You’ve been one of the most outspoken critics of DSM-5, but your ultimate target is really something you call diagnostic inflation. What’s diagnostic inflation, and why should we all be concerned about it?
Allen Frances: Putting aside all the problems with DSM-5, the simple fact is that psychiatric diagnosis has become way too loose. Today, 25 percent of Americans meet the criteria for a diagnosis in any given year. Twenty percent of us take psychotropic medication; that’s one in five people. We now have more deaths in emergency rooms from prescription drugs than from street drugs. Pill popping is rampant, along with all the unnecessary side effects of drugs. The new DSM will just make this worse.
How did psychiatry get itself into that situation?
Frances: Obviously there are any number of causes, but a key turning point goes back over 30 years to the enormous popularity of DSM-III. Before that, psychiatric diagnosis was fairly irrelevant, but once DSM-III became such a bestseller year after year, it attained tremendous influence beyond the therapy room, affecting decisions regarding school placements, disability decisions, courtroom verdicts, who could adopt a child, even who could fly a plane. All sorts of things in society are now determined by diagnosis.
A second major factor was the rise of Prozac in the 1980s and the tremendous…