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Allen Frances, MD

Allen Frances, MD

We doctors need to recognize our limitations and do the best we can within them. Confronting the reality of uncertainty almost always beats the creation of a false certainty.

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.

In the opinion of this psychiatrist and former chair of the chair of the DSM-IV Task Force, the changes in the newly approved DSM-5 will loosen diagnosis and threaten to turn our current diagnostic inflation into diagnostic hyperinflation. There are direct implications for primary care physicians and pediatricians.

Psychiatry has no way to predict mass murder and no way to prevent it. There is no indication that psychiatry can change the statistics of violence or the proclivity of the violent.

There is no psychiatric solution for mass murder. What are the warning signs? Is there a way to protect victims? What can we do to prevent an awful tragedy from constantly recurring?

Our current diagnostic system is based more on subjective clinical judgments and less biological psychiatry. There is not one way to develop symptoms of schizophrenia or bipolar disorder or autistim or OCD.

An excellent study has killed two birds with one stone. It is a clear caution against the DSM-5 proposal for a psychosis risk syndrome and it should temper enthusiasm for rushing ahead with "ultra high risk" prevention programs.

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