Dr. Allen Frances has made great contribution to the field of psychiatry but his current fight to bring the American Psychiatric Association (APA) back from "the road to perdition" of a dysfunctional DSM -V could be the role for which he will be remembered 100 years from now.
He has the stature and a well-deserved reputation to shield away the intellectual bullies that frequently dismiss viewpoints they disagree with by simply saying "you don't know what you are talking about."
For example, talking of a new diagnosis called hypersexuality, to me, is equivalent to diagnosing a Parkinson's disease patient with "uncontrollable tremors." A manic person commonly shows hypersexuality and individuals on amphetamines or cocaine could do the same. In fact, just this week, I evaluated an adolescent with bipolar disorder and "comorbid" ADHD who had been in residential treatment for "inappropriate sexual behaviors" who was kept on the amphetamine while receiving therapy to decrease his hypersexuality.
This is why I think Dr. Frances' contribution transcend his philosophical/scientific views. The fact that we are having this debate and the oracles of psychiatry will pay attention to it, because Allen Frances is involved, open a door that have been closed for years.
In 1999, long before the word blog became part of our daily, I posted a comment in the APA "internet forum" with the title "APA: we have a problem." Dr. Rodrigo Muñoz (APA President then) wrote a nice response but a few others considered that my statements were incendiary. Not surprisingly, the same happened at the American Association of Community Psychiatry. Ironically a infamous comment from one of the NASA scientist who was observing the Challenger fragmentation in space highlights the possible foundation of my critics. The expert in the fly control room Houston said: "Apparently there has been a major malfunction."
Obviously, this type of serene and conservative comment seats well in the atmosphere of political correctness that began in the 80s. Nevertheless, when our new President maintains a similar style in the presence of the Gulf of Mexico disaster he is condemned for "no showing anger." During the oil platform explosion 11 workers died and the environmental damage is still in the making but with the psychiatric misdiagnosis thousands of suicides could have been prevented and much more potentially successful lives would have not ended in prison...but I should keep my cool!
In 1921 Kraepelin described mood swings in pre-pubertal children and before him, Jean Etienne Esquirol (1845) reported several cases of "manic-depressive illness in school-age children." These findings were disregarded by the psychoanalytic movement and it took a very long time for great psychiatrists such as Grabielle Carlson, Karen Wagner, Hagop Akiskal, Joseph Biederman and others to defy the establishment and say: "yes, children can have bipolar disorder."
I wish Dr. Carlson will participate in this debate because, like Dr. Allen, she has "a voice." When your name is Manuel Mota and English is not your first language you can say that Brazil has a great soccer team and many will tell you how wrong you are.
Still, my question to the APA and the American Academy of C & A psychiatrist is this: What is wrong with correcting a misdiagnose if the patients are doing better than with the previous one?
From another angle, I disagree with David Saltman's comment about "emotional disorders" and medications because "emotions" are regulated by chemical reactions in the same way that blood sugar is controlled by insulin. The environment and the parental role is crucial but do nothing if the genetic endowment goes out of control, as many adoptive parents can attest. We do need medications to control mania or panic attacks, even though the only "cure" for panic disorder, OCD and social anxiety disorder is CBT.
Finally, I take issue with Dr. Frances' claim of the lack of diagnostic tests in psychiatry. My question is simple: "Do we need a test to figure out that two white parents will have a white child?"
In closing, the APA is morally obligated to "cut the shade" and to deal with the reality that ADHD is been attributed to children with mental retardation, autism, anxiety disorders, etc. and that keeping its "impartial bystander" position is hurting too many children and adolescents. We have a false epidemic of ADHD and we need to realize that aggressive behavior is not part of ADHD. Besides, lack of attention and hyperactivity can be present in multiple psychiatric conditions, including ADHD, but this illness should be diagnosed when other more logical explanations have been ruled out.
Manuel Mota-Castillo, M.D.
St. Matthews University and UCF
Bipolar Disorder and Genetics: Beyond Question, Psychiatric Times, June 2004
Eliminate Conduct Disorder & ODD. This is The Right Time!, Psychline, Vol. 4, No 4.
The Crisis of Overdiagnosed ADHD in Children, Commentary, Psychiatric Times, July
The Journey Out of Madness, Commentary, June; Psychiatric Times.