Allen Frances and the “Overdiagnosing” of Children

Philip Hickey, PhD
53
2007

On October 31, 2016, the very eminent psychiatrist Allen Frances, MD, architect of DSM-IV, published an article on his Psychology Today blog, Saving Normal. The article is titled DSM-5 Diagnoses In Kids Should Always Be Written In Pencil. (The piece also appeared on the Huffington Post blog on the same date.) The subheading is “Mislabelling children and adolescents is frequent and can haunt them for life.”

As in many of Dr. Frances’s recent articles, the bulk of the text is written by someone else, and Dr. Frances provides an introduction and a summary/conclusion. In this case, the core of the article is written by Juan Vasen and Gisela Untoiglich of Forum Infancias, an Argentine organization of mental health workers dedicated to the “proper diagnosis and treatment of children and adolescents.”

The material written by Drs. Vasen and Untoiglich is basically sound, e.g. “Children and adolescents vary dramatically in the way they develop and in the chronology of their developmental milestones. Individuality and immaturity should not be confused with disease,” but there is also the implication that ADHD is a real disease entity which can be identified with careful and painstaking assessment.

“Accurate diagnosis in children and adolescents takes a great deal of time in each session and often many sessions over a number of months.”

Dr. Frances opens the article by lamenting what he describes as the “three most harmful fads in psychiatric diagnosis, during the past 20 years.” These are:

“Rates of Attention Deficit Disorder have tripled and rates of Autism and childhood Bipolar Disorder have multiplied an incredible 40 times.”

Dr. Frances goes on to write that “Powerful external factors have contributed greatly to this massive mislabelling of kids.” From the general context it is clear that what Dr. Frances calls “massive mislabeling” is not the assignment of psychiatry’s spurious labels as such, but rather what he calls the overuse of these labels.

He then takes his usual shot at pharma:

“For ADHD and kiddie Bipolar, drug companies misleadingly and aggressively sold the ill to peddle their expensive and profitable pills. Their marketing strategy was based on the cynical assumption that starting a kid early on pills might make him a customer for life.”

Dr. Frances frequently blames pharma, while ignoring the role that psychiatry, and he himself personally, played in the proliferation of psychiatry’s so-called diagnoses and the progressive relaxation of the criteria for these diagnoses. I have spelled out in an earlier post how the criteria for ADHD were markedly relaxed in Dr. Frances’s own DSM-IV.

The widespread application of the “bipolar diagnosis” to children was the brainchild of the Harvard psychiatrist Joseph Biederman, MD, but some of the groundwork for this had been laid in DSM-IV.

The earlier edition of the manual (DSM-III-R) had stated that the age of onset of manic episodes

“…is in the early 20s.  However, some studies indicate that a sizable number of new cases appear after age 50.” (p 216)

The corresponding statement in DSM-IV reads:

“The mean age at onset for a first manic episode is the early 20s, but some cases start in adolescence and others start after 50 years.” (p 331) [Emphasis added]

So it was Dr. Frances’s own DSM-IV that first legitimized the notion that this so-called diagnosis could be applied to children.

Certainly, pharma played its part, but psychiatry was hand-in-glove with its generous benefactor, as it has been since the 60’s-70’s.

. . . . . 

The explosion of Autism resulted from the combination of two things: the DSM-IV introduction of a much milder form (Asperger’s) and the far too close linkage of the diagnosis to eligibility for enhanced school services. DSM diagnoses developed for clinical purposes are inappropriate gatekeepers for allocating educational resources. Educational decisions should be based on the child’s educational need, as assessed by educators, using educational tools.”

The reference to Asperger’s disorder is probably accurate, and represents an honest admission on the part of Dr. Frances, but the statement:

“DSM diagnoses developed for clinical purposes are inappropriate gatekeepers for allocating educational resources. Educational decisions should be based on the child’s educational need, as assessed by educators, using educational tools.”

is extremely misleading.

The issue here is that, in general, public schools are required by federal law to make accommodation for children with disabilities. It is also required that these children be taught, not in special education settings, but rather in regular classrooms, whenever possible.

Disability is obviously a complex and difficult-to-define concept. But for practical purposes, the Social Security Administration (SSA) has two broad criteria. Firstly, the child must have a confirmed illness; and secondly, he must have confirmed illness-related functional limitations. Both autistic disorder and attention deficit hyperactivity disorder have been accepted by the SSA as covered illnesses. Evidence of functional limitations is usually gathered from the child’s treatment providers, supplemented as needed by reports from outside consultants.

