Allen Frances Seeks the “Middle Way”


On January 15, 2016, Allen Frances, MD, Professor Emeritus at Duke University, published an article on the Huffington Post.  The piece is titled:  Psychiatric Medicines Are Not All Good or All Bad.

The article denounces both the “medication fanatics” who prescribe psychiatric drugs when they are not needed, and the “die-hard anti-medication crusaders who try to persuade everyone, including those who really need meds, that they are globally unhelpful and globally harmful.”

Dr. Frances advocates a middle ground in which people who need psychiatric drugs get them, and people who don’t, don’t.  On the face of it, this would seem a fairly non-contentious matter, but Dr. Frances’s path to this conclusion is fraught with problems which in my view warrant discussion.

Mental Illness or Transient Emotional Distress

Here are some quotes from the article, interspersed with my comments.

“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 one psychotropic drug (sometimes several), too often not for real mental disorders, but for transient emotional distress or for the demoralization that comes from difficult life circumstances.”

In the third paragraph above, Dr. Frances is drawing a sharp line between “real mental disorders” on the one hand, and “transient emotional distress or…the demoralization that comes from difficult life circumstances” on the other.

Here again, apart from the implication that “mental disorders” have some ontological reality, this distinction has a ring of reasonableness, but in fact, within the parameters of psychiatry’s own classification system (the DSM), there is no reliable way to draw this distinction.

To illustrate this, let’s consider “major depressive disorder,” one of psychiatry’s so-called illnesses.  Presumably, Dr. Frances would consider this a “real mental disorder.”

Here are the DSM-5 diagnostic criteria for major depressive disorder:

“A.  Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly attributable to another medical condition.

  1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
  3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.  (Note: In children, consider failure to make expected weight gain.)
  4. Insomnia or hypersomnia nearly every day.
  5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
  6. Fatigue or loss of energy nearly every day.
  7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
  8. Diminished ability to think or concentrate or indecisiveness, nearly every day (either by subjective account or as observed by others).
  9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation with out a specific plan, or a suicide attempt or a specific plan for committing suicide.

B.  The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C.  The episode is not attributable to the physiological effects of a substance or to another medical condition.

Note:  Criteria A-C represent a major depressive episode.

Note:  Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered.  This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.

D.  The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

E.  There has never been a manic episode or a hypomanic episode.

Note:  This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.” (p 160-161)

So let’s go through the nine “symptoms” and see how we might manage to distinguish those that are indicative of “real mental disorders” from those that should more properly be considered “transient emotional distress or…the demoralization that comes from difficult life circumstances.”  And to concretize our deliberations, let’s invent a “patient”:  a 65-year-old women (I’ll call her Alice), whose husband of 45 years has, out of the blue, informed her that he is leaving her for his 35-year-old secretary who is pregnant with his child, and who really understands him.  And let’s say that Alice is feeling pretty down – in fact, she’s devastated.

“Symptom” # 1.  Alice meets the requirements of symptom # 1.  She has been feeling sad, empty, and hopeless since her husband’s revelation three weeks earlier, and she is frequently tearful.

But what’s particularly noteworthy here is that there is no way to inject into one’s considerations of “symptom” # 1 any information about Alice’s husband’s infidelity or his decision to abandon her.  This was Robert Spitzer’s “great contribution” to psychiatry:  focusing on problems of thinking, feeling, and behaving regardless of the sources of these problems.  It was this honing in on the phenomena presented  that was supposed to lift psychiatry out of the stone-age of psychosocial speculation, and place it on a truly objective and scientific basis.  And this preoccupation with the phenomena, and the utter disregard for the obvious underlying causes, was slavishly echoed in DSM-IV and DSM-5.

It is obvious that Alice is depressed and demoralized because of the “difficult life circumstances” in which she finds herself. But it is equally obvious that she meets the criteria for “symptom” # 1.

In addition, the minimum duration of two weeks makes a mockery of Dr. Frances’s notion of distinguishing real “mental disorders” from “transient emotional distress.”  In the APA’s “diagnostic” system, depression lasting more than two weeks passes the duration test for major depressive disorder.  This, incidentally, is the same duration requirement specified in DSM-III and in Dr. Frances’s own DSM-IV.

 “Symptom” # 2.  Here again, without a doubt, Alice meets the requirements. She’s an old-fashioned lady, and her husband and family had been the center of her world.  Not surprisingly, she’s not getting a lot of joy out of life, she doesn’t feel inclined to go out socializing, or engaging in other activities.

If anyone were to ask her why she’s feeling down, she would, if she felt like confiding in the questioner, explain what had transpired three weeks earlier, and by any ordinary standards, this explanation would be accepted as the true proximate cause of her distress, inactivity, and lethargy. But in the world of psychiatry, none of this matters.  As with “symptom” # 1, there is no way to inject into “symptom” # 2 any consideration of “difficult life circumstances.”

Alice has been markedly despondent and noticeably lethargic and anhedonic for three weeks, so at this point she’s batting two out of two. And remember, she only needs five positive symptoms to have the “illness major depressive disorder.”  So let’s forge on.

“Symptom” # 3.  Significant weight loss or weight gain or decrease or increase in appetite.

Note the proliferation of “ors” – a standard feature of psychiatric “diagnoses.”  So we have four ways in which Alice can “score” on “symptom” #3:  gaining weight (5% per month); losing weight (5% per month); reduced appetite; or increased appetite. And we need only one of these to confirm this “symptom.”

Alice’s husband, let’s call him George, left her three weeks ago. At that point, her weight had been, say 125 pounds.  Since then, she hasn’t been eating too well.  She can’t be bothered to cook very much, and she has lost 5 pounds.  Five pounds over three weeks is the equivalent of about 6 ½ pounds a month, slightly more than a 5% loss in weight.

Bingo!  Alice scores positive on “symptom” # 3.  And readers, please note.  The decrease in appetite doesn’t have to be every day.  The wording in DSM-5 (and incidentally in DSM-IV) is nearly every day.  What does “nearly” mean?  Five days a week?  Four days a week?

And remember, we can’t dismiss Alice’s symptoms as “transient” because they’ve been present for more than two weeks!

“Symptom” # 4.  Insomnia or hypersomnia nearly every day.

