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American psychoanalysis developed a strong tradition linking diagnosis with psychodynamic understanding.

The medical model need not reduce mental disorders to biology or exclude psychological meaning.

Grinker, Gunderson, and modern psychodynamic psychiatry show that diagnosis and depth can coexist.

Psychoanalysis is sometimes portrayed as standing in opposition to the medical model of mental illness. According to this familiar account, psychiatry concerns itself with diagnosis, classification, and disease, while psychoanalysis is interested in meaning, conflict, development, and the individual person.

There is some historical basis for this distinction, but it overlooks an important tradition within American psychoanalysis: one that regarded psychoanalytic understanding and the medical model not as competitors but as complementary approaches to psychopathology.

(Medical model in this context does not imply that psychiatric conditions are reducible to biological abnormalities, but rather that they can be studied as clinically recognizable syndromes with characteristic features, courses, prognoses, and responses to treatment.)

This tradition became closely associated with what is now called psychodynamic psychiatry. Its practitioners were psychoanalysts and psychoanalytically oriented psychotherapists, but their interests extended well beyond psychoanalytic treatment or theory narrowly conceived. They studied psychiatric syndromes, diagnosis, personality, developmental psychopathology, and treatment. The question was not whether a patient should be understood diagnostically or dynamically, but what could be learned from each level of understanding.

American psychoanalysis developed in particularly close proximity to medicine and psychiatry. Unlike psychoanalysis in most other parts of the world, where nonmedical or "lay" analysis became firmly established, organized American psychoanalysis historically maintained close ties to academic medicine. For much of the mid-twentieth century, psychoanalysts occupied prominent positions in American medical schools and departments of psychiatry.

Undoubtedly, this arrangement had its problems. At the height of psychoanalytic influence, dynamic explanations often displaced rather than supplemented traditional descriptive psychopathology, and psychiatric syndromes were interpreted primarily in terms of presumed underlying conflicts. But another strand of American psychoanalysis took a different path. It attempted to bring psychoanalytic ideas into dialogue with systematic observation, diagnosis, and eventually empirical research.

Roy R. Grinker Sr. was representative of this orientation. A psychiatrist and psychoanalyst at the University of Chicago, Grinker was deeply interested in psychoanalytic ideas but........

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