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Beyond Symptom Accumulation: a Lacanian Clinical Approach to Obsession - a Case Study and Theoretical Exposition Julie L

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Beyond Symptom Accumulation: a Lacanian Clinical Approach to Obsession - a Case Study and Theoretical Exposition Julie L Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Summer 2014 Beyond Symptom Accumulation: A Lacanian Clinical Approach to Obsession - A Case Study and Theoretical Exposition Julie L. Futrell Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation 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 This Immediate Access is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. BEYOND SYMPTOM ACCUMULATION: A LACANIAN CLINICAL APPROACH TO OBSESSION A CASE STUDY AND THEORETICAL EXPOSITION A Dissertation Submitted to the McAnulty College and Graduate School of Liberal Arts Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By Julie L. Futrell, M.A., M.Ed. August 2014 Copyright by Julie L. Futrell 2014 iv BEYOND SYMPTOM ACCUMULATION: A LACANIAN CLINICAL APPROACH TO OBSESSION A CASE STUDY AND THEORETICAL EXPOSITION By Julie L. Futrell Approved May 3, 2013 ________________________________ ________________________________ Bruce Fink, Ph.D. Suzanne Barnard, Ph.D. Professor of Psychology Associate Professor of Psychology (Committee Chair) (Committee Member) ________________________________ Colleen Carney, Ph.D. Adjunct Faculty (Committee Member) ________________________________ ________________________________ James Swindal, Ph.D. Leswin Laubscher, Ph.D. Dean, McAnulty College and Graduate Chair, Department of Psychology School of Liberal Arts Associate Professor of Psychology Professor of Philosophy iii ABSTRACT BEYOND SYMPTOM ACCUMULATION: A LACANIAN CLINICAL APPROACH TO OBSESSION A CASE STUDY AND THEORETICAL EXPOSITION By Julie L. Futrell August 2014 Dissertation Supervised by Bruce Fink, Ph.D. 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. iv 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. v DEDICATION Dedicated to my patients, all of whom taught me that therapy truly is a labor of love. vi ACKNOWLEDGMENTS First and foremost, I offer my profound gratitude to my director, Dr. Bruce Fink, without whom I would never have had such extensive exposure to Lacan’s work. How fortunate I feel to have been able to call him my director, professor, mentor, clinical supervisor, and now, colleague. His attention to the detail of my work and commitment to helping me develop my own critical thought and clinical expertise have impacted me immeasurably. To be able to actually say (and mean) that I enjoyed writing my dissertation bears witness to his unwavering belief in and support of me. Simply put: thank you. I offer my heartfelt thanks to the patients about whom I wrote in this work. Psychotherapy can be a difficult and trying journey, and I admire my patients for their courage and perseverance throughout our time together. I can only hope that they continue the work we began together and continue to reap the incalculable rewards of such dedication. To my readers, Drs. Suzanne Barnard and Colleen Carney. To Dr. Barnard, I owe my deepest thanks for emphasizing the necessity of highlighting the roles that gender and culture play in clinical work and for inspiring me to write! My inestimable thanks to Dr. Carney, who took time out of her already incredibly busy schedule to sit on my committee because of her own dedication to and belief in psychoanalysis. Both Drs. Barnard and Carney’s commitment inspires me and their energy is something to behold! To Drs. Leswin Laubscher and James Swindal for endlessly and patiently answering (or helping me find answers) to my sometimes (often) endless questions, for teaching me what it means to really think critically, and for, without fail, supporting my fiery nature and encouraging me to spread that fire. To Dr. Roger Brooke for reminding me to laugh and to not take it all so seriously (and it is way too easy to take it all so seriously). To Dr. Frank Ghinassi for helping me see the bigger picture and encouraging me to find the path that is uniquely mine. To Marilyn Henline and Linda Pasqualino for basically helping me keep some grasp on my sanity over the past few years. How those two women manage to stay calm amidst the craziness of a bunch of clinical psychology graduate students who are seemingly always in a state of panic might just be the eighth wonder of the world. To the Mest family for offering me an incredible place to write my dissertation. Staring out at the breath-taking Atlantic Ocean while writing one’s dissertation goes a long way toward actually getting it done. vii To Drs. Stephanie Swales and Michael Miller for going before me. Their books proved invaluable during the writing process. To Ryan, for his obsessive proofreading skills and general support throughout the evolution of the dissertation. To my parents, Sharon and O.L. Futrell, without whom I would have had a much more difficult time making it through graduate school. Their continuous support allowed me to focus exclusively on the writing of my dissertation, truly something for which I am deeply grateful. (They also had to listen to me complain daily for five years about the dreaded Pittsburgh winter—a feat in and of itself.) To Ariel. I would have moved back to Austin that first year if she hadn’t insisted that I keep moving forward. To Shannon Kelly, who tirelessly and graciously listened to me ramble on about the finer points of Lacanian theory and who concretely helped me find clarity with the case formulations when I found myself lost in a sea of abstract philosophizing. To Leah, Celeste, and Jess, my partners in crime who made certain I did something other than work all the time. At long last, to Dr. Terry Pulver—the biggest feminist I know. viii TABLE OF CONTENTS Page Abstract .............................................................................................................................. iv Dedication .......................................................................................................................... vi Acknowledgements ........................................................................................................... vii Introduction: Locating Lack ............................................................................................1 Introduction to the problem .............................................................................................1 Whither Lacan? ................................................................................................................7 Preliminary observations ...............................................................................................12 Chapter I: A History of Obsession ................................................................................16 Literature review ............................................................................................................16 Psychological formulations of obsession .......................................................................22 Cultural considerations ..................................................................................................44 Method ...........................................................................................................................46
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