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2014 Army Law. 54 (2014)
Saving Normal: An Insider's Revolt against out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life

handle is hein.journals/armylaw2014 and id is 643 raw text is: Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life Reviewed by Lieutenant Michael E. Jones* Resiliency is built into every aspect of our biological, psychological, and social being. We are hardwired to work remarkably well, but are far too complicated always to work perfectly and we can lose purchase on normality by mislabeling as mental disorder each and every one of our glitches. ' II. Background Judge advocates are frequently involved in decision making processes that can result in the administrative discharge of personnel with mental or physical conditions not amounting to disabilities. In Saving Normal, Allen Frances, M.D., convincingly argues that experiencing unpleasant feelings or engaging in activities that have the potential to adversely impact our welfare puts well patients at risk for being diagnosed with a myriad of mental disorders as defined in the newly published Diagnostic and Statistical Manual of Mental Disorders Fifth Edition: DSM-52 (DSM- 5). An outspoken critic of the means and methods used by the DSM-5 task force and the unwholesome silent partnership between the American Psychiatric Association (APA) and pharmaceutical companies, Dr. Frances's concern for the explosive growth of medications being prescribed by physicians and psychiatrists alike is well- grounded and portends rampant diagnostic inflation for many unfounded diagnoses. Dr. Frances expertly and concisely outlines the history and development of psychiatry from Greek times to present day and then critically attacks the alarming trend over the past 60 years of moving away from the use of psychotherapy toward the prolific use of prescription drugs, many of which have the efficacy of a placebo. When choosing between administrative separation and retention in the armed forces, commanders generally lean on their judge advocates to aid them in making a determination about the propriety of separation given the complexity and sensitive nature of mental health issues. Judge advocates must, therefore, be familiar with not only the laws and regulations of the service branches, but also the emerging trend of diagnostic inflation that Dr. Frances highlights in his work. Judge Advocate, U.S. Navy. Presently assigned as Personnel Law Attorney, Office of the Judge Advocate General, Code 13, Personnel Law Branch, Washington, D.C. ' ALLEN FRANCES, SAVING NORMAL: AN INSIDER'S REVOLT AGAINST OUT-OF-CONTROL PSYCHIATRIC DIAGNOSIS, DSM-5, BIG PHARMA, AND THE MEDICALIZATION OF ORDINARY LIFE (2013). 2 AM. PSYCHIATRIC ASS'N, DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (5th ed. 2013). 3 FRANCES, supra note 1, at 97 101. Dr. Allen Frances is currently a professor emeritus at Duke University and has been in the practice of psychiatry since he graduated from medical school in 1967.4 He served as the chair of the task force that was responsible for the production of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition: DSM-IV (DSM-IV) in 1994.5 Since its first publication in 1952, the DSM has gained increasing importance in the field of psychiatry and, since the 1980s, has been considered the bible of mental health disorder diagnostics. Since 2009, Dr. Frances has been a vocal harbinger about the detrimental effects that DSM-5 is likely to have on the practice of psychiatry.6 Dr. Frances believes that direct marketing campaigns by pharmaceutical companies to the general public and the significant number of primary care physicians who diagnose patients with serious mental disorders and prescribe medications after office visits lasting only a few minutes will exacerbate diagnoses under DSM-5.7 III. Role of the Judge Advocate in Administrative Separations Judge advocates are increasingly involved in the analysis that takes place when a commander decides whether to administratively separate a member due to personality disorders and physical or mental conditions not amounting to a disability. Service branches are largely consistent in their administrative policies surrounding the requirements and procedures for separating a member due to a mental health disorder. Army Regulation (AR) 635-200' and the Naval Military Personnel Manual9 (MILPERSMAN) both 4 NORTH CAROLINA MED. BOARD, NCMB Licensee Results, http://wwwapps.ncmedboard.org/Clients/NCBOM/Public/Licenseelnformat ion/Details.aspx?& Entity ID= 31787&PublicFile=l (last visited Sept. 12, 2013). ' AM. PSYCHIATRIC Ass'N, DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, at ix (4th ed. 1994). 6 FRANCES, supra note 1, at 101 03. 7 Id. ' U.S. DEP'T OF ARMY, REG. 635-200, ACTIVE DUTY ENLISTED ADMINISTRATIVE SEPARATIONS para. 5-17 (RAR 6 Sept. 2011). 9 U.S. DEP'T OF NAVY, NAVAL MILITARY PERS. MANUAL, ENLISTED ADMINISTRATIVE SEPARATIONS sec. 1910 (13 Apr. 2005). OCTOBER 2014 - THE ARMY LAWYER - DA PAM 27-50-497 I. Introduction

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