The Carlat Psychiatry Podcast Overdiagnosis with Allen Frances
Jan 6, 2025
Allen Frances, psychiatrist and DSM‑IV chair turned critic, offers a candid take on overdiagnosis. He discusses how normal grief and stress can be mistaken for disorder. He highlights using self‑correction to decide when to treat, warns against quick medication fixes, and urges longer visits, watchful waiting, and careful diagnostic labels.
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Time Cutoffs As Self-Correction Markers
- DSM time cutoffs (e.g., two weeks for depression) are pragmatic markers of when a problem stops self-correcting.
- Allen Frances says focusing on self-correction helps avoid over-diagnosing normal, transient distress.
Ask If Patients Feel Stuck
- Ask patients whether they expect to pull themselves out of a low mood rather than only measuring distress.
- If patients feel stuck, offer external help like medication changes or increased therapy frequency.
Surveys Miscount Distress As Disorder
- Epidemiological surveys overcount psychiatric disorder by measuring symptoms, not clinical significance.
- Frances emphasizes that painful reactions to stress are often normal and not mental illness without impairment.
