ABSTRACT
The aim of this chapter is to analyze the conflict between psychiatry and psychoanalysis as it emerges in admission interviews in the outpatient mental healthcare service. The analysis focuses on the maladjustment between patients, who have been socialized in medical discourse and expect the usual sequential organization of diagnosis and treatment recommendation, and psychoanalysts, who offer the opposite: a treatment recommendation with no diagnosis. I focus on the development of diagnosis in the conflicting expectations of professionals and patients regarding diagnosis and treatment, which usually results in patients being rejected implicitly. However, I also include an example of negotiation with medical expectations which results in successful treatment for a patient with a mild speech impairment. Exclusion is thereby not only a matter of social structure or institutional logic but also an unexpected consequence of small interactions and local decisions.