One thing that psychiatrists do well is weave their net tight, and in this respect, “symptom” # 4 is a doozy.  Here’s the DSM-5 text on this “symptom” (p 163):

“Sleep disturbance may take the form of either difficulty sleeping or sleeping excessively (Criterion A4).  When insomnia is present, it typically takes the form of middle insomnia (i.e.,  waking up during the night and then having difficulty returning to sleep) or terminal insomnia (i.e., waking too early and being unable to return to sleep).  Initial insomnia (i.e., difficulty falling asleep) may also occur.  Individuals who present with over-sleeping (hypersomnia) may experience prolonged sleep episodes at night or increased daytime sleep.”

So, and readers please be warned, this is very abstruse, insomnia can occur at the beginning of the night, or the middle of the night, or towards the end of the night, and hypersomnia can occur during the night or during the day.  So that pretty much covers it.

As mentioned earlier, Alice has been married to George for 45 years.  In all of that time, apart from three obstetrical confinements, she has never slept alone.  The marital bed, which for more than two-thirds of her life had been a place of comfort, solace, safety, and joy, is now a barren and desolate cave, redolent with the aura of betrayal, abandonment, and loss.  She hears house noises that she never before noticed, and the sides of the bed feel cold and foreboding.  So she tosses back and forth, and watches the hours pass on the digital clock.

And then, every few days, utterly spent from the lack of sleep, she crashes on the couch and sleeps for twenty-four hours straight through.

So she has insomnia or hypersomnia nearly every day.

Four out of four.  One more “symptom” and she “has” major depressive disorder.

And with regards to Dr. Frances’s call to distinguish between “real mental disorders” and “transient emotional distress or for the demoralization that comes from difficult life circumstances,” note that as with the earlier “symptoms,” there is no way to register such distinctions.  There is no way within the DSM criteria to acknowledge that Alice’s insomnia or hypersomnia – or any of the other so-called symptoms – are nothing more or less than the result of a truly devastating life event.

Rather than belabor the matter unnecessarily with regards to “symptoms” 5-9, perhaps it is sufficient to note that all of the points made above concerning “symptoms” 1-4 apply also to the latter group.  Alice’s movements are slowed, her energy level is low, she wonders if George’s betrayal was somehow her fault, she is experiencing difficulty making decisions, and she has fleeting thoughts that life isn’t worth living.

So, by the APA’s own standards, Alice has major depressive disorder.  But she also has what Dr. Frances calls “the demoralization that comes from difficult life circumstances.”  And to clarify the invalidity of Dr. Frances’s distinction, it should be noted that the APA specifically asserts that the latter does not and should not constitute an exclusion factor if the criteria for the former are met.  The passage in question is the second “note” between criterions C and D:

“Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) ;may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A. which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered.  This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.”

So, what’s being said here, if we apply it to Alice, is that even if her despondency, lethargy, insomnia, etc., are “understandable” and “appropriate” given her circumstances, the assignment of a “diagnosis” of major depressive disorder should still be “carefully considered.”  But the only way to carefully consider a diagnosis of major depressive disorder is by comparing the individual’s presentation with the nine so-called symptoms.  And there is nothing in any of the nine items that takes cognizance of the reasons a person might be depressed or anxious or inattentive or whatever.  Indeed, this institutionalized indifference to underlying causes and precipitating factors is one of the primary criticisms directed against psychiatry, and to which psychiatry has, in turn, been utterly deaf.

So, to put it briefly, Dr. Frances’s exhortation to distinguish between “real mental disorders” and “the demoralization that comes from difficult life circumstances” is meaningless.  Dr. Frances was a key player in the creation and promotion of a facile checklist system of “diagnosis,” that systematically excluded any consideration of the real psychosocial causes of the problems involved.  Now, as the inevitable and eminently foreseeable consequences of this travesty are being exposed in clear relief, Dr. Frances seeks to reintroduce a consideration of these causes, but without repudiating the spurious medicalizing pigeonholes, and without acknowledging his own role in their creation and promotion.

. . . . . 

Here’s another quote from Dr. Frances’s paper:

“Meds that are very helpful for clear-cut psychiatric disorders usually do more harm than good when used for the everyday difficulties that life throws at us.”

Here again, we see the implied assertion that it is possible to distinguish between “clear-cut psychiatric disorders” and the “difficulties that life throws at us.”  In reality, every “symptom” listed in the APA’s catalog of labels can be readily conceptualized, understood, and addressed as a response to difficulties, or sub-optimal situations, in which people find themselves.  The notion that an individual who scores five out of nine, or three out of six, or four out of ten, on one or other of the APA’s facile check lists, has an illness, is an entirely arbitrary assertion.  Psychiatry has never proven this assertion with regards to any of its so-called diagnoses.  They simply state it to be so.  The fiction embedded in the DSM and in psychiatric practice world-wide is that every conceivable human problem of thinking, feeling, and/or behaving that crosses arbitrary and intrinsically vague criteria of severity, frequency, and duration is an illness, which warrants psychiatric “treatment.”  This “treatment” almost invariably consists of drugs, or high-voltage electric shocks to the brain.

. . . . .

“When prescribed loosely, meds provide little benefit, risk harmful side effects, distract attention from solving the real life problems, and reduce people’s trust in their own resilience and the help they can receive from family and other social supports.”

This is a particularly interesting sentence, in that, with one small amendment, it expresses almost the entire anti-psychiatry position:

Psychiatry as it is practiced in most parts of the world today provides little benefit, risks harmful side effects, distracts attention from solving the real life problems, and reduces people’s trust in their own resilience and the help they can receive from family and other social supports.

. . . . . 

The Undertreated “Mentally Ill” Individuals 

“But there is another side of the equation. Far too many people who need drugs don’t take them — either because treatment is unavailable or because they don’t realize or accept the fact that they need it.”

This has been a common theme within pharma-psychiatry for the past five years or so:  the untold millions of mentally ill people languishing despondently without appropriate treatment.

Dr. Frances provides no reference to support this claim, but that’s not too serious a deficiency, in that pharma-psychiatry has in recent years produced several demographic studies showing that the number of people who “have” a particular “mental illness” routinely exceeds the number of people who are receiving “treatment” for this particular “illness.”

But how do we know that the individuals concerned have the “illness”?  There is only one possible answer to this question:  because they meet the DSM criteria for that particular “diagnosis.”

So Dr. Frances is apparently willing to rely implicitly on the validity and reliability of the DSM criteria when bemoaning the plight of the languishing untreated millions, but seeks to establish transience and life circumstances exclusions from the same criteria when striving to exculpate psychiatry from the charge of wholesale drug pushing.

