Dr. Awais Aftab, psychiatrist and author of a powerful new New York Times essay, argues that diagnoses like ADHD, autism, depression, and bipolar are not precise biological diseases revealed by genes or brain scans but practical clinician judgments about recognizable patterns of distress and behavior.
We synthesize Aftab’s pragmatic perspective with long-standing critiques from Allen Frances (chair of the DSM-IV task force), the NIMH’s shift to the Research Domain Criteria (RDoC) project under Thomas Insel, and decades of research on comorbidity, symptom heterogeneity, and diagnostic instability.