As clinical psychiatrists communicating among ourselves and to other specialties and concerned parties, we need not take diagnostic categories literally. We can save the major valid diagnostic syndromes like paranoid schizophrenia, or panic disorder with agoraphobia, but append other features freely and, most important, change our basic diagnostic stance to a dimensional rather than a categorical one. Arbitrary checklists and time cutoffs ("more than two weeks," "less than six months") can be dispensed with in favor of our best global diagnostic impressions. The focus of psychiatric treatment should be a single diagnosis--a single person--in most cases, with no tiresome Axes involved. Impressions of personality contributions, "stressors" (how I hate the word--its generic tone invites us to leave the patient's story out!), relevant medical illness and so on can go back into a narrative note to be discussed in a nuanced way. Attempts to quantify functioning can be confined to research and otherwise left to lawyers, government agencies, insurance companies and the psychiatrists they employ.
Will this ever happen? As my French-Canadian grandmother used to say, "Don't hold your breath!"
(Interested readers are advised to go to the Web site by Paul McHugh, M.D., [www.hopkinsmedicine.org/jhhpsychiatry/perspec1.htm] and read his systematic and cogent 1992 discussion of these same issues. From his lofty position as chair of psychiatry at Johns Hopkins University, he has long advocated for change in our diagnostic system.)