Getting Back to Normal

We have become a pill popping society. It makes absolutely no sense that twenty percent of our population regularly uses a psychotropic medicine and that the United States has more deaths each year from overdose with prescription drugs than from street drugs.

The causes of excessive medication use are numerous- the diagnostic system is too loose; some doctors are trigger happy in their prescribing habits; the drug companies have sold a misleading bill of goods that all life’s problems are mental disorders requiring a pill solution; and the insurance companies make the mistake of encouraging quick diagnosis on the first visit.

My purpose here is to advise individuals on how best to deal with the risks of overdiagnosis and overtreatment.

Elsewhere I have suggested the things government needs to do. A diagnosis, if accurate, can be the turning point to a much better life. A diagnosis, if inaccurate, can haunt you (perhaps for life) with unnecessary treatments and stigma.

Spend at least as much effort ensuring you have the right diagnosis as you would in buying a house. Become a fully informed consumer, ask lots of questions, and expect clear and convincing answers from any clinician who offers a diagnosis and recommends a treatment. If the diagnosis doesn’t seem to fit, get second or third opinions.

Never accept medication after receiving only a brief diagnostic evaluation, especially if it has been done by a primary care physician who may not be expert in psychiatry and may be too influenced by drug salesmen.

Don’t believe drug company advertisements that end with, ‘Ask your doctor.’ Drug companies profit if they can convince you that you have a psychiatric disorder and need medication. They portray the expectable problems of everyday life as mental illnesses due to a chemical imbalance because this sells pills and makes money- not to help you.

There is a strange paradox in our country. Perhaps half the people taking psychiatric medicines don’t need them, while more than half the people who do need them are not taking them. Symptoms that are severe and persistent should be an immediate call to diagnosis and treatment. Symptoms that are mild and in reaction to a life stress will usually go away on their own.

People visit the clinician on what may be one of the worst days of their lives. Time, resilience, support and changing circumstances often result in dramatic improvement, without the need for diagnosis or treatment. But if you immediately start medication and later feel better, you will likely think the pill did the trick and continue taking it even if it was just along for the ride and isn’t really necessary.

So, watchful waiting beats diagnosis and treatment for mild symptoms’ while immediate diagnosis and active treatment is required for severe symptoms.

How do you decide where you fit? If symptoms are new, in reaction to real problems in your life, and don’t interfere with your functioning, give time a chance. But get help fast if the symptoms are markedly distressing, prolonged, incapacitating, or dangerous.

Study up so that you can have an informed opinion, but don’t make these judgments all alone. Get the advice of clinicians and family. And a decision about treatment, made either way, is not once and for all. You can always start treatment later or decide to stop it as more information becomes available or if conditions change.

If you are on medicine already, don’t ever try to stop it on your own- because you may really need it and also because many medicines cause withdrawal symptoms when stopped abruptly.

The decision to end a treatment is as important as the one to start it. Get help with both- but also always be an engaged and informed consumer.

Allen Frances is Professor Emeritus at Duke University and former Chair of its Department of Psychiatry. He was Chair of the DSM IV Task Force. He is also the author of the recently published, Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life.

9 replies »

  1. Mr. Allen Frances,
    You could make a query. It’s for a friend who needs help. Could you let me mail above. Thank you in advance.

    P.D. I am Spanish. E-mail me, please

  2. Isn’t it also possible, Allen, that you graduated from medical school about a half-century ago and perhaps you are a tiny bit behind in understanding the science?

    Your rantings about ADHD indicate that this is about much more than any sincere feelings about “accurate diagnosis” and “direct to consumer” advertising.

    You stigmatize a disorder that is the first thing to make sense in millions of people’s lives. The before and after stories of their treatment are absolutely inspiring. Yet, you would be happiest if people with ADHD never knew they had it — and needlessly suffered from its potential adverse effects.

    Where does that place you in the DSM?

  3. So You are saying that primary care physicians are more prompt to give medcati ons tha n a psychiatrist? And they are more influenced for farmacy industry than the specialist? No way!

  4. I second the comment on too broad. With MS, people want to carefully consider medication options, but not take too much of a “wait and see” approach, because many of the medications are to slow the course of the disease.

  5. The workplace wellness industry hasnt gotten this memo. They operate in a time warp in which the point is to test and screen and diagnose as many people as possible, and send as many people to get “preventive” doctor visits as possible.

  6. “Never accept medication after receiving only a brief diagnostic evaluation, especially if it has been done by a primary care physician who may not be expert in psychiatry and may be too influenced by drug salesmen.”

    I second your concerns.

    HOWEVER this statement is WAY too broad. There are some cases when medication is appropriate, as I assume you’ll agree. If taken literally – your advice could do almost as much harm as good …

    By all means lets do a rethink, but ‘cmon

  7. Of course if we were rationale enough to follow this advice we wouldn’t be seeing a doctor in the first place, now would we?