The Concept of Dissociation

It would be a mistake to infer from the title of this symposium1 that the subject is one of purely theoretical interest. Actually the issues bear closely on the development of 'clinical' psycho-analysis. To give but one instance: progress in the application of psycho-analytic findings to the diagnosis and prognosis of mental disorder has been increasingly hampered by the adoption of clinical criteria borrowed from more conventional (psychiatric) fields. Quite apart from the fact that standard psychiatric classifications of neuroses and psychoses are too schematic and at the same time too rigid to meet the requirements of the clinical psycho-analyst, it is obvious that they cannot be applied to the multitude of characterological and psycho-sexual disorders that constitute a large proportion of the analyst's practice. Indeed the attempt to combine psychiatric diagnosis with psycho-analytical standards is responsible for a considerable variation in the criteria used by analysts in their consulting work. Although there is general agreement on the differentiation of neuroses and psychoses and comparative unanimity about their prognosis, considerable confusion exists as to the diagnostic and prognostic significance of pathological character changes, inhibitions, perversions and social difficulties. Sometimes analysts fail to discriminate between manifest psychotic reactions and psychotic mechanisms or even episodes the existence of which is inferred on purely analytical (interpretative) grounds. This lack of discrimination may be due in part to inadequate psychiatric experience, but it is certainly increased by the fact that a knowledge of unconscious psychogenetic factors tends to disturb the analyst's appraisal of manifest symptoms. This is reflected in a lack of uniformity in therapeutic recommendations, and in the long run gives rise to misapprehensions as to the therapeutic effect of psycho-analysis. Thus the failure to discriminate between evidence of exce