Allen Frances, MD

I get a strong and encouraging response whenever I write or talk about saving normals from excessive treatment. I get almost no response when I write or talk about the shameful and wasteful neglect of the severely ill. We mistreat them barbarously and almost no one seems to care.

The tripling of ADHD rates in the last 20 years and skyrocketing use of stimulants are sure signs of a fad. The forces promoting it are, and will continue to be, formidable. More in this commentary.

In just 20 years, rates of ADHD have tripled and autism and childhood bipolar disorder have increased forty fold. The last thing our kids need is to be misdiagnosed with “Sluggish Cognitive Tempo” and bathed in even more stimulant meds. More in this opinion piece.

Firearms are the means of death in thousands of suicides and homicides every year. There is no denying that free access and wide availability has made gun death a major threat to our public health. More in this commentary.

Mental health professionals can predict high-risk groups but can’t pick out who will go on a rampage. Murder is too much of a-needle in-the-haystack rare event to ever be reliably prevented with psychiatric tools. More in this commentary.

ADHD has more than tripled in just 20 years-it is now diagnosed in 11% of all kids and in an astounding 20% of teenage boys. More in this commentary.

What harms are there in labelling (or rather often mislabelling) more than a quarter of our troops as mentally ill? The harms are numerous and potentially quite dangerous. . .

According to the author, stimulant drugs that 20 years ago had annual revenues in the tens of millions now are a Pharma "cash cow" with sales that will soon hit $10 billion per year. How did this happen?

"Psychosis Risk" can now be diagnosed as “Attenuated Psychosis Syndrome” and used to bill for insurance reimbursement. Many bearing the diagnostic label are young adolescents and adults in whom schizophrenia or any other psychotic disorder will never develop.

Sexual abuse is shockingly common in the US prison system. It has been reported that about 200,000 prisoners are victims of coercive sex each year. Most of those abused are psychiatric patients misplaced in prison.

Psychiatrists have patients who need help and we have the tools to help them. Some of these tools are technical and specific (meds; CBT); but even these work best only in the context of a rich therapeutic relationship that is based on all that makes us human.

Ideology is much less important than common sense solutions. The mentally ill have many unmet needs and suffer from great and undeserved coercion.

An exchange that contributes in some small way to greater interaction and synergy among all of us who are trying to do our part to relieve emotional and mental suffering.

It is the opinion of this psychiatrist that overtesting and overtreating is promoted and protected by the enormous economic and political power of the medical industrial complex. Here's just a beginning list of what needs to be done.

In the opinion of this psychiatrist, it is long past time to use the Internet to inform and empower health care consumers and reduce the monopoly pricing power of suppliers.

Here are 12 tips on how best to ensure accurate and safe diagnosis, based on the introduction to Dr Allen Frances' recent book, The Essentials of Psychiatric Diagnosis.

Some believe that DSM-5 is filled with glaring mistakes in wording and coding on nearly every page-including some that will undoubtedly cause great confusion.

"Psychiatric diagnosis is certainly imperfect -- but so is much of diagnosis throughout medicine. And whatever the current limitations, psychiatric diagnosis is useful and essential. There are no 'paradigm shifts possible til we learn a lot more. To imply otherwise is misleading and confusing to patients."

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 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, the politicians hypocritically mourn and harrumph, but 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.

It has moved PFAMC from the back 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).

Diagnosing rape as mental disorder is an improper use of psychiatric diagnosis and promotes the abuse of psychiatric commitment to further what would otherwise be an unconstitutional form of preventive detention.

DSM-5 must emphasize that physical symptoms deserve the respect of a thorough work-up before assuming their cause is psychiatric. And people with defined medical illnesses should not be casually mislabeled as also mentally ill just because they are upset about being sick.