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 The original DSM series was motivated by an attempt to  correlate several conflicting classification schemata (such as still  persist in the ICD).  However, since the American Psychiatric  Association was taken over by a set of narrow specialists in  neurobiology in the 1940s (Kirk and Hutchins) it has become an  ever more inflexible instrument.  In general – with a few notable  exceptions such as the grudging acceptance of homosexuality as normal  behavior (the topic of a brilliant episode of This American  Life)  – each edition has been worse than the last.  The new edition  promises to continue this proud trend.Before going into some particular changes for this edition,  let me rehearse two problems with the entire set.   A  significant logical flaw is that it is entirely self-fulfilling: psychiatrists,  psychologists and patients can only get re-imbursements for sessions  attached to a specific DSM diagnosis.  There can be no disagreement with  the code, even if the whole is largely flawed.  In my own experience  and that of my friends, this generally means that we sit down with our  psychiatrist during a session and choose a code which will do relatively  little professional damage if it gets out, and will provide the drugs  that she and I prefer.  I know a large number of  psychologists and some psychiatrists (the non-pill-pushing variety) who  find this a tad abhorrent.  Further, and again I’ll speak for myself as  patient, I find the current set of available conditions massively  restricting. When going through what your average Australian  would call a 'rough spot' several years back, I was offered  variously diagnoses of depression, hypermania, hypomania, manic  depression, ADHD, anxiety, hyperthyroidism and anhedonism  – I deeply  prefer the nineteenth century offerings of melancholic, bustling, a  delicate sort: each with their own social acceptance and romantic  overtones. Bateson's definition of information (a difference which makes a  difference) does not obtain here, since most ascriptions of these  classifications lead to the prescription of a very small set of drugs.I am feeling ever more constrained to always keep my  behavior within acceptable limits.   In the nineteenth century I could,  in my Sherlock Holmes persona – but maybe I’d better not talk about that  one -  fall into a black depression, shoot up some cocaine and play the  violin then come out of my funk and rid the world  of Moriarity.  Today, that archcriminal would quickly get me  hospitalized.  In short, the medicalization of deviance – a term first  deployed in the 1970s – is in its heyday.   Where the United States still manages to see itself as a  haven for liberty,  I wonder how one can maintain that rosy façade in the face  of the medicalization of the minds of most of our population and the  largest incarceration and execution rate (the only really competing  paradigm in the United States to DSM is mortal sinners  vs nice people) in the developed world. Enough of a rant perhaps.  Let’s take as given a tradition of  not recognizing social, communal and family dimensions of difficult  internal lives of citizens. I find it hard to be truly beatific  in a world bent on ecological self-destruction and living in a society  bent on unjust wars and providing no safety net for its poorest citizens  so that many die unnecessarily, but I guess that’s my fault. It’s sad, but fortunately I  have some happy pills.I actually rather  like the potential dissolution of Asperger’s syndrome into Autism Spectrum Disorder - despite the  shocked reaction of parents of some computer geeks, who are often  characterized by some forms of behavior associated with Asperger’s (just  visit the Google campus for a day to verify this).  These are clearly  part of a package of behaviors which run the full gamut from what should  be considered normal to that which is definitely  problematic.  If I had a general theory of what is called mental illness  I would take this principle as a baseline: it’s spectrums all the  way down.  That’s what multidimensionality is all about.  I do find  some fault with Susan Swebo’s report though – what exactly does it mean to  cleave to a principle that collapses without disambiguating:"How to address Pervasive Developmental Disorders – Not  Otherwise Specified (PDD-NOS).  The individuals  currently diagnosed with PDD-NOS may still be described in DSM-V, but  the work group will discuss whether they can redefine ASD in such a way  that the PDD-NOS diagnosis isn’t necessary, as this diagnosis currently  captures a very heterogeneous group of individuals."If I understand the logic of this (though I’m  getting depressed as I write so please don’t pay any attention to me), this means  that a heterogeneous group of individuals  will become homogeneous  (which basically means treated by the same drugs) if we wiggle the  definition of ASD.  And this is seen as a breakthrough rather than  sweeping interesting problem cases under an available carpet? I am not totally  negative about this revision.  Indeed,   I close on a somewhat  hopeful note.  There are revisions being suggested to the definition  of just what a mental disorder is, which  include:"C    Must not be merely  an expectable response to common stressors and losses (for example, the loss of a loved one) or a  culturally sanctioned response to a particular event (for example, trance states  in religious rituals) D.  That reflects an underlying psychobiological dysfunction E.  That is not primarily a  result of social deviance or conflicts with society"If in practice we really honored C and E and  defined D in some useful way (which would have to go way beyond  psychobiological) then we might work towards a socially useful and  culturally rich treatment of mental disorders.   First, though, the  psychiatric community needs to come up with rich treatments of C and E,  since currently childhood deviance or conflict is not seen in this way  (even though it’s of the nature of adolescence) and the set  of ‘common stressors’ and ‘culturally sanctioned’ do not include living  in an overcrowded world (which we know, through rigorous study,  causes  problems for rats). Geoffrey C. Bowker