So  — and this is the critical point — “DSM diagnoses” are not being used as gatekeepers for allocating educational resources. Rather, they are being used as the first stage in disability determination (i.e., the presence of illness). And it is the disability determination that in turn drives the educational decisions, and, in some cases, channels additional funding to the school.

So Dr. Frances is, in effect, lamenting the use of “DSM diagnoses” to determine the presence of psychiatric “illness,” which seems a major about-face for someone who routinely asserts the validity and usefulness of these “diagnoses” for precisely these purposes. The point is this: Once the APA invented the ADHD illness, the door was opened for this illness to become disability-eligible.

And, incidentally, the plot thickens. In 1985 the SSA contracted with the APA to conduct a major study of the standards and guidelines for the assessment of mental impairment. The study lasted two years. The APA made some minor recommendations, but “All recommendations were made on the premise that the basic construct of the SSA’s medical standards and guidelines for the evaluation of claims based on mental impairment should be retained.” [Italic emphasis in original] So whatever criticism Dr. Frances has of the present system, he needs, I suggest, to acknowledge the part his own profession played in the creation of this state of affairs.

But the plot thickens even more. Most of the details involved in the education of disabled children are set out in the Individuals with Disabilities Education Act (IDEA), 1990.  When this bill was being drafted, there was considerable controversy over whether ADHD should be included as a covered “illness.” Opposition came from teacher organizations and the NAACP.  The original act (1990) did not include ADHD.  However, in 1991 the Department of Education issued a clarificatory memo stating that “ADHD” is a covered disability under IDEA. This amendment was the result of intensive lobbying by CHADD and others. And organized psychiatry has been a long-time supporter of CHADD. At the present time there is a downloadable document titled ADHD: Parents Medication Guide on the APA website.  CHADD is mentioned five times and is recommended as a source of information. The document was prepared by the American Academy of Child and Adolescent Psychiatry and the APA.

“OVER-DIAGNOSIS”

Dr. Frances continues:

“It is long past time to tame the wild DSM over-diagnosis of kids.”

Then, after the material written by Drs. Vasen and Untoiglich:

“Thanks so much, Juan and Giselle, for poetically cautioning clinicians to be conservative, never careless or creative, in diagnosing kids. Mislabelling has serious and often longstanding consequences on how the child sees himself, how the family sees the child, and on the misuse of medication. Diagnosis should never be taken lightly.”

and

“Accurate diagnosis in kids is really tough and time consuming. Misdiagnosis in kids is really easy and can be done in 10 minutes. Accurate diagnosis in kids leads to helpful interventions that can greatly improve future life. Misdiagnosis in kids often leads to harmful medication and haunting stigma.”

and

“The stakes are high and the harms sometimes permanent. The best way to protect our children is to respect their difference and to accept uncertainty. I really love the idea of writing psychiatric diagnoses in pencil.”

This notion of conservative, careful and accurate diagnosis is a common theme in Dr. Frances’s writing, but in fact, it’s an empty exhortation, because the criteria are inherently vague and ill-defined.

Let’s consider the first criterion in the APA’s list:

1(a) “often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities” (DSM-IV, p 83)

The DSM-5 wording is almost identical, but adds two examples:  (e.g. overlooks or misses details, work is inaccurate).

To illustrate the problem, let’s imagine a conversation between two experienced psychiatrists, Dr. I. Druggem and Dr. Ak Curate.

Dr. Curate:      You’re diagnosing too many children with ADHD.
Dr. Druggem:  No, I’m not.  I always make sure that they meet the requisite number of criterion items.
Dr. Curate:      But you’re interpreting the criteria too loosely.
Dr. Druggem:  You’re interpreting them too tightly.
Dr. Curate:      Well consider that six-year-old boy you diagnosed last week.  Which criteria did he meet?
Dr. Druggem:  Inattention criteria a, b, c, d, and e.  He also met four of the hyperactivity-impulsivity criteria.
Dr. Curate:      So he met criterion 1(a) – “often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities”?
Dr. Druggem:  Yes, absolutely.
Dr. Curate:      How do you know?
Dr. Druggem:  Because I had his teacher fill out a checklist, and she checked that item.
Dr. Curate:      So the teacher said that he met this criterion.  Did she say how often is often?
Dr. Druggem:  No, of course not.
Dr. Curate:      How often is often?
Dr. Druggem:  I don’t know; I suppose two or three times a day.
Dr. Curate:      I think it would be perfectly normal for a six-year-old boy to make careless mistakes or lose his attention ten or even fifteen times a day.
Dr. Druggem:  No way.
Dr. Curate:      Yes way.

