Diagnóstico em psicanálise: da estrutura ao discurso

Abstract

This master’s dissertation proposes an investigation regarding the issue of the differential diagnosis in the context of the psychoanalytic practice. It consists of a research based on a clinical observation that refers to the operability of both the phenomenological and the structural diagnoses. It suggests an indication of a perspective in which the direction of the clinical handling is not pervaded by the pre-established classificatory rigor, but by the question of the subject in its relation to the Other, his discursive position. We have adopted, as a method, the analysis of five clinical cases: two cases with the same structural diagnosis and three cases with the same phenomenological diagnosis. Despite the classificatory repetition, it could be verified, in these cases, that the clinical conduction adopted was completely different for each one of them: what guided the direction of the treatment was neither the structural diagnosis nor the diagnosis by the phenomenon. The question of the constitutive insufficiency of the diagnosis was, more specifically, the main point of convergence around which we tried to locate the research, in order to detect, in each case, what was determinant, in an attempt to extract from it a diagnostic methodology. We understand that there is, from the outset, a paradox that faces the psychoanalytic theory, insofar as it does not respond to the normative categorization of mental disorders, since the very notion of category subverts the psychoanalytic axiom of the uniqueness of the case. We then sought to identify which nosology would be in consonance with psychoanalysis in terms of the embracement of the subject at the level of the discourse, a nosology that could encompass a clinical methodology capable of considering the uniqueness of the clinical case along with universal diagnostic precepts. This dissertation also touches on the problem of psychoanalysis and the scientific method, since we understand that the diagnosis is paradigmatic of the tension that lies in the relationship between psychoanalysis and science.