The stigma around mental health is alive and well, and people the stigma affects are sadly too often quite the opposite. This stigma is not only perpetuated by lay people that lack education on the matter, but also by some experts in the field of psychiatry. Prominent psychiatrist Allen Frances wrote the book Saving Normal: An insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, Big Pharma, and the medicalization of ordinary life for the purpose of helping “saving normal” as well as help save psychiatry. (Frances 2013, p. 82). More specifically, his stated purpose is to, “alert people who don’t need treatment to avoid it, but equally to encourage those who do need treatment to seek it out and stick with it.” (Frances, 2013, Preface).
Dr. Frances is highly disturbed with the increase of prescriptions for psychotropic medications following the publication of the DSM-IV, for which he was the chair of the task force. He believes that pharmaceutical companies have played a major role in the increase of this course of treatment, since it financially benefits them. Dr. Frances hypothesizes that the utilization of psychotropic medications inhibits the brain’s natural resilience. He argues that most human brains are perfectly capable of adapting effectively to the rapid changes in society. Yet, he contradicts this with the statement, “Our mental discomforts can preoccupy us as much as they do only because most of us don’t have to worry about our next meal or the threat of being eaten by a passing tiger.” (Frances, 2013, p. 81). This statement reads as a strange yearning for the days when most humans existed purely in survival-mode. Dr. Frances does not address the role of inter-generational trauma and the cumulative impact that has on the mental health of those presently alive. He does not consider that present psychiatric problems can be a result of generations of people that existed in survival mode and took actions that were damaging to their children while in that survival mode. Additionally, the author fails to address the result of people that do not receive psychiatric medication and self-medicate with drugs and alcohol.
Dr. Frances presents a very negative view of human behavior in the social environment. He states, “Because veterans’ benefits require a diagnosis of PTSD, PTSD gets over diagnosed.” (Frances, 2013, p. 84). While being untrue, as veterans benefits are accessed on a spectrum of percentage of disability which can be mental or physical, this is also a damaging statement to make. Veterans are a population that is particularly at-risk for to die by suicide about a group of people. 6,261 veterans died by suicide in 2019, which, by comparison, represented 13.7% of suicides among U.S. adults. (U.S Department of Veterans Affairs Office of Mental Health and Suicide Prevention, 2021). Veterans are a population that traditionally shows low help-seeking behavior. Dr. Frances asserts, “The wasted efforts devoted to those who don’t have real disorders deprives those who do from receiving badly needed psychiatric care.” (Frances, 2013, p. 77). It is true that there is a lack of available psychiatric care, and people that need help are having to wait too long for care. A weakness to his argument is that people do not typically arrive in a psychiatrist’s office because things are going well. Are there outliers of people that are seeking psychiatric care for fraudulent reasons? Sure. Do those people need mental health attention? Probably, because I think you must have something very real going on in your life to get to that level of desperation. While that care might not come in the form of medications, a psychiatrist is in a good position to make referrals to other mental health services. I would challenge the author to consider that the issue of scarcity may not be that there are too many fraudulent patients, but too few psychiatric practitioners.
As a social worker, I like to have a good idea about the positionality of a writer, so I did some light research on the author. He is a white, middle-aged man that teaches at a private university in the southern part of the United States. Dr. Frances wrote an article in 2017 titled, “Trump Isn't Crazy. I wrote the DSM criteria and he doesn't meet them.” This book reminded me that the field of psychiatry continues to be dominated by highly privileged people. From the positionality of a wealthy white man, some of his arguments in Saving Normal make more sense. From his perspective, many people could treat things such as depression with lifestyle changes. The fundamental issue with this proposed solution is that while living in a capitalistic society, not all people have access to the lifestyle changes associated with reducing depression, such as regular exercise, eating healthy fresh foods, taking time for self-care, etc. Many people do live in modern-day survival mode and are doing the best that they can in the environment in which they have to live at this moment. Psychotropic medication can help people to continue to live, rather than die, in the environment which they have little power to change, and certainly cannot change while experiencing debilitating depression.
This book did not change my previously held views on the use of psychotropic medications. I was already aware of the mass overmedication of many children, particularly the highly vulnerable group of children that are in the custody of the foster care industrial complex, and the negative impacts. This book did change my thinking on the mental health field. While the field is moving in a positive direction of removing stigma and treating mental health as a spectrum, there are still people that are determined to reverse progress. This book has informed my practice as a clinical social worker in a few ways. The implications for me as a clinical social worker are recognizing that a large part of my practice will be validating the legitimacy of people’s struggles. From a trauma-informed perspective, it is important to know that clients may have experienced stigma from past providers, the very people that were supposed to help them. Dr. Frances aims to “save normal” and “save psychiatry”, but as a clinician I’d rather focus on helping people with problems that are very real to them.
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Important but also detrimental to those with mental health concerns
Reviewed in the United States on March 11, 2020
This book is great for the mental health/medical profession. I agree with the author on many points, especially the over prescription of drugs in the US (especially by PCP instead of psychiatrists). I think this book is a must read for people who know how to use the information for good. But it’s not for the general public!!Why? Because the target audience is mental health deniers who don’t want to accept their diagnosis. He clearly states that mental health diagnosis is the real deal, and medications can help, but the type of person who isn’t medically trained/highly educated will pick this up and use it as an excuse to deny their illness. People like my mother who has the clearest most obvious clinical case of bipolar I I have ever seen. With this book she believes her behaviors are normal and doesn’t need her life saving medication. Or the mother of an autistic child worry ADHD, who desperately needs to follow protocol and medication guidelines to ease her and her child’s suffering (the author all but denies the existence of ADHD and the “spectrum” of autism).The non medical person who needs this book is highly unlikely to pick it up. Who needs it? Any person that lost a loved one and is grieving, but has been diagnosed as “depressed” and given medication. Any person who gets nervous before speeches and their pcp prescribed them strong benzos to take daily. People who aren’t mentally ill but don’t have any knowledge of this profession so they blindly trust their doctors. That is who needs this book, but I have no faith they will ever find it.In summary: it’s a good book, and I agree with him for the most part... but it’s too easy to be used for mental health denial for me to comfortably give it 5 stars. It really should be limited to the mental health field. All Primary Care doctors and mental health workers should read.
Reviewed in the United States on March 11, 2020
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