Does Everyone Have a Mental Illness?


Psychiatrist and author Allen J. Frances, former chair of the DSM-IV task force, outlines why he thinks the DSM-V will lead to millions of people being mislabeled with mental disorders in his lecture “Diagnostic Inflation: Does Everyone Have a Mental Illness?”

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. Some of the most effective rebuttal to psychiatric orthodoxy comes from icons of the field itself when they speak out. Words from such people can’t be dismissed ad hominem as “Scientologist” or “the psychiatry hating fringe.” Psychiatry worships authority, and it’s very effective when their own authorities tell a bit of the truth.

    That’s my reservation here – it’s just part of the truth. Francis, like Healy, maintain their bona fides with psychiatry by maintaining that there ARE brain based mental “illnesses” for which psychosocial methods won’t work, and so require medical intervention. The problem is the same logic they pursue part way in their challenges to psychiatric orthodoxy also effectively rebut or cast doubt on the positions to which Francis and Healy have retreated.

    Francis says DSM III and IV are reliable – but studies show they aren’t (read Kutchins and Kirk, or Paula Caplan); he says about 70% of severe depression responds to medication, while it’s only 20% with placebo – but Kirsh’s The Emperor’s new Clothes says otherwise, and Robert Whitaker’s rebuttal to Francis’s claim supports Kirsch. His most inexplicable claim is that ECT works well for severe depression – studies show ECT is only more effective than sham (placebo) shock treatment during the course of the treatments themselves, and the effects wear off within days, leaving many patients with persistent memory loss.

    Francis says newly diagnosed “schizophrenics” “absolutely” need medication – but Soteria, Bert Karon’s study and Open Dialogue show that’s not so, and the WHO studies show schizophrenia recovery rates are about twice as high in countries not relying on neuroleptics as in countries that do rely on the drugs. Francis says psychiatry does well in the 1/3 of patients psychiatry should stick with – but a lot evidence contradicts that too.

    I welcome Dr. Francis’s clear stance against diagnostic proliferation, his saying out loud that today’s psych. drugs are no more effective than the old ones, etc. But this looks like a combination of genuine concern about DSM V and damage control to save some area of legitimacy for bio-psychiatry.

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  2. Jeez – I wish these comment pages could be edited. I read mine over once they’re put up and find I have tenses and pronouns that don’t match, names wrong (Emperor’s New CLOTHES??).

    I wonder if DSM V will have a “disorder” for people who can’t see the screen all that well and have trouble writing in these little windows.

    Sorry for the typos and bad grammar.

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