And the critical point here is that there is nothing in the DSM, or indeed in any psychiatric guideline, that can resolve this disagreement. There is no way to say which psychiatrist is correct. And the problem is compounded when we recognize that similar definitional difficulties arise when we ask what constitutes close attention versus not-so-close; or careless mistakes versus other kinds of mistakes. And when we recognize that the same difficulties arise with all 18 criteria, it is clear that the term “accurate diagnosis of ADHD” is a logical absurdity. If one invents illnesses with no identifiable pathology, to be diagnosed on the basis of inherently vague checklists, the concept of true prevalence is meaningless.

So what psychiatry has created is a loose algorithm that can be expanded and contracted at will, without any blame or censure being assigned to the “diagnosing” psychiatrist. But it’s even worse than that, because this arbitrarily flexible “diagnosing” is being conducted in a context where there are enormous incentives to make the “diagnosis,” and considerable penalties for declining to “diagnose.”

First in this regard are the pharma companies whose revenue correlates with the number of children “diagnosed.” Secondly, the parents are off the hook with regards to the need to discipline or train their children effectively. Thirdly, the “diagnosis” may entitle the child (or rather his parents) to a disability income. Fourthly, the school may be eligible for additional funding. Fifthly, the psychiatrists stand a very good chance of acquiring a long-term repeat customer.

So everybody wins – except, of course, the child, who loses, especially in the long term. This is the monster that psychiatry has created. And Dr. Frances played a cardinal role.

The problem is not over-diagnosing. The problem is the spurious medicalization of problems that are not medical in nature. And this was psychiatry’s contribution to the great psychiatry-pharma hoax, which they entered with eyes wide open. The deal was simple. We (psychiatrists) invent and legitimize the illnesses, and write the prescriptions; you (pharma) send lots of money, validations, and business our way. And Dr. Frances is very knowledgeable about this matter. In 1995, he and his partners John Docherty, MD and David Kahn, MD, wrote:

“We are also committed to helping Janssen succeed in its effort to increase its market share and visibility in the payor, provider, and consumer communities.”

This was a reference to The Expert Consensus Guideline Series: Treatment of Schizophrenia produced by Drs. Frances, Docherty, and Kahn (The Journal of Clinical Psychiatry, 1996, Vol 57, Supplement 12B) with a generous grant from Johnson & Johnson (owners of Janssen).  The quote is from an expert witness report by David Rothman, PhD, professor of Social Medicine at Columbia University College of Physicians and Surgeons, p 15-16.  The entire issue has been covered in great depth by Paula Caplan, PhD, here, and to the best of my knowledge, Dr. Frances has never publicly acknowledged any wrongdoing or issued any apology with regards to the matter.

FINALLY

Dr. Frances was a key player in the promotion of the psychiatric hoax. As architect of DSM-IV, he had the opportunity to reverse the trend begun by Robert Spitzer, MD, with DSM-III, but instead, Dr. Frances not only stayed on the proliferation/expansionist track, but actually accelerated the pace. His present hand-wringing concerning the mislabeling and over-drugging of children is not convincing.

. . . . . 

 ADHD is not something a child has.  It is something a child does.

 

Support MIA

Enjoyed what you just read? Consider a donation to help us continue to produce content, provide up-to-date research news, offer continuing education courses, and continue building a community for exploring alternatives to the current paradigm of mental health. All donations are tax deductible.

$
Select Payment Method
Loading...
Personal Info

Credit Card Info
This is a secure SSL encrypted payment.

Donation Total: $20.00

53 COMMENTS

  1. I agree so much with your article. Concerning the schools, not only can they get extra money but they (psychologists, social workers, administrators) have been brainwashed by psychiatric orthodoxy. I know of at least three children who would have been put on medication by schools. In each case the parents refused and in each case the children turned out fine.

    • Jeffrey “Robert Whitaker is a menace to society” Lieberman’s own son (the older one of his two) was close to being labelled with ADHD, which Mr. Lieberman could undo because of his power as a psychiatrist. In Lieberman’s own words (a transcript from an interview):

      “Absolutely. I had an experience with my own son. I have two sons. My older son was going to nursery school, and they said he’s not paying attention and were concerned. ‘You should have him tested.’ We had him tested. The neuropsychologist said, ‘Well there’s some kind of, you know, information processing problems, you should see a pediatric psychiatrist.’ I said, “Well, I am a psychiatrist, but I’ll take him to see a pediatric psychiatrist.’ We took him to see a pediatric psychiatrist, spent twenty minutes with him, and he started, you know, writing a prescription for Ritalin. I said, ‘Why?’ and he said ‘Well, he’s got ADHD.’ I said, ‘I don’t think so.’

