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Nowhere is the uneasy alliance between psychoanalysis and clinical psychiatry more readily observable than in the issue of diagnosis. In the past, when psychoanalysis more surely gripped the reins of psychiatric thinking, psychoanalysts may have imagined that there were few distinctions between the disciplines, that psychoanalysis and clinical psychiatry were virtually identical, and that those certified in psychoanalysis constituted the psychiatric elite. Recent developments, as outlined by Dr. Henry Paul-the reemergence of a neo-Kraepelinian nomenclature, the entry of nonpsychiatrists into the ranks of psychoanalysis, and the increasing sophistication of organic formulations for mental disorders-have underscored the distinction between the clinical psychiatrist and the psychoanalyst.
Dr. Paul argues eruditely and persuasively that clinical psychiatric diagnosis is largely inapplicable to the tasks of the psychoanalyst. His bold assertion is adequately grounded in studies of diagnostic reliability within clinical psychiatry and the historical divergence between the concepts basic to Kraepelinian psychiatry and Freudian (and Horneyan) psychoanalysis. Dr. Paul finds an answer in noting that the root of diagnosis is “thoroughgoing knowledge.” Diagnosis, appreciated as meaning “thoroughgoing knowledge,” then, is properly a direction, not a destination.
For the clinical psychiatrist whose perceptions about a presenting patient are organized about that patient's mental disorder, even perhaps about the task of seeking criteria consistent with syndromes described in the pages of DSM-III, diagnosis is a severely limited endeavor, hardly a task equivalent to developing “thoroughgoing knowledge.” True, the APA task force responsible for its compilation disavows that DSM-III even pretends to speak to the question of individuality, to the issue of what makes the presenting patient unique. The Task Force on Nomenclature and Statistics (appreciate the military ring!) is concerned w