The role of the hospital milieu in structural diagnosis

The authors have found the structural approach to diagnosis to be a valuable tool in classifying ill-defined mental illnesses. That approach presumes there are discrete levels of mental functioning: neurotic, borderline, and psychotic. Each can be differentiated by identifying the degree of identity integration, the level of defensive operations, and the degree of reality testing. Two case illustrations are used to describe how the dynamic role of the hospital milieu can be used in conjunction with individual treatment to make an accurate diagnosis. The application of this approach to the diagnosis of adolescents is emphasized.