Allen frances a member of the leadership and the former chair of psychiatry it currently lives in san diego california. He will talk about his latest book is the heaviest of the three. Titled saving normal among many issues tackled the underscores the politics in diagnosis. Please ball club allen frances. [applause] i am very worried about the Current Situation in america and only slightly hopeful of the future prognosis we have become a pill popping society in the wrong people are getting the pills those suits should not be taking the pills are statistics are astounding 20 of the population take the psychiatric medication to . Antidepressant is 11 percent in women over 40 with 25 percent take the antidepressant. 4 of the teenagers are taking stimulants and antidepressant the antipsychotics of class that should be restricted to a small percentage of the population is one of the biggest revenue producing drugs in america with 18 billion per year being used for all sorts of things. Antidepressants, told billion, the completely useless drug xanax is one of the most prescribed in america. We have 7 percent of the population a dip addicted to prescription drugs and it has become a bigger cause of overdose and death. More people die from overdose for prescription drugs they and cartel drugs. People take many turns in Nursing Homes as is common for people to be on antipsychotic drugs that shorten Life Expectancy of the Drug Companies have moved away from the saturated market of adults now they have overwhelmed the childrens market and the last three epidemics of psychiatry was kids att childhood bipolar disorder. How to be get to this point . Part of the problem is diagnostics. I am responsible for some of it that happened on my watch it was complete the relevant and tell 1980 then with three to dream interpretation was the topic of chatter because the diagnosis diagnosis was so clear out there talk about their wife their brother diagnosis it was a popular topic. Even though very expensive books dsm are best sellers hundreds of thousands of books sold a lot of lawyers by a lot of sore the people this is good of the diagnostic system is used well or if it is used for the. 80 percent of the diagnosis and medication is being done by primary car primarycare doctors. 90 80 for a antidepressants, the 60 to balance and 50 percent today psychotic not by psychiatrist the primarycare doctors little trading usually seven minutes with a patient a psychiatric diagnosis is a crucial moment in a persons life if done well if it could lead to a much better life but if poorly it could hurt. You dont want to give a psychiatric diagnosis and medication treatment after seven minutes. We should take this as seriously as buying a house or getting married it is not done with care. Of the illusion was created the coz dsm is simple to read so the illusion is it is simple to read or use so it did not require clinical judgment all Mental Illness was a chemical imbalance. The Drug Companies latched onto this, they tapped into a power that is unique to address to advertise directly to consumers the internet, the magazines. Selling the psychiatric pills so we have a combination of a diagnostic system easily misused, a pharmaceutical industry working hard to make sure that it is a misuse to increase the publics awareness that they have an illness when they dont. Add a company that insurers the doctors right to a diagnosis you for the get reimbursement so instead of having a period of time to study they have to force the diagnosis the first visit that is almost always the worst day of the patients life ago based on the misery they feel when theyre forced to get help people get better on their own with natural resilience its with changes of the environment 25 years ago when aids was a killer testing people and studying before hand the emotional status then after the testing to be but tell them if they were positive and negative to do more emotional testing but the results were amazing the people who were positive headed instant spike of psychiatric those that were negative after six weeks getting back to the usual state so even getting a death sentence people our resilient. The placebo Response Rate for mild or moderate problems is over 50 percent there is very little added by active medication most people who get a pill from the doctor will get better on their own but they will not know that they will take the medicine and very often stayed on them for a few years because they a tribute to the success of the pill rather than the resources. The terrible paradox is wildly over treats people who dont need it those that would get better on their own were under treating people who desperately need it only onethird of individuals with severe depression get to see a Mental Health worker in the previous year. Only onethird we have closed 1 million psychiatric beds over the last 50 years but added 1 million prison beds for psychiatric patients what was originally a Community Psychiatry movement the spent on Community Services and housing instead of the person does not have a place to live creates a nuisance crimes is sent to a prison and stays for long periods of times because they dont understand the rules dave or put in solitary and behave in a way that makes it hard to ever be discharged all the resources that we should be spending on their real psychiatrically ill are spent on those that are normal but having problems we have to save those designations of normal for those that are misdiagnosed but the new diagnostic system makes matters that were already bad much worse so we have discovered even the last provision 20 years ago the way it was used was not the ada cheese that triple dash got to some also childhood bipolar disorder and also adults a conservative document led to the tremendous increase of diagnostic rates mostly exaggerated. They opened the floodgates to have the diagnostic hyperinflation but with dsm five normal grief could be easily misdiagnosed all you have to do after losing the love of your life have loss of energy trouble sleeping if you have that just two short weeks you could have major depressive