Symptom and Structure

Lacan’s list of clinical structures or diagnostic categories may seem small: psychosis, neurosis and perversion, neurosis being divided in turn into hysteria, obsession and phobia. It may also seem arbitrary: why are there not 4 fundamental structures, or 6 subdivisions of neurosis?

Of course, Lacan inherits his diagnostic categories from Freud, and there may be a sense that he is continuing to elaborate the key terms of a rich and productive legacy, in a manner someone who writes on a figure like Deleuze aims not simply to produce critical commentary on his work, but extend it into new domains.

Lacan, on this account, would be a kind of Freudian. But what of the groundedness of the terms inherited from Freud? As a philosopher, Deleuze provides arguments for the ideas and structures he puts forward: his work must be phenomenologically compelling, in the case of appeals to experience, and deductively so, in the case of appeals to the conditions of experience; it must also be logically consistent; it is incumbent on the philosopher to provide demonstrative and sometimes verifiable grounds for for his claims.

With Freud, however, so much depends upon clinical work, upon working with patients as an analyst and, of course, upon being analysed oneself. As such, much that is central to psychoanalysis must remain closed to those of us who have been neither analysand nor analyst. This is so even for those who have a sense of its enormous ambition – psychoanalysis, as Sinthome said somewhere, can be understood as a transcendental account of the symptom, exploring its conditions of possibility.

As such, the clinical structures Lacan identifies provide much more than a cursory mapping of particular symptoms encountered in analysis. He does not seek, for example, to continue to the multiplication of clinical categories Fink, commenting on Lacan, finds among American psychiatrists, psychoanalysts and psychologists: ‘depressive disorder’, ‘bipolar disorder’, ‘panic disorder’, ‘hyperactivity’, ‘hypnoid states’, etc. None of these categories is able to excavate the determining structures that account for the symptoms they map, being content merely to analyse each pattern of symptoms to its smallest constituents, and targeting it with drugs or specific therapeutic techniques.

Psychoanalysis does not take a symptom-by-symptom approach, since the same symptoms can actually be found in disparate kinds of people. Fink gives the following example:

A woman who is anorexic can legitimately be categorised as having an ‘eating disorder’, but then we already know this as soon as we are told she is anorexic. If, however, she is diagnosed as hysteric, we can begin to situate the role of her ‘eating disorder’ within the larger context of her psychical structure. This may allow us to see, for example, that the same role played by her anorexic in her teen years may have been played by vomiting when she was a child, shoplifting when she was in her early twenties, and high-stress, high-volume trading as a stockbroker in her later years.

Then the classificatory scheme to which Lacan appeals has the advantage of being able to understand what unifies those symptoms the patient manifests. The practice of psychoanalysis appeals to a transcendental account of symptoms that cuts across the specificities of their manifestation in particular patients.

This account cannot be presented detachedly in the manner of a philosophical treatise, since it depends upon clinical practice – upon the analyst’s experience as a practitioner who comes to the use of Lacanian diagnostic schema over a considerable period of time. Fink refers often to those analysts who are under his care; presumably, the analyst him- or herself will need to be watched over and guided. Over time, however, the schema will take on usefulness and significance for the practitioner, as he or she begins to intuit common features of patients in the same diagnostic category.

Here, the analyst must not be misled by the appearance of symptoms which overlap from structure to structure: obsession and hysteria can manifest themselves, for example, in compulsive rituals and somatic symptoms; hysterical traits like conversion can be found in obsessives and obsessive traits in hysterics. It is no surprise that Freud sought an absolutely definitive account of hysteria, since this would allow the analyst to lay bare the fundamental mechanisms that regulate the patient’s psychic economy. But Freud was unable to find one, leaving only provisional definitions of hysteria and obsession, which as Fink notes, are often internally inconsistent.

‘In his lifelong attempt to formalise and extend Freud’s work’, Fink writes, ‘Lacan provides the basis for a structural understanding of obsession and hysteria that Freud did not provide’. His account of the diagnostic schema is supposed to open up the key structures that account for symptoms; as such, he may be taken to have produced the transcendental structure Freud looked for, but was unable to produce. But this structure can reveal itself only to those who are analysts themselves, and have undergone a lengthy period of training.