Download the free Kindle app and start reading Kindle books instantly on your smartphone, tablet, or computer - no Kindle device required.
Read instantly on your browser with Kindle for Web.
Using your mobile phone camera - scan the code below and download the Kindle app.
Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life Hardcover – May 14, 2013
International Bestseller • "An extraordinarily important book." —Marcia Angell, Harvard Medical School
A deeply fascinating and urgently important critique of the widespread medicalization of normality, by "one of the world's most prominent psychiatrists" (The Atlantic)
Anyone living a full, rich life experiences ups and downs, stresses, disappointments, sorrows, and setbacks. Today, however, millions of people who are really no more than "worried well" are being diagnosed as having a mental disorder and receiving unnecessary treatment. In Saving Normal, Allen Frances, one of the world's most influential psychiatrists, explains why stigmatizing a healthy person as mentally ill leads to unnecessary, harmful medications, the narrowing of horizons, the misallocation of medical resources, and the draining of the budgets of families and the nation. We also shift responsibility for our mental well-being away from our own naturally resilient brains and into the hands of "Big Pharma," who are reaping multi-billion-dollar profits. Frances cautions that the newest edition of the "bible of psychiatry," the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), is turning our current diagnostic inflation into hyperinflation by converting millions of "normal" people into "mental patients." Saving Normal is a call to all of us to reclaim the full measure of our humanity.
- Print length336 pages
- LanguageEnglish
- PublisherMariner Books
- Publication dateMay 14, 2013
- Dimensions6 x 1.09 x 9 inches
- ISBN-100062229257
- ISBN-13978-0062229250
Customers who bought this item also bought
The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive DisorderHardcover$20.15 shippingGet it as soon as Monday, Apr 15Only 1 left in stock - order soon.
The Myth of Mental Illness: Foundations of a Theory of Personal ConductThomas S. SzaszPaperback$15.53 shipping
The Book of Woe: The DSM and the Unmaking of PsychiatryHardcover$17.20 shippingGet it as soon as Tuesday, Apr 23Only 1 left in stock - order soon.
Clinical Assessment and Diagnosis in Social Work PracticeJacqueline CorcoranHardcover$17.97 shipping
Customer reviews
Customer Reviews, including Product Star Ratings help customers to learn more about the product and decide whether it is the right product for them.
To calculate the overall star rating and percentage breakdown by star, we don’t use a simple average. Instead, our system considers things like how recent a review is and if the reviewer bought the item on Amazon. It also analyzed reviews to verify trustworthiness.
Learn more how customers reviews work on AmazonReviews with images
-
Top reviews
Top reviews from the United States
There was a problem filtering reviews right now. Please try again later.
This country spends more on prescription medicine than any other country. Direct to consumer TV ads are out of control. Showing only how wonderful you will feel after you take their drug while the rapid voice over gives non-stop difficult to grasp and even more difficult for any non-medical person to understand side effects of these drugs. We take something as simple as shyness and turn it into mental illness.
Dr. Allen reports:
"We should not be making patients of people who are basically normal and ignoring those who are really sick. Psychiatry is certainly not alone in its overreaching—we are just a special case of the bloat and waste that characterize all of U.S. medicine. Commercial interests have hijacked the medical enterprise, putting profit before patients and creating a feeding frenzy of overdiagnosis, overtesting, and overtreatment. We spend twice as much on health care as other countries and have only mediocre outcomes to show for it. Some of our citizens are harmed by too much medical care, others by shameful neglect. Medicine and psychiatry both stand greatly in need of taming, pruning, reformulation, and redirection."
Frances, Allen. Saving Normal . William Morrow. Kindle Edition.
We are lead to believe by the D to C commercials that if we are tired, grieving or worried about some situation we find ourselves in, that we may be mentally ill and in need of medications...lots of medication. One commercial lately touts a medication as an "add on" for your depression medication!! They talk about "If your depression still doesn't go away after being on medication, you should ask your doctor about adding XXXXX." OMG! How much medication can we take? Should we take? We've run amok of medication as the answer to all life's problems!!! Some times life just sucks! Sometimes we just have to bear up under difficult circumstances. We are resilient creatures! We need to give ourselves credit and understanding that we will come out of whatever our condition is at the moment. Everything today must be fast! Fast download speed, fast food, fast result, etc.
As Dr. Allen says in this book we need to treat those people who are actually mentally ill and allow those who are not to work out their issues with a shoulder to lean on, someone to talk to and with empathy. We should not rush to find the right freaking pill!
