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Saving Normal 
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Post Saving Normal
I thought I might make a few posts on a book I've started to read, if anyone might be interested. It's called Saving Normal: An insider's revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma, and the medicalization of ordinary life., by Allen Frances, M.D. At the heart of the controversy is the definition of normal. The problem is that there is no definition, really. Neither philosophy nor science nor medicine have been helpful in providing one. What has happened in the mental health field, the author says, is that in a nexus of influence and money, normal has been progressively redefined as sick. Frances was himself the lead psychiatrist on the DSM-IV project (which leads me to ask: why the change from Roman to Arabic numerals?). He now regrets any role he might have had in liberalizing several diagnoses so that more people can be declared ill. The new manual, DSM-5, continues this harmful trend, he believes, and so he has decided to turn against friends and colleagues by lobbying the American Psychiatric Association (publisher of the DSM) and by writing this book.

The following are commonly known facts, but I still become amazed by the human brain, "by far the most complicated thing in the known universe. The human brain has 100 billion neurons, each of which is connected to 1,000 other neurons, making for a grand total of 100 trillion synaptic connections. Every second, an average of 1,000 signals cross each of these synapses; each signal is modulated by 1,500 proteins and mediated by one or more of dozens of neurotransmitters. Brain development is even more improbable--a miracle of intricately choreographed sequential nerve cell migration. Each nerve has to somehow find just the right spot and make just the right connections. Given all the many steps involved and all the possible things that can go wrong, you might want to place your bet on Murphy's Law and chaos theory--the odds appear to be stacked against normal brain functioning" (p. 10).

Despite what we've come to know about the brain (probably relatively little), science has not made it possible to determine the physical constituents of either "normal" brains or of brains that could be diseased. This gap in knowledge has let in tremendous subjectivity and seeming arbitrariness in the classification of mental functioning. The result has been a burgeoning in the number of mental states, behaviors, and personality types that are considered needing of medical (i.e., psychiatric) treatment.



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Saffron
Wed May 22, 2013 7:12 am
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Post Re: Saving Normal
Give a man a hammer, and he will be surprised at how many nails there now seem to be scattered about the landscape, if I can paraphrase an old saying.
Maybe researchers get too rapped up in their fields, and see psychological process anywhere and everywhere. I'm not sure this is so harmful though, at least not if discretion is applied. Can't comment all that much, as I haven't seen the DSM 5, but much of this can be a matter of degree, can it not? ADD, for example, may be a relatively new category, and one that has seen large scale mis-diagnosis, but there are most definitely sufferers, individuals whose life would be hell without drugs.


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Wed May 22, 2013 12:27 pm
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Post Re: Saving Normal
etudiant wrote:
Give a man a hammer, and he will be surprised at how many nails there now seem to be scattered about the landscape, if I can paraphrase an old saying.
Maybe researchers get too rapped up in their fields, and see psychological process anywhere and everywhere. I'm not sure this is so harmful though, at least not if discretion is applied. Can't comment all that much, as I haven't seen the DSM 5, but much of this can be a matter of degree, can it not? ADD, for example, may be a relatively new category, and one that has seen large scale mis-diagnosis, but there are most definitely sufferers, individuals whose life would be hell without drugs.


Frances says that one of his biggest fears in writing the book is that his message will be construed as anti-psychiatry and anti-medication. Already Scientology has cited his work! He still believes that psychiatry helps people, although those who need it the least tend to get too much of it, and those who must have it for health tend not to get not much. Drugs also help a lot of people, as you say.



Wed May 22, 2013 10:13 pm
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Post Re: Saving Normal
Does not have a definition? Then how can it be redefined? My ears perked up on that one. LOL!



Thu May 23, 2013 5:55 am
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Post Re: Saving Normal
I've always thought that as our society grows more complex, there are a larger percentage of people who find it difficult to negotiate. Certainly our youngsters who are diagnosed with ADHD because they can't sit still and focus for hours on end are now medicated as a means to keep them in line. Teachers don't want to have to deal with unruly kids as they may seem compared to those who can pay attention and do well academically. But there was a time when these ADHDers did well in society that valued physical prowess and action more than it does today.

