Allen Frances
@AllenFrancesMD
Author 'TWILIGHT OF AMERICAN SANITY, A PSYCHIATRIST ANALYZES THE AGE OF TRUMP' 'SAVING NORMAL' Chair, DSM-IV Task Force. Former Chair, Duke Dept of Psychiatry
Common sense re psych meds in pregnancy: only continue when stopping risks exceed staying on risks. Hard to quantify but consider severity/duration/frequency/age of onset previous episodes; dose/duration of meds; mother's preference. Middle positions usually best in psychiatry.
There’s a particular kind of colleague from whom an insult can be regarded as something of a compliment.
I think this paper attacking need for careful psych med deprescribing is useless. 2 fatal flaws: 1)Averaging withdrawal symptoms over entire group misses clinical reality that only a fraction of patients have severe withdrawal- but can be terrible for them 2)Follow way too short
@AllenFrancesMD What’s your opinion on this paper conclusion that mood worsening was not associated with antidepressant discontinuation and that later presentation of depression after discontinuation is indicative of depression relapse? jamanetwork.com/journals/jamap…
I blame myself for current fad- mislabeling all human distress as "Autism". nytimes.com/2025/06/23/opi… Any diagnosis that suddenly seems to explain everything really explains nothing. History of psychiatry is littered with fleeting fashions.
Do you agree with the emerging literature (and well established community wisdom) that many of those dx’d with PD, esp BPD/EUPD are actually autistic & it’s been missed?
Important post below on shameful neglect of mentally ill in US. For more detail: "The Psychiatric Bed Crisis in the United States" psychiatryonline.org/doi/full/10.11… Reagan in 1980 began criminalizing mental health rather than treating it. Trump now adding cruel police state punishment.
Some folks seem to think that reducing reliance on involuntary psychiatric admissions means reducing the availability of inpatient services. That’s a terrible mistake! There is a huge need and demand for voluntary inpatient care. I talk to people every day who wish they could…
Trump is turning US into police state. Homeless need housing/social support/psych care. Dont need criminalization/warehousing in dreadful jails or fake psych "hospitals" I support involuntary commitment for the few- but this is punishment for the many. share.google/xYqL3k5FC37iOp…
Trump's health leaders are fools/knaves/charlatans/conspiracy theorists. He picked worst person in world for each health position. Makary, FDA head, seemed better choice-but he too is a disaster. Trump corrupts all he touches. "You lie down with dogs,you wake up with fleas."
𝗙𝗗𝗔 𝗘𝘅𝗽𝗲𝗿𝘁 𝗣𝗮𝗻𝗲𝗹 𝗼𝗻 𝗦𝗲𝗹𝗲𝗰𝘁𝗶𝘃𝗲 𝗦𝗲𝗿𝗼𝘁𝗼𝗻𝗶𝗻 𝗥𝗲𝘂𝗽𝘁𝗮𝗸𝗲 𝗜𝗻𝗵𝗶𝗯𝗶𝘁𝗼𝗿𝘀 (𝗦𝗦𝗥𝗜𝘀) 𝗮𝗻𝗱 𝗣𝗿𝗲𝗴𝗻𝗮𝗻𝗰𝘆: On July 21st, the FDA convened a panel to discuss SSRI use during pregnancy. Unfortunately, the selection of panelists appeared…
Our pets also getting way too many psych meds: 1)Behavioral training takes lots more effort/time 2)Vets too quick to prescribe 3)Big Pharma pushes meds 4)Perfectionist owners expect pets to be perfect 5)Nervous owners assume pets also nervous 6)We don't know if harmful long term
and I feel like dogs/cats are being over prescribed meds s well 😔
Psych meds way over- prescribed in kids: 1)without clear indication 2)serious short term side effects/long term impact 3)Not enough therapy/family,school,social support 4)Poor/minority kids most harmed 5)Need much better guidelines/monitoring I love practical studies like this:
📢New Study in @BMJMentalHealth: Over Half of Children on Antipsychotics Miss Key Health Checks; Poor Monitoring, Patchy Guidelines Highlight Need for National Standards. @nottmhospitals @UniofNottingham Link: mentalhealth.bmj.com/content/28/1/e…
AI research study confirms my intuition that the most effective element in #CBT is asking open ended questions that get patients thinking & challenging previous beliefs. Aaron Beck was genius at framing great questions- rubbed off on daughter Judy & CBT therapists they trained.