      So, long story short, he ended up graduating from University of Pennsylvania, law school at Columbia, he’s in a top law firm. So, yes, it happens, and part of that is social pressure.”

      I personally have no problem with people taking substances voluntarily that they feel helps them. How do you prevent being labelled and everything else that comes with it? The more of these people you go to, the more labels you get.

      • I believe that the pharma problem has now also trickled into medical diagnoses and treatment as well. My mother is just 70 and has always been thin and had low blood pressure. 5 years ago she also stopped smoking. But somewhere along the lines someone put her on “blood pressure medicine”. Next thing, she has COPD and emphazema. She pants all the time like she just ran a race. I kept trying to tell her to get off the bp meds, but she wouldn’t hear of it. She was (and is) convinced that if she didn’t do what the doctor told her to do that her insurance would “drop her”.

        Another example is cholesterol medicines. There weren’t enough people who “needed” them, so they changed the criteria.

        It’s a sick world when we invent things to solve problems before the problems even exist. It’s like snake-oil salesmen.

  2. Dr. Frances knows as well as anyone what it means to be haunted for life. He’s trying to undo his damages and hoping to win a naive new audience by championing ideas that sound good and in fact are good.

    When the fog of psychiatric correctness clears, you still have a doctor who believes that some individuals’ personal ways of being are diseases to be eradicated. He’s not been clear on what the individuals are expected to do or be after their genuine selves have been rendered impotent and silenced.

    • BetterLife, truer words were never spoken. The backlash against psychiatry is growing, and quack Frances must see the handwriting on the wall – his legacy is toast if he’s too slow to flip-flop on the pseudoscience that has wrecked so many lives.

      • There is such a thing as Critical Psychiatry. It was started by psychiatrists that do not like the system and see the damage it has done. Equally they also acknowledge that there are people who are in profound states of emotional distress for want of a better way of describing it and that these people need help.

        Anti psychiatry claims that there is no such thing as emotional distress, no one ever needs help and if we just got rid of the whole thing, everything would be ok. Which is simply not true. From the dawn of time there have been people who did require assistance, who could not manage alone. The DSM lists intellectual disability. Are we to say that no such thing exists, that everyone has the same intellectual capacity as everyone else and none of them require support. I know people with profound autism, and they cannot live without 24/7 support. Again that is in the DSM. Equally I know people who have diagnosed themselves with autism, who require no support and have no trouble functioning in society, and claim that autism never disables anyone.

        I do not know that frances has quite reached the level of critical psychiatry but he is heading there. Critical psychiatry does not claim to be and never will claim to be anti psychiatry. It is anti diagnosing normal emotional reactions, ie grief, but it also very much about trying to find ways of supporting people who truly do experience profound states of emotional distress and of course supporting them in ways that assist them to heal and be part of life, rather than destroying them and making them worse. It does this by critically analysing research and seeing what the research evidence says, which is very much what Whitaker does.

        • Dear Belinda – you said: “Anti psychiatry claims that there is no such thing as emotional distress, no one ever needs help and if we just got rid of the whole thing, everything would be ok.”

          Interesting you should say that – I’ve noticed how this view of anti-psychiatry is spreading around the internet – I think it’s coming from lead psychiatrists and is trickling down. Still… at least the phrase ‘anti-psychiatry’ is entering the public consciousness – that’s something, I suppose.

          What does it mean to be ‘anti-psychiatry’? Ted Chabasinski explored this question in his blog post: “Of course I’m Anti Psychiatry. Aren’t You?” Here’s the link… https://www.madinamerica.com/2013/10/course-im-anti-psychiatry-arent/

          • Everyone has there own views of everything. There are many things in the anti psychiatry movement I do not like. If you want to hate me for that, do that. I am very CRITICAL of psychiatry, which is a very big difference. My views are more aligned to those of critical psychiatry, and I doubt you even know what it is.

            To claim I know nothing of the anti psychiatry movement would be a joke, considering I was a member of it and left it. I found no more assistance from it, than I did from the mental health system. And in fact I got abused by many people in it. The fact that it loves abusing people as much as the traditional mental health system, was not something I could accept, and nor do I believe anyone should.

