Allen Frances and the Increasing Use of Antidepressants


On May 16, 2018, the prestigious and venerable psychiatrist Allen Frances, MD, gave an interview to Christiane Amanpour on CNN. You can see the video here. It’s titled How Antidepressant Withdrawal “Can Trap People.”

Here’s how the interview opened:

CA: “So you know, I just wanted to start by saying that who knew that antidepressants were addictive. It’s not what you associate with things like antidepressants. You think of pain-killers, obviously, and drugs and alcohol, and cigarettes.”

AF: “Well they’re not really addictive in the sense that benzodiazepines are addictive, or cocaine or alcohol. They don’t cause the same degree of functional impairment when you’re taking them, but they definitely do have a withdrawal syndrome, and that withdrawal syndrome traps people. It’s so easy to start an antidepressant and sometimes so very difficult to stop it.”

One could quibble with the phrase “not really addictive,” but Dr. Frances does acknowledge that antidepressants “have a withdrawal syndrome” which “traps people,” which is pretty much what the word addictive means.

In addition, DSM-IV (1994), drafted under Dr. Frances’s chairmanship, was clear and specific concerning the addictive properties of antidepressants. The section on Substance-Related Disorders contains the following:

“Many prescribed and over-the-counter medications can also cause Substance-Related Disorders. Symptoms are often related to the dosage of the medication and usually disappear when the dosage is lowered or the medication is stopped. However, there may sometimes be an idiosyncratic reaction to a single dose. Medications that may cause Substance-Related Disorders include, but are not limited to, anesthetics and analgesics, anticholinergic agents, anticonvulsants, antihistamines, antihypertensive and cardiovascular medications, antimicrobial medications, antiparkinsonian medications, chemotherapeutic agents, corticosteroids, gastrointestinal medications, muscle relaxants, nonsteroidal anti-inflammatory medications, other over-the-counter medications, anti-depressant medications, and disulfiram.” (p 175) [Emphasis added]

This recognition is repeated almost verbatim in DSM-IV’s Text Revision (2000) on page 191.

However, if we fast-forward to DSM-5 (2013), we find no mention of antidepressants in the section Substance-Related and Addictive Disorders. All that remains is an entry called Antidepressant Discontinuation Syndrome, relegated to the chapter Medication-Induced Movement Disorders and Other Adverse Effects of Medication. The point of which was, I suggest, to undo the “damage” that DSM-IV had done to psychiatry’s mainstay drug class, by removing the reference to antidepressants from the substance use/dependence chapter. Additionally, note the use of the word “discontinuation” rather than the more usual “withdrawal,” which has connotations of dependence and addiction.

So essentially, Dr. Frances and his DSM-IV colleagues opened the door to the notion that antidepressants could be addictive. For psychiatry this posed the threat of a recurrence of the benzodiazepine reversal of the 80’s, and had to be quashed.

The Antidepressant Discontinuation Syndrome entry in DSM-5 contains this very telling quote:

“Symptoms appear to abate over time with very gradual dosage reductions. After an episode, some individuals may prefer to resume medication indefinitely if tolerated.” (p 713)

Which sounds very like a sanitized description of addiction.

Also of note in DSM-5, there is this pure gem of psychiatric arrogance and deception:

“Symptoms of tolerance and withdrawal occurring during appropriate medical treatment with prescribed medications (e.g., opioid analgesics, sedatives, stimulants) are specifically not counted when diagnosing a substance use disorder. The appearance of normal expected pharmacological tolerance and withdrawal during the course of medical treatment has been known to lead to an erroneous diagnosis of ‘addiction’ even when these were the only symptoms present. Individuals whose only symptoms are those that occur as a result of medical treatment (i.e., tolerance and withdrawal as part of medical care when the medications are taken as prescribed) should not receive a diagnosis solely on the basis of these symptoms. However, prescription medications can be used inappropriately, and a substance use disorder can be correctly diagnosed when there are other symptoms of compulsive drug-seeking behavior.” (p 484)

In other words, if the customer takes the pills exactly as prescribed, including, presumably, any prescriber-approved increases, he or she cannot become addicted, and “diagnostic” assessments that suggest otherwise are “erroneous,” even in cases where tolerance and withdrawal are clearly evident. The only way that prescription medications can cause addiction is through inappropriate use and “compulsive drug-seeking behavior” on the part of the client.

In DSM-IV (1994) and DSM-IV-TR (2000), there was specific acceptance that use of antidepressants can cause substance use problems, and there is no reference to inappropriate use. In DSM-5 (2013), all reference to antidepressants has been removed from the Substance Use chapter, and the general point is made that people can’t become addicted to “…prescribed medications (e.g., opioid analgesics, sedatives, stimulants)…” and, presumably, antidepressants, as long as they take them as prescribed. In typical shoulder-sloping fashion, the APA has absolved itself of any responsibility for iatrogenic antidepressant and opioid addiction, and has laid the blame squarely on the “compulsive drug-seeking behavior” of the clients. How convenient, particularly in the context of the present opioid and antidepressant addiction epidemics and the “apparently unmotivated” suicides and murders.

But Dr. Frances offers no criticism of psychiatry for this deceptiveness, nor even for reversing the candid admissions that he himself drafted into DSM-IV and DSM-IV-TR.

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Here are some more quotes from the CNN interview, interspersed with my comments:

CA: “And how do you find that out? I mean how much science is there on the difficulties, and how do people know when they’ve been on it too long, or it seems such a fluid area of medication and prescription.”

AF: “Well, it’s a deeply held secret. There’s almost no research on the withdrawal syndrome. There’s absolutely no interest on the part of the pharmaceutical companies in advertising the fact that getting on an antidepressant may trap you for years and maybe for life. So they’ve discouraged research, they don’t report adverse findings. The pharmaceutical industry is only marginally less ruthless than the drug cartels, and it’s not in their interest to advertise this, so there’s been very very little research, and we really don’t know how the long-term use of these medications may affect the brain. We’re doing a kind of public health experiment on hundreds of millions of people around the world without really understanding the long-term effects.”

Note the sentence: “There’s almost no research on the withdrawal syndrome.” The first antidepressants were developed in the 1950’s and were on the market by 1960, fifty-eight years ago. At the present time, untold millions of antidepressant prescriptions are being written world-wide each year.

Yet here’s Dr. Frances telling us that there’s “almost no research on the withdrawal syndrome.” And is he telling us this as an indictment of psychiatry? Is he acknowledging that routinely prescribing and promoting brain-impairing pills on which there is virtually no withdrawal research is a disgrace to the profession of psychiatry? No. Again, in the same shoulder-sloping fashion, he’s blaming pharma! Pharma have “no interest” in the addictive potential of these products. Pharma have “discouraged” research. Pharma doesn’t report adverse findings. Pharma are almost as ruthless as the drug cartels.

So, what we’ve got here is a self-styled medical profession that has been prescribing and actively promoting a class of drugs for almost 60 years, with little or no information concerning their withdrawal characteristics. And Dr. Frances blames pharma for this state of affairs! Why couldn’t organized psychiatry (e.g. the APA and Britain’s Royal College of Psychiatrists) have pursued such research? Why couldn’t the psychiatry departments of various colleges have pursued such research, either singly or collaboratively? And how could psychiatry be so venal and corrupt as to promote and prescribe these drugs without even this basic level of knowledge concerning their addictive potential?

And note the phrase:  “…we really don’t know how the long-term use of these drugs may affect the brain.” After 60 years and countless millions of prescriptions, psychiatry doesn’t know how the long-term use of these drugs may affect the brain!

And from there to the truly macabre:

“We’re doing a kind of public health experiment on hundreds of millions of people around the world without really understanding the long-term effects.”

And although Dr. Frances doesn’t acknowledge this, the “we” of this quotation can only be psychiatry. Psychiatry, if we accept Dr. Frances’s statement, is surreptitiously experimenting on hundreds of millions of people worldwide, without even a semblance of informed consent.

But, in fact, it’s even worse than that, because they’re not really doing an experiment. In a genuine experiment, negative results are published. But psychiatry is just dishing out the pills, trotting out the “safe-and-effective” pablum, and suppressing negative information.

