I personally think this is a great sort of walk-through of the pitfalls of the strictly DSM-based approach. I don’t necessarily see it as something that particularly reflects this guy. If he wanted to create a new diagnostic approach to include people who are, in a sense, indistinguishable from the patient population of strictly DSM-V bipolar that would be its own study. In addition to the above, and a host of other matters, this article does demonstrate something about how diagnosis and diagnostic approaches greatly influence how we understand, classify, and teach psychiatry, psychology, medicine, and other clinical fields. Plus, it presents some things about practitioners understanding of patients and clinical priorities in patient visits can be so structured by these approaches, research based on them, even conventional clinical wisdom structured by them, and so on. They cause a ripple effect, and one that influences clinical and academic practice in a sufficiently complex and opaque way. So, even clinical providers, academics who try to radically depart from these approaches are still quite effected by it.
That said, the point I really want to reach is that it’s my opinion—and there is a body of academic work within and about many clinical fields on this matter— that the longevity of these diagnostic approaches and their bases, the categorization of disorders, how clinical fields themself are taught, how priorities are set in the clinic is owed and hugely influenced by the necessity (and the hegemony) of US insurance coding, especially as it relates to prescription drugs. I’m not insisting that prescriptions, or necessarily any of this is inherently negative in it’s effects, just that insurance coding as it is, health insurance in the US as it is, has (sometimes quite extreme) far reaching influence over essentially every aspect of clinical practice, research practices. At least that’s my opinion/conclusion/interest in this article.