            I have my own personal story and experiences. Everyone else has theirs.

            If you need to hate and denigrate me then do that. But fact is you know nothing about me or my story. Nor do you show any ability to consider anyone else’s viewpoint.

            Ted is not the universal leader of the antipsychiatry movement and has never been elected by them. Yet you claim that HE ALONE determines that it is and what it is not. He claims they are not against all psychiatrist’s. Yet the post I responded to, perhaps you should read it, said that claiming that some psychiatrists were good was underminding the anti psychiatrist movement. So which is it, can the anti psychiatry movement even decide. This is what I came across more than a decade ago. People claim to be it, yet cannot even decide what it is.

            As I stated I was a PAID member of the antipsychiatry movement for MANY years, I did not LEAVE it for no reason. In fact I left for similar reasons as I left the mental health system. Do not claim you know anything about me, when you know nothing at all.

            Perhaps you should do your research on the differences between critical psychiatry and anti psychiatry. You claim to be an expert on them.

        • Belinda,

          I have never encountered an anti-psychiatry advocate who has claimed that there is no such thing as emotional distress. Indeed, such a notion is clearly false.

          The critical point, which is made over and over in these pages, is that the problems/concerns in question are not illnesses, and that the “treatments” afforded by psychiatry are based on deception, and do more harm than good.

          With regards to intellectual disability (formerly called mental retardation), you might be interested in a post I wrote on this topic several years ago.

          http://behaviorismandmentalhealth.com/2009/12/06/mental-retardation-a-stigmatizing-label/

          I am familiar with the Critical Psychiatry Network in the UK, and have written about their position and their papers. If you are interested in my views on this, please see these two posts:

          http://behaviorismandmentalhealth.com/2013/01/01/psychiatry-the-sham-science/

          http://behaviorismandmentalhealth.com/2013/01/27/a-critical-look-at-critical-psychiatry/

          In addition, Joanna Moncrieff, one of the founding members of the Critical Psychiatry Network, has written: “Thus I sometimes refer to ‘mental illness’, although I do not consider that psychiatric conditions are usefully or validly regarded as illnesses.” The Myth of the Chemical Cure (p xi).

          I obviously have no problem with your disagreeing with me on any topic, and your comments are welcome. But please don’t accuse me of inane rubbish.

  3. “ADHD is not something a child has. It is something a child does.”…. Does that line sound familiar to you? It should! It’s the last line of Dr. Hickey’s comments in the article, above. Now, to be fair to Dr. Hickey, I *THINK* that I know what he’s trying to say. I *THINK* that he’s trying to say that ADHD is something a child *DOES*, and not something a child *HAS*. Does that make sense to you, too?
    Well, I’m sorry, but it does *NOT* make sense to ME!….
    First, Hickey tells a good (sadly true!) story about the pseudoscience drug racket known as “psychiatry”, and how the psychs knowingly colluded with drug companies to fabricate bogus “illnesses” to serve as excuses to $ELL DRUG$…. Many of us here at MiA already know that sad story, and too many of us here, were personally victimized by the scam. While none of the unsubstantiated (bogus) alleged “diagnoses” made against me, were for so-called “ADHD”, which is the main focus of this particular article, still, I suffered just the same. The 2 most common drugs used in so-called “ADHD” are Ritalin, and Adderall, and they’re both basically prescription SPEED. (methyphenidate, and amphetamine, respectively).
    Which brings us back to the point. So-called “ADHD” is a deliberate hoax designed to sell drugs. There’s no “there” *THERE*. ADHD is exactly as “real” as presents from Santa Claus. What most often gets diagnosed as “ADHD”, is in fact NORMAL BEHAVIOR, especially for young boys…. I think Dr. Hickey understands that, and I’d be surprised if Dr. Hickey doesn’t correct himself here.

      • Hmmm…..
        Maybe try: “The various observed behaviors deliberately mis-identified as so-called “ADHD”…..
        (Honestly, I am humbled at your reply, even if I did goad you in to it!…. 😉
        ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
        OK, maybe not your “professional” / “medical opinion”, but as a general comment:
        Isn’t it very possible, if not likely, that say, an 8yr old boy with a difficult home life, who is put on Ritalin, and later “acts out” angrily & destructively, could in fact be exhibiting signs of amphetamine intoxication? See why I’m not asking you in terms of a medical opinion? I’d think the answer to my Q? would be *YES*. And, wouldn’t the presence of the Ritalin in his system make it just that much more difficult for the young boy to exercise whatever self-control an 8-yr old has? Yes? ~B./

    • Yeah, funny how the shrinks STOLE that phrase “Bible” from the Judeo-Christian community! But, that’s their biggest market! *ALL* of the so-called “diagnoses” in the DSM were INVENTED, not “discovered”. And, they only exist as excuses to $ELL DRUG$…. FOLLOW THE MONEY…. Besides, if they included hypocrisy and greed, they’d also have to include IGNORANCE, ARROGANCE, and self-delusion. Or maybe “idiopathic anosognosia”….or whatever the hell they call that made-up crap!…. Keep speaking, “anothervoice”, we need a good chorus here!….