On August 22, 2013, Connecticut Assistant Attorney General, Patrick B. Kwanashie, stated publicly that the “medications” that Adam Lanza was taking when he murdered 26 people in New Haven, Connecticut on December 14, 2012 would not be made public, lest such publication might encourage other people to “stop taking their medications.” He made his statement in response to AbleChild’s request for Adam Lanza’s medical records. And although Mr. Kwanashie didn’t divulge the information, it is clear from what he did say that Adam Lanza was indeed taking psychiatric “medications.”

If Allen Frances is genuinely interested in these matters, shouldn’t he have protested this cover-up? Shouldn’t the APA, who tell us that they have their “patients” best interests at heart, have been screaming their objections to the very heavens? Shouldn’t they have initiated lawsuits to have the information divulged? Shouldn’t they have used every ounce of clout at their disposal to have this issue opened to public scrutiny?

Meanwhile, the shootings and suicides continue.

In 2016, the late Senator John McCain and Congressman David Jolly introduced twin bills in their respective chambers mandating post-mortem drug screening, including screening for psychiatric drugs, in the cases of all military veterans who had taken their own lives.  The bills died from lack of support. Why did the APA not support this proposal? Shouldn’t psychiatry want the link between antidepressants and suicide publicized? Did Dr. Frances himself support the bills?

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CA: “New figures from the New York Times show that fifteen and a half million Americans have been taking antidepressants for at least five years, and that rate is almost double since 2010 and more than triple since 2000. How easy is it to actually get the prescription in the first place?”

AF: “There’s nothing easier in the world than starting an antidepressant. Primary care doctors are given far too little time with their patients, and the only way they can get a patient out of the office satisfied after a seven-minute visit is to write a prescription. 80% of the antidepressants are prescribed by primary care doctors, usually after seven minutes, under heavy pressure from both the patient and from the drug company to prescribe the medication. On the other hand, stopping the medicine can take years. It requires for some people a very, very slow taper, and without that they’ll have symptoms of return of anxiety, of depression, flu-like physical symptoms, and often they will misattribute these return of symptoms to thinking that they’re getting depressed again, when in fact it’s just the result of withdrawal side effects.”

Well there’s not much ambiguity there: the GPs are to blame. But not entirely— they are given “far too little time” and they are under “heavy pressure” from the drug companies (mean ol’ pharma again) and from “the patient.”

This, of course, is the same drum that Dr. Frances has been beating for the past decade or so: psychiatrists are the good guys; and all the woes associated with the use of psychiatric drugs are to be laid at the feet of pharma, the over-prescribing GP’s, and the drug-seeking “patients.”

But, as always, Dr. Frances chooses to ignore the most salient point: that if psychiatry had not invented the spurious illnesses, not a single one of those prescriptions could ever have been written. If psychiatry had not self-servingly concocted and promoted the great lie that every significant problem of thinking, feeling, and behaving constitutes a drug-correctable aberration of brain chemistry — “an illness, just like diabetes” — then none of the problems that Dr. Frances laments could have occurred.

In addition, Dr. Frances’s efforts to slough responsibility for the present state of affairs onto the GP’s is particularly untenable. GP’s, the world over, take their leads from the specialists. The vast majority of ear, nose, and throat problems, for instance, are treated by GP’s, not ENT doctors. But the GP’s make use of diagnostic procedures and treatments that have been developed, formalized, and packaged by the specialists for use in general practice. Ordinarily, only the unusual, difficult, or intractable cases are referred to the experts. New discoveries or improved procedures developed by the specialists are passed along to the GP’s for general use through peer-reviewed journals, continuing education, and other means.

But — and this is the critical point — if it were discovered that the GP’s were making serious, systematic, diagnostic or treatment errors on a large scale, immediate corrective measures would be undertaken by the specialists, using every available means of dissemination. Is Dr. Frances seriously trying to persuade us that GP’s are systematically ignoring psychiatry’s criteria and wantonly mis-prescribing pills, and all that the poor psychiatrists can do is watch helplessly from the sidelines and wring their hands in pious but hopeless frustration? Where are the press releases from the APA denouncing the malpractice? Where is the exchange of correspondence between the APA and the American Academy of Family Physicians? Where are the complaints from the APA to the various medical licensing boards? Where are the warnings to the public?

Psychiatry has labored diligently for decades to promote the spurious notion that depression which exceeds certain arbitrary, vague, and unvalidatable thresholds of severity, duration, and impact constitutes a brain illness. And the fact is that, with the help of pharma dollars, they have been phenomenally successful in selling this destructive and disempowering hoax.

Psychiatry has knowingly and deliberately created a system and an ethos in which virtually anybody who is experiencing the ordinary slings and arrows of misfortune can be diagnosed with a “brain disease” and prescribed drugs and/or electric shocks. Every move that psychiatry has made in the past fifty years has been calculated to further this end. Against this background, Dr. Frances’s persistent efforts to shift the blame for this state of affairs to GP’s, pharma, insurance companies, and even to the clients themselves, is a distortion of the historical record.

In addition to all of this, Dr. Frances is choosing to ignore the well-established fact that the prescribing practices of psychiatrists are just as hurried and perfunctory as those of the GP’s.

Here are some illustrative quotes going back to 2009.

“There can be little doubt in our current era that the brief ‘med check’ is becoming standard practice in psychiatry.” (p 1)
Glen Gabbard, MD, Psychiatrist, Psychiatric Times, September 3, 2009

“Even psychiatrists who deplore 15-minute med checks recognize that they have become standard care in psychiatry.” (p 40)
Douglas Mossman, MD, Psychiatrist, Current Psychiatry, June 2010

“I think many of my colleagues have practices with four, five, six hundred patients. And people are surprised when they hear those numbers, but when you’re seeing patients for 15 or 20 minutes every month, every two months, sometimes every six months, or once a year, quite frankly, you can imagine how you could have that many patients.” (p 5)
Daniel Carlat, MD, Psychiatrist, NPR July 13 2010

“Trained as a traditional psychiatrist at Michael Reese Hospital, a sprawling Chicago medical center that has since closed, Dr. Levin, 68, [Donald Levin, MD, Doylestown, Pennsylvania] first established a private practice in 1972, when talk therapy was in its heyday.

Then, like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart.” (p 2)
Gardiner Harris, Journalist, New York Times, March 5, 2011

“In the past few decades, the focus has shifted more toward the brain and away from the mind. And changes in reimbursement systems today have rewarded hurriedly written prescriptions and encouraged psychotherapy to be provided by nonpsychiatrist therapists.” (p 4)
Jeffrey Lieberman, MD, Chair, Dept of Psychiatry, Columbia University, Psychiatric News, August 27 2013

Note the condoning phrase: “…changes in reimbursement systems today have rewarded hurriedly written prescriptions…” Psychiatrists, poor little lambs that they are, just couldn’t resist these rewards.

“In the old days, people made fun of those rigid 50 minute appointments psychiatrists had with patients that focused mainly on psychotherapy. In today’s world, however, an appointment that long for all but new patients has become a dinosaur of the past at many clinics. In its place is now the infamous 15-minute ‘med check’ which focuses on symptoms, medications, and side effects.” (p 1)
David Rettew, MD, Psychiatrist, University of Vermont, Psychology Today, November 10, 2015

“Today, many outpatient psychiatric care providers are employed to provide ‘medication management’ in brief 15- to 20-minute visits. In qualitative interviews, patients and psychiatric care providers alike expressed that psychiatric care has been narrowed to the act of prescribing medications.” (P 1-2)
William Torrey, MD, (Professor of Psychiatry, Dartmouth School of Medicine) et al, Psychiatry Online, March 1 2017

“The 15-minute medication management visit has become one of the standards of psychiatric practice.” (p 1)
Mark Moran, Senior Reporter at Psychiatric News, Psychiatric News, May 30 2017

“‘It’s like going through a McDonald’s drive-thru. You drive through the window, they give you your prescriptions, and you’re on your way.’

