It’s been a year now since the publication of DSM-5, and much of the media coverage up to this point has focused on the critics. But how are ordinary clinicians adapting to the specifics of the new DSM and what are their questions?

Allen Frances learned first-hand how, even when motivated by the best of intentions, changes in the “bible of psychiatry” can have large-scale negative consequences no one can foresee.

In the intense debate its publication has sparked, DSM-5 has both its critics and its champions. One of the latter is Jack Klott, who says that the new edition is “the best DSM ever written.”

Darrel Regier, vice chair of the DSM-5 Task Force, appears a mild, unassuming researcher, slightly bemused that the release of what was intended to be a more accurate, nuanced, and rigorously researched manual has raised such an uproar—a virtual in-house outbreak of oppositional defiant disorder, and surely the most intense and widespread challenge to DSM’s legitimacy in its 62-year history.

Whether you’re a critic or a proponent of DSM-5, this edition will affect your practice.

Since the release of DSM-5, its critics have complained that the definitions in the new edition are now too broad, too inclusive (or not inclusive enough), too biological (or not biological enough), too vague, too quixotic, too unscientific, too much under the thumb of Big Pharma—the list goes on. However, since few people argue that mental health professionals can treat people or do research without some sort of diagnostic system, at this point we’ll have to make friends with DSM-5.

The widely acknowledged chief spokesperson for the opposition against DSM-5 is none other than Allen Frances—perhaps the last person you would expect to trash this latest, biggest DSM.

Troubled by a lack of clients to fill private session hours, some psychotherapists are updating how they do one-on-one therapy to bring themselves more in line with what people want. They’re adding e-therapy, web chats, text exchanges, or email consultations.

Part of the problem with the very concept of a DSM in the internet world of today is that big, ponderous volumes packed with information don’t carry the old sense of capital-A Authority anymore.

For everyone, from lunchbucket therapists like me to the nation’s psychiatrist-in-chief, making a DSM diagnosis is the ritual you have to perform to get the system to work.