  4. Regarding overdiagnosing – I’ve been watching the watering down and expansion of the autism diagnosis over the last 30 years. When I was a child, autism was very much associated with Rain Man. I didn’t know anyone diagnosed with autism throughout my entire childhood and young adulthood. In my thirties, the last eight years, suddenly I know multiple people whose children supposedly fall on the autism spectrum – and yet only one of them has symptoms that people would traditionally label autistic. One out of half a dozen kids. The others are high functioning bright kids without clearly perceptible behavioural issues of any kind. I’m talking sweet, kind, well-behaved, academically gifted children and the parents go on about how exceptional their autistic child is. I’d go so far as to say it almost seems trendy to have an autism spectrum diagnosis right now.

    • Agreed, PrettyPurplePill, those are my observations, too. And, there’s a related dynamic at work, also. I’ve seen exactly THIS, here in my hometown: For various demographic reasons, mostly folks having smaller families, with less kids, and more choices for schooling kids, the public school student population is either not growing, or actually shrinking. But, costs continue to rise, forcing local homeowners – whose property taxes pay a large part of the school bill – to pay ever larger sums for “free” public schools. Also, more “coded”, and “labeled” students requires more employment of “para-professionals”, and “classroom aides”, &etc., THAT costs money, but it also helps hide the true unemployment rate, and the true cost of sending good factory jobs overseas. BUT, when a kid is “coded” with some bogus “disability”, then a whole bunch of FEDERAL money kicks in, to the profit of the local schools. Yes, that’s what I’m saying. *SOME* “diagnosis” is being done for no other purpose than to bring more TAX money into the schools….
      Don’t believe me? I know a family that I actually worked with. The kid got a (*MAYBE* legit…) diagnostic label, lots of extra staff, and the local agency conspired w/the school, and local system, to throw the kids’ family out of their apartment, into homelessness, and then “CPS” got involved in a FRAUDULENT “neglect petition”, which resulted in an 8-yr old girl being judicially kidnapped, sent into a special institutional “home”, put on Seroquel, and further abused. This was all done to make money for the school district, and cover up the crimes of the local “agency”, which was STEALING SSDI & SSI funds from disabled clients. God, I wish I was making this shit up….

        • Thanks, >humanbeing<, good 2 C yur comments again! Yeah, I know what you mean about being "depressed". Too bad we BOTH KNOW that an "antidepressant" would only make it worse, huh?! 😉
          So, I do my best to get over the worst of the emotional response, then use that energy to continue my own study and work to educate, inform, and make things better. And, remembering the littlest victims gives me courage to WORK for THEM, and continue to speak out against the ongoing pharmaceutical GENOCIDE.
          I will NOT run. I will NOT hide. I will STAND, and SPEAK OUT!
          That's what I'm doing here, now! &I'm glad to see YOU, TOO! 🙂

    • It wasn’t until after my child got 100% on his state standardized tests that I got a call from the school social worker, not to congratulate me on raising an intelligent and polite young man as a sane person would expect, but rather to unjustly and incorrectly accuse me of “keeping your child up late nights studying and pushing him too hard.”

      Apparently, the social workers are in the business of trying to drug up all the children who are not within the bell curve, even the intelligent, well behaved children. Unfortunately for that social worker, I wasn’t interested in having my child labeled with a “trendy” DSM stigmatization and drugged to diminish his intellect. Truly, the school social workers have run amok.

    • Could not agree more if I tried. I know a 3 year old diagnosed last month, the SOLE thing the child did, was not share with other children. 3 year olds don’t share, it is not in their nature to know how to share. We send them to preschool to learn that. He has no problems with language or with non verbal communication. Does all age appropriate social behaviours. But quite simply he is acting like a 3 year old, so now he has autism, I guess everyone in the world has autism then!

