Diagnosing and Prognosing in Psychoanalysis

Diagnosis and prognosis are terms carried over from physical medicine into psychoanalysis. Explaining their original and changing connotations may perhaps best be done through a brief historical survey of the two disciplines. This will also afford a broader basis for arriving at possible operational definitions for modern psychoanalysis.

Scientific medicine, which began in the middle of the nineteenth century, started with its focus on pathology. Its interest, was in expanding knowledge of disease for better diagnosis and prognosis, and with the hope of better therapy. Guided by the scientific methodology of the time, it naturally used causal thinking. It sought specific etiologies for which it later found specific therapies. It operated with the notions of symptoms, disease entities and cure. Eventually, normal physiology and biochemistry asserted their importance. With them came preventive medicine and, ultimately, a focus on the maintenance of health. Psychosomatic medicine began to develop and with it the notion of social,1 as well as socialized, medicine. Physical medicine had moved from a focus on sickness in an individual to an interest in people as social beings—in short, to an awareness of the physical and psychological aspects of individuals in their environments.

More advanced thinkers in medicine have also become aware of the inadequacy of their concepts of disease entities, specific etiologies and specific therapies. This is reflected in the work on stress, particularly by Selye, who operates with the concept of the general adaptation syndrome.2 This begins to be a unitary process concept. Internists have also become more cautious about the notion of cure. They speak more in terms of relief of symptoms, amelioration of disease processes and stabilization at a level. They are aware that the effects of medications—such as ACTH and cortisone—wear off and that recurrences happen. For these reasons many carry on concomitant psychotherapy. Where they feel more