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I should like to start with a remark Dr. M. Katan made at the meetings with Anna Freud in Cleveland in 1956. He stressed that today diagnosis no longer should consist in giving a name to a certain group of symptoms, but that diagnosis should be based upon metapsychological insight. The diagnosis arrived at by descriptive psychiatry can now be connected with a concept of the structure of the illness concerned. This viewpoint makes present-day diagnosis consist of a metapsychological evaluation of the total personality.
It seems to me that this new formulation is of the greatest importance for the evaluation of the conflicts of the child under five. The child under five gives us the opportunity to study two types of conflict, namely, the one existing between the infantile ego and the environment, and the other type in which the conflict has already become internalized. This diagnostic distinction between two groups, in which either the external or the internal conflict prevails, leads, as I will presently discuss, to the decision whether guidance of the mother can be expected to be of sufficient help or whether direct treatment of the child will be necessary.
Where the conflict is still an external one, that is, between the ego and objects in the environment, there of course we have to include