A mountain of anomalies and a canyon of pitfalls have not dissuaded psychiatrists from taking the descriptive approach to diagnosis. They simply ignore them. Others see promise of advance in more of the same approach. They propose dimensional measures of the symptoms. They compound the error of backward reasoning. Again major depressive disorder says it all. The word “major” betrays its dimensional nature. Had the authors of DSM adhered to their original intent to call the other end of a continuum “minor depression” instead of dysthymia they would have made its facile quality blindingly clear, but monetary considerations overcame logic and honesty. Insurance companies and Medicare could refuse payments. The courts could award trivial damages to the litigants they assess. Public relations would suffer; to the self-pitying minor sounds like an insult. With such principles, how could psychiatry fight its way out of a paper bag?
In any case, subjective complaint does not have a measurable dimension. Who can tell how much the shoe pinches? In the facile manner of pain specialists, do they offer a scale say of 1 to 10, or any other number that seems right, to give the subjective a spurious objectivity? Only for the gullible or the believer does a scale transform the subjective to a seemingly objective number. From the illusory magic of scales statisticians have evolved marvelously impressive exercises of dimensional assessment that reinforce blindness to the elephant in the room. Bunkum baffles brains.