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War Department Technical Bulletin, Medical 203 is presented in historical context as the first psychodynamic nomenclature. The history of Medical 203 is presented to show how Medical 203 was adapted to become DSM-I. Medical 203 then is compared and contrasted to DSM-IV to illustrate how changes in the modern DSMs have led to an 800% increase in the number of psychiatric diagnoses over the last half century. The role of critical history is emphasized in evaluating those changes and in speculating about the next 50 years of psychiatric nomenclature.