Le cas de Monsieur Y. : du traumatisme à l’exception

The objective of this article is to clarify the specificities of the psychoanalytic approach to trauma, based on the study of a single clinical case. Whereas contemporary discourses tend to emphasize the role of lived events in the emergence of a psychopathological picture, we aim to demonstrate how psychoanalysis operates a shift in perspective vis-à-vis deterministic and linear explanatory models. Focusing on the case of a psychotic patient in his fifties who had lost his sight following a gunshot wound, we demonstrate how psychoanalysis invites us not to place the emphasis intrinsically on a past event. Rather, it suggests looking at the singular and unpredictable response of the subject as an individual, in a diachronic perspective that takes into account the importance of temporality and hindsight. In this way, I was able to study how this patient gradually integrated the traumatic event into a singular subjective construct. In turn, this allowed me to understand the stabilizing mechanisms of this construct, through the prism of the Freudian hypothesis of delusion as an “attempt at healing”.

Method

The method I adopted is that of the single case study. This approach was chosen as it is the only one that can illustrate the singularity of the subject's response in its diachronic character. In particular, I deliberately chose the style of an analytical case study. This differs from the ideal of scientific objectivity insofar as the psychoanalytic technique is characterized by the importance given to the transferential dimension in the cure, and thus calls upon the subjectivity of the therapist. Thus, I endeavored to reconstruct the history of this patient in its diachronic unfolding, by recounting the biographical and anamnestic elements as they appeared during the clinical encounter. To support this further, I integrated elements from the archival consultation of medical records. I then studied the evolution of the patient's subjective position through the prism of Freudian and Lacanian theories on psychosis.

Results

A psychoanalytic approach made it possible to demonstrate that in this patient, his position as the object of an injury predated the occurrence of his wounding by firearm. This later event was thus initially reintegrated, by him, within the framework of the logic of the delusion of persecution that predated it. Nevertheless, the social recognition of his position as a victim may have induced in him a pacifying effect. He was able to reinterpret the event in the aftermath, based on the construct of a position of exception. In that position, he assumed the figure of the ‘seer’ who played the role of naming, leading to a significant appeasement of the persecution anxieties.

Discussion

Here I propose a discussion of the possible similarities between the position of exception constructed by this patient, and the cases of President Schreber and the writer James Joyce. In particular, my aim was to show that the delusional construction of my patient differed from the logic of the ‘pousse-à-la-femme,’ and that it was also not analogous to the production of a Borromean sinthome. This was because his delusional construct did not enable his re-inscription into any form of social bond. Nevertheless, the therapeutic work carried out with this patient during his last hospitalization made it possible to pinpoint how the transferential relationship can, in some cases, help the psychotic patient to make use of the therapist as a partner. Such a partner authenticates the advent of a position of enunciation, and the action of naming through the process of delusion.

Conclusion

The single case method made it possible to demonstrate that the psychoanalytic approach to trauma offsets any tendency to make the traumatic event the causal root of the psychopathological picture. By looking at the patient's history in its entirety and its complexity, it was possible to emphasize the unique and unpredictable nature of the subject's response. The temporal logic of Freudian hindsight calls for a re-evaluation of the encounter between the subject and the event from a dynamic and diachronic perspective. Such a re-evaluation takes into account structures that are already in place, the singularity of the subject's history, as well as the unpredictable creative potential of each individual. In addition, the therapeutic relationship may form a fourth aspect, when it becomes a support and accompaniment to the subjective creation.