When interviewed, a psychiatric outpatient used these words to describe what it is like to receive care in a 15- to 20-minute ‘med check’ visit—a form of psychiatric service delivery that is now found across the country.” (p 1)
William Torrey, MD, (Professor of Psychiatry, Dartmouth School of Medicine) et al, Psychiatry Online, June 15 2017

The reasons that psychiatry has almost entirely abandoned talk therapy in favor of hurried med-checks and prescriptions are: firstly, it enables them to make a great deal more money; secondly, it entails less stress and effort; thirdly, it helps psychiatrists feel like they are “real doctors” — confirming “diagnoses,” adjusting doses, checking for adverse effects, etc; and fourthly, the med-check approach is entirely consistent with the bio-bio-bio, chemical imbalance approach that has been avidly promoted by psychiatry since the drugs came on the market. Here’s another quote from the very eminent and scholarly Dr. Lieberman. The quote is from the same paper cited above:

“In the revisions that will follow DSM-5, which was released in May, we anticipate that psychiatric diagnoses will move beyond descriptive phenomenologic criteria to measures of pathophysiology and etiology and that they will involve laboratory tests to identify lesions and disturbances in specific anatomic structures, neural circuits, or chemical systems, as well as susceptibility genes—the kinds of tests that routinely inform the diagnosis of infection, cardiovascular disease, cancer, and most neurological disorders. The research that occasions these developments may not just enhance our ability to make diagnoses, but may fundamentally redefine the nosology of mental disorders.” (p 3)

Well, we’re 5½ years post-DSM-5, and as yet none of Dr. Lieberman’s bio-centric predictions have come through. Nevertheless, the spurious chemical imbalance theory remains the primary driving force behind the rushed assessments and the hurriedly-written prescriptions. After all, if “major depressive disorder” can be “diagnosed” by confirming five hits on the facile checklist, and if responsiveness to “treatment” and potential adverse effects can be assessed with a few more brusque questions, then why waste time asking customers irrelevant questions about their personal lives, their relationships, their fears, their loneliness, their empty nests, their sense of purposelessness? Fill out the forms, write the prescriptions, and next please! Kerchung.

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CA: “Well in fact there is one woman who is one of the people you focused on in your book, and it’s Sarah, and just to remind again that 80% of antidepressants you say are prescribed loosely by GPs after an interview that usually lasts less than about ten minutes. So this Sarah says that she was misdiagnosed as being a depressive when she was just really very sad and grief-stricken about the suicide of her son, and she told you, quote: ‘The doctor was clinical, brushing aside my fears and my loss. I needed someone who would understand and share the pain that I was going through, not put a cold, medical label on it.’ How much of that kind of situation and diagnosis did you see as you were doing your book?”

AF: “Well I think she’s a particularly poignant, heart-breaking case, because her son had actually himself been mistreated, over-prescribed medication. It caused side effects, and he actually killed himself with the medication he was prescribed. She’s feeling grief, and after a few minutes, a doctor over-prescribes medication for her. This is a very common story. I think people have to become educated for themselves, their family members, and particularly their children, not to accept a quick diagnosis of depression, not to accept the pill. The diagnosis of depression should take not just one session, but normally weeks, and sometimes even months. Most people come to a doctor on the worst day of their life. If nothing is done except watchful waiting, support, advice, most of those people get better in the short run. What’s happening now is they get a very quick prescription of a pill, and then there may not be an end point, because stopping the pill will be so difficult, and the person will assume that the pill is keeping them well.”

In this context, it’s worth mentioning the bereavement exclusion, which in DSM-III effectively barred the “diagnosis of major depression” in cases of bereavement, except in cases of “prolonged duration,” which was generally accepted as two years. Dr. Frances’s DSM-IV reduced the waiting period to two months, and DSM-5 eliminated the bereavement exclusion altogether.

It also needs to be asked: where did the woman — Sarah — get the idea that a physician would understand and share her pain of bereavement? In the old days, which I — and I’m sure Dr. Frances — well remember, people didn’t consult physicians for sadness or bereavement. They discussed these matters with family, friends, relatives, neighbors, colleagues, clergy, etc., and they found in these discussions resonance, comfort, support, encouragement, and hope. Today, many people consult physicians because they have been sold the falsehood that depression is an illness, a neurochemical imbalance, that can only be ameliorated by psychiatric drugs. And psychiatrists have been the primary promoters and, incidentally, beneficiaries of this falsehood.

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CA: “Well, let’s play a little bit of devil’s advocate, because you make a bit of a distinction between situational grief and feeling really low, and then proper depression.  I mean, there are, there is some benefit, isn’t there, to be treated, potentially with medication, even for a situational amount of feeling low. Is there, or not? Can one sort of micro-target like that?”

AF: “Well, let’s be very clear. There’s a cruel paradox that we’re over-treating the worried well and we’re terribly neglecting the really ill, and the medications are absolutely essential for people with severe depression. There’s no one size fits all. It’s not that medicines are good or bad. Medicines that are very effective for the few become harmful only when they’re misused with the many. I think in terms of situational depressions, short-term reactions to job loss, divorce, financial troubles, it’s always better to watchfully wait, and psychotherapy is by far the preferable first line treatment instead of medication.”

Apart from the unsubstantiated assertion that “medications are absolutely essential for people with severe depression,” Dr. Frances’s response has a superficial ring of plausibility and correctness. But, like everything else, in psychiatry the logic is problematic. Let’s take a look.

The implication in Dr. Frances’s response is that within the psychiatric framework, it is possible to distinguish between people “with severe depression” who are “really ill,” and people who have “situational depression,” and who are, presumably, not really ill (“the worried well”).

But in fact, one of the primary agendas of every DSM since DSM-III has been cause-neutrality. This principle was initiated in DSM-II (1968) and — except for the bereavement exclusion — was largely integrated into psychiatric “diagnosis” in DSM-III (1980). According to this principle, if you’ve got the “symptoms” — regardless of their proximate cause — you’ve got the disease. So, with regards to depression, if a person meets five or more of the nine items on the facile and unvalidatable checklist, he or she has depression — the illness. Whether the depression is a short-term reaction to a job loss, divorce, financial trouble, exploitation, persistent abuse, poverty, being in prison, or anything else, is entirely irrelevant. This, of course, is nonsense, but it has been a central pillar of psychiatry since DSM-III (1980). And it has been a central pillar of psychiatry because it is good for business. If people are despondent, they can be enrolled as paying clients. They can’t be allowed to slip the net just because there’s a perfectly good reason for their sadness!

So when Dr. Frances draws a distinction between situational depression and severe depression, he is not reflecting psychiatry’s formal position, and he is certainly not reflecting current psychiatric practice.

Psychiatry’s movement to cause-neutrality was deliberate, relentless, and selective. Selective, in the sense that it was the psychosocio-economic-cultural causes that were eliminated from consideration, while the putative biological causes were promoted with all the energy and resources that psychiatry could muster, including pharma-developed CE credits — not only for psychiatrists — but for virtually every profession that had any interaction with psychiatry’s targeted population. The push towards so-called cause-neutrality was firmly established in DSM-III (1980), was developed and reinforced in DSM-III-R (1987) and DSM-IV (1994), and was completed in DSM-5 (2013).

At present, the only residue of “situational depression” in the DSM is adjustment disorder with depressed mood. This “diagnosis” has an interesting history.

In DSM-I (1952), it was called “adult situational reaction” and was described as follows:

“This diagnosis is to be used when the clinical picture is primarily one of superficial maladjustment to a difficult situation or to newly experienced environmental factors, with no evidence of any serious underlying personality defects or chronic patterns. It may be manifested by anxiety, alcoholism, asthenia, poor efficiency, low morale, unconventional behavior, etc. If untreated or not relieved such reactions may, in some instances, progress into typical psychoneurotic reactions or personality disorders.” (p 41)

The term “low morale” suggests mild depression, while the phrase “with no evidence of any serious underlying personality defects or chronic patterns” suggests an absence of “mental disorders.” The preamble to this section of the manual is also interesting:

“This general classification should be restricted to reactions which are more or less transient in character and which appear to be an acute symptom response to a situation without apparent underlying personality disturbance. The symptoms are the immediate means used by the individual in his struggle to adjust to an overwhelming situation.” (p 40)

In DSM-II (1968), the name of the “diagnosis” was altered to adjustment reaction of adult life. No definition was provided, but a number of examples were described, including:

“Resentment with depressive tone associated with an unwanted pregnancy and manifested by hostile complaints and suicidal gestures.” (p 49)

This “diagnosis” occurs in the section headed “Transient Situational Disturbances” which are described as follows:

“This major category is reserved for more or less transient disorders of any severity (including those of psychotic proportions) that occur in individuals without any apparent underlying mental disorders and that represent an acute reaction to overwhelming environmental stress.” (p 48)

Of particular note are the phrases: “…in individuals without any apparent underlying mental disorders…” and “…overwhelming environmental stress,” both of which suggest that the reaction in question is essentially a normal and reasonable response, even if the response is severe.

