diagnostic categories don't neatly dissect out, and--aside from sleep apnea--none of our diagnoses is made by a lab test. this isn't DSM, this is psychiatry.
the DSM was written by a lot of thought leaders, almost all of whom donated their time for years on the project. most of us have a negative knee-jerk reaction to the term "thought leaders," but it generally means people a lot like you who spend their nights and weekends writing about psychiatry without payment. not that they don't get paid, since they often get grants and promotions for their work, but most could make more, more efficiently, by seeing patients.
Imprecise and undoubtedly slated for further change, DSM isn't some arbitrary roster of obsessional lists, it's the best assessment of psych categories we have. Critics of DSM haven't read it--it's been out less than a week--so I'll assume their hostility is a displacement from their hostility toward psychiatry. Al Frances is a bit different since he's an insider, but do note that his criticisms are generally undercut by the final product: the book does not pathologize normal stuff. if psychiatrists excessively diagnose, they're ignoring the requirement for distress and dysfunction.
And, anyway, the increasing diagnoses have developed during the tenure of Frances's DSM-IV and seem to have developed because psychiatrists don't know the DSM rules but instead just diagnose based on some other sort of internally-developed set of criteria that are almost certainly more idiosyncratic than the DSM.
I also cringe when I hear that most of us treat pharmacologically based on symptoms. Yikes. Evidence of therapeutic efficacy is based on diagnostic categories, not on symptoms. Chasing symptoms with medications is lazy on our part and often hurtful to our patients. Sometimes, it's the best that we have, but our patients deserve doctors who know their own field.
Critique away, but I don't really understand anyone being proud of criticizing a document they haven't studied, and of not having a working knowledge of the document that is probably the most robust and consensus-driven understanding of our field that exists. And a working knowledge is more than looking up codes online or imagining that the criteria for a diagnosis are either obvious (and can be concocted by each of us as we see fit) or impossibly vague (so who cares what the text might say?).
What's the stylistic thrust of obscure historical diagnoses? Serious question. As someone who likes history, I'm just curious why you love psychiatric history and what you get out of it.