disorder. I have had that. I still have mitre narrow cognitive disorder old age has been transformed there is no way at this point we can accurately identify people but it is premature to be labeling as predementia i bade be there soon but no need to label me now. I have an eating disorder only one huge payout per week for 12 weeks ive had that over 55 years. [laughter] my grand kids on their worst could be diagnosed what is previously known as tempered disorder but if you get them on as a bad day with a doctor that does not know what he is doing and attention Deficit Disorder it is very easy for adults and those drug czar performance and heating and recreational it is clear they will be of use deepen more than they are now now judges are getting in the Second Market they get them and sell them. 30 percent of college kids and 10 of highschool kids because kdd is so ubiquitous in canada a study of 1 million kids the best predictor of adt board december or jay you very. The youngest of the class is especially a boy almost twice as likely to get the diagnosis we should be spending more money on smaller glasses and gym teachers the kids could be active rather than mislabeling that there really educational problems were over diagnosing the gse because you can give them a easy transition back to civilian life they have symptoms but we dont have to label it as a disease the only way to get care with an economic recession some of that is a real depression but a lot of it is we dont provide the death of the safety bit. Return this social problem in to a medical problem is the only way to pay the rent so we start those problems and appropriately but it is way too important with Drug Companies that are out of control spending twice as much money on marketing and controlling politicians most of the research that they do is to extend that patent life theyre just things from their profile rather than the health of the population. Is there eddie chias this could change in the future . David and goliath. Because that it is theyre promoting the diagnosis that the best hope comes from the rest the initiatives promoted by the greatest medical journal in the world helped along very much by Consumer Reports in the universitys to make clear how much america is over testing across the board. That we spend prices much as other countries with lousy results right now i have a friend who is dying from kidney diseases but she got the cats began testing for loan cancer she got testing she did monday destroying her kid these in the evidence is the movement was preventative medicine we get there early and interbreed early intervene early across madison the best example is two years ago now it is not recommended prostate testing did not increase the Life Expectancy and mortality was the same but with excessive treatment it turned out there doing way too much testing for Breast Cancer in populations better to young without risk factors we expect women to have the same bone density and 50 as 24 and we have been treating hypertension and way too early. There is a program called choosing wisely with gen medical specialties to identify areas of over treatment isnt over diagnosis. So it is not just more costeffective but site page three is part of the effort. We have the power to change all the problems in the field and america will wise of sometimes the early treatment for the early diagnosis is often this diagnosis in we should be devoting the efforts more to those in that is the best dancer. The best example of the possibility of change of a pessimistic and buyer reduce big tobacco. 25 years ago a ruled like a big pharma nobody would imagine this want to put people trying to alert the public to the risk of smoking to any degree of success to change like that because they could not advertise. The conquest of over diagnosis will have to be the same way. The public will have to realize we have gone way overboard, the best interest of the patient to the floor in the choosing Wisely Initiative shows they move in that direction. Despite that david and goliath we have the slingshot in that is a good time to bring you into the discussion. If you have questions go to the microphone. Excellent presentation. I appreciate how you did not read from a script. That is a refreshing. I have asked workers syndrome and i find the media discourse to be very troubling with optimism spectrum disorders. Is the diseased to be cured. I find that very insulting and i find it a symptom of a narrow typical society that cannot accept neurological differences. I am fine the way i am and i dont want to be cured. I of eccentric and i feel like ive a good contributing member to society. What your thoughts about that . Thank you we have homogenized everything with all the same genetic korn korn, homogenized School Curricula less abandoned individuality a and people our different and evolution of this diversity the great expression is the rainforest dont have just one kind of tree but hundreds of different species. We cannot tell them apart of less you are a botanist but you need the diversity because you dont know what will come up to the future and evolution plays belong game. Making seeing his uniform and standardizing works in the short run but not long term. We are different because evolution wants us to be the tri lead to have some people who would see the world differently because there are situations you will see clear it needed people compulsive or paranoid or narcissistic. There is now one way of being that is best for a person or best for the tribe i have reviewed every definition of mental disorder it is nonsense. None of those works very well operationally to decide what should be considered a mental disorder or who has worn. We can define the individual clearly but it is vague there is no good concept. Youll never get a good definition that there is no big definition of normal. Because it is not what is abnormal or it gets to what is not normal and if you look at the entomology are the statistical meeting or the sociological median it is always arbitrary where you draw the line. In 1960 the first since this of mental disorders theres six