In DSM-III (1980), the section title is Adjustment Disorders. So the problems in question have “progressed” from reactions (DSM-I) to disturbances (DSM-II) to disorders (DSM-III). And, of course, in psychiatry, as in general medicine, the term disorder is essentially synonymous with the term illness. So, by 1980, these problems had become full-blown psychiatric illnesses (presumably “just like diabetes”). Here’s the DSM-III definition:

“The essential feature is a maladaptive reaction to an identifiable psychosocial stressor, that occurs within three months after the onset of the stressor.  The maladaptive nature of the reaction is indicated by either impairment in social or occupational functioning or symptoms that are in excess of a normal and expected reaction to the stressor.” (p 299)

Note the introduction of the word “symptoms,” a critical step in the spurious medicalization process.

Adjustment disorder with depressed mood is described as follows:

“This category should be used when the predominant manifestation involves such symptoms as depressed mood, tearfulness, and hopelessness.” (p 301)

Again, notice the word “symptoms.”

The entries in DSM-III-R are essentially similar to those in DSM-III.

In DSM -IV (1994), adjustment disorder is defined as follows:

“The essential feature of an Adjustment Disorder is the development of clinically significant emotional or behavioral symptoms in response to an identifiable psychosocial stressor or stressors.” (p 623)

Again, note the use of the word “symptoms” and “clinically significant.” Also note that the focus has shifted from the nature/severity of the stressor to the development of clinically significant “symptoms.”

The progression to illness status continued in DSM-IV-TR (2000).

“…a reaction to a stressor that might be considered normal or expectable can still qualify for a diagnosis of Adjustment Disorder if the reaction is sufficiently severe to cause significant impairment.” (p 679)

So the fact that the individual’s reaction might be entirely commensurate with the stressor is not relevant.


“Adjustment Disorder has been diagnosed in up to 12% of general hospital inpatients who are referred for mental health consultation, in 10%-30% of those in mental health outpatient settings, and in as many as 50% in special populations that have experienced a specific stressor (e.g., following cardiac surgery).  Individuals from disadvantaged life circumstances experience a high rate of stressors and may be at increased risk for the disorder.” (p 681)

The entry in DSM-5 (2013) is essentially similar to that in DSM-IV-TR.

The point of all of which is that within the successive revisions of the DSM there has been a clear and persistent agenda to fallaciously present situational depression as a bona fide illness.

So Dr. Frances’s attempt in the CNN interview to distinguish between people experiencing “situational depression” and people who are “really ill” is very misleading. Within the psychiatric hoax, situational factors (even including bereavement) are irrelevant to the question of whether the person is “really sick.” And this is no accident. This has been one of psychiatry’s primary agenda items for the past forty years. And, it should also be noted, it is not a finding of fact. Rather, like everything else in the psychiatric hoax, it is a matter of fiat. Psychiatrists say so; therefore it must be true.

In addition to all this, the nine criteria items are hopelessly vague and subjective. Anyone consulting a psychiatrist concerning feelings of depression can be shoe-horned into a “diagnosis of depression” without much difficulty, and almost inevitably drugs will be prescribed to “treat” the “brain illness.” This is the situation that psychiatrists have deliberately, systematically, and self-servingly created. For Dr. Frances to blame this state of affairs on pharma is not credible. Certainly, pharma was a staunch ally to psychiatry in the nefarious endeavor. But not one inch of progress could have been made on this drug-pushing bonanza without psychiatry’s firm and unremitting commitment. Pharma did indeed provide generous funding, of much of which Dr. Frances himself deigned to partake, but at every juncture, psychiatry, with eyes wide open, called the shots, eliminated the concept of exogenous depression, formalized the so-called cause-neutral criteria, pretended that they had identified a brain illness, and banked the checks. And they continue to perpetrate the hoax to this day.

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CA: “So what is your solution, then to this over-diagnosis crisis? Not, I don’t just mean for doctors to have more time, but people, how should individuals be sensitized and made aware of this problem?”

AF: “Well I think you’re doing that, and I’m trying to do that with this program. I think that there are several things that need to be done. The first and most obvious is that we need to tighten the diagnostic criteria for how physicians and people regard clinical depression. We need to tame the pharmaceutical industry. They should not be advertising directly to consumers. That happens only in the US and New Zealand, and both countries have remarkably high rates of antidepressant use. We need to convince the insurance companies to allow primary care doctors to get to know their patients, so that their only recourse is not writing a prescription. And most of all we need to inform the public to be more afraid of medication and less afraid of their emotions and of illnesses. I think that the overwhelming clinical experience and research finding is that most people with transient, mild depression will do very well on their own, and people should trust to their own resources, get support from their family, get psychotherapy way before they consider medication. The medication should be the last resort for people who have severe, chronic depression. It shouldn’t be the means of treating the aches and pains of everyday life.”

There are several noteworthy points in this response.

Firstly, note the phrase “clinical depression,” a vague term, used extensively in psychiatry to convey the impression of illness, but without any supporting evidence. There is no APA diagnosis called clinical depression.

Secondly, Dr. Frances is calling for the tightening of “diagnostic criteria,” but note the wording: “we need to tighten the diagnostic criteria for how physicians and people regard clinical depression.”[Emphasis added] Specifically, he’s not calling for a tightening of the DSM criteria, but rather for a change in how GP’s and the public view depression. In other words, there’s nothing wrong with psychiatry and its so-called diagnostic manual; it’s the GP’s and the “patients” again!

Thirdly, his contention that “we need to tame the pharmaceutical industry” rings hollow in the light of psychiatry’s long-standing hand-in-glove relationship with pharma.

Fourthly, Dr. Frances contends that the GP’s “only recourse” is to write a prescription, because “the insurance companies” won’t “allow” them to get to know their patients. Apart from the extraordinarily condescending tone, this contention of Dr. Frances’s ignores the reality: that GP’s prescribe psychiatric drugs in the way that they do, and in the quantities that they do, because they have received the message from psychiatry that this is not only right and proper practice, but is also necessary to combat this “illness” which has — according to psychiatry — reached epidemic proportions world-wide. Psychiatry has actually created the situation where a GP who does not routinely assess for depression and does not prescribe drugs when reports of depression are presented, is rendering him/herself liable to malpractice action. Coupled with which, psychiatry’s routine but false assertions that the drugs are “safe and effective,” and their stubborn resistance to any suggestion to the contrary, has fostered the very culture of misplaced complacency that Dr. Frances here laments.

Fifthly, Dr. Frances’s assertion that “we need to inform the public to be more afraid of medication and less afraid of their emotions and of illnesses” is too little, too late. This is especially the case in that psychiatry for the past five decades has poured resources into the opposite message: that all significant problems of thinking, feeling, and/or behaving —  including bouts of sadness or despondency — constitute brain illnesses; that psychiatry has the protocols to diagnose these “illnesses”; that failure to professionally treat these “illnesses” will entail multiple dire consequences, including possible suicide; and that psychiatric drugs — often to be taken for life — are the treatment of choice.


Much of what Dr. Frances says is sensible, but it would be a good deal more convincing if he would lay the responsibility for the present state of affairs squarely where it belongs:  on psychiatry, its disempowering labels, and its destructive “treatments.”


I suggest, in all sincerity, that Dr. Frances abandon his attempt to absolve psychiatry from blame in these matters, and that he join the anti-psychiatry movement. Dr. Frances’s present exculpation mission is doomed to failure because psychiatry is indeed the primary culprit, and it is only within the anti-psychiatry movement that Dr. Frances will find uncompromised congruence with his present desire to expose the excesses which he so clearly deplores.

I realize that many of my readers will greet this suggestion with a measure of skepticism, and some, even, with hoots of derision. But wait!