Or to put the matter more simply:  how does Dr. Frances know that the languishing millions have real “mental illnesses”?  Perhaps their distress is simply a reflection of “the demoralization that comes from difficult life circumstances,” and they would “get better just with the passage of time and/or brief counseling.”

The fact is that psychiatry’s agenda is – and for at least the past fifty years has been – to widen its diagnostic net, and to get as many people into “treatment” as possible. To this end, psychiatry has fabricated an invalid, hopelessly vague “diagnostic” system into which almost any person experiencing even the slightest distress or problem from whatever cause can be readily shoe-horned.  This is not an accident.  It is clearly evident in virtually every facet of psychiatry, including its present push for early intervention for depression, social awkwardness, unusual thinking patterns, inattentiveness, etc… And in this regard, it is noteworthy that Dr. Frances’s own DSM-IV was a major development in these endeavors.  For Dr. Frances to seek to distance himself now from the rampant drug-pushing that characterizes his chosen profession is disingenuous at the least.

. . . . .

“So we are trapped in the cruel, dumb, and sometimes tragic paradox that the wrong people often take meds, while the right ones don’t.

This terrible situation has many causes that have been discussed already in previous blogs. Our focus here will be on what has been a futile and harmful struggle between two different “one glove fits all” mentalities.

On one side are medication fanatics — some of whom are psychiatrists but also many primary doctors who prescribe 80% of psych meds.

On the opposing side are die-hard anti-medication crusaders who try to persuade everyone, including those who really need meds, that they are globally unhelpful and globally harmful.”

So, Dr. Frances tells us that we are “trapped” in the situation of over-drugging some people, while under-drugging others.  This “tragic paradox” has many causes, but the cause on which Dr. Frances is focusing here is the futile and harmful struggle between the “medication fanatics” (most of whom, incidentally, are GP’s!) and the “die-hard anti-medication crusaders who try to persuade everyone, including those who really need meds, that they are globally unhelpful and globally harmful.”

Well this is all quite a leap, but let’s see if we can disentangle any coherent threads.

Dr. Frances asserts that “we” are trapped in this tragic paradox.  By “we,” he perhaps means psychiatry, or maybe all humanity.  It’s not clear.  But let’s initially assume that he means psychiatry, at which point it becomes obvious that the statement is false.  Psychiatry is not in any sense trapped in any of this.  Rather, organized psychiatry is exulting in the success of its burgeoning influence, and has employed tawdry PR practices to push the expansionist balloon to ever increasing limits.  Renée Binder, MD, is the President of the APA.  In her list of top ten accomplishments by the APA in 2015, she cites the development of early intervention programs with schools, judges, employers, and “faith-based leaders.”  She also cites “Increasing access to care for our patients through tele psychiatry.”

But if by “trapped” Dr. Frances is referring to those millions who were lured into psychiatry’s web of drug dependence by the “incurable disease” hoax, and who now find themselves unable to quit, then of course Dr. Frances is correct.  These individuals are indeed trapped.  Or if Dr. Frances is referring to those even more misfortunate people who are incarcerated without trial in psychiatry’s so-called hospitals, and forcibly drugged and shocked, then again, Dr. Frances is correct:  these people are indeed trapped.

The proximate cause of the rampant drugging has been psychiatry’s expansionist agenda; and the mechanisms that facilitated this expansion were the unabashed invention of new “illnesses,” the inherent vagueness of the “diagnostic” criteria, and the deliberate exclusion of any consideration of psychosocial causative factors.

And with regards to the “die-hard anti-medication crusaders who try to persuade everyone, including those who really need meds, that they are globally unhelpful and globally harmful,” I can only say that I haven’t encountered many such individuals within the anti-psychiatry community.  In fact, the general stance that I have perceived within this community towards people who choose to take psychiatric drugs is one of concern, coupled with respect for the right of each individual to make his or her own decisions on these matters.  There is wide condemnation, however, within this community of psychiatry’s almost universal practice of inducing people to take drugs under the pretense that they are suffering from incurable illnesses, for which they need the drugs to maintain “remission.”  Within the anti-psychiatry movement, this practice is rightly considered a hoax and a travesty of medical practice.

. . . . . 

At this point in his article, Dr. Frances inserts what I assume is a copy of a letter that he had received from Virgil Stucker, MBA, in which Virgil calls for a ” middle ground between opposing wholesale beliefs that psychiatric medicine is all good or all bad.”

Dr. Frances echoes this theme, and then:

“I used to be more enthusiastic about the possibility of psychosocial treatment replacing meds, or markedly reducing the doses need, even in the most severely ill. In the mid 1980’s, I helped plan and conduct a large study that compared three medication strategies in the continuation phase of treatment for people who had recovered from a psychotic episode: 1) usual dose; 2) one fifth dose, and; 3) placebo. All groups also received intense family support in the community. Some people did fine with less or no meds. But the catastrophes remain unforgettable.”

Here again, Dr. Frances provides no references.  He has been a prolific writer over the years, and it is entirely possible that he has in the past advocated replacing psychiatric drugs with psychosocial interventions, but I’ve never come across this theme in his writings.  If he would care to provide references, I’d be happy to take a look.

Similarly with regards to the study that he helped plan and conduct in the mid-80’s.  I searched the PubMed list of his publications from 1980 to 1990, but could find nothing that seemed to match the description Dr. Frances provides here.  Again, I’d be happy to take a look at the study if Dr. Frances will provide the reference.

It’s difficult to offer any comment on Dr. Frances’s reminiscence that “the catastrophes remain unforgettable.”  We’ve all seen catastrophes in this business.  Most of the ones I’ve seen have been the direct result of the toxicity and disempowerment that are an integral part of psychiatry’s “treatments.”

But subjective assessments, as Dr. Frances should know, are notoriously unreliable.  Which is why, in complex matters in which we have a personal stake, it is better to rely on science.  Robert Whitaker, of MIA, wrote a response to Dr. Frances’s paper on January 27, and on the subject of science vs. subjective impressions, he wrote:

“In his Huffington Post blog, Allen Frances argues for prescribing practices that he describes as a middle way. Prescribe them to the right patients, because for these patients the drugs can be life-saving, but curb the overuse and polypharmacy that can prove harmful to so many, particularly for those who have ordinary problems, as opposed to real psychiatric disorders. As you can see in his blog, he also sees this middle way as informed by his own clinical experience.

