>> we don't typically diagnose for the purpose of figuring the underlying causes

> If you do not understand the underlying cause, you may prescribe the wrong treatment.

Diagnosis isn't typically about finding the right treatment. That is because the majority of treatments aren't diagnosis specific, they are SYMPTOM specific.

In the beginning... Just about every theorist had their own classification system, their own lists of symptoms they attempted to assess, their own theory of the causes of those symptoms (e.g., oedipal conflict or fear of disintegration or whatever). Psychiatry seemed to be at the pre-science stage because it wasn't really possible for clinicians to talk to each other, agree on the presence / absence of symptoms, agree on the cause of the symptoms, agree on the treatments for those symptoms etc etc etc.

The DSM III was considered 'revolutionary' because it attempted (as much as possible) to be a-theoretic or agnostic between different theories. The thought was that by describing certain symptoms as being behaviorally operationalized as much as possible different clinicians could agree as to whether the symptom was present or absent (there would be inter-rater reliability). There was much greater inter-rater reliability than there used to be, that is for sure, but inter-rater reliability is still poor (not much above chance for the majority of symptoms / conditions).

The DSM isn't a-theoretic, of course. Some disorders are defined partly on the basis of presumed etiology (e.g., post-traumatic stress disorder or substance induced disorders). It still makes unwarranted judgements or assumptions (there is a big literature on that with respect to the borderline personality diagnostic category in particular). But it did signify a major theoretical advance from what had gone before. It served to unify the field of psychiatry. And more than that, it served to unify all the fields that deal with mental disorder (clinical psychology, education, sociology, anthropology, social work, councelling, mental health nurses, care workers etc etc etc). And (perhaps even more importantly) it made the American Psychiatric Association ONE %#@&#! of a lot of money!!!

But the DSM doesn't traffic in causes (as much as possible). In fact... Causal reasoning in psychiatry tends to go like this: Drug x helps people with condition / symptom / diagnosis x. Drug x helped person T therefore person T has condition / symptom / diagnosis x.

It is an invalid inference... But it is an inference that is employed nevertheless. The more there are 'magic bullet' drugs (treatments that are diagnosis specific) the more we say that whether the drug works or not is the major evidence for whether the person really was accurately diagnosed with that condition or not.

The inference is invalid because... EVERYONE has improved concentration etc with stimulant (ADD / ADHD medications). The efficacy of stimulants thus fails to distinguish between people who are low end of normal range and people who have an inner dysfunction. But then maybe... There is no different? And maybe... Task demands (e.g., to 'sit down and shut up') are inappropriate, really. But then... Why look at our schooling system when we can simply drug kids out of being behavior problems? And why spend a great deal of time with those kids teaching them how to behave (teaching their parents to teach them how to behave) when we can call it a 'disorder' and medicate them out of it?

People seem to have the following dichotomous assumption: Either the kid has some inner dysfunction which is out of the kids control but for which they can be treated... Or... It is my fault for being a bad parent.

It is of course a false dichotomy... But we seem to WANT disorders to proliferate. We seem to WANT people to be diagnosed with a disorder for (we think) their own good... The trouble is that pathologizing the individual often prevents us from taking a good hard look at our social practices around schooling, the way authority figures often treat children, some of our childrearing practices etc. We seem to want... People to be drugged to tow the line and I'm far from convinced that psychiatry adequately assess peoples often legitimate complaints when it assumes that the person is dysfunctional (and thus undermines their authority as witness).