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IN INTRODUCING THE PANEL, THE CHAIRMAN noted the difficulties DSM-III poses for the psychoanalyst. Because DSM-III attempts to be descriptively precise and avowedly atheoretical, there may be no easy overlap between the needs of organized psychiatry and the needs of the practicing psychoanalyst.
Wallerstein cited two cogent reasons for beginning with "Psychoanalytic Nosology: An Historical Review." First, it is critical to understand that a dynamic conception of nosology is "an ever-changing and a constructed corpus" contingent on expanding clinical and theoretical knowledge. Second, nosology and diagnosis achieve relevance only when considered in the overall context of case formulation, treatment indications, treatability, and treatment planning.
Wallerstein began with a review of Freud's lifetime interest in formulating a psychoanalytic nosology. In the Studies on Hysteria (S.E., 2, p. VII; S.E., 3, p. 159), Freud distinguished three varieties of hysteria: hypnoid, retention, and defense, later collapsed as a "neurosis of defense" (S.E., 3, p. 47). In his first nosological paper, "The Neuro-psychoses of Defense" (1894), Freud defined three distinct entities; conversion hysteria, obsessional neurosis, and hallucinatory psychosis, which represented different attempts to cope with or defend against an incompatible idea, or set of ideas. In conversion hysteria, the affect, split from incompatible idea, enters the somatic realm. In obsessional neurosis, the split-off affect remains in the psychic sphere but attaches itself to ideas not otherwise incompatible creating "false connections" which are the obsessional ideas. In psychosis, the incompatible idea is avoided by a flight into psychosis.