But, here’s the rub: the ‘middle way’ he describes is not an evidence-based practice. It is not a practice that is informed by science that tells of drugs that induce a dopamine supersensitivity, which may increase the biological vulnerability to psychosis; or of science that tells of drugs that shrink the brain, with this shrinkage associated with worse negative symptoms and functional impairment; or of animal research that tells of why antipsychotics fail over time; or of science that tells of much higher recovery rates over the long term for unmedicated patients. Those are drug effects that are not immediately visible to the clinician, but rather are made known through the illuminating powers of science, and they pertain to those with ‘clear cut psychiatric disorders’ too.”

. . . . .

Back to Dr. Frances’s paper, in which he concludes:

“There will never be one right decision on psychiatric medicine that applies to everyone. In the US, there has been far too much acrimony and far too little cooperation among providers, families, and disaffected users — as if there were one right answer. This results in bad treatment and ineffective advocacy for the mentally ill. Mental health care in Europe is in much better shape because no such opposition hinders cooperative efforts in clinical decision making or political advocacy.”

The meaning here isn’t entirely clear.  Dr. Frances seems to be saying that acrimony and lack of cooperation between psychiatrists and non-compliant clients results in “bad treatment” and “ineffective advocacy.”  Earlier in his paper, he stressed that there were two sides to the coin:  the “medication fanatics” and the “die-hard anti-medication crusaders.”  But now the onus seems to be sliding towards the “disaffected users.”  And this is confirmed in the next sentence:

“Mental health care in Europe is in much better shape because no such opposition hinders cooperative efforts in clinical decision making or political advocacy.” [Emphasis added]

Note the word opposition; not disagreement; not conflicting views; not differences of opinion; but opposition.

And what kind of opposition?  Opposition that “hinders cooperative efforts in clinical decision making or political advocacy.”

Now, as I’ve said before, Dr. Frances’s writing isn’t always entirely clear, but I can’t find any interpretation of this last sentence other than:  things are much better in Europe because they don’t have an anti-psychiatry movement which challenges psychiatrists’ clinical decision making, and which undermines psychiatry’s efforts to lobby politicians on matters pertaining to psychiatry’s agenda.

So, while Dr. Frances began by decrying two villains:  the “medication fanatics” and the “die-hard anti-medication crusaders,” in the final analysis, he seems to have settled on just one:  the antipsychiatry movement whose members have the audacity to challenge psychiatrists’ clinical decision making, and pharma-funded political lobbying.

So much for his pursuit of a middle ground!

. . . . . 

Incidentally, on a factual note, I don’t think the situation in Europe is any more or less favorable to psychiatric hegemony than is the case here in the US.  I believe that in all parts of the world, the psychiatric hoax is widely accepted, and psychiatric “treatments” are widely practiced.  But everywhere there is “a stirring in the hills.”  A stirring whose growing energy will one day sweep psychiatry and all its fraudulent works and pomps into the great maw of historical obscurity.  And people will ask:  How could something so fundamentally flawed and rotten have been accepted and promoted by civilized people for so long?  And people will dig up the writings of psychiatrists like Dr. Frances, and they will shake their heads in wonder and horror that apparently educated people could lend their support to such a destructive and far-reaching hoax.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.


  1. Mr. Philip Hickey, this article was so truthful, eye opening, and so well written that it left me speechless. Thank you so very much for sharing your articulate wisdom with those of us less fortunate. And by that I mean, those of us who have actually developed Dementia from years of taking psychiatric drugs, ECT’s, and the devastating, permanent cognitive impairment from multiple psychiatric drug ‘cold turkey’ withdrawals. But, I sure understood every single word you said. Thank you!

    Report comment

    • The article, ‘Setting the Record Straight on Antipsychotics’ in Psychiatric Times has been sitting on my desk for over a week. It’s a very hard read. I became so enraged when reading it that I had to keep setting it down to keep from becoming physically ill. Allen Frances seems to take no responsibility what so ever in his part for creating three major mental disorder epidemics in this country welcoming in millions of unsuspecting, naïve (me) patients for big pharma. What a payday this must have been for him. As angry as I am with psychiatry for taking control and ruining my life by prescribing so many psychiatric drugs over a 35 year period that it’s amazing I’m alive today so I don’t like to venture in the ‘angry’ arena anymore. But this sentence in his article is what took the cake for me, “I and many others fought vigorously against these dangerous misuses of antipsychotic medication.” I wish he would have included proof at just how hard he really fought. We patients are the ones who fought just to make it though another day of suffering while being lied to, poisoned, and left to the wolves for becoming good, ‘compliant’ patient’s.

      Report comment

  2. Excellent post, as always, Dr. Hickey.

    “There is wide condemnation, however, within this community of psychiatry’s almost universal practice of inducing people to take drugs under the pretense that they are suffering from incurable illnesses, for which they need the drugs to maintain ‘remission.’ Within the anti-psychiatry movement, this practice is rightly considered a hoax and a travesty of medical practice.”

    Absolutely I agree lying to patients and their families, claiming a patient has a “lifelong, incurable, genetic mental illness,” while ignoring absolutely everything going on in the person’s real life, is appalling and insane behavior.

    Here’s a little excerpt regarding how I was diagnosed with the “lifelong, incurable, genetic” “bipolar” disorder, in relation to the DSM definition at the time:

    “IMPRESSION: AXIS1: biopolar with manic psychosis.” Let’s look into what “bipolar” technically is at this point, since this was the psychiatric stigmatization that stuck, at least for a while. It’s now been taken off my medical records.
    “Bipolar Episode and Bipolar Disorder
    “Bipolar disorder is characterized by more than one bipolar episode. There are three types of bipolar disorder:” If my condition qualifies as a “bipolar episode,” and we know it’s my first episode, then it does not technically qualify as “bipolar disorder” at this time, according to the first sentence here.
    “1. Bipolar 1 Disorder, in which the primary symptom presentation is manic, or rapid (daily) cycling episodes of mania and depression.” Well, Rob seems to be claiming my “primary symptom presentation is manic.” There was no “rapid cycling,” however.
    “2. Bipolar 2 Disorder, in which the primary symptom presentation is recurrent depression accompanied by hypomanic episodes (a milder state of mania in which the symptoms are not severe enough to cause marked impairment in social or occupational functioning or need for hospitalization, but are sufficient to be observable by others).” My primary symptom presentation was not recurrent depression, I wasn’t complaining of depression. And Rob hadn’t described me as depressed, “She has a well to do appearance and she is quite personable. Her friendliness gives rise to … smiling and laughter.” Although we still have to see what mania actually is, to understand the difference between mania and hypomania. But we’ll finish the bipolar definition.

