To my mind, this is a little too much like saying that diagnoses of AIDS were "scientifically meaningless" until HIV was definitively isolated. A syndrome isn't

To my mind, this is a little too much like saying that diagnoses of AIDS were "scientifically meaningless" until HIV was definitively isolated. A syndrome isn't devoid of predictive power or other practical meaning just because we haven't identified a perfect biomarker or treatment protocol or diagnostic threshold for it. There's still considerable debate over the full etiologies of diagnoses like (for example) multiple sclerosis and muscular dystrophy, but we can't wave our hands and attribute those to deficits of character or an oppressive society or "unresolved trauma" [1] the way we can with mental illness diagnoses. Sure, the DSM is basically a dumping ground for various obnoxiously imprecise syndromes that don't clearly belong to another specialty such as neurology or endocrinology. But that doesn't make those syndromes "scientifically meaningless". It's one thing to say that these definitions should not be taken as gospel for determining future research directions. It's something else entirely to say that they're "meaningless" and "not fit for purpose" based on a philosophical notion of "meaning" or "purpose" that itself isn't rigorously defined. [1] It's funny how "biopsychiatry" is expected to identify precise molecular pathways or anatomical derangements or genetic markers, but once the paradigm is flipped to the more psychodynamic approaches, rigor suddenly doesn't matter so long as we can tell a compelling story about how our experiences shaped us.