This is all very interesting and I always wondered why the DSM was such a big deal and it always led to the labeling and insurance aspects. What has not been mentioned and is very scary to me as a professional,parent, and client is that the community mental health centers are at the mercy of paperwork and productivity documentation. There are professionals who job for the government and insurance is just to peruse records and see if they can find a mistake that would invalidate the progress note and the center would not get paid. On the other side of the Looking Glass are professionals in the Mental Health Center( that I am sure the good doctors knows well) who go through the progress notes and records making sure those types of mistakes are taken care before the credentialing and other folks come and do their own reviews. In the early eighties we could have 3 hour and a half sessions to make a diagnosis and we had the option of NOS. Not otherwise specified. This was a label that I loved and used frequently. So much has changed and the folks coming into Community Mental Health Centers to work are not aware of the past and accept what is now happening as adequate. Special Education is a separate but somewhat similar ball of wax. Lables in some states are weighted that is if you have the diagnosis of TBI ( traumatic brain injury) the school is given more money) in the mid nineties TBI was big in my state and my son was one of the first to carry that diagnosis which lasted until a twenty minute pedsneuro assessment changed it to Autism. The fact that he could have both diagnosis never passed any professionals mind except my own. And he still doesn’t fit any category so he is basically on his own. Very High level functioning except for socialization with peers and fine motor skill issues. The issue in IEP’s ( individual education plan) is that you do have to fit into a mold to get services and even then the services are only for a certain level. PT and OT services are only for school related issues. Family dinner and restaurant issues are not allowed. Teachers spend hours of extra time with the IEP. It was originally a great idea. All children should have one but it has gone into the dust with the bureaucracy. The cauldron seems to be bubbling which is a good thing. Look at TB and the diseases that seem so simple now but lead many professionals to do things that simply did not work at all.