Diagnosis: psychiatric and psychoanalytic perspectives

In summary, I have reviewed in broad outline the field of descriptive psychiatry and pointed out some of the newer post-Kraepelinian areas of interest, such as the borderline concept; genetics, including pharmacogenetics; the issue of categorization and dimensionality; and the newer aspects of the DSM-III, such as the multiaxial diagnosis and the introduction of diagnostic criteria for the mental disorders. In addition, I have reviewed some aspects of the psychoanalytic movement and its influence on the way patients are assessed. I attempted to offer some speculation about why the psychoanalyst has been considered a so-called poor diagnostician by the psychiatric community, and then attempted to point out why the psychoanalyst is probably the most accurate of all diagnosticians in the true sense of the word--knowing throughout. Finally, I pointed to two Horneyan concepts in what might be called the beginning of a diagnostic psychoanalytic nosology. The first is the concept of vicious cycle diagnosis, and the second the diagnosis of underlying alienation in patients with varied clinical typologies and mental disorders. I have omitted, by focusing on pathology, what might be the most important of all issues for the analyst: diagnosis of the constructive forces. We also need to develop a classification of constructive forces, and more technical attention should be focused on their identification and nurturance.