    “3. Cyclothymic Disorder, a chronic state of cycling between hypomanic and depressive episodes that do not reach the diagnostic standard for bipolar disorder (APA, 2000, pp. 388–392).” Rob doesn’t list which of these “bipolar disorders” he thought I had. But I had never cycled between mania and depression at all. Let’s see what mania actually means:

    “Manic episodes are characterized by:
    A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).”
    During the period of mood disturbance, three (or more) of the following symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:
    (1) increased self-esteem or grandiosity
    (2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
    (3) more talkative than usual or pressure to keep talking
    (4) flight of ideas or subjective experience that thoughts are racing
    (5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
    (6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
    (7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)” (APA, 2000, p. 362).

    Depressive episodes are characterized by symptoms described above for Major Depressive Episode.”
    Well, I didn’t have elevated or expansive moods, but I was justifiably irritated by my now ex-pastor’s bullying for more than a week, so we must say Yes on A. However, according to B, we need four of the items listed above to be “present to a significant degree” for me to be considered “manic.” There was no increased self-esteem or grandiosity, so no on number (1). No decreased need for sleep, so no number (2). Kohn claimed I had “pressured speech,” but after reading the definition and looking at how little actual information he listed from me, personally, we concluded I did not seem to suffer from “pressured speech” at this time. So that means a no, on number (3). The Risperdal had caused the type reaction listed in (4) so we can say maybe on number (4), if adverse reactions to drugs are not excluded. Kohn kept directing the conversation to Dr. Barb and friends concerns, but we did keep correcting him, so I’d say no on number (5). I did have the increased libido issue, we now know was likely caused by the Wellbutrin, so we need to see if an adverse reaction to an antidepressant (“safe smoking cessation med”) is excluded or not. And I had started some new activities at my son’s new school, but this was nothing atypical for me, seemingly not discussed with Kohn anyway, and it had nothing to with an increase in goal-directed activity, so we’ll say a maybe on number (6). As to number (7), again, I did have the odd increased libido issue but it did not result in any actual sexual indiscretions, since I did not actually have sex with my husband on the day I wanted a “little afternoon delight.” Oh, and this explains why Barb apparently believed a $400 donation to a children’s charity is evidence of a mental illness.
    So, Rob concluded I suffered from “bipolar with manic psychosis.” But according to the definitions of bipolar and manic, it appears I had no yeses, except I’d been irritated by my ex-pastor’s behavior for more than a week, three possible maybes, two of which were due to the increased libido via the Wellbutrin, the other due to the allergic reaction to the Risperdal. But four yeses are required for a bipolar diagnosis, when the person is only irritated, rather than “persistently elevated, expansive.” And all maybes dealt with what we now know are bad reactions to drugs. In 2002, the DSM in use was the DSM-IV-TR. So what does the DSM-IV-TR have to say about whether adverse reactions to drugs count towards a bipolar diagnosis? Wow, this is hard to find online in 2015, the DSM5 has changed the definition of bipolar. We’ll discuss this later, and postulate as to why it was changed, and whether the change was actually a wise modification. I may have to pick up the book again at the library … oh, good, no I don’t, here’s a continuation of the DSM-IV-TR bipolar definition. The government’s and many medical sites don’t list the whole definition any longer it seems, but psychologist Dr. Philip Hickey’s site still does. Here’s a continuation of the definition of bipolar according to the DSM-IV-TR:
    “C. The symptoms do not meet criteria for Mixed Episode.
    “D. The mood disturbance is sufficiently severe to cause marked impairment in
occupational functioning or in usual social activities or relationships with others, or 
to necessitate hospitalization to prevent harm to self or others, or there are psychotic
    “E. The symptoms are not due to the direct physiological effects of a substance (e.g., a
drug of abuse, a medication, or other treatment) or a general medical condition (e.g.,
    “Note: Manic-like episodes that are clearly caused by somatic antidepressant
treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count 
toward a diagnosis of Bipolar I Disorder.”
    Let’s first check what a Mixed Episode is. “In the context of mental disorder, a mixed state, also known as dysphoric mania, agitated depression, or a mixed episode, is a condition during which features of mania and depression—such as agitation, anxiety, fatigue, guilt, impulsiveness, irritability, morbid or suicidal ideation, panic, paranoia, pressured speech and rage—occur simultaneously or in very short succession.” Since I wasn’t complaining of depression or mania this would not apply. And this is good news, the three maybes, which we now know were caused by the antidepressant withdrawal, adverse reactions to the Voltaren and Ultram, and the severe allergic reaction to the Risperdal, an anti-psychotic aka neuroleptic, “should not count toward a diagnosis of Bipolar I Disorder.” And we also know from my calendar notes that the mood disturbance was not sufficiently severe to cause impairments in usual social activities, and the only “relationships” I was irritated with were with the couple at whose home my child refused to play, likely due to abuse, and the pastor who denied my daughter a baptism, seemingly unethical people, in other words. So we seem to have the medical proof that Rob Kohn’s “IMPRESSION” of “bipolar with manic psychosis” was an incorrect impression, according to the actual medical evidence. In reality, the only actual symptom of bipolar I suffered from at this point, according to the DSM-IV-TR criteria, was being justifiably irritated by some people who abused my children.

    Report comment

    • Someone Else,

      Thanks for this comment. What you’re describing is not unusual within psychiatry. They point to the DSM when they want to convey the message that their diagnoses are rigorous and reliable, but dispense with its formalities when they deem it expedient to do so. In fact, there’s this nice little sentence in DSM-IV-TR:

      “The specific diagnostic criteria included in DSM-IV are meant to serve as guidelines to be informed by clinical judgment and are not meant to be used in a cookbook fashion.” (p xxxii)

      So they’ve got themselves covered, whatever the situation!

