The Inmates Seem to Have Taken Over the Asylum

Mental health practitioners and patients are being poorly served by the organizations most entrusted to represent their interests. We have entered a truly remarkable silly season of interacting absurdities committed by the American Psychiatric Association, the National Institute of Mental Health, and the British Psychological Society. May, it turns out, is the cruelest month for mental health.

It started with DSM-5 offering its untested new diagnoses that will mislabel millions of the worried well as mentally ill -- turning our current diagnostic inflation into hyperinflation and distracting attention and resources away from the people who really need help.

Then the NIMH recklessly renounced all syndromal DSM diagnosis as invalid. But NIMH has nothing to offer now in its place except an oversold and undeliverable promise of some future strictly biological model of mental illness that will take decades to deliver -- assuming it can ever be delivered at all. Despite the words that make up its name, NIMH seems to have lost any interest in the current mental health of patients in the U.S. who are suffering greatly under draconian budget cuts and a disorganized nonsystem of care.

Now the British Psychological Society has produced its own brand of extremist posturing, offering its own quixotic paradigm shift away from the notions that the brain has much to do with mental illness or that schizophrenia and bipolar disorder are useful constructs. Instead mental health problems should be framed primarily in psychological and social terms.

This is all Alice Through The Looking Glass foolishness. The NIMH biological reductionism finds its absurd reflection in the British Psychological Society pscho-social reductionism. Responsible leaders of powerful organizations should know better than to suggest that complicated mental illnesses can ever be reduced to simple and reductionistic answers.

We need a model of mental illness that attends to the biological, to the psychological, and to the social. We need leaders who address the current unmet needs of patients -- who are not so enchanted with utopian grand designs for the distant future that they lose interest in the urgent problems of the present.

DSM-5, the NIMH, and the BPS have all gone far wrong and all for the very same reason -- each has prematurely promised a grandiose paradigm shift when none is remotely possible. Paradigm shifts emerge from new scientific findings -- not from bloviating statements, however well intended.

Patients and practitioners are the collateral damage of this ridiculous controversy. Patients who need help may well lose faith in a mental health establishment that seems so confused and is so confusing. Practitioners are generally humble and competent and deserve leaderships that are not so arrogant and bumbling.

It is past time to have just one thing in mind in preparing diagnostic manuals or statements about mental illness that will be widely disseminated. Will this help or hurt our patients' access to quality care?

So my plea to the American Psychiatric Association, to the National Institute of Mental Health, and to the British Psychological Society -- spare us your empty promises of premature paradigm shifts and instead help us take better care of our patients.

Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.