In August 1983, Dr Frances co-authored (with Katherine Shear, MD, and Peter Weiden, MD) a short article in the Journal of Clinical Psychopharmacology. The article is titled Suicide Associated with Akathisia and Depot Fluphenazine Treatment, and presents case reports of two men who had killed themselves shortly after receiving injections of depot fluphenazine (Prolixin), a neuroleptic drug. One of the men jumped from a rooftop; the other jumped in front of a train. Of course, two case studies don’t prove a causal link, but here’s what the authors concluded:

“Although we cannot be sure that akathisia caused the deaths of our patients, akathitic symptoms seemed to be immediate precipitants of suicidal behavior.”

Although this formal conclusion is worded cautiously, the text of the paper leaves us in little doubt that the unbearable nature of the neuroleptic-induced akathisia was the proximate cause of the suicides.

Evidently Dr. Frances took this matter to heart.  Eleven years later he introduced the proposed diagnosis neuroleptic-induced akathisia in DSM-IV (1994). The problem was described in detail, including the observations that “in its most severe form, the individual may be unable to maintain any position for more than a few seconds” and “akathisia may be associated with dysphoria, irritability, aggression, or suicide attempts.” Prevalence was estimated to be 20%-75% of people taking neuroleptic drugs. The entry ran to two and a half pages. (p 744 – 746)

However, in DSM-5 (2013), the name of the problem was changed to medication-induced acute akathisia. The entry was reduced to four and a half lines, and there is no mention of irritability, aggression, suicide attempts, or prevalence. (p 711)

So here are two questions that Dr. Frances might want to ponder. Why did the APA, in the drafting of DSM-5, choose to suppress the critically important information in his earlier article and in his DSM-IV proposal? And why does he himself continue to defend a profession that would put its own guild interests ahead of client safety in such a blatant and unabashed fashion?

I suggest the time has come for Dr. Frances to jump ship. Psychiatrica, the siren that seduced him in his youth, has led him into the twin eddies of error and self-justification, and increasingly shows herself as the destructive monster that devours the people she purports to serve. It is time for Dr. Frances to come over to the right side, and to put his pen and his inside knowledge to good purpose.


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.


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  1. So, Dr. Hickey, do you think Dr. Frances has indeed seen the error of his ways? Or is he just talking out of both sides of his mouth?

    He criticized the concept of mental illness in the past and changed his mind for a prestigious post afterward.

    He is still shirking his own responsibility in this mega-scam. Just a little cog following orders….

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  2. “I suggest, in all sincerity, that Dr. Frances abandon his attempt to absolve psychiatry from blame in these matters, and that he join the anti-psychiatry movement. Dr. Frances’s present exculpation mission is doomed to failure because psychiatry is indeed the primary culprit, and it is only within the anti-psychiatry movement that Dr. Frances will find uncompromised congruence with his present desire to expose the excesses which he so clearly deplores.”

    So funny. Thankyou so much for that.

    “The pharmaceutical industry is only marginally less ruthless than the drug cartels”

    Allen Frances Paid Role in Creating Psychiatric Epidemics:

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  3. Great article, but, and long but, I don’t really see Dr. Frances jumping ship. He should be asked how he feels about forced treatment because I know he’s in bed with E. Fuller Torrey and D.J. Jaffe. Notice his line about people with “serious mental illnesses” versus “the worried well”. It’s the same line you get from Torrey and the TAC.

    Allen Frances, if he felt a little twinge of remorse, never came completely clean about the DSM-IV, and it is my guess that he never will. All of these manuals, successively making it easier for doctors to diagnose patients, and thus prescribe drugs, have sent the “mental ill health” rate, and with it the use of pharmaceuticals, soaring.

    He also thinks ADHD is a legitimate disorder for which some people need to take drugs. He just has questions about the numbers. Okay. Do you think Allen Frances’s doubts and reservations are going to bring those numbers down one iota? Certainly not.

    This Allen Frances is the same Allen Frances who was taking money from Johnson & Johnson in the 1990s for helping them to write a set of schizophrenia guidelines that favored Resperidal as the preferred means of treatment.

    Once he’d finished with editing the DSM-IV, this kind of critique became his way of staying in the limelight, and being an APA bigwig, and former editor of the DSM, stay in the limelight he did. He’s getting all this attention because of his former roles, as well as his position as Duke professor emeritus. He’s not, and he never was, a real critic of the system. He’s just got a new way to grab the limelight even though his chief role in the drama has faded from view, and he’s now some kind of ineffectual gadfly.

    You make a good point about the GPs. Would GPs be prescribing so many pills if the APA had taken a position against excessive drug use? Certainly not. Allen Frances, in blaming everybody else but members of his own profession, was only showing his true colors, but we knew what those were all along. If you were expecting anybody to jump ship it shouldn’t be Allen Frances. If he’s any kind of performer, thank Heaven, all I have to do to get rid of him is to change the channel.

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      • Something of the sort, yes. He’s a “mental health” policeman who believes in his business. He knows the drugs are bad for you, but when it comes to doing something about them, that’s a relative matter for him. In all seriousness, when it comes to saving the day, I wouldn’t expect a lot out of Allen Frances, and as far as those expectations go, he hasn’t let me down yet.

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      • I like your summation Rachel. Someone should call his bluff. Expose him as a wimp who is afraid to stand up to his masters, a phony “whistleblower” with one foot still in the corruption.

        Who would be the bad cop in your scenario btw?

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        • Jeffry Lieberman, and others of his ilk, are still pretty much all bio-psychiatry, if with a psycho-social spin. Also, Ronald Pies, who knows where he coming from, except in so far as he’s a fork-tongued defender of the guild.

          Allen Frances actually had communications that I read with E. Fuller Torrey. If you’re looking for a ‘bad cop’, maybe it’s E. Fuller.

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          • Still waiting for a PSA from Dr. Pies undeceiving the public about the chemical imbalance lie touted on commercials, thus proving how well-informed he is. Lol.

            The con man’s pretty angry folks think he’s dumb enough to believe the lies he promotes. Check that. His limbic system is hyperactive.

            But alas! Undeceiving the public might result in massive outbreaks of agnosognosia. Which might undermine the unquestioned credibility of his profession. Which would be a tragedy.

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          • “D.J. Jaffe has written a brilliant, compassionate, and disturbing book that best explains the mess of our mental health non-system and how to solve it.”
            ~Allen Frances


            “Over his long career as researcher, clinician, and ardent advocate, E. Fuller Torrey, MD has been the most persistent and most effective champion for those with severe mentally illness.”
            ~Allen Frances


            “Psychologists criticize psychiatry for its reliance on a medical model, it’s terminology, its bio-reductionism, and its excessive use of medication. All of these are legitimate concerns, but psychologists often go equally overboard in the exact opposite direction- espousing an extreme psychosocial reductionism that denies any biological causation or any role for medication, even in the treatment of people with severe mental illness.”
            ~Allen Frances


            “”Chemical Imbalance” was a #BigPharma scam to push drugs on normal people experiencing the expectable sadness/anxiety of everyday life. Not to be confused with people who suffer from severe mental illness which really does require meds.
            ~Allen Frances, Tweet on Twitter

            Emphasis added.

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          • Jaffe and Pete Earley are neither one MDs yet they scream at Bob Whittaker for daring to write about people ruined or killed by psych drugs.

            Earley has a son he got angry at because the boy was unhappy and hungry for assurance of his father’s love. He pretended his son was trying to murder him to get him “helped.” (Accusing him of attempted suicide wasn’t dramatic enough I guess.) Apparently Kevin is the designated scapegoat everyone in the family picks on.

            As far as Jaffe’s family drama it reads like a Tennessee Williams play. “Stelazine!!!” Yeah. That play.

            Based solely on the way they treated these unwanted, despised family members, these scoundrels–a writer of sleazy marketing ads and a hack journalist–claim to be experts. Almost on level with the shrinks themselves.

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    • I suffered (Historically) from Akathisia which made me Unpredictable and was the Worst Experience of my Life, and my GP at London W2 has (very recently) entered this onto my records.

      I also presented an information document on Akathisia to him, which he avoided to the extent that he was capable.

      Most GP s in the UK prescribing SSRI s are very ignorant of the potential effects of these drugs but when they eventually find out they will need “help” themselves.

