Probably every therapist in private practice had a favorite diagnosis; "I diagnosed almost everybody with 'adjustment reaction' because I didn't want to hurt them," says Dana Ackley, a clinical psychologist in Roanoke, Virginia. "I could hardly ever remember what I diagnosed for my clients it didn't really matter but I could tell you chapter and verse about the details of their lives."
Formal diagnosis, specifically the entire DSM enterprise, was regarded as a practice from the Pleistocene era of inappropriate medicalization, fossilized in a manual that nobody took very seriously. Even after the publication of the vastly expanded, explicitly medical DSM-III in 1980, and the revised edition (DSM-III-K)that appeared 7 years later (together adding 110 categories to DSM-//), diagnosis remained a marginal matter of…