      Report comment

      • Yes, it’s not remotely scientific, reliable, rigorous, or valid. My psychiatric practitioners thought a dream query was “psychosis,” according to their medical records. And everything is “mania,” to the psychiatrists – “driving to Chicago,” is a “sign of mania” (from the suburbs); “regular moderate exercise” is a “sign of mania,” making a donation to a children’s charity is a “sign of mania;” losing 30 pounds, over a six month period, upon the advise of a doctor, is a “sign of mania.” If my psychiatric practitioners were correct, the whole world is “psychotic,” since we all dream; and everyone living in the Chicagoland area, who commutes or drives into the city for any reason, is “manic.” I’m not quite certain how insanely stupid, or staggeringly unethical, today’s psychiatrists can get.

        Report comment

  3. Philip, your points are quite similar to those below, which I made responding to the Whitaker-Frances dialogue in another comment. The biggest weakness is that Frances continues to – has to – keep ignoring the lack of validity and poor reliability of DSM diagnoses. This for me is the Achilles heel that will sink the leviathan of diagnosis-based psychiatry, when enough people become aware of its spuriousness.

    The title of Frances’ article – “Psychiatric Medicines Are Not All-Good or All-Bad” – is actually quite humorous is viewed in context. It’s a straw-man position, consisting of invented figures in Frances’ mind who think of drugs as totally good or bad, with Frances playing the role of the wise elder looking down on the bickering children from his cool, Olympian height. The response to Allen Frances’ article title should be, “Well, Duh! Tell us something we don’t know…”


    There are several delusions apparently operating in Frances’ thinking, including:

    1) Seemingly not realizing that a primary reason for the “unique adversarial relationship” between service users and providers/families in the US might be because overdrugging and biological labeling are so severe in the US, and that service users mostly hate taking the drugs and being labeled with fraudulent non-illnesses – especially those labeled with “real clear-cut disorders”. Indeed, Grace Jackson’s research indicates that the United States, a country with 4% of global population, consumes over 60% of antipsychotic drugs taken annually.

    2) Seeming to misunderstand what is being said about outcomes/research on drugs on average/aggregate, and what is being suggested for individuals. Whitaker is not discouraging meds for people who might be judged to need them by certain professionals. He’s saying that from the 30,000 foot view, most of the data shows that drugs either aren’t needed or should be used short-term only.

    3) Delusionally assuming that mental health “professionals” can reliably distinguish between people who “have severe mental illnesses” and those who don’t. This assumption is so common by psychiatrists: assuming the are talking about something real and reliable when they say “schizophrenia” or “bipolar”. The reality is there is no sharp line between people “with” or “without” these labels – and they are labels applied to people, not brain diseases people have – it’s a continuum with people’s problems constantly shifting due to diferent life experiences. There’s no clear-cut group that absolutely needs or absolutely doesn’t need drugs. And the reliability of the labels like schizophrenia is just crap: These labels are fake artificial demarcations, like saying that three stars in the sky really are Orion’s Belt, as I commented in another post. These words mean little in these individualgroup level studies, even less when applied to an individual. The DSM 5 field trials with their horribly low reliability were the nail in the coffin for DSM diagnoses.

    In his writing, Frances ignores that drugs are still being prescribed for “illnesses” that don’t even exist in the sense of being able to be reliably identified and in being valid. The writing of Mary Boyle (Schizophrenia: A Scientific Delusion), Richard Bentall (Madness Explained), Jeffrey Poland, Stuart Kirk, Paula Caplan, and other qeustioning psychiatric diagnosis is still powerfully relevant. As well as the admissions by Insel and Hyman that the DSM is a fraud. There can’t be a “middle way” that is “evidenced-based” when your diagnoses are a scam.

    That’s what Allen Frances really is: An Emperor without any clothes, the defender of a fraudulent system. His is an approach that privileges anecdotes and rhetoric over real data and evidence, because the psychiatric system he helped build doesn’t have real evidence or validity. But of course, as its former emperor, he can’t admit what a fraud it is.

    Report comment

    • BPDTransformation,

      I agree with you very strongly that there is no possible middle way with something as blatantly wrong as psychiatry. It’s like trying to find a middle way with flat-earthers or people who subscribe to theories of witchcraft. Psychiatry is fundamentally flawed and rotten.

      Report comment

  4. When Allen Frances speaks of his “middle way” he neglects to mention that extremism that would lock innocent people up, and drug them, against their will and wishes, all on account of presumed “illness”.

    I don’t think he has any intention whatsoever to modify that extremism.

    People should have the right to refuse unwanted and harmful treatments. When a person has no right to choose for him or herself on the “medication” and treatment issue, the person who would express that choice is not the extremist. The person or persons who would be denying that choice, and with them citizenship and constitutional rights, are the extremists.

    People are dying because of the extremism that enforces Allen Frances “middle way”. It is no “middle way”. It is the totalitarian way, that is, it is extremist. It is the kind of a “middle way” that was practiced in the old south prior to the war between the states..

    Report comment

  5. This guy Spitzer — were people just talking about him here recently? Because it seems that based on the info here he might be termed the “father” of decontextualizing behavior and misrepresenting it as symptomatology.

    And people will ask: How could something so fundamentally flawed and rotten have been accepted and promoted by civilized people for so long?

    I’ve often thought this myself. We should routinely refer to psychiatry as being on par with alchemy, the flat earth theory, etc. in terms of its validity.

    Report comment

    • There’s a very telling piece about Spitzer at… Here’s a snippet.

      From Jon Ronson’s blog…
      “But when I asked Spitzer about the possibility that he’d inadvertently created a world in which some ordinary behaviours were being labeled mental disorders, he fell silent. I waited for him to answer. Finally he said, “I don’t know.”

      “Do you ever think about it?” I asked him.

      “I guess the answer is I don’t really,” he said. “Maybe I should. But I don’t like the idea of speculating how many of the DSM-III categories are describing normal behavior.”

      “Why don’t you like speculating on that?” I asked.

      “Because then I’d be speculating on how much of it is a mistake,” he said. There was another long silence.”

