I may have a slightly unusual experience in that over the years I've seen analysts who were also psychiatrists. All were reluctant to "use" diagnosis, perhaps because they were depth oriented analysts so didn't really believe that system of labeling really meant all that much. Even at the very beginning when I needed more meds, they went with what they thought would work, and it wasn't really based on standards of a diagnosis, so some off-label types of things.

Now I see a relational analyst. Even though I had seen his friends and colleagues previously, he did a full intake and took time to formulate his impression of me. He did not rely on any previous diagnosis made and in fact rejected them in consultations he had early on. I no longer need meds, except for sleep and occasional anxiety. So even though a psychiatrist he works primarily as a therapist.

We have had many discussions about diagnosis and how it works and how it doesn't. For some people, a diagnosis, at least at first, can help them understand how a set of seemingly unrelated things they do or feel are tied together. It does have some initial explanatory power and can be a relief for some people.

But there are no people in the DSM. And it is not the "bible" as some psychologists say it is. I have found that psychologists are more attached to these things than psychiatrists. I think there is envy in the psychology community about not being real "doctors" so they like to be called "doctor" anyway. And I've found that they sometimes have slightly off views about psychiatrists and also about the use of medications, but these views don't seem founded on any real understanding when I have heard them expressed. Many view psychiatrists as pill-pushers only and pawns of the pharmaceutical companies. This is patently false. So many psychiatrists actively resent the way they have been boxed in. And even if they are primarily prescribers, they still often use the free samples from the companies to give to patients to help them out.

But like I said my experience might be unusual because the psychiatrists I know or have seen myself are all also analysts which I do think changes things. Since you have to undergo your own lengthy analysis to become an analyst, this probably deeply affects the way they approach people. And I'm not talking about typical Freudian views. Most of these people are engaged in contemporary analysis which is quite different than old fashioned views. Analysts in fact have other ways of understanding and tend to use those rather than DSM categories. It's only when it comes to billing or other things that they resort to standard labels.