"Real psychiatric disorders require prompt diagnosis and active treatment—they don’t get better by themselves and become harder to treat the longer they are allowed to persist. In contrast, the unavoidable everyday problems of life are best resolved through our natural resilience and the healing powers of time. We are a tough species, the successful survivors of ten thousand generations of resourceful ancestors who had to make their precarious daily living and avoid ever-present dangers far beyond our coddled imagining. Our brains and our social structures are adapted to deal with the toughest of circumstances—we are fully capable of finding solutions to most of life’s troubles without medical meddling, which often muddles the situation and makes it worse. As we drift ever more toward the wholesale medicalization of normality, we lose touch with our strong self-healing capacities—forgetting that most problems are not sickness and that only rarely is popping a pill the best solution."
Frances, Allen. Saving Normal . William Morrow. Kindle Edition.
I love the section on ADHD!! OMGosh we over-medicate children because they are full of energy and we demand they sit still.
Dr. Frances: "ADHD is spreading like wildfire. It used to be confined to a small percentage of kids who had clear-cut problems that started at a very early age and caused them unmistakable difficulties in many situations. Then all manner of classroom disruption was medicalized and ADHD was applied so promiscuously that an amazing 10 percent of kids now qualify. Every classroom now has at least one or two kids on medication. And increasingly, ADHD is becoming an explain-all for all sorts of performance problems in adults as well. How could this possibly happen? There were six contributors: wording changes in DSM-IV; heavy drug company marketing to doctors and advertising to the general public; extensive media coverage; pressure from harried parents and teachers to control unruly children; extra time given on tests and extra school services for those with an ADHD diagnosis; and finally, the widespread misuse of prescription stimulants for general performance enhancement and recreation. The most obvious explanation is by far the least likely—that the real prevalence of attentional and hyperactivity problems has actually increased. There is no reason to think the kids have changed, it is just that the labels have. We now diagnose as mental disorder attentional and behavioral problems that used to be seen as part of life and of normal individual variation. The most convincing evidence of this comes from a large study with a particularly disturbing finding. A child’s date of birth was a very powerful predictor of whether or not he would get the diagnosis of ADHD. Boys born in January were at 70 percent higher risk than those born in December simply because January 1 was the cutoff for grade assignment. The youngest, least developmentally mature kids in the class are much more likely to get the ADHD diagnosis. The birthday effect was almost as influential in girls. We have turned being immature because of being young into a disease to be treated with a pill.3,4,5"
Frances, Allen. Saving Normal (p. 142). William Morrow. Kindle Edition.
Frances, Allen. Saving Normal (pp. 141-142). William Morrow. Kindle Edition.
I HIGHLY RECOMMEND THIS BOOK!
Quite generally, Dr. Frances notes that “we have not figured out ways of translating basic science into clinical psychiatry...The expectation that there would be a simple...neurotransmitter...explanation for any mental disorder turned out to be naive and illusory” (p. 10). Accordingly, it would have been desirable for the book to include some ample treatment of neuronal/synaptic intricacy to drive home how severe the lack of requisite knowledge is regarding mainline psychiatric prescription drugs. A sound relevant scientific basis for configuring and administering psychiatric drugs simply does not exist.
The essence of this major deficiency might have been explained as follows: the few neurotransmitters that are mimicked by many of these drugs are but an exceedingly small number of the agents active in various synapses throughout the human body. And synapses typically contain a wide assortment of different neurotransmitters coincidentally active. Consequently, the intricacy of the myriad of ongoing interactions within any given synapse is essentially unfathomable now, even at the leading edge of neuronal research. Only the coarsest of neurotransmitter effects are known, and then only on a poorly controlled and grossly observed basis. See Valenstein’s “The War of the Soups and the Sparks” for an accessible account of how formidable and obscure these synaptic operations remain. In consequence, the extant knowledge of synaptic interactions provides no adequate scientific foundation upon which to configure and administer psychiatric drugs.
Moreover, on page 173 Dr. Frances offers a more general and truly alarming assessment that implicitly encompasses the foregoing neurotransmitter commentary. Rather bluntly, he asserts that “Psychiatry’s research revolution is...in a deep rut when it comes to progress in clinical diagnosis and treatment. There has been no real advance in diagnosis since...1980, and no real advance in treatment since the early 1990s.” Alas, this contention does not receive a focused or coherent elaboration anywhere in the book. It would seem though that this appraisal accords with the continuing poor scientific basis for commonly prescribed psychiatric drugs. The book should have dealt with this matter head-on. Also, his assessment above would seem to prompt consideration of other crucial issues. What is being taught in medical schools? What impact does curriculum have on the psychiatric practices that he disparages? After all, “Eighty per cent of prescriptions are written by primary-care physicians” (p. xv).
