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This chapter is intended as a preliminary contribution calling attention to the importance of the subject, given in the hope that it will lead to a discussion in which analysts with various types of experience will take part.
Before making my own specific contribution, in which I indicate why I do believe that psycho-analysis has a contribution to make to classification, I must attempt an historical sketch. This sketch will be inadequate and perhaps inaccurate, but if I omit this task I have no background against which to give my opinion as to the profound effect that recent psycho-analytic developments have had on our attitude to psychiatric classification. The recent developments that I refer to are the concept of the false self, the linking of psychopathy with deprivation, and the understanding that psychosis takes origin at a stage at which the immature human being is truly dependent on environmental provision. These three ideas have been chosen because they have interested me personally.
In the early days of psycho-analysis Freud concerned himself with three aspects of psychiatric illness. One was behaviour, the patient's relation to reality. The second was symptom-formation, which Freud established as a communication, this concept being part of his new understanding of the unconscious. The third was aetiology, which Freud transformed by introducing the idea of the developmental process. Freud studied the development of the instinctual life and this involved him in the theory of childhood sexuality, which eventually led to the theory of the pregenital instinctual life of the human infant and to the concept of the fixation points. The aetiology of psychiatric disorder now demanded of the clinician an interest in history-taking. In this way the