Discussion

IN CONSIDERING THE RANGE OF CONCEPTUAL and therapeutic issues that arise during the analytic treatment of a patient such as the man presented by Dr. Spear, it is worthwhile to at least acknowledge that whatever is said is inevitably played against the background of differential diagnosis and its subtle influence on what an analyst hears and what stance he takes with his patient. As I thought about this individual in relation to his diagnosis, and whether I myself might or might not prefer some other nosological description, I recalled an incident that recently occurred on a plane trip back to New York City that generally sums up my view, with rare exceptions, as to the place of differential diagnosis in analytic work. Just as the flight crew was preparing to serve dinner the loudspeaker came on and the stewardess said: "For today's menu you have a choice of chicken or lasagna, but I don't want you to be too upset if you don't get your first choice because I've tasted them both and they taste remarkably similar."

In doing analytic work, diagnosis is in a certain way like airline food. It is good to have on the trip but don't take the label overly seriously; just take in enough of it to keep you from feeling too empty on the journey. Most importantly, don't be too upset if you find along the way that the chicken tastes remarkably like lasagna.

Beginning with Freud (1896), (1909), (1913), the obsessional disorder has been an historic centerpiece in the evolution of psychoanalytic clinical entities. The explication of what the obsessional person is all about as a human being has generated, particularly within the interpersonal school of thought, some of the most original