The death of specificity in psychiatry: cheers or tears?

During the past five decades, psychiatry has pursued two goals, one being specificity of diagnosis and treatment, and the other a series of all-inclusive diagnostic manuals that paradoxically emphasized the absence of definite boundaries between disorders, and the absence of definite boundaries between disorders and normality (although normality was never defined). Leaders in the field continue to emphasize that diagnoses must be validated by the pathogenesis, course, and response to treatment of specific disorders. However, many current genetic and family studies have failed to support the concept of diagnostic specificity, as has the current use of psychotropic agents, which are now being prescribed with little regard for diagnosis. Although the switch from a categorical diagnostic system to a dimensional system has not been formalized, it seems to have already occurred in practice.