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The problem of psychoanalytic nosology has confounded all of us in our clinical since the discoveries of Freud. Inconsistencies in
our nosological framework have been increasingly noted and inaccuracies have been present so frequently that they have become the rule. Even today our unpreciseness in diagnosis continues. More than that, some analysts believe an initial diagnostic study contaminates the analytic process and others feel the diagnosis is immaterial to the understanding of the patient or the proscribed treatment. On the other hand, there has been an increasing number of analysts who feel that to better understand the specific psychopathology, our psychoanalytic theories and the psychoanalytic treatment process itself, issues of diagnosis cannot be ignored as if there has always been mutual understanding and agreement in all these areas. The pressure for more confirmable diagnoses continues not only in the field of psychoanalysis, but in psychiatry as well, which is now using a neo-Kraepelinian basis for the psychiatric disorders, the 1980 Diagnostic and Statistical Manual of Mental Disorders (DSM III).
Since the publication of the DSM III, the third diagnostic manual since 1952, considerable efforts have already gone into the planning for the next manual, DSM IV, testifying to the similar confusion in psychiatric nosology. Because of this confusion, psychiatrists point to the need to improve on our ability to categorize psychiatric disorders in order to be able to develop more significant research to tease out etiological factors. But many of the diagnoses in DSM III are couched in statistical and behavioral terminology that gives little understanding of the intrapsychic conflicts, the particular defenses utilized, the influence of the past, and the effect of reality on specific psychopathology. Such knowledge would increase our awareness of the psychodynamic factors involved and lead to a more effective diagnosis, a more accurate evaluation of th