The Case as Exception — On Luis Izcovich, The Clinical Case in Psychoanalysis: A Lacanian Perspective

What is a case in psychoanalysis? The question Luis Izcovich¹ poses at the opening of his new book is, on the face of it, a question that should already have been answered. The case is the most familiar form psychoanalytic transmission takes — what one presents in cartels and seminars, what an analytic training is supposed to prepare one to construct. And yet, as Izcovich notes, the question of what constitutes a case in psychoanalysis has not been adequately settled in the century since Freud invented the talking cure. The form belongs to medicine, where a case verifies a diagnostic category against the universal of a syndrome. The DSM is the contemporary expression of this logic: the category precedes the patient, the patient verifies the category. It is Izcovich’s contention that psychoanalysis adopted the case-form without ever clarifying precisely what distinguishes the psychoanalytic as such.

The book's answer to this question, its central thesis, can be stated thus: a case in psychoanalysis is the production of an exception, not the verification of a category. The case is what Izcovich, in a recurring phrase, calls the beyond of the structure: the moment at which an analysis demonstrates how the singularity of a subject's relation to jouissance exceeds the structural classifications, and forces those classifications to be rethought. In this way, the book sharpens a distinction Lacan states but never fully develops: the distinction between the particular and the singular.²

The distinction has a long philosophical history. The terms universal and particular descend from Aristotle. The singular as a separable third category emerges later, with the scholastic problem of universals, and receives its most consequential settlement in William of Ockham's nominalism — the position, against the realism of universals, that only singulars are real. Kant, beside the universal and the particular judgement, marks out a third logical species: the singular judgement. He leaves it, Lacan notes in Seminar IX: Identification, as "something like a toothing stone," present in the architecture, unbuilt-upon. Izcovich enters the lineage through Pierre Alferi's Guillaume d'Ockham le singulier (1989),³ which supplies the formula that does much of the philosophical work in the book: "Singularity is the absolute as such, only heart of things, every being's coincidence with himself.”

What Izcovich draws from this lineage is the distinction itself, put to clinical work. The particular is the subject in a set: the clinical structure, the identifications, the symptom-formation that allies a subject with hysteria or obsessionality. The singular is something else: the off-standard marks of infantile jouissance, the irreducible mode by which language has impressed itself into the body of this subject and no other. The structure-based clinic aims at the particular; the case-based clinic aims at the singular.

The distinction is fundamental, and also one Lacanian clinicians often fail to maintain in practice. Anyone who has sat through clinical seminars will recognise the slippage. A case is presented. Within minutes the discussion has settled into the well-worn grooves of "a case of hysteria" or "a case of obsessionality" — here the unsatisfied desire and the question of being a woman, there the postponing doubt and the dead father who cannot be relinquished. The singular case recedes behind the diagnosis made to recognise it. Izcovich's argument is that this reflex, however well-intentioned, closes off our attention to singularity. It returns the analytic clinic to the medical diagnostic method from which the case-form was inherited. The psychoanalytic case is not the illustration of a category. It must exceed it.

Izcovich is not claiming that the analyst can simply abandon the particular for the singular. The analyst still needs to recognise what kind of subject is speaking: the structure that allies this analysand with hysteria, that one with obsessionality, another with psychosis. The structural reading orients how the analyst listens, the position taken in the transference, and the form that interpretation can take. Furthermore, without the structure-based clinic there is no psychoanalytic clinic in the proper sense: no shared discourse, no transmissible knowledge between practitioners, no way for one analyst's work to speak to another's.⁴ The case-based clinic adds a second move. The structural placement does not contain the subject, and the analytic act has to operate on what exceeds it. Both are required for psychoanalytic work: the particular as its precondition, the singular as its proper object. Izcovich's case for the singular is not a case against the particular but a case against the particular's monopoly on how we think about a case.

The rest of the book extends this thesis through further moves. The case is a clinic of the real, sustained by what Izcovich calls a "learned ignorance" — the most elaborate form of knowledge. With the parlêtre, interpretation shifts from truth to the jouissance of the speaking body. Psychosis is read as singularity rather than deficit. The case clinic shifts what psychosis can be in analytic work. The late symptom, the sinthome, is used logically. The book lands, at the close of Chapter 6, on a sentence I keep returning to: "The case-based clinic, as a clinic of the real is a clinic à deux. Not two subjects, but two partners of jouissance." The analyst is the second partner of jouissance, except that the analyst's speech is itself emptied of it. The case is what the two of them produce.

Having put the book down, I am struck by how vital its intervention is for clinical practice. It gives Lacanian psychoanalysis its clearest statement to date of what the case in psychoanalysis is, and how it can be transmitted. Izcovich keeps the argument within Lacanian clinical work, its proper home, but the form of the claim is more general. Anyone who wants to think with singularity, clinical or critical, faces the same question: whether the case, the work, the subject is being read as the verification of a category one already had, or as an exception that reorganises the very category itself.

Footnotes

1) Izcovich is a senior analyst of the IF-EPFCL (International of the Forums of the Lacanian Field / School of Psychoanalysis of the Forums of the Lacanian Field), the strand of Lacanian work that took shape after Colette Soler and others departed from Jacques-Alain Miller's World Association of Psychoanalysis (WAP) in 1998.

2) Lacan's preface to the Walter Verlag German edition of the Écrits (1973), in Autres écrits (Seuil, 2001), pp. 557 ff. Not yet in a formally published English edition.

3) Pierre Alferi (b. 1963), French poet and philosopher, son of Jacques Derrida; Guillaume d'Ockham le singulier is his 1989 doctoral thesis, an influential reading of Ockham's nominalism as a metaphysics of the singular. Untranslated.

4) An alternative approach to this problem can be seen in the WAP/Millerian current, where the Borromean clinic of knots — drawn from Lacan's late teaching — has come to supplement or partially displace the structural categorical clinic as the central diagnostic framework.