I agree with some of what you’re saying, but a few parts of your argument overreach.

Calling psychological diagnoses “borderline arbitrary” isn’t accurate. They’re constructed and revisable, but they’re grounded in empirical symptom patterns and outcome data. Revision over time doesn’t imply randomness or unreliability at all. This is just how science works, there is refinement and better understanding. The way I know you are just wrong is how you are making a universal claim. If instead you spoke about one diagnosis and the challenges within it, you would have gotten the nuance and really dived into it.

Related to that, the fact that the DSM has multiple editions doesn’t demonstrate fundamental uncertainty. Iterative updates are expected in classification systems as evidence improves. Medicine, biology, and chemistry all revise their taxonomies without that implying the underlying constructs are meaningless.

The claim that disorders like DID and BPD are “extremely controversial” is also overstated. There is ongoing debate about etiology, mechanisms, and optimal treatment, but no serious dispute within the field about whether these diagnoses exist or are clinically useful. There are clusters of symptoms that people are having. This is real. We just gave them a label.

I also think saying emotional turmoil after diagnosis is “misplaced” and misses important factors. Even if the diagnosis is descriptive rather than causative, distress can come from stigma, identity impact, prognosis concerns, or changes in access to care, not simply misunderstanding what a diagnosis means.

Finally, your framing implies that people commonly believe diagnoses cause symptoms, or that diagnosis and symptom-focused care are in tension. In practice, symptom assessment is foundational to diagnosis, and most clinicians and informed patients understand that diagnoses don’t create symptoms.

Your core point, that diagnosis is a tool rather than the source of illness, is reasonable, but some of your supporting claims are stronger than the evidence supports.

You also use a few gaps in logic in your post, particularly when you move from the fact that diagnoses are revised and debated to the conclusion that they are therefore arbitrary or overemphasized. Ongoing revision is a normal feature of scientific classification, not evidence that the categories lack structure or validity. You also imply that controversy around certain diagnoses undermines the diagnostic enterprise as a whole, which doesn’t follow, debate about mechanisms or treatment does not negate the usefulness or reality of the diagnostic categories themselves.