Frances led the task force that produced the DSM IV in 2000. "What motivates me is the experience of having inadvertently contributed to fads and psycho-diagnosis that have resulted in over-diagnosis and over-treatment," Frances said. "Some of this happened during DSM IV, even though we were more conservative with that document than they've been with DSM-5, with its many changes that are unsupported and, in some cases, quite reckless."
For example, Frances said DSM-5 would mislabel one in four people with chronic pain and irritable bowel syndrome with the DSM-5's newly created "somatic symptom disorder," which is diagnosed when a person has spent at least six months steadily thinking of and being anxious about their medical illness.
According to Frances and other like-minded critics, a confluence of related factors resulted in an "over-medicalizing" and over-diagnosis of mental illness. Chief among them, they contend, is that an increasing number of primary care and other nonpsychiatric doctors are dispensing anti-psychotic drugs, despite their lack of training in that area of medicine. Aggressive sales and marketing by pharmaceutical companies may also be driving the surge.
Those factors, Montgomery said, were likely part of what was at play after her baby's stillbirth.
"I had no mental illness. I had never been medicated. I had not even suggested that I was depressed," she said. "And I kept asking if anyone merely knew a therapist that I could go talk to about what was clearly a traumatic experience."
While Montgomery didn't require prescription medications, even DSM-5 protesters acknowledge that there are people whose disorders demand such intensive intervention, perhaps throughout their lifetime.
Still, critics say the upcoming manual veers in the wrong direction.
"The DSM-5, in many ways, reflects the politics of psychiatry these days," said Dr. Joel Paris, author of "Prescriptions for the Mind: A Critical View of Contemporary Psychiatry," a psychiatry professor at McGill University and researcher at Mortimer B. Davis-Jewish General Hospital in Montreal, Quebec.
"Everybody has a kind of investment in certain diagnoses. Those who are studying a particular disorder often are saying, 'Well, this is much more common than you think they are. Oh, the prevalence is very high.' But we risk losing legitimacy because of over-diagnosis. ... The fact is that most people get by with bad patches in their lives. They recover."