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  4. Thank you so much for posting this article. The analysis and HONESTY are what I’ve been looking for (and what I’ve suspected for years!). Sad that I know “more people than not” that are on psychotropic medication. And sad that more caution of Pharma is not taken by all. The next generation is changing their DNA to such an extent, that I fear for the well-being of their children, and hope that my daughter will be able to find a “non-medicated” man with which to have a family.
    I think drug tests should automatically be done after suicides and mass-shootings to start a database in hopes of gathering more info about the connection between psychotropics and suicide/homicide.
    I’d love to spread the word, but the power of Pharma is so strong that my voice gets squelched and ridiculed. Not sure what to do anymore except to just protect me and my own!

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  5. I’m not anywhere near as much of an expert on these matters as Philip Hickey is. But Philip remarks consistently throughout this article that he feels that Allen Frances and psychiatry are the two chief culprits to blame for the entrenched tragedy which is patients’ lives. I beg to differ. Granted, Allen Frances’ condemnation of the drug industry is on par with his of psychiatry. But there the similarity ends.

    There’s an entire Establishment of filthy people who are behind the travesty which is patienthood. What about our dear friends the, “advocates?” (read: N.A.M.I.) Maybe a better criterion for determining who’s to blame and who isn’t would be to look at who’s pro-medical model, and who isn’t.

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  6. Philip

    Brilliant! Perhaps your best blog ever. You should definitely publish an entire book with all of your similar writings, and this particular blog should be centrally featured in that book.

    This blog is not just a call for Allen Francis to abandon and condemn psychiatry for its crimes and its illegitimacy as a medical specialty, but a call to ALL so-called “critical psychiatry” doctors, and other similar minded critics, to finally make the necessary leap to “all the way” anti-psychiatry.

    Carry on, Philip. Your writings are a beautiful and inspiring weapon in the struggle for human emancipation from all forms of oppression.


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  7. A captivating and educational read that I am only partly through with no plans to “skim.” But I had to stop here to interject:

    “We’re doing a kind of public health experiment on hundreds of millions of people around the world without really understanding the long-term effects.”

    ‘Scuse, but note that he doesn’t say “we were doing a public health experiment,” past tense, and have seen the light, but “we ARE” doing such. Isn’t this an admission of ongoing culpability in criminal human experimentation?

    OK, back to the article…

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    • Still reading. I agree with RL, this is a kickass article, and I’m finding almost nothing to add; every time I’m about to expand on a point Phil drives it home in the next sentence. Here’s a thought though,

      The research that occasions these developments may not just enhance our ability to make diagnoses, but may fundamentally redefine the nosology of mental disorders

      Note the use of the word “may,” as in “it’s possible,” as in “we haven’t a clue really.” This is identical to language in adverts for neurotoxins which ramble on about how “it is believed” that the effect of the drug on serotonin and/or dopamine “may” correct an imbalance. There is virtually nary a definitve statement to be found.

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      • Hey, I’m done! I don’t have a lot more to add; this is indeed a classic piece and it’s good to see you writing, Phil. For the record, Phil mentioned to me once that his only focus was the success of anti-psychiatry, and that he had no ego concerns. I can confirm that this has proven true, probably the only person I can make such a statement about.

        As for joining the anti-psychiatry movement, there will never be an incentive for someone to be tarred & feathered when they can be speaking before audiences of compliant admirers. There’s certainly no money to be had, at least not until “anti-psychiatry” becomes a consumer commodity. And no one should worry about that immediately, we’re not worth the effort of co-opting at this point. Some of the best promotion for anti-psychiatry is done when esteemed shrinks like Lieberman and Frances publicly fret about “anti-psychiatry,” which I guess is psychiatry’s version of the Red Menace.

        I’ll finish pretty much where I started, i.e. pondering criminal liability of various sorts. Hard to avoid with quotes like these:

        Dr. Frances contends that the GP’s “only recourse” is to write a prescription, because “the insurance companies” won’t “allow” them to get to know their patients

        Echos of Nuremberg?

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  8. Dr. Philip Hickey, Thank you! This is an exceptional and crucial blog!!
    When I was unwittingly snared by a psychiatrist simply because I had insomnia from chemotherapy (and steroids you must take to try lessen internal damage from the chemo) I didn’t know (at that time) that psychiatrists disregard any and all (often blatant) ‘causes’ of a person’s distress or suffering, even toxic side effects of chemo. I didn’t present or report even 1 of the criteria allegedly needed for any diagnosis but unbeknownst to me was immediately given 4 major psychiatric diagnoses anyway. Then prescribed an anti- psychotic for sleep. When I had horrible side effects the first night from the anti-psychotic, including hallucinations I refused to take another pill. Then I was further denigrated as “non-compliant”. When I began to fight the damaging labels I bought Dr. Allen Frances book Saving Normal; An Insider’s Revolt plus read his “12 Best Tips on Psychiatric Diagnosis”. I felt it was a commendable step in right direction but since finding MIA and becoming aware of the horrendous harm so many have suffered I hope he reads this detailed and powerful blog and soon takes a stronger stance.

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    • Rosalee, Don’t be fooled – Allen Frances is a devious wolf in sheep’s clothing. He is the public face of guild Psychiatry, and has a powerful platform in the mainstream media which he is using to save his “profession” from sinking into the mire. This interview is a classic example. He captures the public mood of outrage at being misled about “antidepressants” whilst neatly deflecting all responsibility for the current situation away from Psychiatry. His tricks are easy to spot once you know them…

      1. Allege scarcity of data: “There’s almost no research on the withdrawal syndrome.”

      2. Bring in a bigger villain: “The pharmaceutical industry is only marginally less ruthless than the drug cartels, and it’s not in their interest to advertise this, so there’s been very, very little research.”

      3. Pass the blame on: “80% of the antidepressants are prescribed by primary care doctors.”

      4. Re-assert Psychiatry’s ultimate authority in these matters: “There’s a cruel paradox that we’re over-treating the worried well and we’re terribly neglecting the really ill…”

      5. Big-up the drugs as ‘life-saving medication’: “the medications are absolutely essential for people with severe depression.”

      In the UK, our top psychiatrists are already following his lead and spinning these very same lines to the press…

      “Professor Wendy Burn, president of the Royal College of Psychiatrists, said antidepressants are ‘a life-saver’ for many people but ‘not enough research has been done into what happens when you stop taking them’.” (Independent 2 Oct 2018)

      Journalists will buy it, and the message will filter down through blogs and social media to the public at large. Psychiatry, as always, will come up smelling of roses.

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  9. Great article. I especially like how you took each statement of Dr. Frances’s and broke it down, or how you went back through the history of a diagnosis and showed the progression of changes. It takes a topic that people may not realize actually has a history that is relevant and important, and clears up the confusion. This is the kind of nuts-and-bolts thinking that we need to get out there for people to see so they can make up their own minds what they think of it all. This article is a great resource.

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  10. AF: “We need to tame the pharmaceutical industry. They should not be advertising directly to consumers. That happens only in the US and New Zealand, and both countries have remarkably high rates of antidepressant use.”
    According to this article
    New Zealand has a much lower rate (approx. 1 in 13) of antidepressant use than the UK and I don’t think drugs are advertised to the public in the UK.

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  11. I didn’t see anything listed in the comments about how this psychiatrist rigged things so that a particular neuroleptic would be used more often, obviously benefiting a drug company. This is the same thing that Beiderman did to benefit Johnson and Johnson so that their drug would be used to treat “bi-polar” in children. He is not as squeaky clean as he’d like to present himself. I can’t remember her name but a woman who is an author, activist, and I think a psychologist wrote about this and has lectured about it.

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  12. We all must remember that psychiatry is not going anywhere soon despite these types of powerful exposures of their scientific nonsense and related crimes against the people.

    My making such a statement is NOT to underestimate the value of such exposures (like that of Philip Hickey) as an organizing tool. This kind of work is critical educational work for building an important human rights movement.

    An underlying theme (though not directly identified as such) in Philip’s writing is an overall indictment of the role of profit and power within the workings of the capitalist system. The profit motive drives Big Pharma’s push to sell drugs by any means necessary, and encourages and sustains the guild interests of psychiatry.

    AND MOST IMPORTANTLY, psychiatry and their entire disease/drug based paradigm of so-called “treatment,” has now become a vitally important means of social control, maintaining order within the empire.