The evident overtreatment of purported psychiatric disorders (as listed in the latest Diagnostic and Statistical Manual, or DSM) effectively results in the medication of many essentially normal patients who are victims of intentionally False Positive diagnostic criteria and thresholds. Note the book’s commentary on “DSM-5's highly subjective and catch-all criteria” (p. 195). Such cases of unwarranted prescriptions dilute treatment of needful patients, and yield side effects among the False Positive ones. Those side effects prominently include increased propensity for obesity, diabetes, and heart disease. Throughout the book, the author states that the DSM’s disorder categories in many cases effectively prescribe/trigger “epidemics” as practicing physicians adopt its incipient new “fads” in diagnosis and medications. Moreover, such diagnostic inflation spans all DSM disorders, so that now about one in five adults in the US is taking some kind of psychiatric drug (p. xiv). Much to Dr. Frances’ credit, he recommends a six-step diagnostic protocol (p. 222) to reduce this treatment binge, while better serving the truly needful.
Another driver of diagnostic inflation obtains from government or insurance benefits requirements. Specifically, a diagnosis is typically required to ensure benefits, and hence of the physician’s being paid. Hence they are motivated to up-diagnose to safeguard their remuneration. The author notes for example that veterans’ post-traumatic stress disorder (PTSD) is over-diagnosed for that reason, while some ailing veterans opt to tough it out and live with untreated afflictions. Hence, PTSD is both highly overdiagnosed and undiagnosed (pp. 85, 157 & 159). In part for such reasons, it is not surprising that “Since 2005 there has been a remarkable eightfold increase in psychiatric prescriptions among our active duty troops...and hundreds die every year from accidental overdoses.” (p. xv). In the context of side effects, I wish that Dr. Frances had explored the possible correlation between high suicide rates among service personnel and their pervasive use of prescribed psychiatric drugs. Note how often the drug advertisements on TV issue warnings about suicidal feelings that may accompany the taking of certain drugs. Surely, there must be some study of that nature, albeit one perhaps deliberately kept from the American public.
Finally, the book closes with recommendations to remediate the excessive or unwarranted prescription of psychiatric drugs. Background for these recommendations is well developed in the book, with the note that the various influences/contributors regarding diagnostic inflation tend to work in concert. Of course, the large pharmaceutical firms (Big Pharma) dominate the drug promotion coalition. Moreover, these factions have no significant organized opposition. The following synopsis of recommendations is in part taken from pages 210-211:
1. Curtail Big Pharma’s direct-to-consumer advertising
2. Eliminate Big Pharma’s subsidies to professional organizations & personnel
3. Eliminate Big Pharma’s sponsorship of consumer advocacy groups
4. Relax VA and health insurance diagnosis stipulations to qualify for benefits/coverage
5. Prohibit the political, regulatory & bureaucratic personnel from migrating to the pharmaceutical firms with which they have had dealings until at least three years lapses.
In sum, the message of this book is of first importance, but in my view at least, the focus and impact are diluted by repetition (e.g., virtually the same descriptive pattern/content for each disorder addressed) and extranea (e.g., marginal value of anecdotal case histories), as well as by incompleteness (coverage lacking on pivotal topics as noted above). The writing per se is alright, but I nevertheless found the book wearisome to continue reading. Still, I am glad that I did, as I am very thankful for the “Insider’s Revolt”.
Top reviews from other countries
Also valuable is the lesson regarding the relationship between big corporations and big government. When incentives for those organizations are aligned, the general population tends to suffer. Regulation might help but the solution to this kinds of problems lies within a profound change in our collective relationship with "authority".
This book is one of the best defences for authentic human diversity and a warning against a pseudoscientific-backed totalitarianism. It is an inspiring read for saving normal en keeping sanity at this times of widespread medicalization of everyday life.
For those who work in the area of counseling, therapy and psychiatric care: You may feel that finally some old shrink jumped out of his bath tub yelling "Eureka! Eureka!" and in true Archimedes style starts to solve the troubles people have puzzled over for a long time. In a way, yes, I think this is how this book may be read (although I don't think it is what the author really thought). It stresses, once more, that the border between healthy and sick in psychiatric diagnosis is fluid. It stresses that we should go back to the good old days of actually talking to our clients or patients before diagnosing them.
I call this book a wake up call. A wake up call for all those dedicated to helping people and moving away from treating patients. We know so very, very little about the "chemistry" involved in mental health issues, we should stop treating patients and start helping people. Maybe this book will raise just a few more to stand up to their believes. Because - let's be frank - those who don't want that will call Allen Frances a geriatric wacko who needs a new source of income. Or something along those lines anyway. And will fail to see that there is truth in this book.
This is not an anti-psychiatry book. Not a book condemning all of psychiatry but asking the discipline of psychiatry to step back and reflect on how they are doing their work.
Some of the criticisms are not applicable to the situation in Germany. For example: there is no direct advertising to patients of psychoactive drugs. Nevertheless, more than the author himself seems to think actually applies to this system just as much as to the one he is referring to.