What is the most effective ingredient in cognitive-behavioral therapy (CBT)? "Asking open-ended questions," concludes this AI-driven analysis: pubmed.ncbi.nlm.nih.gov/39625130
"Psychodynamic Therapies: How Did We Get Here & Where Are We Going?" ●Past- featuring the contributions of Darwin, Freud, & Ferenczi ●Current Status- describing essential features that promote change ●FutureDirections- integration with other techniques psychotherapy.net/article/allen-…
Today's Aaron Beck Day (born 7/18/1921; died 11/1/2021) Among great pioneers in psychotherapy practice/research/training. During last decade, he created CBT for schizophrenia/added a spiritual component to CBT. One of the people I most admired & daughter Judy is just like him.
Today we celebrate 'Dr. Aaron T. Beck Day'. In my view, Beck was 2nd greatest contributor in history of psychotherapy (after only Ferenczi). Learn more about his life/contributions to therapy technique by joining Beck Institute description of his legacy: beckinstitute.org/aaron-t-beck-d…
Very funny feeling waking up to discover that my ideas have been put on sale by someone at a 60% discount- but I guess I should be glad they are still worth something.
Buy the "Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life" audiobook today and save 60%! Offer ends 07/30. @AllenFrancesMD, and @AllenFrancesMD audiobooks.com/promotions/pro…
I wrote a book on Trump: "Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump" Bottom line: Trump's psychology is completely transparent & uninteresting. Ingredients: narcissism, cruelty, selfishness, greed, envy, vengeance, pettiness, insecurity, cluelessness
@AllenFrancesMD Maybe the public would be served by a more clear, detailed understanding of him or someone just like him. There are many ways this would be useful. From whom could that information credibly come? yahoo.com/news/trump-dec…
Historical anomaly: Term "psychosis" derives from Greek word "soul"- but is used today to describe conditions caused mostly by brain dysfunction. Term "neurosis", coined by Cullen 300 yrs ago, derives from Greek word "neuron", meaning nerve- but is more a dysruption of the soul.
I recently re-learned that Greek ψυχή -> psyche ->soul Psych meds hits different
I strongly oppose the current fashion of giving multiple diagnoses to most patients. Some ars now are tagged with 4,5, even 6 mental disorder labels. Every associated symptom being considered a new diagnosis. Results in wild overtreatment/stigma/& drowns signal in noise.
A dilemma I faced today for the mental health professionals, especially addiction medicine specialists on X A 40y/M patient with Alcohol Use Disorder who has had multiple admissions for withdrawal delirium - has started avoiding going out in public. The reason he gives is that…
As alleged expert on personality diagnosis (wrote DSM section/founded personality journal) I must confess to perpetual confusion on best method. DSM/ICD/psychologist's dimensions all have fatal flaws. Personality diagnosis is crucial in clinical work but definitional nightmare.
“a trait-based conceptualization of personality disorders amounts to the argument that there is no such thing as a personality disorder” psychiatrymargins.com/p/either-all-p…
People ask why I think "Borderline Personality Disorder" is nonsensical/awful term: 1)Not descriptive of what patients actually experience 2)Doesn't clarify what borders 3)Is catch-all lable used by clinicians to describe patients they dont like 4)Leads to misdiagnosis & stigma
Borderline Personality is among most useful/most misused diagnoses in psychiatry. Pros: 1)Signicant public health problem 2)Effective treatments 3)Predicts suicide risk & course Cons: 1)Over-diagnosed 2)Misleading name 3)Stigma 4)Clinicians use label for patients they dont like
Borderline Personality is among most useful/most misused diagnoses in psychiatry. Pros: 1)Signicant public health problem 2)Effective treatments 3)Predicts suicide risk & course Cons: 1)Over-diagnosed 2)Misleading name 3)Stigma 4)Clinicians use label for patients they dont like
Italian psychoanalyst Alessandra D'Agostino and I recently penned a defense of the diagnosis of borderline personality disorder in @PsychTimes. Unfortunately, the internet is filled with misinformation about the condition.
Why I routinely under-diagnose: 1)Initial impressions often wrong 2)We see patients on worst day- doesnt extrapolate to future 3)Easy to later up diagnose 4)Hard to erase wrong label 5)Harms of overdiagnosis far worse- stigma/meds 6)I wish all diagnosis could be written in pencil
Classic paper from 1988 on "deliberate misdiagnosis," which, as the name implies, reflects the practice of knowingly and intentionally rendering an inaccurate psychiatric diagnosis. My sense is that this is a pervasive practice today, rationalized by some clinicians to avoid…
'No Treatment As Treatment Of Choice' (1982) My favorite paper by me. Even more relevant now because over-treatment so much more common. Hippocratic Rule of Thirds: 1/3 don't get better w treatment 1/3 get better without it Only 1/3 need treatment Trick is picking out that 1/3!
This classic paper by @AllenFrancesMD and John Clarkin is one of my favorites. If psychotherapy is a specific treatment for psychopathology, then it makes sense that it is not always indicated.