    They continue to drug the more potentially volatile sections of society and shift people’s attention away from inherent social problems within their System, and refocus people’s attention on so-called personal/genetic “flaws” in human nature.

    So ALL our anti-psychiatry work must continue to find the ways to link psychiatry’s present existence AND future (and its ultimate demise) to the historic end of capitalism as a form planet wide social organization.


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    • psychiatry and their entire disease/drug based paradigm of so-called “treatment,” has now become a vitally important means of social control, maintaining order within the empire

      Or as some might call it, “Te Empire’s New Clothes.”

      So let me return to my constant point, the significance of which few seem to appreciate, i.e. IF psychiatry is objectively an arm of social control/”law enforcement,” WHY do “anti-psychiatry” people continue to base their analyses on the false (unconscious?) belief that we are battling an errant field of medicine? If the prison abolition movement based its organizing around the belief that prisons were actually poorly run homeless shelters it would be in pretty bad shape. We need to strategize with an understanding that we are dealing with a system of control, not poorly conceived “help,” and that showing “better ways of helping people” is irrelevant to the true purpose of psychiatry, hence useless as a focus of those organizing to defeat it.

      The next trap is feeling obligated (or guilt tripped) to come up with “real” help to compete with the false “help” offered by psychiatry, hence implicitly adopting the meme that “help” consists of “going somewhere” for “services,” and the false argument that fighting psychiatry is illegitimate unless we provide an “alternative” version of what it (falsely) claims to do, i.e. become some sort of mirror image. We don’t need to go there.

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      • Why do so many people willingly seek out psychiatric “help” Oldhead?

        A lot of us had emotional problems to start with. Many felt there was something “wrong” with us because we were awkward or too smart or fashion impaired. I had repeatedly been criticized and bullied as a teen for my lack of social skills, or the “wrong” body. Built like a big, ugly plough horse instead of a dainty figurine.

        Psychiatry offered easy but false answers in capsule form. Now I’m the fattest, ugliest woman alive with fewer social graces than the characters in Big Bang Theory. Cocktails bloated my body into a gross cartoon and public ostracism through my shrink “educating” my friends/family got me thrown out of college and segregated.

        We would have been better off trying street drugs of course. We are more alienated and damaged than ever kudos to the quacks. But there you have it.

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  13. Well, bless his heart.
    One can’t avoid the omnipresent ‘brand’ that is Allen Frances. He finds it impossible to turn the knob of his own voice to ‘off’. Over the years, since he was ‘un-friended’ by the APA, he has nearly ‘pulled a hammy’ positioning himself as the multi-headed hydra in psychiatry, vigorously crafting and marketing a seemingly independent ‘wisehead’ visage, balancing his ethically corrupted past with his relentless campaign for acceptance, credibility, and legacy-restoration by all branches of the industry; APA, ‘civilian’ readership (NYT, et al), industry associated, government publications, and ‘mindful’ (kind of) ally of the anti-movement.
    Like an idealogical pretzel, he announces, pronounces, and feverishly edits his messaging to be almost all things to all sides; a pure creature of his psychiatric in-breeding, both academic and, most importantly, commercial. He must be exhausted.

    Those of us who have been on the receiving end of Dr. Frances’ contributions to the industry vis a’ vis the DSM-IV, are hard-pressed to fully appreciate his infinite apology tour that has morphed into a third-party candidate status in the convo; not really conventional psych, not really anti-psych, more ‘all-about-Allen’ psych, a message that speaks more to his refusal to put his money and mouth where his lost ethics used to be and spending his senior years endlessly grooming his own professional reflection in the mirror.

    I was a recipient of Allen’s efforts when, in 2004, I was ‘slam-dunked’ into a “lifelong, acute, chronic” bipolar 1 diagnosis with an SMI “forever” chaser. In January 2016, I ran to my car and peeled out of the clinic’s car park clutching paperwork that vacated both (!) and have devoted the past 3 years to restoring my health, body and soul.
    As MIA readership is pretty much an ‘inside baseball’ audience, details of my lost decade misses the point and are painfully familiar; I was introduced to heretofore unknown territory like despair, terror, comprehensive physical decay in brain and body, and exposure to the basest instincts in mankind. My loss of self-determination and credibility was thorough and immobilizing, right on schedule.

    In July 2018, prior to having an essay published on this subject, I invited Dr. Frances to check it out, as he had had an enormous contribution to my current mental health. I purposefully kept the invite ambiguous and ‘swiss’. He promptly tweeted me back with “look forward. glad to be of help. best, al”.
    It was as predictable as the sun rising in the east. He assumed I was thanking him. What an a**hole.

    Join the Resistance, Al. With your big megaphone and massive self-confidence, you might just save your own soul while turning those self-described (but getting fainter) “mea-culpa’s” into hard currency. It might help mitigate the dark, deep damage you delivered to millions who can’t articulate because they’re drugged for the rest of their lives. That’s not me anymore.
    I know what you did, as do so many others. I am YOUR creation; don’t be afraid, fully embrace me. My bona fides on this subject are unimpeachable. I paid the check for your sins.
    You’re welcome….and you owe me and the millions of others, bigtime.

    Al, listen up…..character is destiny.

    Thx Dr. Hickey, for continuing to expose this guy and generously giving him some much needed career counseling. You are far more diplomatic than I could ever be…considering.

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    • “I was introduced to heretofore unknown territory like despair, terror, comprehensive physical decay in brain and body, and exposure to the basest instincts in mankind. My loss of self-determination and credibility was thorough and immobilizing,..”


      Thank you, Kartman08

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  14. The Mood Disorders Work Group introduced the criteria for the bipolar disorders: –

    “The bipolar 1 disorder criteria represent the modern understanding of the classic manic depressive disorder”.

    (DSM 5).

    This is outrageous.

    A chemical brain injury caused by SSRI/SNRI neurotoxicity – (“in a patient with NO mental illness, given an SSRI/SNRI by their primary care physician as “the only way they can get their patient out of the office satisfied after a seven minute visit is to write a prescription”) – is to be routinely mis-labelled as “Bipolar Disorder” – for life.


    They will then be (surely fraudulently?) permanently recorded on the S.M.I Register.

    Condemned to a totally destroyed life – “Lebensunwertes leben” – Lives Unworthy of Life.

    A life prematurely terminated by drugs with such devastating, multi-systems toxicities as Valproate and Risperidone.

    Isn’t it unforgivable, as well as grotesquely unethical, that this is considered to be an acceptable “Medical Practice”?

    Duties of A Doctor:

    “You must tell patients if an investigation or treatment might result in a serious adverse outcome”.

    Primum Non Nocere. “Let Wisdom Guide”. “Cum Scientia Caritas”.

    TRM 123. Retired Consultant Physician.

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    • Connor M. karen you got your eyes over this ? I’m going to inform you of why people become manic on these drugs and it isn’t due to ‘bipolar I disorder’ and why it is therefore fraud at the expense of destroying peoples lives as the retired consultant correctly points out.

      “The work group also clarified that mania induced by treatment with antidepressant medication counts as a manic episode for the purpose of diagnosing bipolar I disorder.”

      People become toxic (toxic psychosis/akathisia) on these drugs because they are unable to metabolise them correctly. This is because we ALL HAVE DIFFERENT strengths (phenotypes) of metabolising enzymes. An area of science proves this called pharmacognetics. I think this was one of the first gene tests available going back something like 20 years, but today still, few people get this test, pretty much no one in the UK gets it. The ‘doctors’ know this, especially the DSM people who put this in place.

      Pharmacogenetics Made Easy:

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      • A crude way to estimate (“guesstimate?”) this is with the old (quantitative) Hoffer-Osmond Diagnostic test. You probably won’t see one of these in the UK, because Hoffer was a Canadian, one of those folks who seem to be regarded as ignorant hillbillies by the highly educated in the UK. The old Canadian Schizophrenia Foundation once made a booklet form of this test, so that schizophrenic Foundation members could check themselves out if they felt themselves possibly becoming “strange” again, so they could adjust or resume their vitamins. It was also used to screen alcoholic candidates for psychedelic therapy, which isn’t recommended for those with greatly disturbed perceptions, that class of individuals not responsive to such treatments.

