Book Review: Saving Normal

  • I have in my hands a copy of the book Saving Normal by Allen Frances, M.D.

    He's the psychiatrist that was the chair of the DSM-IV Task Force. As you might know the DSM is the bible of psychiatric diagnoses: the Diagnostic and Statistical Manual of disorders.


    Allen Frances was compelled to write this book after witnessing how proud his colleagues were to publish the DSM-V. Allen Frances wrote Saving Normal as "an insider's revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma, and the medicalization of ordinary life."


    I read the section on the perils of diagnosis inflation that caused stigma and hardship for people with mild distress or ordinary feelings. I read the section on how psychiatry got it right for people with severe psychiatric symptoms.

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    Allen Frances is not against the judicious use of psychiatric intervention for people who need it like those of us with schizophrenia and bipolar. Rather, he is against the runaway train of big pharma greed and the overuse of psychotropics for purposes other than their intended use given to the "worried well."


    He excoriates that the "worried well" can easily get this unnecessary treatment while people with severe psychiatric symptoms can't get legitimate treatment.


    I have no doubt that grief is a natural reaction to the loss of a loved one and shouldn't be in the DSM. Yet I wouldn't be so quick to champion delusions or hallucinations or mania or suicidal thoughts as "personality traits" to be coveted like a self-appointed bipolar "expert" does.


    I'm all for saving normal yet it begs the question: Why are certain behaviors considered normal and others are viewed as aberrant?


    No: really.  I have one perpetual beef with this concept.


    I have an abiding distrust in how so-called normal people are held up as model citizens when a lot of them are seriously screwed-up and others with mental illness diagnoses can be outstanding members of society.


    Saving normal? Please: We need to save different. As a long-lost female blogger once wrote: "We need to put normal on the shelf and give different a fighting chance."


    Left of the Dial is the title of my memoir because I played alternative music on the radio that was dubbed left of the dial music. It's the clarion call to do your own thing and not give in to the stigma: to find joy and satisfaction in living your life true to yourself as the one and only you.


    If others in society view you as a creative oddball, you have two choices: fear reprisal and give in to self-doubt that there must be something wrong with you. Or continue on your merry way, confident in your lifestyle and dedicated to your art.


    Those of us who march to a different drum should carry on.  This is my singular forceful stance because I don't consider people to be freaks when they don't conform to society's views of what's normal.  Not everyone is going to be married with children.  Not everyone is going to work on Wall Street.  Those of us able to live in tune with ourselves shouldn't feel poorly because we're out of tune with what passes for normal.


    Mind you Allen Frances doesn't want to throw the baby out with the bathwater:

    This esteemed psychiatrist is right when he tells us in his book that we have to save psychiatry while we're at it.  Positive psychiatry can be swan-like in how it transforms patients into individuals capable of having full and robust lives after they have a breakdown.


    Your mental health treatment team should absolutely be your allies in championing the goals and dreams you have in your life.  A great psychiatrist can lead you back to yourself.


    The fault in the system isn't only in the hands of pharmaceutical companies. Plenty of unethical or simply clueless mental health professionals exist that are all too happy to push pills and bill for inflated diagnoses so they can make money to line their palms. The profit motive gets in the way.

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    It is the duty of every psychiatrist, other medical doctor, therapist and any professional to do no harm.


    It is also the duty of every individual seeking medical attention to act as his or her own self-advocate. Do the research. Ask questions. Listen to your intuition if you suspect what your provider recommends as treatment will do more harm than good.


    I write about this in my recovery guide Live Life Well. I quote the SYMS clothing store motto: "An educated consumer is our best customer."


    I'm so not freaked by having a diagnosis. Thus I champion early if not immediate treatment for someone who exhibits schizophrenia symptoms or bipolar symptoms. From peer counseling, I see the benefit of getting help for these medical conditions.


    Getting an accurate diagnosis and the correct treatment in timely fashion when you have a bona fide medical condition can be liberating and save your life. It can enable you to live your life Left of the Dial: on your own terms, as your own beautiful self.


    I'll end here now with one thing:


    Normal is in the eye of the beholder.


    I agree with Allen Frances, M.D. that there's a great risk in medicalizing ordinary behavior.


    Yet I don't believe that psychiatry must rob people of individuality and flatten out a person's personality. The goal of treatment is to get a person to recovery: to get the person to the point where he or she can have a good life: a life filled with meaningful activity, healthy relationships and personal achievement.


    Coming up in 2014 in the New Year I will write about this in detail at HealthCentral.


    I will in the coming year talk about a new development: The Positive Psychiatry Movement.


    Stay tuned.



    I comment as a footnote to my news article because it needs to be clear that I don't think temper tantrums or intermittent explosive bursts of anger are normal expressions of ordinary human behavior as Allen Frances states in his book.  A co-worker who has this problem could pose a dangerous risk in your workplace.  I also don't think people should be told that we should accept this kind of treatment from other people.


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    In today's society, anger, rudeness and violence acted out towards others is all too common yet I don't think this behavior is normal as Allen Frances claims.  I certainly don't want to be beat up or bullied or bear the brunt of a person's hostility.  Allen Frances needs to offer an alternative to psychiatric treatment for these kinds of people who are unhinged.


    Allen Frances also does not believe that mass murderers like the Norway killer have mental illnesses.  He thinks they are ordinary people who are normal.  I'm not glad to see that such mentally unhinged violent people are touted as being normal citizens.


    At the least, they're sociopaths or psychopaths.  They're not normal.


    Persistent grief after a loved one dies is normal.  Yet I don't think it should be lumped together with the kinds of behavior I just mentioned.  Claiming the Sandy Hook elementary school killer was a normal person too just doesn't cut it with me either.


    Normal people don't engage in violence.  They don't act hostile to other people.  They don't attack you either physically or emotionally or verbally.


    We need to cut the b.s. and call a spade a spade: not all commonly accepted behavior is normal.  It might not require psychiatric treatment yet it's not healthy either.


    It might not belong in the DSM yet it doesn't belong in the world.


Published On: January 12, 2014