now we have a couple hundred and 25 percent of the population will be labeled as mentally disordered and 50 percent lifetime pretty soon everyone will have disorders before they die. Every time you make a small change even like gaspers we did not realize we could have tripled the rate of classic got to some. Weve never retrieved it would go one out of tanner one that of 81 of 51 dash 38 in korea. The rates our arbitrary it is a populist boundary. If you change the definition you capture millions of patients. If we do ask fervors would have exploded it we would have included it. It is a problem for some especially at the level that you occupy. You use the metaphor about david and goliath you used to be goliath the editor of the dsm value are on the other side what is the reaction to your book and how receptive the profession of psychiatry and Mental Health is to criticism of you have brought to the table . Nothing that i said today that is not common sense. That is all i have. The only people that dont get our experts in the field they only know all little about some alleged. So much i have been hurting expects experts they have never said my area needs to be reduced were digressing to the people they always wore a about the patient they never think of the suggestion as if it is in their laboratory with ours in hours you dont realize in reallife so experts cannot be trusted to make final decisions. Have basically the rest of the world gets set but the experts have been very stubborn. They shouldve had a public trust that went beyond their own narrow conception. Talk about people at influencing them i dont think was a fight the original conflict of Interest Period the intellectual and also more dangerous. Even more than it is fatal. You are right to on target. We have some mental disorder is rigo to life and hopefully we overcome that but i just dont know but i feat you are right on target too much over diagnosis in a treaty in the wrong way. It is that definition of marble and a vote set to scrutiny a concept that has so much power because once you have that label of the disorder but it could be harmful if it is not accurate. We should be restricting the term mental disorder to five or 10 of the population that has such clearcut symptoms everybody says they need help very distressed we need to help them. We should not be extending the term with a disorder of the 50 and now expanding that further it is very hard to diagnose it is always a good idea when it is not clear. To get a Second Opinion period your family dont rush into a diagnosis or treatment most people in psychotherapy is underutilized. It is for mild to moderate problems the logger lassie fax talking about free treatments of 10 or 15 sessions we should talk about the advice and counseling and the auspices of time when that doesnt work the diagnosis should come after the. Not prior to it. What was the paradigm shift . That is a good question and. I was very concerned about this system changing too much we had a conservative approach. We rejected almost everything. We thought we put a clamp on the system that we were naive we reject did childhood bipolar disorder favor able to convince the field that it could be applied to kids who did not have the selling of their views but were irrigable it is not just the all the goliath i was trying my best and failed to take that Current Situation and to make it much worse with the very by a diagnosis. [applause] and its apologists from theater felt for he teaches drama in the anthropology appealing his research and writing look at how military Service Members thank communities jew and communities rely today they will be reading from in discussing the book making war at fort hood life and uncertainty in a military community his book is crafted and wellwritten it was all coming together for be in the section entitled spaghetti. That is the chapter to read but it all made sense as i read the post script that details the shooting spree in powerful topic and a powerful writer. Please welcome kenneth macleish. [applause] need. The key for those kind words. And faq to the humanities tennessee and for health and society it is a joy to be here with you today. I and anthropologist so in a way in the core of what i studied for what is normal groups of people that alex was Justice Craig n. Such a way to have a sense of how high the stakes of normalcy canby and what really matters for what is normal from place to place sam person to person so i am concerned with ways people experience those military institutions and the phenomenon for most of us in this survey because not all of us but what is relatively remote and if we tend to regard as exceptional or outside of the norm. But my research took place at the u. S. Army for a hood in Central Texas and ft. Hood is one of the biggest military installations in the world home to about 50,000 soldiers entering the type i was there the number of combat brigade had just come back after participating in the surge. End this is the war that went online minivans through the wrist appointments and this is with is very much a part of everyday life a chronic condition bill in to the livelihood and their families rather than the exception that was far away. Added is also a place where the mental and Emotional Experience as well as a standard aspect of everyday life. I am thrilled to be sharing this panel today with the idea is of mentalhealth war is what is called the medical was stationed of ordinary life this is important of wildlife those that the military understands through medical categories not the least of which is p. T. A steve. P. T. Sd and one of those that strikes me is the way these categories occurred against a background of a different set of norms than what the rest of us are accustomed to and what science and medicine may have had in mind when they constructed these categories they have incredibly complicated history. There are complex challenges samper found for the abilities that characterized military life that are not necessarily will captured by the diagnostic labels. The light labels and diagnosis could be important with care and compensation