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The application of psycho-analysis to the psychoses has not led to an effective therapy like its use in the transference neuroses and more recently the war neuroses. The pathological explanation of the psychoses, however, has undergone radical alterations through Freud's concepts, just as was the case with chemistry as a result of Dalton's and Lavoisier's work. The aim of any discussion of the issues relative to this subject must be to ascertain the reasons why the outcome of this new psychopathology has been a new therapy for the 'neuroses', and not one for the 'mental diseases', and also to suggest possible improvements. In this paper we shall be concerned with these improvements only in so far as they relate to the investigator and his methods.
Psychiatrist and analyst are dissimilar in their nature, their subject of investigation, their hopes and their methods. Both have the same mass of symptoms for their material, but the difference lies in their conception of it.
As contrasted with the analyst, the psychiatrist suffers from certain definite psychic scotomata. The subject of his investigation is the conscious, the brain as its hypothetical correlate, and the body in general.
The analyst is characterised by the removal of the scotomata, so far as we recognise them. His sphere of investigation is extended to the unconscious; he puts the libido and the ego impulses as hypothetical correlates behind the phenomena.
The primary medical aim—to establish the diagnosis—has a different significance in psychiatry from that which it has elsewhere. It is usual in medicine to allocate the case, according to its diagnosis,