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


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