The Principles of Psychiatric Classification

THE psycho-analyst cannot postpone indefinitely the task of correlating psychiatric data with his own formulations on mental development, more particularly since material advances have been made in recent years in charting the earliest phases of ego-development. Psycho-analysts have no animus against existing classifications, but feel that their complexity'tends to be in inverse ratio to the fundamental understanding achieved. The three main divisions are, moreover, closely interlocked. The conditions of an ideal classification were then considered, in particular the need for a system which will stimulate research. A purely descriptive method is not only inadequate but retrogressive. Nevertheless, it is temporarily of value if combined with other factors. It is also essential to relate the psychoses to mental phenomena as a whole. This involves correlation with the historical modifications of ego-structure. We must realize how psychotic infantile development actually is. A third factor is also necessary. This must be a specific (or almost specific) factor, in this case "loss of reality sense," i.e., disturbance of ego-object relationships. As a preliminary to discussion of the developmental factor a description was given of psycho-analytic views of ego-structure, the relation of the ego to instinct and environment, and the r6le of anxiety as a signal system. Anxiety is the Alpha and guilt the Omega of human development: these reactions give rise to a series of instinct and ego modifications. Infantile instinct consists mainly of libidinal and aggressive tendencies, the former being divided chronologically into "primacies," viz., oral, anal and infantile genital. The author takes the view that any combination of libidinal and aggressive relations to an object gives rise in the infant to an ego-system or nucleus: also that the oral system contains many other nuclei apart from the main oral nucleus. These scattered formations converge about the age of two years, but already they are responsible for schizophrenic settings or fixations. The primal oral nucleus is probably independently responsible for melancholia. The later more organized nuclei representing anal and genital phases are associated with the neuroses. The earliest ego formations have not yet been fully investigated and in this field of research psycho-analysts and psychiatrists could advantageously co-operate. In particular, the " decomposition " products, stereotypies, etc., of schizophrenia require careful study and classification in order to establish the most primitive nuclear elements. The primitive ego's relations to objects.-The fundamental point is that to begin with confusion exists as to ego-object boundaries. This is technically called " primary identification" of ego and object. Later this is followed by mechanisms of