book review  

P. Fedida & F. Villa ed.: Le cas en controverse / The single case as controversial.
Monographies de psychopathologie, PUF, Paris, 1999.
review by Olivier Nicolle

This book takes its place in a series of monographs published by one of the most renowned academic research centres for psychoanalysis in France (Laboratoire de Psychopathologie fondamentale et de Psychanalyse, Université Paris-VII). It gathers a range of 17 papers from French clinical researchers about the single-case issues and, as such, reflects some main ways contemporary psychoanalytic thinking in France deals with this subject.

When speaking about contemporary research in our psychoanalytic field, the controversy is well-known between the single-case methods advocates (Freud, Ferenczi, Abraham, Klein, Lacan and all the other founders of psychoanalysis to begin with) and the supporters of the so-called "empirical" (i.e. quantitative) methods such as random controlled trials and probability inductive evaluation. One knows to what extent the dogma of "evidence-based medicine" has flooded the medical clinical practice. Is it now tending to invade the psychoanalytic psychotherapy field, above all from diverse budgetary pressures? Looking exclusively for therapeutic evidences might lead us to rely on "false evidences": as we all know, it can be for instance a terrible gap between what shall be termed as an evidence for "healing" on the scale of a 2,3 or 5 years research, and what could be termed as a therapeutic integrative process on a human life history scale.

The many authors of this monograph happily go beyond this discussion "in defence" ( …that had seemed a somewhat outdated one for long times…, but alas!…) and their papers are diversely dedicated to an underlining of what makes up the single-case method specificity and consistency, proving that the single-case possessed, and does possess today a founding place in the theoretical and theoretic-technical steps of psychopathology and psychoanalysis. As we know, all the paradigmatic figures and models we use in our day-to-day analytic and therapeutic practice stemmed from such carefully elaborated single-case studies. So, what do we call a "case", and is it still possible to speak about "a psychoanalytic case" as in the past? What are we looking for, when presenting a "case"? Which implicit theory does support the way we present these "model cases"? How do these "cases" may contribute in elaborating a theoretical problematic? Is the "case" truth the same as the "true history" of a person?

The authors show that the single-case is a scientific operation and, as such, has not to be tied down to any "bona fide" or evident factual truth principle, but must tend at making possible any creative and renewing elaboration of a transference/counter-transference saturated material for both case reporter and case reader, using the theoretical frame as a meaning operator and as a shoring.

In fact every narrative (and particularly a case-narrative) results from any semiotical-linguistical operation, which is open to analysis, and which is compelled by any epistemological model, say "scientific" or "historical", "literary" or "hermeneutic", for instance. So single-case has to be linked not only with pathology monograph, but also with tales, myths, historical reconstruction, roman, and "family roman". At this step, case narrative sets up some kind of a psychic space where analysts may communicate, and it connects psychoanalysis with other scientific fields.
When the times comes for new clinical understanding of psychic individual and of its place in life and culture, the single-case issues do open a thinking space where not only psychoanalysis, psychiatry, psychopathology and outcome assessing are invited, but also epistemology, language sciences, history and anthropology.

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last modified: 2001-07-25