      Report comment

  6. Philip, you bring up many of the things I’ve asked him, and thought of many times. I don’t agree on many of his views on a clear cut group who are needlessly on him, or the reverse. However even if I’m wrong, Allen Francis offers no solution to this problem. It’s not like psychiatrists will put a sign on their office door, labeled over prescribing. There would be no way to tell either way. This seems to be what everyone was saying. He had claimed antipsychotics weren’t adding to worse psychosis, and the number of psychosis hasn’t got up. I asked where he got that, because even according to him, the criteria has widened. He never answered. I had guessed it wasn’t from people diagnosed, as along with most of the world, he seems to reject that as valid. What puzzles me the most, is how he says it like it’s clear cut. People need to stop taking medicine that don’t need it, and people who need it should get it. Yet, he never addresses how one would even know the difference between these supposed pill fanatics, and responsible prescribers. He also never mentions, the conflict of the need to identifie clear cut disorders, in a book that supposedly is full of flaws. He just lists subjective actions. Don’t over prescribe, don’t under prescribe, use better diagnostic processes and tools. Regaurdless of someone’s opinion, this is not helpful. According to him it takes an expert in psychiatry to distinguish, but it sounds like he’s saying it would take an expert to dituingh its real experts. He claims for a middle way, but offers no clear explanation. We can also prescribe 1/4 of all people, by putting everyone’s name in a hat, and calling it the middle way, and it could be considered a middle way, but won’t make it sesible.

    Report comment

    • Kayla, I don’t what you meant to write–“sesible” is not a word. Sensible. But your perceptive and ironic comments add to Philip’s article by showing the absurdity of Frances’ project. I have not read Frances’s latest piece. But it has longed seemed obvious that Frances is aiming his weapons at “psychotics” and those who don’t urge them to take neuroleptics. These were the original victims of psychiatry–particularly “schizophrenics:”– and Frances is really interested in “saving normal” or more aptly saving normals and containing and controlling the real abnormals, or saving schizophrenia, “the sacred symbol of psychiatry”, to quote Szasz. In other words saving schizophrenia is the same project AS saving normal. I don’t k now what his motivation is–probably a sentimental attachment to the paradigm, as Thomas Kuhn would say. It’s obvious as Hickey points out there are no scientific grounds for the distinction. If pressed he’d probably say something specious and banal like the good clinician is not merely a scientist but an artist—as if a real artist is a poisoner and not a radical social critic –like Artaud.
      Seth Farber, Ph.D. The Spiritual Gift of Madness…

      Report comment

      • Seth,

        The ”schizophrenics” are the ‘bread and butter’ of psychiatry; and the medication doesn’t ‘treat’ them it ‘switches them off’.

        What I found was that very basic psychotherapy (not medication) was ideal for full recovery. I suppose this is why countries that can’t afford a psychiatric system have far better outcomes.

        Report comment

      • Bingo, Seth. That’s exactly what Francis is doing. Donning the robe of a “great crusader” to save something everyone agrees with in the first place (“normal” people don’t need antipsychotics), but in reality, it’s a disguise to ensure schizophrenia continues to be misunderstood and the great money earner for his profession. I am forever grateful to Robert Whitaker and Mad in America for bringing schizophrenia out from the shadows and holding it up to examination. This scares people like Francis.

        Report comment

        • Bingo, Seth. That’s exactly what Francis is doing. Donning the robe of a “great crusader” to save something everyone agrees with in the first place (“normal” people don’t need antipsychotics), but in reality, it’s a disguise to ensure schizophrenia continues to be misunderstood and the great money earner for his profession. I am forever grateful to Robert Whitaker and Mad in America for bringing schizophrenia out from the shadows and holding it up to examination. This scares people like Francis.

          Misspelled Frances’s name because I didn’t want to scroll all the way up to check it and I notice that some commenters don’t know how to spell his surname either. Must have been thinking of Anne Francis, lol.

          Report comment

          • Seth and Rosa

            What Frances is trying to save is the profession of Psychiatry. His entire being is wrapped up in his stature as a doctor and his past contributions to advancing the growth of modern Psychiatry. He deathly fears what might be in the future for his life’s work, his reputation, and his economic standard of living.

            Historically all those people who seek to stake out some sort of middle ground are usually afraid of what they deem to be “extremist” positions that threaten to bring down certain institutions that are in danger of crumbling.

            It is more than obvious why he would attack the anti-psychiatry critique of the disease/drug based paradigm of so-called “treatment.”

            He also knows that the growing exposure of his profession by its collusion with Big Pharma, its unbridled mass drugging and the related backlash, and the complete corruption of all the science justifying Biological Psychiatry’s reason to exist as a medical profession is serving to seriously undermine Psychiatry’s credibility in the world.

            He desperately wants to rain in what he views as Psychiatry’s “excesses” before all credibility is lost and the walls start to crumbling to the ground.

            He is trying to present himself as a “voice of reason” and an “appeaser” amongst a sea of confusion and more “extremist” positions.

            History always brings forth such figures and voices like Dr. Frances. It is a good sign that our opposition work has done enough to create the conditions for such an “appeaser” to desperately feel the need to speak out with this type of message.

            It is also vitally important that these “middle ground” positions be critically examined and exposed for what they are – reactionary and backward bullshit!


            Report comment

          • Rossa, Richard, Yes well Bob is following in the tradition of Thomas Szasz–and R D Laing for that
            matter. They were the professionals to bring “schizophrenia” “out of the shadows.” Szasz put his finger on the mark when he titled his book, Schizophrenia: The Sacred Symbol of Psychiatry.

            I think Richard Lewis is absolutely correct. I would add to it Szasz’s point that the belief in the construct of “schizophrenia” (and other “psychoses”) is the symbolic key to saving Psychiatry. Frances reminds me of the 19th century when psychiatrists were fighting to get control of the “lunatic asylums.”
            This was before Freud made it possible for psychiatry to colonize everyday life, and pathologize “normal” people . Frances’ middle way, is a rearguard battle. “Leave normal people alone” he is saying, “but we psychiatrists are the rightful custodians of the seriously mentally ill who need our medical treatments.”
            The 19th century psychiatrists were fighting against “lay” people who operated institutions, including the “moral reformers” who had a far better “recovery rate” in institutions for “lunatics.” Today Frances is fighting non-medicalist therapists and peer support groups in the survivors’ movement with the same message, “We are the rightful custodians of the mentally ill.”
            But as Richard notes these middle ground positions must b e exposed. Psychiatry is a sham–it would have fallen decades ago but it sold its soul to the multibillion dollar pharmaceutical industry which has turned America into a nation of people addicted to the most poisonous drugs.
            IT is the “lunatics” now who are leading the battle against these corrupt institutions. The “extremists” hope to see the fall of the psychiatric- pharmaceutical industrial complex and the revival of the tradition of mutual aid and
            indigenous healers.
            Seth Farber, PhD

