Case Histories

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Case histories are a classic form of documentation in psychopathology literature. They range from clinical sketches to highly detailed and extended accounts, as in the Madeleine case, which occupies both volumes of Pierre Janet's De l'angoisseà l'extase (1926-1928).

Psychoanalysis caused the form to drift toward what might more properly be called a "report on analysis." With a view to publication, analysts elaborate written accounts based on everything they have heard from a patient, in order to reconstitute the sense and significance of the patient's psychic and symptomatic functioning, as well as the progressive unfolding of the cure itself in the transference/counter-transference exchange.

Sigmund Freud evokes his patients in his early writings (Studies on Hysteria, 1895d), but it is in dealing with the analysis of the Rat Man that he expresses the difficulty of giving an account of an analysis, in a letter to Jung dated June 30, 1909: "How bungled our reproductions are, how wretchedly we dissect the great art works of psychic nature! Unfortunately this paper in turn is becoming too bulky. It just pours out of me, and even so it's inadequate, incomplete and therefore untrue. A wretched business." (1974, p. 238).

Reports are difficult to write because where previously the analyst disentangled the elements in the flow of associations, in order to allow the interpretable meaning to organize itself, in the report, the analyst instead must dismantle and take apart in order to reproduce. Between communication in the analysis and the communication of the analysis, the transformation is as radical as that which exists between the logic of primary and secondary processes.

The heuristic necessity of the report on the analysis is nevertheless obvious because it is this reflective phase that enables us to focus on any given point of theory, thus breaking not with clinical practice but with the rule of not initially selecting anything in order to afford equally-distributed attention to the associational material. As a transmission of knowledge without a prescriptive target, and relating equally to theory and to clinical practice, the analysis report belongs in the theoretical domain (Laplanche, 1980).

The desire to give an account of the analysis derives from the analyst's counter-transference. The disturbance then becomes the object of thought and the motive for communication and may even remobilize the analyst's questions about his own non-analyzed past. But the report also has an institutional, more or less codified role and forms a part of exchanges that contribute to progress and recognition.

Freud stressed the ethical and moral problems posed by the analysis report: "It is certain that the patients would never have spoken if it had occurred to them that their admissions might possibly be put to scientific uses: and it is equally certain that to ask them themselves for leave to publish their case would be quite unavailing" (1905e [1901]). But he nevertheless defends the necessity for it in a letter to Oskar Pfister (June 5, 1910): "Thus discretion is incompatible with a satisfactory description of an analysis; to describe the latter one would have to be unscrupulous, give away, betray, behave like an artist who buys paints with his wife's house-keeping money or uses the furniture as firewood to warm the studio for his model. Without a trace of that kind of unscrupulousness the job cannot be done" (1963, p. 38).

The models for dreaming and jokes shed light on the respective methodologies used for the situations of dialogue and transcription (Mijolla-Mellor, 1985). While commenting on the difficulties relative to reports on analysis, Freud highlights the necessity for them and also their power of seduction, commenting that his case histories read "like novels" (as in the case of Katharina, 1895), a fair turning of the tables on someone who never hesitated to see novels as the equivalent of case histories.

SOPHIE DE MIJOLLA-MELLOR

See also: "A. Z."; "From the History of an Infantile Neurosis" (Wolf Man); Aimée, case of; "Analysis of a Phobia in a Five-year-old Boy" (Little Hans); Anna O., case of; Cäcilie M., case of; Eckstein, Emma; Elisabeth von R., case of; Emmy von N., case of; "Fragment of an Analysis of a Case of Hysteria" (Dora/Ida Bauer); Hirschfeld, Elfriede; Katharina, case of; Little Arpåd, the boy pecked by a cock; Lucy R., case of; Mathilde, case of; "Notes upon a Case of Obsessional Neurosis" (Rat Man); Richard, case of; Studies on Hysteria. Bibliography

   * Freud, Sigmund. (1905e [1901). Fragment of an analysis of a case of hysteria. SE, 7: 1-122.
   * ——. (1955a [1907-08]). Notes upon a case of obsessional neurosis (Rat Man). SE, 10: 151-318.
   * Freud, Sigmund, and Breuer, Joseph. (1895d). Studies on hysteria. SE,2.
   * Freud, Sigmund, and Pfister, Oskar. (1963a). In Heinrich Meng and Ernst L. Freud, (Eds.), Psychoanalysis and faith: The letters of Sigmund Freud and Oskar Pfister (Eric Mosbacher, Trans.). New York: Basic Books.
   * Freud, Sigmund, and Jung, Carl Gustav. (1974a [1906-13]). The Freud/Jung letters: The correspondence between Sigmund Freud and C. G. Jung (William McGuire, Ed.; Ralph Manheim and R. F. C. Hull, Trans.). Princeton, NJ: Princeton University Press.