but they also have a blind eye to the broader field of a broader experience said the military so with that in mind what i will share today is about the broader field of conditions and with apologies i will read. [laughter] but i hope youll keep everyones attention and before i begin i also want to add i am incredibly grateful and indebted to the people who shared their stories and trust and insight with me to help me make the book what it is. So the title of the passages the tears of the manifest a back to a bureaucratic rollcall designed to be there a prolonged for well or a quick reunion. It has a significance of military communities as yvette focus and intensity that defined the collective experience separation, and attachment with a stone faced humanity and the human frailty of the people. People want to know if i had been to a manifest in wanted to make sure that i did. A lot of time it is held in a jam and indeed it is such a familiar seed of the endangerment that it often has the setting for the Life Insurance that appears at other publications. It seems odd behalf and appropriate it should be a place with useful Association Competition become a discipline, humiliation and play. The gym looks like a normal Highschool Gym with slogans and i can stand geometric designs and stars and stripes above the bleachers. But the gym at ft. Hood does have signs up permanently with block letter images specific to the location but as a constant reminder to those that were playing basketball above the doors out to the parking lot some say on the opposite walls sable come home these are those coming from and going to war for whatever reason this is outdoors next to the headquarters a long line stretching and for a mile or more in like the heathers and this is square with not much to it with a handful of offices for the walls are mostly bare behind the long stretch of parking lot and next door of nondescript warehouse where the soldiers will widen to retrieve the weapons a good part of the Field Artillery some were deployed the next day the smaller never have gone ahead. The Field Artillery was water the only combat armed branches open to women he had an acquaintance of mine her husband who already served two tours and with the disposition once jerry and forceful was said the parking lot and told the the and was deployed it was up to a series of events leading for departure. There was a briefing for soldiers family members the detail of the appointment were they would be where they could dig could not be reached and who to contact and under limited circumstances for emergencies the army was taking the soldiers it would not break the back to tell their gridiron stop. The next day was a family day for the entire brigade that was be a tory fund. [laughter] donated by a a host of all over texas was served over el wide field over a giant water tower a football tournament and speeches and the award presentation and line dance thank line dancing with the manifest is about saying goodbye. The soldiers will gather said with little fanfare they will board the plane over to the Army Air Field and then they go to baghdad. Wives and children and friends will gather and wait to pass those of the ec last hours together and watched the buses depart and they will disperse. Around 10 00 the soldiers show up with those that they have with them and those that arent limited to a plain white box those that stand in line across the parking lot with the loading dock next door waiting on the platoon leaders. They pass in and out of the building that opens onto the sidewalk. The soldiers settle all over the lawn joined by parents and siblings ian friends those the interspersed with the bright tone of sneakers or bare limbs or long hair. To little girls alternate between e. D. A cupcake for hanging on to their dads leg. Also won the one with the puppy as they go to the front of the building it is a summer day is overcast and hot. People go to sashayed. Families sprawled from groups and little kids run around couples hold each other as closely as they can. And exercise of waiting sitting through the precious and painful hours. As we skirt the edge of the crowd it seems upbeat. Not much different than a family day the week before. Together with family and Families Together with the odd mix of publication and the pleasure of socializing and the attention of the appointment not palatable to be. Did bill introduces me to the wives of the other officers and for many of them it is the third deployment. One of these ladies tells me a lot of young couples dont make a. Another gestures almost half of them wear no patch indicating they have not deployed before they have all been told to expect it to last 15 months although they will come xii the extension plus another season ways of their mind. Stayed busy. That is how you get through. I have already cried once. When i talk to the friend a few months earlier she said she preferred to stay away they did not want to be around other people when they try to save their own good buys but those of data before have done it at home so that is why it is called. Earlier that morning she packed letters it to scare for him to find a letter. Death dotterel angels will watch over you. After a while a couple dozen soldiers called into formation then they dispersed. They looked innocuous. Did deal jokes they should have a fundraiser so wives kim paid money to smash the hell lot of the bus. There is another formation that and other every bette just waits and i think i will see a lot of crying. But now just a few robert dawn just a few more minutes it is between scorn and put upon. They brought me here to see the crying. The families continue in bet with some signal that i as they begin to go to their weapons little kids are hoisted up them put back down. Couples twist in a final crunch and hold on for dear life then they pull themselves away the hands are dripping. They walk across a few feet and form them want orderly line. I look for the crying there is a little but that does not start and held the buses pulled away. Of the minutes dry god then take about this happens cleve or quick course