McAnulty College and Graduate School of Liberal Arts
Contemporary approaches to psychotherapeutic intervention increasingly utilize a medical-based diagnostic system focused on identifying and eradicating discrete symptoms. Mental "disorders" are determined by identifying "pathological" behaviors and superficial symptoms which are then lumped together arbitrarily and labeled as specific "mental illnesses." Despite a gross lack of supporting evidence, these "mental illnesses" are then attributed to various brain abnormalities and biological malfunctions, most often with reference to "chemical imbalances" believed to be the origin of mental distress. Evidence for such biological reductionism is presented conclusively, with little regard for the implicit ontological assumptions made by such a positivist perspective. When psychopathology is viewed in this way, the role of human experience is devalued, resulting in an egregious medicalization of human distress that has devastating consequences for those who suffer.
The work of Jacques Lacan offers a radically different approach to diagnostic formulation and treatment that has, until recently, largely been ignored in Western psychology. This dissertation seeks to participate in correcting this imbalance by offering a Lacanian clinical approach to working with obsession. I offer two case studies of former patients--both of whom presented with classic symptoms of the medical syndrome known as obsessive-compulsive disorder--to illustrate Lacan's structural approach in contradistinction to a descriptive, symptom-based approach. I endeavor to make Lacan's obsessive structure and his diagnostic schema accessible to mental health professionals interested in employing Lacan's work. To do so, I utilize a qualitative case study methodology, with particular emphasis on the psychoanalytic interview. I draw specific attention to the difference between obsessive-compulsive disorder and Lacan's obsessional structure. Finally, I highlight the ethical implications for clinicians of the ideological construction of mental distress as solely biological and suggest that Lacan offers a diametrically opposed discourse that is sorely lacking and needed at this time.
Futrell, J. (2014). Beyond Symptom Accumulation: A Lacanian Clinical Approach to Obsession - A Case Study and Theoretical Exposition (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/562