      One of the hallmarks of autism is that they do not copy or notice other people, they do not read people. Yet the latest is girls are not being diagnosed because they copy to much and their autism, is looking and copying the other girls to fit in, which goes completely against, anything a person with autism is able to do. Parents complaining that when the girls are finally diagnosed in the teenage years, they do not want to go to social skills training and instead just want to play and hang out with their friends, because they are in denial about their autism?!! How does the child have friends if they have autism?

      The other thing I really hate is the parent blaming that is now going on for parents who are on the more severe end of the spectrum. If they just believed in the child as I did the child would not have those problems. But their child never had them to begin with.

      Adults who suddenly discover in their 30’s they have autism, yet no one ever knew anything was wrong, they are working full time, married, raising children, wide circle of friends around them. And they suddenly become expert on the whole spectrum.

      I am well aware of adults who were diagnosed with aspergers when it first came out, who had been diagnosed with over 30 different conditions, changing because they never fit, since they had normal language development, although took things literally, didn’t read people, spoke in an odd manner they were not diagnosed with autism, because they were not rain man. But these were never normal people for want of a better word. They had never functioned, they had never had friends, never coped in the world. Which is completely different to what we see today.

      The diagnosis rate of autism has been SOLELY at the milder end of the spectrum, and each new increase is based on widening that criteria.

  5. Over-diagnosing is a tautological phrase, similar to over-poisoning.

    One useful aspect of these sorts of arguments is that, as both sides of the psychiatry/pharma dyad tend to point the finger at the other when the spotlight is focused on them, we can be collecting the quotes made by these “authoritative” people to use as needed in our own efforts.

  6. Phil,

    Did you know that new neuro-imaging breakthroughs have been made that allow the diagnosis of ADHD to be precisely made via having children wear brain-wave measuring helmets that track the intensity and degree of inattention down to the millisecond?

    Gotcha… they haven’t!

    You’re right; these arbitrary criteria show why what I usually say is true: Every psychiatric diagnosis is a misdiagnosis. Because no psychiatric diagnosis has explanatory power, and psychiatric diagnosis is always lacking in validity.

    Diagnosis is indeed the Achilles heel of psychiatry, and thus should be a target for critics to hammer away at indefinitely for years to come, just as soldiers would attack the weakest part of a castle wall repeatedly in order to bring the structure to the point at which the whole edifice collapses.

    The current RDOC (Research Domain Criteria I think?) of the NIMH is another diversion tactic by mainstream psychiatry: having failed to establish the validity of current DSM disorders, they have made an empty promise that future brain circuits will be identified that are causal to “mental disorders” and which will uncover a valid biological basis for the DSM disorders. This attempt is almost certainly doomed to fail.

    Perhaps this might be a good subject for a future article, Phil – getting out ahead of NIMH and their Research Domain Criteria, and predicting how future neuro-imaging research will inevitably fail to identify replicable biomarkers for “mental disorders”. It will look all the more convincing if critics can predict the failures ahead.

    • Matt: Check out the Wikipedia entry for “cognitive neuropsychiatry”….If you really want to engage in some intense mental masturbation, try reading an article in their journal.(linked on the wiki page….). Talk about grossly over-educated BU**S**T!….

    • One must be careful when joking about psychiatry because their “truth can be stranger than fiction!” Mainstream psychiatry has already claimed that “new neuro-imaging breakthroughs have been made that allow the diagnosis of ADHD to be precisely made via having children wear brain-wave measuring helmets.” Evidently, you have not heard of the renown psychiatrist, Dr. Daniel Amen.

      Dr. Amen was the darling of public television a decade ago for famously claiming exactly what you joke about! Wikipedia introduces Dr. Amen as follows: Daniel Gregory Amen (born 1954) is an American psychiatrist, a brain disorder specialist, director of the Amen Clinics, and a ten-times New York Times bestselling author. Amen’s clinics offer medical services to people who have attention deficit hyperactivity disorder (ADHD) and other disorders. They use single photon emission computed tomography (SPECT) as a purported diagnostic tool to identify supposed sub-categories of these disorders, as devised by Amen.”

      This was all the rage a decade ago, but has waned from criticism; however, Dr. Amen is still getting rich pushing this BS because it is such logical support for psychiatry… IF IT WAS TRUE!

      Best wishes, Steve

      PS- Comments to a previous post: the APA introduced “clinically significant criteria” for their diagnoses (starting with the DSM-IV). With this simple phrase, the APA states that only clinicians can understand their diagnostic criteria, and properly use their manual. Hence, the APA cleverly discounts criticism of the DSM based on the lack proper insight by non-clinicians. Also, I am unable to offer IT advice about videotaping because I am completely dependent on assistance.

