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Frances I think was worried about his legacy disappearing with DSM-5, because there was a big push to change things in a major way compared to DSM-IV. Ultimately I don't think that really happened; DSM-5 was a change but not the radical change I think the chairs and primary committees wanted it to be.

Frances' flooding of media outlets around that time was sort of strange in certain ways. He seemed to correctly identify potential problems in the mental healthcare system but then had this idea that changing things in the DSM to address some of its issues would make everything worse. It felt as if he was co-opting concerns everyone was having to argue for not changing anything at all, and in the process turned everything on its head.

The DSM is a very political document with a lot of interest groups involved at all levels, which is why it didn't change even more than it did. As a result, you had NIMH circumvent the whole process with RDoC, which then in turn seems to have had a relatively short life (maybe?) associated with changeover in its own administration.

It feels as if everyone has their own schema for thinking about mental illness, and the whole field moves along without any serious consequences. There's probably a lot of reasons for this, including scientific and medical sociology, and the complexity of mental wellness and illness as a domain. But it makes me wonder if some of the distinctions that are argued to be critical are really that critical in the end.