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Allen Frances
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Allen Frances MD is Professor Emeritus at Duke University and former Chair of its Department of Psychiatry. He was Chair of the DSM IV Task Force. He is the author of "Saving Normal" and "Essentials of Psychiatric Diagnosis."

Allen Frances was the chairperson of the DSM-IV Task Force, a former chair of the Department of Psychiatry and Behavioral Science at Duke University School of Medicine, and is the author of two new books: Saving Normal and Essentials of Psychiatric Diagnosis.

Entries by Allen Frances

Privatization Has Been a Colossal Flop

(64) Comments | Posted May 23, 2015 | 4:07 PM

Let's get this straight. I am a penny pincher, who hates waste and wants a lean and efficient government.

But, that said, we have to face the fact that our massive privatization of what once were government functions has been a failure. There are some public services...

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Preventing and Treating School Refusal and Severe Social Withdrawal

(3) Comments | Posted May 14, 2015 | 1:15 PM

I first heard about 'hikikomori' on a visit to Japan 25 years ago. It was a new term then, used to describe severe and prolonged school refusal in teenagers, sometimes evolving into complete social withdrawal. The person's life would become confined to a bedroom, with no friends and minimal contact...

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Think Twice Before Getting Knee Surgery

(3) Comments | Posted May 6, 2015 | 9:12 PM

During the 4,000-year history of medicine, doctors have done terrible things to patients. We gave them arsenic and mercury; we bled them; we made them vomit, and we gave them laxatives; we made them hot, and we made them cold. A lot of this was nonsense, sometimes dangerous and even...

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Life Is Not a Premortality Condition, and Death Is Not Treatment Failure

(2) Comments | Posted April 21, 2015 | 8:43 PM

"Medical research is making such astounding progress that soon none of us will be well."
--Aldous Huxley

In my last blog post I discussed the importance of dying well and with dignity -- at home, at peace, sent off by a loving family, not in an impersonal...

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Dying Well Means Dying At Home

(2) Comments | Posted April 11, 2015 | 6:32 PM

"Count no man happy till his end is known." Herodotus

This was true in ancient Greece 2500 hundred years ago. It is even more true today -- aggressive end-of-life hospital care, the lack of sufficient palliative care, and unduly restrictive assisted suicide laws make it impossible for most people...

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Can We Replace Misleading Terms Like 'Mental Illness,' 'Patient,' and 'Schizophrenia'

(12) Comments | Posted April 5, 2015 | 4:50 PM

"When I use a word, Humpty Dumpty said in rather a scornful tone, it means just what I choose it to mean -- neither more nor less. The question is, said Alice, whether you can make words mean so many different things. The question is, said Humpty Dumpty, which is...

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Don't Give Up On the Difficult Patient

(0) Comments | Posted March 31, 2015 | 1:38 PM

Forty years ago, I had my most angry professional moment. It happened at a weekly meeting that included all our faculty, staff, and trainees- about two hundred people. A young and arrogant, not very bright, third year psychiatry resident rose to complain bitterly about the 'crappy patients' he and his...

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Falls End Lives; Good Balance Saves Them

(0) Comments | Posted March 24, 2015 | 7:02 PM

The wisest doctor I know says this to his elderly patients: "There are two keys to having a long and happy life: one is don't fall; two is stay away from doctors." (Nicholas Capazzoli)

Two is related to one because doctors often over prescribe medicines that increase the risk of...

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Buying and Selling Binge Eating Disorder

(8) Comments | Posted March 12, 2015 | 3:06 PM

A drug company recently received FDA approval to peddle its speed-like pill for 'Binge Eating Disorder' (the very same pill that is already widely overused for ADHD). And it is sparing no expense pushing the drug -- a former world tennis champ is the shill and commercials are everywhere.

