Psycho-Analysis and Nosology

In preparing this paper I felt some doubts: nosology seems to be a rather futile hobby of psychiatrists, not very popular with psycho-analysts, with the exception of some isolated attempts at clarification of nosological issues. So why return to the subject at all?

As an introduction, I think it is wise to say a few words first on the psychiatric situation in Holland and my own position in it. In Holland we are living in a rapidly changing situation. Psychiatry, university psychiatry at least, had been inspired largely by German nosological psychiatry though it changed from being a purely Kraepelinian system to a more liberal system wherein syndrome diagnosis and multiconditional thinking had their places. Psycho-analysis, with its small psycho-analytical society developed in a position of relative isolation, although at many times analysts had positions in psychiatric hospitals and on university staffs. The really great change came a few years ago when a number of senior posts in the universities were filled by analysts. In the psychiatric hospital at Amsterdam this meant attempting new systems of diagnosis (description of syndrome, assessment of personality structure and its main dynamic and genetic features) and starting new discussions of the relations between the traditional nosological system and psycho-analytical thinking. My own position in this changing psychiatric world has some similarities with the general trend of development. I started in traditional nosological psychiatry, went into analysis later and experienced for a considerable time the situation of living in two different worlds of thought. The inner balance between the two modes of thinking was maintained by isolation. It was, and still is to some extent, like speaking two totally different languages, as Zetzel (1965) has emphasized, with the confusing complication that they are using many words in common, but with different meanings, explicitly or implicitly. Undoing this isolation i