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

The purpose and approach of this book is given elegantly at the very end of this almost-300 page long book: “Normal is very much worth saving. So is psychiatry (283).” Earlier in the book, the author states that this book is “part mea culpa, part j’accuse, part cri de couer (xviii),” and so it is. In between these two statements is a book that is both deeply informed about the pressures that face mental health efforts, the corrupting influence of big pharma (and just about everyone, it seems, hates big pharma [1]), and the dangerous assault to the very concept of normal by a combination of worried people who want to medicate the ups and downs from life and those who stand to profit from this worry. The fact that the author himself was in charge of the DSM-IV project, and had mistakenly believed that it would help limit the spread of diagnostic inflation, wherein healthy people were labeled as sick in order to increase profits and pander to the worries of contemporary life and enable passivity, makes this book even more intriguing as a read.

The insider knowledge of this book, of the inertia of bureaucratic guild politics, of the fatal conflicts of interests of so many doctors and professional societies, of the importance of the media in mobilizing public opinion, which has often been a two-edged sword, and many more areas are discovered. Perhaps the most chilling aspects of the book are where the author discusses his own faults, whether they be his absent-mindedness and gluttony or his mistakes as a clinical psychiatrist, which he looks back on with obvious regret. The author is candid and honest, and is definitely a sympathetic narrator of his profession and its current crisis, even as he points to its value in helping those in need. He also discusses some rather chilling made-up disorders that narrowly missed inclusion in the official DSM, including “hebephilia” [2], and how such diagnoses would dramatically inflate the number of people who are considered mentally ill. This is a clear problem, as there is a marked tendency to wish to take away the choice of people through labeling proclivities and behaviors as mental disorders and not choices, to remove responsibility from restraining oneself if one’s desires are blameworthy. Most of us, and the author explicitly agrees, would rather be considered bad than mad, for at least we would own our choices and how we responded to the conditions of our lives, with the hope that we act in restraint for the well-being of ourselves and those around us.

This books speaks with great passion and compassion on several interrelated balances. For one, it seeks for normal people to take greater responsibility to avoid bogus diagnoses that create stigma and limit life and provide potentially lethal side effects through the abuse of medicines for nonexistent conditions. But on the other hand, it also urges compassion and care for those who do struggle from serious mental illness and who, for a variety of reasons, may not get the help they need. Indeed, the misuse of scarce resources in mental health for those who are well often makes it more difficult to help those who really do need help the most. This book is full of stories of people on both sides–those whose issues are debilitating, even crippling, and who need intervention, and those who can bounce back with a bit of time and the encouragement of friends and family. Indeed, it is time and observation that help us best to draw the line between those who are sick and need care and those who are well and merely need the compassion that serves us all well. If this book encourages compassion on those who suffer deeply from real mental anguish, self-responsibility for people to be critical about fad diagnoses and legal pill pushers, and righteous indignation to those who exploit others through chemistry and marketing, it will have done a very good job indeed.

[1] See, for example:

https://edgeinducedcohesion.wordpress.com/2015/01/01/book-review-big-pharma/

https://edgeinducedcohesion.wordpress.com/2014/12/31/book-review-bad-science/

[2] The sexual preference for underage teenagers.