      • I’d call that a regular Clock Work Orange situation and scenario, but I rather think making humor of the situation a good thing rather than bad. The more serious we get about mental health treatment and psychiatry, the more serious “serious mental disorders” become. Provided with a little levity, those weighty diagnoses have a way of dissolving, if not into thin air, into laughter anyway.

        • Frank, so-called , (or “Serious Mental Illness” ) already IS a thing.
          I’ve seen it used repeatedly in various contexts, and usually by non-psychiatrists. Usually, it’s in the form of some 501(c)3 claiming, for example, “We spend your donations wisely, helping those with SMI to live better lives”, or some such tripe and claptrap….. But I do agree that laughter is the best medicine, and we need to all remind ourselves to laugh, and joke more.
          Q.Do you know why angels can fly?
          A: Because they take themselves so lightly….

          • Regarding the Q & A. Sure, the same could be said of pigs.

            “Serious Mental Illness” literally is NOT a thing. However, it is a thing in the public consciousness.

            I hardly think Serious Mental Illnesses are any more provable than Frivolous Mental Illnesses.

      • Yup

        I’ve had people online at other sites extoll “Dr.” Amen’s clinics and skills…and a close friend has had her son FUBAR (don’t know how to help that boy at this point) by a ‘diagnosis’ from one of “Dr.” Amen’s brainscans (only 3+grand) and given a fistful of prescriptions. Just last month he cold turkeyed his *whatever* and ended up in jail for running loose on the freeway.

        Sad sad sad.

        • Because he “cold turkeyed”, he almost certainly experienced a TOXIC WITHDRAWAL REACTION, the sequelae of which includes CRIMINAL INCARCERATION. Only in America, can you get thrown in *JAIL*, because some quack shrink gave you too much of the wrong kind of DRUGS….
          Of course, whatever trauma the kid had experienced before, will only be made worse in jail….
          Too bad we can’t find out what DRUGS at what DOSES the “Dr.” gave him….

  7. I read this article awhile back by a couple of psychiatrists claiming diagnosis an art. Apparently Allen Frances is of the same mindset.

    Frances could have improved his Huff Post blog by giving it the heading, Diagnoses In Kids Should Always Be Written in Invisible Ink, or perhaps, Diagnoses In Kids Should Seldom Be Made but, of course, he’s not going there, medicalization being his medium.

    He has this idea that moderation would make his profession more exacting, but no amount of moderation is going to give bogus diagnoses a substantial and tangible reality, and drugging people who aren’t literally sick is not going to make them any more, so-called, “well”.

    Allen Frances is a poser, and his critical stance is transparent. There are real critics out there who saw through the DSM, and the entire psychiatric BS enterprise, long before he or Robert Spitzer arrived on the scene.

    You’ve got to be careful with Frances though, one moment he’s criticizing the DSM, and the next he’s defending his profession from it’s detractors. If he were a double agent, I’d say his cover must have been blown long, long ago.

  8. Thanks as always, Philip, I would just like to add I’ve actually witnessed school employees stand around at a cocktail party diagnosing various children with DSM disorders. The school employees seem to love the fact that they’ve been given the right to defame little children with made up and scientifically invalid “mental illnesses,” to bring in more money for their schools. Personally, I found this an unseemly, even appalling, cocktail party discussion, however.

  9. Once again, Dr. Hickey strikes the bull’s-eye. Well done. Keep up the good work.

    Do Frances and his fraudulent friends fathom the suffering that they are inflicting upon millions of innocent children? Are they aware that the Savior of the world has given a special warning to those who dare to offend his little ones? If not, they should be made aware as soon as humanly possible.

    “But whoso shall offend one of these little ones which believe in me, it were better for him that a millstone were hanged about his neck, and that he were drowned in the depth of the sea.” (Matthew 18:6)

    The Lord doesn’t mince words, and He invites all men everywhere to repent.

  10. dr hickey,

    i think your blogs are my very favorite, as you write so well and in black and white. if someone states that almost all psychiatric diagnoses are invalid, but a couple are, or that most psychotropic drugs are evil, but there are exceptions, he has lost me. you tell it like it is, crystal clear, and if someone asks me for more information on the fraud that is psychiatry/big pharma, i send him to do more research on your website. thank you for helping me explain the truths to the people in my life who must know these truths. all the very best,

    -erin