...
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Wilderness Programs for a Struggling Child

(2) Comments | Posted March 10, 2015 | 3:38 PM

Psychiatry doesn't work well for behavioral problems. In the old days, psychotherapy was the primary treatment, but it didn't help much. You mostly hoped the kid's behavior would improve with age before he got into too much trouble (as happened two thirds of the time).

Now, antipsychotics have become the...

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'Diagnosisgate' Deconstructed and Debunked

(51) Comments | Posted March 6, 2015 | 5:03 PM

Paula Caplan has been peculiarly furious at me for more than 20 years. The enduring chip on her shoulder first formed when I didn't take seriously her written proposal that 'Delusional Dominating Personality Disorder' be considered for DSM IV. I honestly thought she had submitted 'DDPD' as a clever satire...

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Psychotherapy Works, But Not For Everyone

(8) Comments | Posted February 10, 2015 | 3:52 PM

Treatments that work well for most don't work well for all. And even effective treatments have side effects and complications. This is true of medication and surgery- and it is also true of psychotherapy.

Psychotherapy is a proven effective treatment and should be the first choice for mild to moderate...

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Welcoming the Mentally Ill Back Into Our Community

(2) Comments | Posted February 2, 2015 | 5:45 PM

Brain research may be the greatest scientific adventure of our time, but it has had no practical payoff for the mentally ill. We have learned fantastic things about what makes us tick, but none of the findings has helped a single patient.

The National Institute of Mental Health is betting...

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The Latest Hypocrisy in SVP Expert Testimony

(2) Comments | Posted January 26, 2015 | 11:32 AM

The United States Constitution does not allow 'preventive detention' -- a much abused 18th century prerogative of royal power that was abhorrent to our founding fathers. We are meant to be a country of law, not arbitrary state power. No imprisonment on suspicion that someone might commit a crime and...

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How About Informed Consent for All Medication

(2) Comments | Posted January 21, 2015 | 8:50 AM

Doctors prescribe way too many medicines for patients who don't really need them. A lot of the pressure comes from intense drug company marketing. Some comes from patients who aren't happy leaving the office without a pill. And doctors have too little time with each patient to explain non-pill solutions...

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The Crisis of Confidence in Medical Research

(5) Comments | Posted January 12, 2015 | 1:46 PM

It's been many years since I have trusted anything I read in a medical or psychiatric journal. There is an enterprise wide positive bias; findings never seem to replicate; benefits are hyped; harms are hidden.

Drug companies bear most of the blame -- the research they sponsor is shoddy and...

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There's No Back Pain Surgery Can't Make Worse

(2) Comments | Posted January 5, 2015 | 10:32 PM

Surgery is much less science-based than the rest of medicine. It is almost impossible to subject it to studies that are double-blind and placebo-controlled. Surgical guidelines are therefore necessarily much more anecdotal than based on evidence.

Lots of elective surgery is probably unnecessary, and back operations are the most notorious...

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Having a Severe Mental Illness Means Dying Young

(39) Comments | Posted December 29, 2014 | 10:58 PM

People diagnosed with serious mental illness -- schizophrenia, bipolar disorder, or severe depression -- die 20 years early, on average, because of a combination of lousy medical care, smoking, lack of exercise, complications of medication, suicide, and accidents. They are the most discriminated-against and neglected group in the U.S., which...

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The Globalization of Attention Deficit Disorder

(0) Comments | Posted December 22, 2014 | 9:35 AM

Mental disorders have become a global commodity. A diagnostic fad heavily promoted first in the US now quickly spreads around the world.

Multinational corporations have perfected the profitable art of international marketing. The reach of Big Pharma stretches everywhere in the world with a sales pitch easily translated into every...

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Pro and Con: The British Psychological Society Report on Psychosis

(1) Comments | Posted December 15, 2014 | 4:57 PM

The original etymologies and current usages of the words "psychosis" and "neurosis" are confusingly topsy-turvy.

"Psychosis" literally means a disease of the soul or mind, but for more than 100 years this term has been used to describe only the severest forms of mental disorders, those that have at least...

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