dramatically. Some women dash out to get the last embrace and one couple leaguers awkwardly. Squads amplitudes shout out questions and jokes the names. Some are smiling some look a little haste. But there with each other now and on the sidewalk the families and wives and girlfriends are to each other now the they have been put back into place producing the intimate group one minute he belong solely to the people that come to see him than the next minute he belongs to the army. Then the buses drive off. The soldiers are now deployed ive looked around for the daily news of tears afraid to do it i see what cheeks but there is no spectacle but many are already gone. It seems like a small moment but there is no passage to the riverside. Science and protocols but no flood of tears or closure. To the closure, antril for 15 months when they return . Can if they know they are headed out to again and even that precious time fills with a Field Training and weekends away from home . No closure just persisting with daily life in the face of the burden of fear and anxiety period now the girlfriends are the children were in a different form the soldier themself. Instead of soldiers to do the work of not coming undone. I say to buy to the women that i met. He disappeared in miss the entire departure then he emerges a giant action figure framed coming up the back door she said you left yet here he said id go. And then walks off. He turns to leave my wife doesnt understand if it is hard for them it is harder for the man you feel you abandon your family. She called after me the last time and i did not look back. She was mad. She did not understand. Other soldiers have told me this you feel like shipped when you get on that bus and everybody else is on the verge of breaking down the you dont let it take you over you dont want to see me crying he wants spee to know the other side but what they dont know what they fail to understand. The manifest is a break reacted to as a break but also just the extreme scene of the ongoing condition. The pain and absence and promise of the anticipation and duration the way through the best insurance and have practiced some combination of the two. This is what it means to cry at home the slow movement through time between people and the feature that makes it that poses the dilemma which should matter more or less or another or another. Think you. [applause] i am curious the access if the army was welcoming of you . The devil is curious if you arrived reaction from the subjects or the military apparatus . I was fortunate to be able to spend a lot of time of the base working with the civilian volunteer organization and where i had permission to conduct research and in that capacity i could spend so much time. As what often happens used throughout a bunch of different to feelers to link up with people who you are interested in speaking to their new work with what you have got. So communicated with the Public Affairs office which was rather slow going than other avenues i had with working with people and eventually i got the four will access when i had enough people on hand to to get what i was interested in. In terms of access, i really expected that to i would run into a lot of people that were suspicious or reluctant to talk about their experience. I did read into a couple of people here and there i dont want you to talk about me but for the most part i was tremendously blowed away by the generosity of the willingness of people to shared their experiences and there is a lot to be said been interested outsider that potentially feels misunderstood or the world that surrounds them. And i think that served me well and im that fantastic people in terms of reactions it is mostly positive. What i find myself thinking about what is i tried very hard to make it accessible that is academic with the tone and i am concerned about the problem of access the with the friends and acquaintances items still in touch with i have gotten at least will wises well wishes and that has been tremendous a gratifying but i am still waiting. Did you see any signs of dissent were questioning wiry taking part in some of the lunacy of american imperialism . The Corporate Media tends to not focus on any of at at all where i try to balance my Corporate Media or democracy now about soldiers refusing to deploy a and i just wondered did you see any signs of that . That is a great question. They sure do you answer is in my experience basically common no. One friend was involved with a Veterans Advocacy Group and there is a lively antiwar Veterans Movement made up of a different organizations to rework the it is politically important for a lot of them. But that conventional language rather on principle in general or with regard to specific policy decisions that is what is completely well aware of. Lead has a range of opinions but the immediate experience does not necessarily like up with the stories with the framework so that is quite interesting and vague what they used to describe what it is for. At least these are recognizable from in the military communities dont take account of what the daily lift experience is to do is a work of going to war. Sometimes they have critiques of the military that were differently orientedently oriented and others with a sense of a failure of communication with the real challenge to think about what is getting talked about or vice versa. The last couple of years i have heard the news a lot soldiers being referred to as warriors instead of as the g. I. Or soldiers. That is quite a different concept of a different type of society. Do they refer to themselves as warriors . I have certainly seen that term used a law it in the media or military line great jazz well. It varies tremendously by context i am not sure there is anybody at was close to id my research did my research that i identified out right. But at the same time the way it works is oftentimes through labels and people strategically announce to identify strongly with particular labels. So i can see how it could take on significance in certain situations but not something that i can relate to. Thank you. [applause]