Saving Normal

Saving Normal by Allen Frances is an exploration of the major diagnostic inflation currently occurring in the field of psychiatry. Frances, a prominent and accomplished psychiatrist, is best known for being chair on the task force in the production of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), often considered the “bible of psychiatry”. Being an insider, Frances has extensive knowledge of the causes of diagnostic inflation and exactly how the psychiatry field has faced difficulties. In Saving Normal, Frances delves into the history of diagnosis, presents the negative effects of its increase, and considers solutions to this rapid rise. Asserting that the the increase in diagnosis is out of control,

Frances intends to improve psychiatry by bringing attention to the negative effects of diagnostic inflation and encouraging new guidelines to focus psychiatric treatment on those who legitimately need it. Frances is ultimately successful in his attempt to bring awareness to this issue while developing a sound argument that there are many negative effects of diagnostic inflation.
Before diving too deeply into the details of recent diagnostic inflation, Frances explores the history of diagnosis in attempt to reveal the root of the problem and provide evidence that there is a problem.

He explains that following World War II, psychiatric care finally took off, yet diagnoses were “a quiet and insignificant backwater completely ignored” (61). This is powerful passage because it shows shows how mental problems were successfully treated without a diagnosis. Frances’ intent is to focus psychiatric treatment on those who need it. By only treating symptoms rather than a diagnosis, only those who actually require treatment will receive it. It wasn’t until the late 1970s when the third edition of the DSM (DSM-III) started being created. A group of psychiatric experts hashed out the details of the manual through plenty of arguing and little consensus. Frances writes how “there seemed no way of choosing among their various suggestions,” and because of the haphazard way it was created, the DSM-III ignored the context of many symptoms and made minor conditions into mental disorders (64). This evidence is very effective in Frances’ argument. By exposing the DSM-III, one of the main factors behind modern diagnosis, as poorly developed and justified, he leads the reader to question the validity of the current system. Frances’ inclusion of a light but comprehensive history of psychiatry is an example of his effective style: namely, writing a book that an

ordinary person could understand and enjoy even though his thesis is directed at those within the psychiatric field.
Next, Frances starts an in-depth look at how diagnostic inflation is having negative effects.

Before he begins, however, he immediately explains the counter argument, that today’s society is more stressful than the ever, leading to more people developing mental disorders. He approaches this argument with logic and writes that among the many “who have ever walked this earth, we are undoubtedly the luckiest (81). He elaborates that while there are day to day pressures, we rarely have to worry about predators or our next meal (81). This argument is rather effective in reasoning, considering there are few if any scientific studies that can compare modern levels of stress to ancient ones. Next, Frances provides his main evidence for the harm of diagnostic inflation through a series of examples. The most effective example he uses is how the most recent DSM made temper tantrums a mental disorder (disruptive mood dysregulation disorder), which has lead dangerous antipsychotics to be prescribed to children as young as two (177). He poses that there is an “ambition to label as mental disorder every inconvenient or distressing aspect of childhood” (177). This example is especially effective because reveals the absurdity of modern diagnoses and may strikes a chord with parents worried about the safety of their children. Later on, Frances includes series of stories, each detailing an instance where overdiagnosis had negative effects. One of these is the story of Todd, a boy who at

age two was diagnosed with autism, “the fad diagnosis of the day” due to speaking difficulties (248). Over time, it became clear that he was not autistic, but the effects lingered. Even those who know Todd’s situation “talk down” to him and people make constant assumptions about him (250). This example is especially effective. First, it provides an example of the harm of giving out diagnoses without more examination. It also inclines the reader to relate to Todd and feel sorry for those who have been put in poor situations due to overdiagnosis. Frances finishes his book with a plea to save psychiatry by reversing diagnostic inflation which reminds the reader the relevance of his writing and clearly asserts his purpose in his message (282).
Saving Normal is tremendously unique and effective piece of writing. Allen Frances, a man near the pinnacle of his field, explains any complex aspects of psychiatry in a way that anyone can understand and appreciate. Doing so, he has greatly expanded the support for reforming psychiatry to solve diagnostic inflation, enabling the ordinary person to share his worries of diagnostic inflation by creating a relatively simple yet thoroughly interesting work. Frances’ thesis is very similar to my own. I will supplement my own work with statistics and examples from his book.