I thank Christopher Lane for his comments on my posting regarding the term "disorder." I elaborate here on topics he raised.
The concept of "disease" does not take us back to Galen and brethren; on the one hand it takes us back to Hippocrates, who took the concept of disease seriously in a clinical sense, prioritizing clinical syndromes as the source of knowledge (not biological theory, unlike Galen); on the other hand, the concept of disease is thoroughly modern. Consider the rest of medicine, and tell me that there is no such thing as disease. If not the diseases of cancer and coronary artery disease and stroke, what are the ethereal conditions that kill people right and left?
I agree with Prof. Lane that we need to be honest about where we are ignorant and where there is not evidence of disease; the most honest approach would be to delete such conditions from DSM, or to give them a non-disease label. But we also need to be honest when we have knowledge of disease. This is a step Prof. Lane appears unwilling to take. The humble spirochete, cause of half the world's psychosis before penicillin, would beg to differ. Skepticism about disease seems to me to represent a misunderstanding of science, common among academics who have not engaged in science. In science, ignorance is the flipside of knowledge; one can never say one knows without also implying what one does not know, and vice versa. This should not pose any reason for concern by Prof. Lane or by those patients who have previously received those other labels, if they accept and appreciate science. A century ago, all Americans were diagnosed with labels which are mostly out of use today; people are not now unhappy that their great-grandparents had been diagnosed with pleurisy, or ague, or catarrh, or King's evil, or phthisis - and given treatments now known to be ineffective, such as bleeding. This is the nature of science, to make errors, and to approximate the truth by correcting those errors. Yet postmodernist ideology rejects science and the concept of truth, an approach feasible in literature and philosophy, without harming anyone but college sophomores, but, if applied to medicine and psychiatry, deadly to the general public.