            Report comment

      • Seth, I do notice, that he seems to aiming at “psychotics”, in particular the most. Although, I’ve heard him go after people who he thinks don’t need the medicine, and I am getting that there is no line between them. He’s also gone after the people who supposedly over prescribe, which is also hard to distinguish. I see those projects as the same as well. He seems to want to create a wedge between, the “ill”, and the “well”. I see a lot of irony, and absurdity. The more I look for answers the burrier it becomes. I wouldn’t be surprised if he says medicine is an art, especially since he seems to be saying mental illness too complicated to point to any physical proof. Only along with this critasizing left, and right, preaches unity, as the solution. Is he just trying to divert people from criticizing the real problems with psychiatry. Aside from the fact that they’re outlandish, his ideas of cutting back on medicating people, it would hurt the field, a lot. You’d think he’d get backlash. Unless nobody expects this to happen. Although the whole “undermedicated” theory and, his ideas for that are frightening. Obviously, a lot is about more forced meds. They’re even throwing people who take them willingly under the bus, from taking it away from people who don’t even want them. Because they don’t expect medicine when they aren’t sick, from a doctor. Whatever it is, to stop the forced medicine has to be the start. If it starts, now we could prevent a lot stuff from both occurring and cementing. It’s tough, but if done right will be unbeatable. Psychiatry, right now doesn’t have to explain themselves. If enough people point out, how they aren’t, or the lies. Just, right now people aren’t even willing to ask questions. They just want laws passed, where the psychiatrists can decide everything, without ever asking anything. Judges barely look up, and just nod.

        Report comment

      • Although frightening, hopefully there will be a time when all of this can be made useful. Some of the things he is saying, should make people avoid psychiatry altogether. Just goes to show, that this is field is able to get by on fear, and is exempt from winning people over with reason.

        Report comment

  7. In Dr. Frances’ list of items that suggest depression, I noticed several items that can actually indicate the existence of items responsive to non-drug based physical treatments. Take the items concerning weight gain or loss- is Alice gaining weight, but is she also feeling cold much of the time? Or is she losing weight and feeling hyper much of the time and does she have a peculiar kind of intense stare.
    Take the items involving loss of appetite- has Alice lost the sense of taste and smell? This responds to zinc salts, not antidepressants. He doesn’t seem to believe in searching for patient dysperceptions to cut down on the excitement on the ward brought on by thoughtless antidepressant use.

    Report comment

  8. Philip,

    Great article as always. What is bleeping scary is I would qualify for a depression diagnosis thanks to what I feel are years of being on psych meds messing up my sleep cycle big time. This has resulted in hypersomnia and insomnia issues which of course is depressing as h-ll since I feel like I am on my own regarding solving the problem.

    When I referred to this as pseudo narcolepsy on Dr. Healy’s blog, he said some of the meds have an effect on the orexin system which does influence the sleep wake cycle.

    Report comment

  9. Allan Frances is a textbook example of how psychiatry colludes with capitalism and those in power. He goes on about people in prison who should be in psychiatric facilities or recieving psychiatric treatment. Yet he is ignorant of the massive prison population in the USA and how, as a book I read recently put it, “For all intents and purposes, the prison industrial complex became the primary primary housing provider for the poor, homeless, and mentally ill.” In the meantime political violence against people of colour, queer, and the homelss contiued.” What this book does not say, but which seems obvious to me, is that growing inequality, racism and violence and prison conditions will drive people mad.

    Report comment

  10. Unfortunately, in the states of Louisiana, New Mexico and Illinois, clinical psychologists with additional training and certification are allowed to write drug prescriptions. I hope psychologists in other states are not lobbying to be able to do the same. I am sorry that psychologists in those states were ever granted permission to write prescriptions.

    Report comment

    • The medical community in Illinois has a very well organized system set up to railroad as many people as possible into the psychiatric “system,” especially anyone who has ever dealt with prior easily recognized iatrogenesis, or “complex iatrogenesis,” like adverse drug reactions. Here’s a brief description of the crimes committed against patients, by one of the doctors I had the misfortune of being medically unnecessarily shipped to:

      But since the IL medical community is medically unnecessarily shipping patients to hospitals, then misdiagnosing and “snowing” patients, for profit. No doubt, they need more prescribers.

      And the doctors who were arrested, even the “king of nursing homes,” doesn’t even get prosecuted. The courts and government really do need to start actually putting these criminal doctors behind bars, or at least start taking away their licenses, but no. Let’s give more doctors prescribing privileges instead. It’s all about the $$$.

      Report comment

      • Dr. Hickey,

        Yes, I very much appreciated what you wrote in Behavior Therapist on the subject of prescription privileges for clinical psychologists. Thanks for writing the article in the first place and for giving us the link to it here.

        Report comment

  11. “When prescribed loosely,” meds are problematic, according to Dr. Frances. But we must assume the prescribing is being done based on the DSM, which is inherently “loose” in its diagnostic accuracy and relevance, as you so ably elucidate here. So how can prescribing NOT be done loosely, even when it is intended to be done just for “clear-cut psychiatric disorders” and not for “everyday difficulties”. The current system is a Jello mold on top of a Jello mold on top of a Jello mold. –Harper West,MA, LLP

    Report comment

  12. Hi Dr Hickey,

    you write;

    “The fact is that psychiatry’s agenda is – and for at least the past fifty years has been – to widen its diagnostic net, and to get as many people into “treatment” as possible. To this end, psychiatry has fabricated an invalid, hopelessly vague “diagnostic” system into which almost any person experiencing even the slightest distress or problem from whatever cause can be readily shoe-horned. This is not an accident.”

    Almost any person? I know a Community Nurse who can ‘verbal’ any person into a mental illness and have them in a cell dribbling from the mouth within an hour. And with the misrespresentation of the grounds required by the law for this to occur by our Chief Psychiatrist it doesn’t even need to be “reasonable”. The medical practitioner who “suspects on reasonable grounds” that a person requires treatment has become ‘the medical practitioner need only suspect on grounds they believe to be reasonable’. Reasonable is whatever the doctor thinks these days lol.

    This will be handy now that ‘domestic violence’ is a mental illness and the police have a needle squad ready to do some snow jobs on about 700 people in our community (number given by Police Commissioner). I think the estimated number of people who were to be affected by Community Treatment Orders was put at about 60, and it blew out to 3000 within months for some reason. Unintended consequences I guess.

    I think given the situation we should just scrap our laws because the impression of protection is misleading people into a false sense of security and allowing their trust to be exploited to their detriment.


    Report comment