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Defending Psychiatry From Reckless Attacks

By Allen Frances, MD | March 31, 2011

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 recent posting, they make 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! I must strongly disclaim this incorrect and misleading attribution. At a fundamental level, I could not have a more opposite view of psychiatry than that expressed by the Alliance. My critique of diagnostic inflation and over treatment in no way "validates" the Alliance and its reckless antipsychiatry 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 diagnosis and treatment. It is vigorously engaged in a determined effort at throwing out the precious baby with the bath water. Psychiatry is seen as a toxic evil and the Alliance deems itself a crusader, charged with the role of protecting the victims. This is a wildly inaccurate and simply terrible message for the millions of people who desperately need and benefit greatly from psychiatric help. So again, no-- I do not validate the Alliance 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 over diagnoses, over testing, and over treatment. 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 of targeted reformation, not blind and undiscriminating attack. 
 

 

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by Ronald Pies | April 03, 2011 1:01 AM EDT

I applaud my colleague Allen Frances for his robust renunciation of the AHRP line of attack. Like many who understand neither general medicine nor psychiatry, AHRP begins with the false premise that psychiatrists claim to "...possess scientific certainty about the diseases they treat. After all, the DSM didn't save the profession, and become a best seller in the bargain, by claiming to be only provisional."[click on link to AHRP]

Anyone remotely familiar with the intense debates within psychiatry can only laugh at the notion that we wallow in feelings of "scientific certainty"! In the preface to the DSM-IV, we read that, "...there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders, or from no mental disorder...boundary cases will be difficult to diagnose in any but a probabalistic fashion."

The text goes on to say, "...DSM-IV reflects a consensus...derived at the time of its initial publication. New knowledge generated by research or clinical experience will undoubtedly lead to an increased understanding of the disorders included in DSM-IV...and to removal of some disorders in future classifications."

These are not the words of absolutists or authoritarians. If there is the whiff of arrogance and grandiosity in the air, it is coming from AHRP and other virulent anti-psychiatry groups.

At the same time, AHRP's misappropriation of Dr. Frances's views and statements should serve as a cautionary tale for all of us in this battered profession: what we say to one another, and how we say it, will be weighed, sifted and often distorted by those who wish to do our profession harm--and who represent a threat to the care of our patients.

Ronald Pies MD, Editor-in-Chief Emeritus, Psychiatric Times

 

by Nancy Wilson | April 03, 2011 12:19 AM EDT

Dear Dr. Frances: I found hope in the interview you did for the magazine Wired while I struggled with ending an abusive relationship with my own psychiatrist. I was in your camp for many years working as a nurse in psychiatry. In recent years my experiences as a patient as well as a professional have positioned me in a distant camp, somewhere between APA and AHRP. The truth in these matters, I believe, can be found only within the psychiatrist-patient dyad. See Jay Katz on countertransference in The Silent World of Doctor and Patient (pp. 147-150).






 
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