Anyway, I'm biased about this issue. My youngest son was diagnosed with ADHD, a process initiated by his school. I have an idea. Give the kids more recesses and dispense with homework, so kids can be kids and run and play and throw the ball to each other.

I have another thought. That I'm normal and my son is normal. It's the rest of them who are abbie normals.


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Post Re: Saving Normal
I can certainly feel empathy for your situation geo, and I think this is something that happens a lot. There are a raft of medications available today, and so also a huge temptation to choose one, and have a quick fix.

That said, I think there is another end of the spectrum, where these medications really make a difference. I've seen folks that would spend their time bouncing off the walls without some sort of intervention. For them, medication is not ideal, but the only real way to have a reasonable life. And there are many that know this, and are grateful for it. Why this sort of diagnosis is more common today, I don't know. Perhaps something has changed in our culture, environment, or our evolution. Or perhaps we had the same in yesteryear, but such individuals were just bunged into the army, or other institution, or just clubbed into submission. I think in the past, many individuals would have been written off as weird, odd, or willfully distasteful, and that would have been that. Today there is more of an attempt at definition, imperfect as that might be.


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Thu May 23, 2013 6:41 pm
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Post Re: Saving Normal
ADHD is one diagnosis that that has become much more commonly assigned, especially to boys (at more than twice the rate of girls). Another is autism, including Asperger's. No doubt the causes of the increase are complex. It would be interesting to compare the diagnosing of mental illness or syndromes to the diagnosing of physical disease (not that the two are totally separate, since mental illness is also physical). There are also medical diagnoses that increase in prevalence, of course. The reasons can be varied, ranging from introduction of new germs into the human population (AIDS and Lyme Disease), to better means of detecting that the disease is present (prostate cancer), to possible social causes (which may account for some of the increase in celiac disease). So for mental disorders as well, we might have different causes of increase for different diseases. Then there is the opposite situation, diagnoses having decreased or become extinct. This is likely to happen as a result of scientific progress, and probably here the medical diseases that have replaced the old ones or been added to the menu are likely to be regarded as "real,' that is based on solid science. New or expanding mental diagnoses may be more suspect because the data is just not as solid as for diseases of physical systems. That's been the dilemma for psychiatry, and it's why a condition exists that is scientifically scandalous: psychiatry is sometimes called an art as well as a science.



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Thu May 23, 2013 7:36 pm
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Post Re: Saving Normal
geo wrote:
I've always thought that as our society grows more complex, there are a larger percentage of people who find it difficult to negotiate. Certainly our youngsters who are diagnosed with ADHD because they can't sit still and focus for hours on end are now medicated as a means to keep them in line. Teachers don't want to have to deal with unruly kids as they may seem compared to those who can pay attention and do well academically. But there was a time when these ADHDers did well in society that valued physical prowess and action more than it does today.

Anyway, I'm biased about this issue. My youngest son was diagnosed with ADHD, a process initiated by his school. I have an idea. Give the kids more recesses and dispense with homework, so kids can be kids and run and play and throw the ball to each other.

I have another thought. That I'm normal and my son is normal. It's the rest of them who are abbie normals.

geo, what Frances says about the bulge in ADHD diagnoses might interest you. When he and his team revamped the criteria for diagnosing ADHD in the early 1990s and put these in DSM-IV, they estimated that a fairly modest 15% more people would be diagnosed. Apparently the feeling was that children who had symptoms causing them distress weren't getting help under the old guidelines. In 1997, drug companies came out with new and expensive medications for ADD and "were simultaneously set free to advertise them directly to parents and teachers. Soon the selling of ADHD as a diagnosis was ubiquitous in magazines, on your TV screen, and in pediatricians' offices--an unexpected epidemic was born, and the rates of ADHD tripled."

The ADHD boom exemplifies Frances' main topic in the book, which is the "medicalization of ordinary life." One might defend this trend as an attempt to be helpful to more people, but Frances has become something of an apostate within his profession and sees a dark and harmful side to it.



Sat May 25, 2013 7:06 am
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