identified between a particular pattern of abnormality and a particular developmental course. Thus within each of the major theoretical orientations there is a singular model for borderline personality disorder, narcissistic pathology, antisocial personality disorder and so on. Within modern psychopathology and psychiatry the trend is towards differentiation and specificity. Evidence is rarely found linking entire classes of disorders with particular pathogens, but rather specific pathogens linked to specific sub-classes within diagnostic groups. The single case orientation of clinical research has not served psychoanalysis well in this context. It is hard to generate a specific nosology using many single cases, all observed from slightly different vantage points. Studying case series with reference to a single schema may be more productive in this regard. John Clarkin’s (1994) work at Westchester looking at sub-classifications of borderline personality disorder from within a combined DSM-IV and structural object relations theory framework is an excellent example of the value of this approach. There is a further sense in which psychoanalytic constructs are often overly global. For example, object relationships are often treated as a singular phenomenon yet clearly, even at a descriptive level, they encompass a number of subservient functions. These include empathy, the quality of self-object representations, the affect tone of relationships, the ability to maintain these and to invest emotionally in them, understanding interpersonal interactions and so on. It is understandable from a clinical viewpoint, but probably counterproductive from the point of view of research, to conceive of object relations and similar constructs in such a global way. The meaningful categorisation of forms of pathology will be compromised unless we are able to be more specific about the particular aspects of object relations pathology which we see as common to a specific disorder. Many current theories fail to distinguish between components of a process and a developmental course and thus create potential ambiguity. It is a regrettable general characteristic of our theories that they rarely explain the specific disorders which an individual is likely to develop given quite general characteristics of early experience. Our models do not regularly identify specific remote or proximal variables which account for the emergence of specific symptoms or the nature of the interaction among predisposing variables and other contributory factors. Thus we are rarely able to comment meaningfully on demographic trends such as recent increases in the prevalence of eating disorders or the varying prevalence of disorders across the life-span – for example the spontaneous improvement in borderline personality disorder in middle age (Stone, 1993). Psychoanalytic concepts, as we have seen, often have multiple referents (e.g. narcissism). Some of these pertain to the developmental course (e.g. inadequate experiences of mirroring and soothing) others to underlying mental states (e.g. a fragile sense of self) and yet others to manifest presentation (e.g. a grandiose view of the self). Stating this in more general terms, it would seem desirable to aim at shifting from an interest in global constructs and towards a greater concern with individual mental processes, their evolution, their vicissitudes, and their role in pathological functioning. There may be a trade-off between explanatory power on the one hand and differentiation and exactitude on the other. That is to say, analyses at a global level offer an apparent power of explanation. This will be lost if the level of analysis is shifted to a specific mental process. However, the inexactitude of global-level analysis ultimately causes fragmentation and precludes the possibility of integrating findings across reports. It seems then, that as part of the scientific attitude the preferred level of analysis of the psychoanalytic researcher should be groups of individuals (series of cases) and specific mental processes rather than global descriptive characterisations. A more scientific attitude would require us to be more developmentally and culturally specific about risk factors as well as suggest working in collaboration with other disciplines to address the problems of symptom specificity and specificity across the life course. 1-%&#">,)+%&?"+()*%#@,)"+&"!&@B,%#+@,)<%&@??">+,(& Again speaking generally, in current clinical research there is a notable lack of serious consideration of alternative accounts when relationships are proposed between clinical observation and theory. It is very rarely that authors genuinely consider how the observations they report may be accounted for by
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