Conversations in Critical Psychiatry: Allen Frances, MD


From Psychiatric Times: “Conversations in Critical Psychiatry is an interview series aimed to engage prominent individuals who have made meaningful criticisms of psychiatry and have offered constructive alternative perspectives to the current status quo. It is Dr Aftab’s hope that these discussions will stimulate a much-needed debate in the psychiatric community.

Awais Aftab, MD: I have always been intrigued by Dr Allen Frances’ views on psychiatric diagnosis. I was in medical school when DSM 5 was in development, and it was fascinating to see his relentless commentary on issues related to diagnostic inflation and diagnostic validity as an inside critic. His critique also served as a portal for me (and many others) to explore larger philosophical issues in psychiatric diagnosis. This made him an ideal candidate to converse with for the launch of this interview series on critical psychiatry.

In many ways, you are one of the architects of modern psychiatry, yet you have also emerged as one of its most prominent critics. How do you see your own relationship with the field?

Allen Frances, MD: I think psychiatry is among the noblest of professions, but I think that it has drifted astray from best practice. It is heartbreaking to me that 600,000 of our most severely ill patients are either in jail or homeless and that we have done so little to advocate for the community mental health centers and affordable housing that would have freed them from confinement and ended the shameless neglect.

I fear that too many psychiatrists are now reduced to pill pushing, with far too little time to really know their patients well and to apply the rounded biopsychosocial model that is absolutely essential to good care. We also have done far too little to educate the primary care doctors who prescribe 80% of psychiatric meds on the principles of cautious prescribing, proper indications, full consideration of risks, and the value of watchful waiting and tincture of time.

I despair the diagnostic inflation that results from a too loose diagnostic system, aggressive drug company marketing, careless assessment, and insurance company pressure to rush to judgement. Diagnoses should be written in pencil, and under-diagnosis is almost always safer and more accurate than over-diagnosis. And, finally, I object to the National Institute of Mental Health (NIMH) research agenda that is narrowly brain reductionistic; it has achieved great intellectual masterpieces, but so far has not yet helped a single patient. So, in sum, I have loved being a psychiatrist, but wish we were better organized to end psychiatric suffering.”

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  1. What is spin?!

    It is heartbreaking to me that 600,000 of our most severely ill patients are either in jail or homeless and that we have done so little to advocate for the community mental health centers and affordable housing that would have freed them from confinement and ended the shameless neglect.

    Uh, I’ve got it. *Waving hand*

    Seeing “mental illness” as the primary cause of homelessness and jail-time?

    Personally, I don’t think psychiatry “among the noblest of professions”, and I wish we were better organized to bring that particular form of criminal activities to an end.

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    • After 4 years on Psychiatric Drugs in the Community in Ireland I was like an Alcoholic:- “I couldn’t live with substance and couldn’t live without it”. In this state I would have been lucky to end up in jail (only that I found a route out).

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  2. This guy isn’t a critical psychiatrist. He’s a wolf in sheep’s clothing, a dyed in the wool (excuse the pun) bio psychiatrist masquerading as a critical psychiatrist. I wouldn’t trust this guy if my life depended on it. If I remember correctly he wrote something for a drug company so that their drug would be used rather than their competitors’ products. I think he got paid for it. I believe that he has very large conflict of interests all over the place.

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  3. I do agree, he does talk “out of both sides of his mouth.” But I don’t think Allen Frances is terribly honest, personally.

    For example, he says of biological psychiatry, “The credibility of this model has been destroyed as we have learned more about the unfathomable complexity of the human brain and the complete failure of genetics and neuroscience to provide useful answers about what causes psychiatric problems.”

    In reality, I think Robert Whitaker pointing out the – antidepressant and ADHD drug induced – iatrogenic etiology of the “childhood bipolar epidemic” better explains why the “credibility of this model has been destroyed.” Not to mention the complete scientific fraud of the ‘chemical imbalance’ theory.

    Then Frances goes on to say, “Schizophrenia and other severe psychiatric disorders clearly have a strong biological contribution and cause a qualitatively, as well as quantitatively, different level of suffering far beyond the everyday problems of living.”

    There is no proven biological contribution to “schizophrenia” either. But the “schizophrenia” treatments, the antipsychotics/neuroleptics, do create both the negative and positive symptoms of “schizophrenia.” The negative symptoms are created via neuroleptic induced deficit syndrome, and the positive symptoms are created via antidepressant and/or antipsychotic induced anticholinergic toxidrome.

    So both “bipolar” and “schizophrenia,” which are the “severe psychiatric disorders,” are iatrogenic illnesses – NOT “genetic” illnesses – which are created with the psychiatric drugs.

    I’d like to see Allen Frances be honest about the adverse effects of the drugs he worked so hard to push.

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  4. At Some Stage Psychiatry + General Medicine Has Given Itself The Right To Kill It’s Patients (I don’t just mean in parts of Europe in the 1930s).

    Dr Allen Frances Identified Suicide + Homicide Risk concerning the Drugs (below) in 1983:-

    I described Akathisia to Doctors at Galway, Southern Ireland in 1986 in a (ADR Warning Request Letter) concerning Depot Fluphenazine. In Response, an Inaccurate Account of me was sent over to the UK by doctors at Galway with requested ADR Warning Deliberately OMMITTED.

    Psychopath Dr Donlon Kenny from Galway even sent me a personal letter of (False) Reassurance.

    “Doctors” in the UK have kept the 1986 ADR Warning Request out of my Records while placing Full confidence in the “Doctors” from Galway.

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    • “At Some Stage Psychiatry + General Medicine Has Given Itself The Right To Kill Its Patients,” yes they have.

      “the total number of deaths caused by conventional medicine is an astounding 783,936 per year. It is now evident that the American medical system is the leading cause of death and injury in the US.”

      But apparently the majority of these deaths are caused by the psychiatric drugs.

      So we are living through our very own, modern day, unmentioned in the mainstream media, psychiatric holocaust. I wish those psychiatrists had learned holocausts were bad “in the 1930s.” Rather than repeating the worst of history over, and over, and over again.

      “The definition of insanity is doing the same thing over and over again and expecting a different result.”

      Psychiatrist: “But our atypical (new) neuroleptics are much better than our old neuroleptics.” Oops, no they’re worse. They cause extreme weight gain, diabetes, breast growth in boys, in addition to all the other known adverse effects of the old neuroleptics, like akathisia, tardive dyskinesia, psychosis, apathy, brain atrophy, etc.

      So who are actually the insane people? The psychiatrists are the insane people, and their “bible” was debunked six years ago.

      How long until our government stops allowing the inmates to run the asylums?

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