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Allen Frances
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

The Perils Of Polypharmacy

(2) Comments | Posted June 21, 2016 | 9:43 AM

Polypharmacy was once the exception in psychiatry, now it seems to have become the rule. Patients frequently are taking 3,4, even 5 psych meds at one time. And often it's primary care doctors, not psychiatrists, who are doing the prescribing -- usually without adequate training in psychiatry.

Some polypharmacy is...

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Trump Is Breaking Bad, Not Clinically Mad

(3) Comments | Posted June 9, 2016 | 10:27 AM

Now that Donald Trump is improbably close to becoming president, several frightened commentators are suggesting he receive psychiatric evaluation to ensure he is not mentally ill. The amateur diagnoses most often floated for Trump are Narcissistic Personality Disorder or Borderline Personality Disorder.

I know something about Personality Disorders, having written...

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Religious Freedom Shouldn't Trump Other Civil Rights

(1) Comments | Posted June 2, 2016 | 11:34 AM

"Your Liberty to Swing Your Fist Ends Just Where My Nose Begins"

Sounds simple, but in real life, the resolution of conflicting rights is much less clear-cut. In a previous blog, my wife Donna Manning and I tackled the fuzzy and fraught boundary between religious rights and gender rights.


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U.S. Mental Health Care Goes From the Worst To Even Worse

(1) Comments | Posted June 1, 2016 | 1:31 PM

My despair about the neglect of the severely ill in the U.S. has been described in many previous blogs. The most despairing was titled "World's Best and Worst Places To Be Mentally Ill" -- with (you guessed it) the U.S. being the worst.

A new report...

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Conclusive Proof ADHD Is Overdiagnosed

(31) Comments | Posted May 23, 2016 | 1:21 PM

There are 3 possible explanations for the  explosion of the ADHD diagnosis during the past 20 years -- with rates that have skyrocketed from only 3-5 percent of kids to 15 percent.

1) Diagnostic enthusiasts celebrate the jump as indication of increased awareness of ADHD and better case finding.


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Behavioral Addictions: A Dangerous and Slippery Slope

(6) Comments | Posted May 16, 2016 | 11:49 AM

A seemingly small and barely noticed organizational change in DSM-5 disguises what is really a giant conceptual leap -- one that may eventually cause large and harmful unintended consequences.

In DSM IV, the section covering addictions referred only to the compulsive use of substances. In DSM-5, the concept of addictions...

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Antidepressants Work, But Only For Really Depressed People

(4) Comments | Posted May 7, 2016 | 12:04 PM

The biggest mistake in DSM III was introducing the very broad and heterogeneous category 'Major Depressive Disorder'. This combined under one rubric what had previously been two seperate and quite different presentations: 1) severe, melancholic, delusional, or incapacitating depressions, and 2) reactive to stress, mild, and often transient depressions. The...

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What You Need To Know About The Genetics of Mental Disorders

(4) Comments | Posted April 30, 2016 | 10:36 AM

"For every complex problem there is an answer that is clear, simple, and wrong." H. L. Mencken

The nature/nurture debate on the causes of mental disorder generates no end of silly controversy by proponents on both sides.

The biological reductionists act like the secret of psychiatric disorders is written in...

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Stopping the False Epidemic of Adult ADHD

(8) Comments | Posted April 14, 2016 | 2:21 PM

The history of psychiatry is filled with fads. A diagnosis quickly gains momentum, is pushed by thought leaders, captures the imagination of clinicians, picks up widespread media attention, and soon attracts word of mouth buzz among potential patients. Rates escalate. New and exciting treatments are hyped. Miracle cures abound.


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Keith Conners, Father of ADHD, Regrets Its Current Misuse

(35) Comments | Posted March 28, 2016 | 12:17 AM

Keith Conners can rightly be called the "Father of ADHD". He was there at the birth of the disorder and probably knows more about it than anyone else on the planet.

Fifty years ago, well before there was an ADHD diagnosis, Dr Conners analyzed the data on the very first...

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Balancing Patient Freedom With Safety And Well Being

(3) Comments | Posted March 19, 2016 | 2:24 PM

I have always hated involuntary psychiatric treatment. It is demeaning to human dignity, subject to abuse, and extremely unpleasant both to experience and to recommend. But there are rare times when pressuring someone into treatment becomes the lesser evil, preferable to the risks of suicide, violence, jail or homelessness.


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Saving Psychotherapy From the Medication Takeover

(13) Comments | Posted March 6, 2016 | 9:35 AM

One of the best experiences of my career occurred in the 1980s when I was a member of the group that decided which psychotherapy studies would be funded by the National Institute of Mental Health.

It was hard work. Every three months, we would review about twenty-five studies, knowing that...

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Can DSM-5 Correct Its Mistakes? I Say No, DSM-5 Says Yes

(10) Comments | Posted March 1, 2016 | 9:56 AM

DSM-5 stirred great public and professional controversy because it was so carelessly done and included so many obvious mistakes. At the time, the American Psychiatric Association tried to appease critics with the promise that the errors not picked up before DSM-5 publication would promptly be corrected after. DSM-5 was advertised...

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Psychiatry And Anti-Psychiatry

(13) Comments | Posted February 22, 2016 | 10:05 AM

Psychiatry used to be a biopsychosocial profession that allowed time to get to know the person, not just treat the symptom. But drastic cuts in the funding of mental health services have dramatically reduced the quality of the service they can provide. Psychiatrists are now forced to follow very large...

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Setting the Record Straight on Antipsychotics

(6) Comments | Posted February 16, 2016 | 12:15 PM

My first experience with antipsychotic medication was in the early 1960s, shortly after they were introduced. As is usual with new treatments, benefits were appreciated before harms were realized. Delusions and hallucinations improved, but patients developed many very unpleasant side effects- a strange fixed stare, muscle rigidity, uncontrollable movements, agitation,...

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Do Antipsychotics Help or Harm Psychotic Symptoms?

(1) Comments | Posted February 1, 2016 | 12:19 PM

This is the latest, and perhaps last, of several debates with Bob Whitaker on the role of antipsychotics in treating psychotic symptoms. It was triggered by a recent email exchange that clarified our areas of agreement and disagreement. Bob's blog summarizing his views and how he arrived at them can...

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We Have Too Many Specialists and Too Few General Practitioners

(2) Comments | Posted January 21, 2016 | 11:17 AM

"It's more important to know the patient who has the disease, than the disease the patient has." This was true when Hippocrates said it 2500 years ago -- and it remains true today.

Unfortunately, doctors no longer know their patients. GP'S are overworked, underpaid, and must shuttle patients in and...

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Psychiatric Medicines Are Not All Good or All Bad

(7) Comments | Posted January 15, 2016 | 11:22 AM

To take or not to take psychiatric medicine? That is the question.

Far too many people answer yes and take meds they don't really need for problems that would get better just with the passage of time and/or brief counseling.

More than 20 percent of Americans are on at least...

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A Tribute to Robert Spitzer, the Most Influential Psychiatrist of His Time

(0) Comments | Posted January 8, 2016 | 10:56 AM

There is an ongoing debate whether the flow of history is pushed forward more by ineluctable forces or by the prominent people who represent them. I usually subscribe to the former opinion, but must admit the relevance of the latter in the one small piece of history I got to...

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The Social Cure For Mental Illness

(3) Comments | Posted December 21, 2015 | 9:05 AM

"Everyone is much more simply human than otherwise." - Harry Stack Sullivan

The United States is the worst place in the developed world to have a severe mental illness.

By failing to provide adequate care and housing, we have condemned 350,000 to jails and 250,000 to...

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