as an unwilling soldier in its dangerous campaign to discredit psychiatry and to discourage psychiatric patients from staying in treatment and taking medication."

First, AHRP is committed to the principle of voluntary informed consent. We do not "draft unwilling soldiers."

Second, AHRP does not have to discredit psychiatry. Psychiatry's financially compromised leadership and the dubious practices of many of its practitioners have accomplished that all by themselves.

We reached out to you because, in your recent writings and utterances, you expressed concerns similar to ours. AHRP has long expressed worries about psychiatry's aggressive moves to pathologize ever more behavior patterns as diseases. Most recently, as you did, we criticized the American Psychiatric Association's DSM-5 panel for lowering--or even eliminating--the previous DSMs’ threshold for diagnosing mental disorder. 

In particular, AHRP is concerned about the DSM-5 proposal to adopt "Psychosis Risk Syndrome" and "Temper Dysfunctional Disorder," which will pathologize millions of healthy children. We are also concerned about the proposal for a "Minor Neurocognitive Disorder," which will pathologize everyone over age 50 with minor forgetfulness as “at risk” for Alzheimer's. You know as well as we do that the most likely result of these changes will be the exponential increase in prescriptions for antipsychotics and other psychotropic drugs.

You refer to "a posting titled "Toxic Victims or Mentally Ill?” I have no idea whose posting you are referring to. No such titled post was ever disseminated by the AHRP, nor does such a titled posting exist or ever existed on the AHRP website.

The actual AHRP posting, "Inside Psychiatry's Battle to Define Mental Illness," borrows its title from Gary Greenfield's extensive portrait of you in the January 2011 issue of WIRED Magazine.

In the WIRED article, Greenfield writes that you, Dr. Frances, came out of retirement "to launch a bitter and protracted battle with the people, some of them friends, who are creating the next edition of the DSM. And to criticize them not just once, and not in professional mumbo jumbo that would keep the fight inside the professional family, but repeatedly and in plain English, in newspapers and magazines and blogs. And to accuse his colleagues not just of bad science but of bad faith, hubris, and blindness, of making diseases out of everyday suffering and, as a result, padding the bottom lines of drug companies. These aren’t new accusations to level at psychiatry, but Frances used to be their target, not their source. He’s hurling grenades into the bunker where he spent his entire career."

In the article, you are quoted as stating that: “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.”

Furthermore, you acknowledged "keenest regrets" that the DSM-IV under your leadership “made mistakes that had terrible consequences.”  Specifically, the DSM-IV redefinitions of autism, attention-deficit hyperactivity disorder, and bipolar disorder set off an epidemics of these "disorders" accompanied by skyrocketing prescriptions for psychotropic drugs (most notably, antipsychotics) for children.

Indeed, as the WIRED article summarizes, "Shortly after [DSM-IV] came out, doctors began to declare children bipolar even if they had never had a manic episode and were too young to have shown the pattern of mood change associated with the disease. Within a dozen years, bipolar diagnoses among children had increased 40-fold. Many of these kids were put on antipsychotic drugs, whose effects on the developing brain are poorly understood but which are known to cause obesity and diabetes."

You accuse AHRP of engaging in "a dangerous campaign to discredit psychiatry and to discourage psychiatric patients from staying in treatment and taking medication."

But, Dr. Frances, if there is no definition or valid criteria for psychiatry's DSM diagnoses--the official basis for psychotropic drug prescription -- then surely there is no medical justification for anyone "staying in treatment and taking medication."

Moreover, Gary Greenberg quotes you as being horrified at the idea of more “kids getting unneeded antipsychotics that would make them gain 12 pounds in 12 weeks hit me in the gut. It was uniquely my job and my duty to protect them. If not me to correct it, who? I was stuck without an excuse to convince myself.”

So, what is "ludicrous" about the AHRP Infomail stating that Dr Frances' "publicly expressed criticism of psychiatry's grandiose ambition--demonstrated by its ever expanding list of unvalidated disease designations and reliance on demonstrably harm-producing chemical interventions-- essentially validates the criticism expressed by the Alliance for Human Research Protection for more than a dozen years"?

Dr. Frances, which statements that you made, and that appeared to agree completely with the AHRP’s own critiques, do you now disavow?

Vera Hassner Sharav