The Cost of Checklists in Psychiatry

Key points

Checklists drive quick diagnoses but miss patient context and biography.

Benzos, SSRIs, and stimulants are often prescribed far beyond guidelines.

Polypharmacy adds risk—multiple drugs, higher side effects, little benefit.

Reimbursement rewards pills, not counseling—profit drives overprescribing.

The debate over revising the Diagnostic and Statistical Manual of Mental Disorders (DSM) is not merely intramural. Because the DSM functions as psychiatry’s master reference, the way it defines disorders shapes the scope of services and prescribing for years to come.

When the DSM-III appeared in 1980, it broke with earlier editions that reflected rivalries among psychodynamic, behavioral, and biological schools. Its architects sought to resolve diagnostic muddle by introducing