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    • You described the course of my “disease” TRM 123.

      No more mood swings. But my brain is horribly damaged. Shrunken frontal lobes. I struggle to clean my room. Not sure I can ever hold down a job. I am indeed disabled thanks to psychiatry.

      Not exactly depressed. But few would envy my isolated life in poverty. Forced to live with elderly parents thanks to roaches over running the HUD slum I occupied.

      Never was a “Patty Duke bipolar.” I’m a teetotaler virgin in my 40’s. I was a model teenager who religiously observed curfew and strove for good grades. Never partied. Graduated from high school a year early with the highest average.

      Psychiatry did not make me “marriage material” to quote Patty. Sad since I have a capacity for love and loyalty no one wants. Leprosy does not make for good marriage prospects. 🙁

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      • Rachel, my heart hurts bigtime when I read of the harm that’s been inflicted on your life but I must say your witty and brilliant mind still comes through loud and clear! Love your humor, and your perceptive and very witty comments.

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      • Rachel777,

        Your resilience within such suffering moves me deeply.

        The ADRs of these psychotropic drugs extend far beyond the dreadful physical injuries to brain, endocrine system, breasts, metabolism, gut, liver, temperature regulation, skin et al.

        Beyond AKATHISIA and other neurotoxicities – (Which I consider are chemical brain injuries, mis-classified as “psychiatric” or “neuropsychiatric” ADRs).

        The PIL should identify that all psychotropic drugs cause:

        Neurotoxic changes in thinking, emotion or behaviour associated with distress and problems in social, work or family activities.

        Your primary care physician and/or psychiatrist likely denies and/or does not understand this.

        Hence if you report these adverse drug effects, your prescriber will usually be programmed to refer to the A.P.A. definition of “Mental Illness”: —

        “Mental illnesses are health conditions involving changes in thinking, emotion or behaviour associated with distress and problems in functioning in social, work, or family activities”.

        Prescription psychotropic drug neurological-toxicites therefore, cannot be differentiated from “mental illness” and vice versa.

        The impact of sloppy diagnosis, and incompetent differential diagnosis, is likely to be mediated through “Serious Mental Illness” mislabelling for life, further injuries from more and more psychiatric drugs and yet more labels, then yet more drugs.

        As you so clearly describe, the iatrogenic isolation, exile from society, denial of employment and career opportunities, denial of relationship/marriage/child bearing aspirations, economic deprivation, humiliation, and overwhelming loneliness are devastating PREDICTABLE and PREVENTABLE ADRs.

        All of the above result from the fact that a “psychiatric label” relegates a human being, with all their unique, individual potential, to the category of those who are unworthy of society.

        Unworthy of empathetic and skilled medical care in their “future”.
        Pretty much unworthy of anything, even compassion, from those whose duty it is to care.

        What is the DSM 5 category for Iatrogenic Lebensunwertes Leben?
        Life Unworthy of Life.

        How can those whose raison d’être is supposed to be the alleviation of suffering, cause such human devastation?

        Why can’t they think before they label?

        To paraphrase: How much harm can be done to so many, by so few?

        TRM 123. Retired Consultant Physician.

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  15. Dear Philip, its nice to see you again.

    The drug companies sell drugs just like the junk food companies sell junk food; of course it’s Psychiatrys responsibility not to poison “patients”.

    Dr Allen Frances (et al) identified Fluphenazine Decanoate depot injection as a “killer drug” in 1983, something I am grateful for. He has spoken out against premature intervention of young people on the grounds that most of these young people will never need this. He has stated decent housing to be the one of the most important things a person needs to remain sane. I support all of these points.

    But I don’t support “Psychiatric Diagnoses” or “Chemical Solutions” – because I got better as a result of not taking my “medication” with the help of “Psychology”.

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    • Thank you for posting her name here. She was on one of the DSM committees and was so disgusted by the lack of true science informing any of the new diagnoses being proposed that she quit in protest. She said that it all depended on who yelled and screamed the loudest in the arguments that ensued and that they took votes and that’s how things made it into the DSM. Really scientific!!!!!

      Yes, she did a great number on Francis, exposing how he was paid by a drug company to promote their product. And now he has the gall to sit there as if he’s the most squeaky clean psychiatrist ever! If there is a hell there will be a special place there for psychiatrists, especially unethical, lying, dishonest psychiatrists.

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      • Someone mentioned that some of these new “diagnoses” were proposed as men washed their hands at the sink of the men’s room. And the person wasn’t kidding, they were serious. The DSM is just a pile of bull shit. Also, Paula pointed out that the committees that create new editions of the DSM are composed of white, upper class men, with very few exceptions.

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  16. I ALMOST posted a nice comment about Mr. Allen Frances, after I watched the video of him speaking to Amanpour on CNN. (I’ve heard “CNN” means “Clinton News Network”, or “Communist News Network”, but I’m not sure which is more correct.) Then i read ALL the comments before I posted my own. When I got to Auntie Psychiatry’s comment, I knew Frances’s goose was cooked. Here, Auntie Psychiatry responds to Rosalee, (above), and it’s SO IMPORTANT, that I’m gonna cut-n-paste it here:
    Auntie Psychiatry wrote:
    “Rosalee, Don’t be fooled – Allen Frances is a devious wolf in sheep’s clothing. He is the public face of guild Psychiatry, and has a powerful platform in the mainstream media which he is using to save his “profession” from sinking into the mire. This interview is a classic example. He captures the public mood of outrage at being misled about “antidepressants” whilst neatly deflecting all responsibility for the current situation away from Psychiatry. His tricks are easy to spot once you know them…

    1. Allege scarcity of data: “There’s almost no research on the withdrawal syndrome.”

    2. Bring in a bigger villain: “The pharmaceutical industry is only marginally less ruthless than the drug cartels, and it’s not in their interest to advertise this, so there’s been very, very little research.”

    3. Pass the blame on: “80% of the antidepressants are prescribed by primary care doctors.”

    4. Re-assert Psychiatry’s ultimate authority in these matters: “There’s a cruel paradox that we’re over-treating the worried well and we’re terribly neglecting the really ill…”

    5. Big-up the drugs as ‘life-saving medication’: “the medications are absolutely essential for people with severe depression.”

    In the UK, our top psychiatrists are already following his lead and spinning these very same lines to the press…

    “Professor Wendy Burn, president of the Royal College of Psychiatrists, said antidepressants are ‘a life-saver’ for many people but ‘not enough research has been done into what happens when you stop taking them’.” (Independent 2 Oct 2018)

    Journalists will buy it, and the message will filter down through blogs and social media to the public at large. Psychiatry, as always, will come up smelling of roses.”

    I myself am living proof that psychiatry is a pseudoscience, a drug racket, and a means of social control.
    I myself can NOT identify as “anti-Auntie Psychiatry”! “Anti-psychiatry”, yes.
    But Mr. Allen Frances and his ilk damn near killed me, and stole what should have been the best 20 years of my life, and caused IATROGENIC damage to the rest of it….

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  17. Yes, I agree, this article is brilliant. I was cracking up over Frances’ statements. Just in themselves, they are typical of a shrink…speaking out of both sides of his mouth. Passing the buck. Refusal to take responsibility. Setting a terrible example also. Even blaming patients…and as a physician he’s supposedly a person that patients look up to, a role model of sorts.

    If Allen Frances was my employee and I witnessed him acting like that I would reprimand him because I would want my work associates to take responsibility for their own actions. If I kept him on I would demand that he clean up his own spilt milk. Lying and claiming you’re “delegating” only gets you in hot water.

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  18. I witnessed a library cop reprimanding a young student for holding his head down appearing to be asleep at the library. I was shocked. In fact, he was not asleep. He was holding his head like that because he was watching a video on his cellular telephone and wanted to shield his phone from the bright lights. So he was hovering over the phone and looking down into it, certainly not napping. I was so appalled at this cop’s behavior (and the fact that she reprimanded me for quietly eating at the library when I was a regular patron and I was truly starving) that I plan to write to the library administration and complain. While it’s a rule you can’t eat there, I was then stuck eating outside in the cold. At that point someone mistook me for a homeless person because I was so starving after a two-hour, freezing cold bus ride. Libraries shouldn’t be run like penitentiaries. They used to be sanctuaries for people. Sad.

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