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I think you're confusing the use of the DSM with it's purpose. The DSM is supposed to reflect reality as its primary goal, it's written by unelected technocrats. To the degree that those technocrats are using the DSM to control industry they are usurping the role of the people. As a sanity check imagine if the APA was run by a right wing extremists group and they included leftist beliefs as a mental condition requiring involuntary hospitalization. It would certainly "fulfill the goals of the DSM authors" to include things like this, but I'd argue it is not the intended role of the DSM or its creators to be making politically salient points. They're doing a run around social consensus making and the political process itself and this would be very obvious to its defenders if it were their own ox being gored.
Sure, in a perfect scenario, the Best DSM (BDSM) measures the public impact of each response to each phenomenon. Then Congress enforces using the BDSM's best-impact response whenever insurance asks if something is covered. Popular opinion is preserved.
How should such a document be updated?
If social consensus changes, and people on aggregate believe that gay sex is okay, or that tiktok is a mental illness, or that the appropriate treatment for anxiety is mockery, that should be reflected in the BDSM. Scott might suggest a prediction market solution, or Congress could vote on each line item like a spending bill. In the interest of avoiding stalemates and weird corner cases of our full economy or democracy, we'd be incentivized to import a lot of those systems, too. For the BDSM to fully respect "the role of the people" it has to include a lot of overhead.
The solution we've used instead is delegation. As citizens are bound by judges with tenuous connections to any actual voters, insurance companies are bound by recognized experts. Yes, this leaves room for said experts to abuse their authority. So does every other practically implementable system! The fundamental principle of popular will remains even when diluted.
I understand believing the experts have exceeded their mandate on a specific issue. There is enough friction in the process that they really aren't held very accountable, and the cost to spin up an alternative is eye-wateringly high. Call it a market failure. The fact remains, though, that an effective DSM must include some level of value judgment. Without it, an apolitical/biological document cannot fulfill the delegated purpose.
Does the BDSM include a category for people who like to be tied up and called mean names?
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The apa isn't elected, they just produce a document that is currently being fed into the legitimate system. It's like there being an exposed config file for some important system that has been found and captured by a special interest, in time the hole will be patched. But we shouldn't pretend this is a legitimate purpose of the design, it was never intended for the DSM to be used as a political lever. To the extent it is being used as one it should be objected to.
This impulse people have, to recognize that there is a legitimate process for achieving some goal but instead using some hacked work around to subvert the process because it is easier than arguing your case convincingly to the public is just tyranny. That's all it is. Of course tyranny is expediant. I do not trust people who defend this impulse.
No, I think choosing whether or not homosexuality is a disorder is exactly the legitimate purpose, as intended, of the DSM.
The government wants a way to tell what insurance should and shouldn't pay for. That means it absolutely has to include judgment about what requires treatment. There can be no alternative that just describes symptoms.
Consensus, at some point, settled on this document produced by some technocrats. Now you're convinced that they've altered the deal, that the earlier version was privileged in some way that DSM-5 is not.
How do you propose such a document gets updated, if not by the authors coming together and saying "hmm yeah, that's a good pull request"?
You could have, you know, two different lists? You understand that what insurance has to pay for mean the rest of us are required to pay into it right? This is a tax benefits system with extra steps.
Yes, unelected authors. Not the people. Unelected beaurocrats vetted by the industry that brought us frontal lobe lobotomies and repressed memories. I am not impressed by this process.
So what process would impress your cynical self?
I get that you're unhappy about unelected bureaucrats raising your taxes. What's your solution?
Tangentially but the actual truth would be to change our medical/insurance/regulatory system be different in so many ways that this question would be irrelevant. But more in line with your question continue having the scientific body produce a descriptive sheet according to whichever natural category carried out in the best possible faith. Hell make multiple lists if you think there are competing natural categories. And have a department of the federal government responsive to the people take those recommendations into account and create a clear regulatory document detailing the diagnostic and treatment criteria that insurance must accept. Ideally this would be a relatively bipartisan commission. If the people want boner pills covered in all cases or no cases that should be a decision left to the people. Not some group of people who are totally not bought and sold by Viagra LLC.
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