Allen Frances, MD

Education and discussion will be the most powerful ways to mitigate the risks of DSM-5. The more people know about psychiatric diagnosis, the more safe, accurate, and useful it will be.

The British Psychological Society has issued a press release that rivals the silliness of DSM-5 and the National Institute of Mental Health.

The flat out rejection of DSM-5 by National Institute of Mental Health is a sad moment for mental health--and an unsafe one for our patients. The APA and NIMH are both letting us down, failing to be safe custodians for the mental health needs of our country.

The poorly conceived DSM-5 Somatic Symptom Disorder substitutes a false psychiatric certainty that misleadingly covers medical uncertainty about the appropriate diagnosis. It is better to admit what we don't know than cover it with meaningless labels.

The intense level of international interest in DSM-5 is a great surprise. Although DSM has become a research standard around the world, it is rarely used by clinicians outside the US and therefore poses a much lesser threat to their patients. So why all the prominent media coverage in countries outside of the US?

Money should not be wasted on futile preventive programs to detect mental health problems that don't yet exist. Instead, resources should be invested where there is desperate need—to properly treat and decently house psychiatric patients who are now shamefully neglected.

The liveliest debate in psychiatry today is where to draw the line between mental disorder and mental health. So much rides on the decision—who gets treated and how, who pays for it, whether a criminal is deemed mad or bad, whether someone gets damages in tort cases, who qualifies for disability payments and eligibility for extra school services, whether someone can adopt a child—and there's a whole lot more.

The 3% to 5% of kids who are particularly gifted are also at special risk for being tagged with an inappropriate diagnosis of mental disorder. Caution is necessary when diagnosing.

After each violent tragedy, politicians mourn and harrumph, but they wind up buckling under pressure from the NRA, fiscal constraints, and the prison and gun lobbies. Repeated dramatic events can shake the complacency and cowardice of a stalemated Congress and state legislatures.

DSM-5 has moved a section called “Psychological Factors Affecting Medical Condition (PFAMC) from the of the book (where it is not a mental disorder) to front and center in the chapter on Somatic Symptom Disorders (where now it will be a mental disorder).