66 TITLE

THE PECULIAR CASE HISTORY: FINDING PURLOINED

MEANING IN SUBJECTIVE TEXTS*
by Elizabeth Bradshaw, M.Sc.

“Let me caution you that this is an affair demanding the greatest

secrecy, and that I should most probably lose the position I now hold,
were it known that I confided it to anyone…the business is very sim-
ple indeed, and I make no doubt that we can manage it sufficiently
well ourselves; but then I thought Dupin would like to hear the details
of it, because it is so excessively odd.”
— Monsieur G., in Edgar Allan Poe’s “The Purloined Letter” (1844)

In 1956, Jacques Lacan made public an interpretation of Edgar Allan

Poe’s 1844 short story “The Purloined Letter” that raised questions for both
literary theorists and psychoanalysts regarding the nature of expression and
truth (Muller and Richardson, 1988). The case history, like Poe’s story, chal-
lenges the issues of representability and veracity.
“The Purloined Letter” opens as two men — an unnamed narrator
and his friend, the investigator, C. Auguste Dupin — are presented by the
Parisian Chief of Police with an “exceedingly odd” case: a sensitive letter
has been stolen in plain sight from the royal boudoir. Dupin suggests to the
Chief of Police that perhaps the trouble in this case is not its complexity, but
rather that it is “too plain … a little too self-evident.” Eventually, we dis-
cover the solution to the mystery of the purloined letter is indeed ingenious
in its simplicity: the original thief had simply changed the outward appear-
ance of the letter and hidden the document in plain sight. Dupin tests this
theory, and proves triumphant, by disguising himself in order to find and
steal the letter once again. His actions, however, shift the letter’s signifi-
cance: once found, the letter is no longer purloined, and yet Dupin’s actions
have transformed the letter again into stolen material.

* I wish to thank Mr. Stephen Grosz and Maurice Marcus, M.D., and my
colleagues Mr. Jakob Engel and Miss Lisa Riordan Seville for comment-
ing on drafts of this paper.
 AUTHOR 67

In the literary and psychoanalytic worlds, Poe’s story has both provoked
and served as the textual backbone of an interdisciplinary dialogue among
psychoanalysts and theorists alike. It is a story of concealment and expo-
sure, of contexts, and of shifting signifiers. Peculiarities of the psychoana-
lytic case history as a literary genre, like the purloined letter, are so fully in
view that their implications often escape notice: they are inherently inte-
grated into the structure of the writing itself — in plain sight. However, as
clinical material is transformed into a written case, the complexity of such
an action can often be left unaddressed.
A case history creates meaning out of inherently subjective material. The
analytic experience — the subject of the case history — only exists in a
dyadic relationship within the consulting room, at a specific time. Once
removed from this physical and psychic space, the case history becomes,
like the manifest dream, a derivative production. Like the purloined letter,
the case history is problematic in its very nature, for once it is found it can
no longer be lost, and thus loses its most defining feature. However, like the
purloined letter, the case history — when all of its problematic issues are
conceived — can incite discussion and debate regarding clinical technique,
the act of writing, and questions that lie at the foundation of psychoanaly-
sis.
As Lechte (1996) claims, that which is repeated in writing is “there when
it is not there, is not there when it is there, and is found only as lost…. It is
a purloined letter, with the emphasis on ‘purloined.’ Where is a letter that is
essentially purloined to be found? Once found, is it no longer purloined?”
(p. 19). The case history can only be found if we adequately address the
inherent peculiarities as we begin the search for meaning.
Case histories, then, like the purloined letter, do not represent objective
“real world” information, but rather consist of multiple inherently subjective
levels that are valuable in their own right. As both an object and a story,
“The Purloined Letter” thus provides an apt metaphor for the peculiarities
of the case history — disguise, consent, ratiocination, authorial authority,
transference curiosity, countertransferential enactments, and the limits of
language — as they apply to writing in psychoanalysis. How these idiosyn-
cratic features function and how they set case histories apart from other gen-
res is the subject of this essay.
68 TITLE

I. Methodological Peculiarities in Case Histories

“Well, the disclosure of the document to a third person, who shall be name-
less, would bring in question the honor of a personage of most exalted sta-
tion.”
— Prefect, in E.A. Poe (1844), “The Purloined Letter,” p. 8

Even as he created the form, Freud expressed his concerns regarding the
inherently problematic nature of writing psychoanalytic case histories. In
the early years of writing his pivotal works — a canon within the canon,
Patrick Mahony (1989) argues — Freud admitted to the methodological and
theoretical problems involved in writing such cases. In his 1918 preface of
“The Wolf Man,” Freud states: “I have abstained from writing a complete
history of his illness, of his treatment, and of his recovery, because I recog-
nized that such a task was technically impractical and socially impermissi-
ble” (p. 8). Although Freud claimed that his case histories revealed “the inti-
mate connection between the story of the patient’s sufferings and the symp-
toms of his illness” (Breuer and Freud, 1895, p. 161), he further acknowl-
edged that “no means has been found of in any way introducing into the
reproduction of an analysis the sense of conviction that results from the
analysis itself” (p. 13).
The case history is meant to be a narrative account of what happened dur-
ing the course of an analysis. Like Poe’s story, the case history consists of
minute details and verbatim dialogue. However, it includes other layers of
meaning such as the patient’s symptoms, their meaning, the patient’s life
history, the words and actions of the analyst, the analytic process, the ana-
lyst’s intentions in writing up the case, as well as the reader (Michels, 2000).
Like the story of “The Purloined Letter,” the case history attempts to simul-
taneously embody multiple dimensions of perspective and narrative in order
to reflect the myriad complexities of real life. In his 1920 case of a homo-
sexual woman, Freud sums up the complications inherent in attempting to
address these numerous concerns in his comment that “linear presentation is
not a very adequate means of describing complicated mental process going
on in different layers of the mind” (p. 160). This echoed his 1908 letter to
Jung in which he argued quite succinctly that “[a] real, complete case can-
not be narrated but only described” (Wright, 1974, as quoted in Michels,
2000, p. 357).
 AUTHOR 69

Another methodological oddity of analytic case histories — also found in

perfect crimes — is the unknown identity of the central character. The need
to protect analysands’ identities is potentially in conflict with the need to
retain enough detail to render clinical accounts meaningful. Can an analyst-
author both protect his patient’s identity and also effectively and accurately
communicate the most relevant aspects of the analytic process without sub-
stantially altering the authenticity or intelligibility of a case?
This conflict is intrinsic to case histories. Freud (1905) discussed the
problem of maintaining confidentiality in the Prefatory Remarks to his Dora
case. He described his fear of being “accused of giving information about
[his] patients which ought not to be given” (p. 7). This fear drove him to
change all names, wait four years to publish the case, and choose a patient
from a remote area. His deliberate protections leant credulity to his assertion
“that every case history … will be secured against their perspicacity by sim-
ilar guarantees of secret” (p. 9). Even in Poe’s story, both the sensitive con-
tents of the purloined letter, as well as the original perpetrator’s identity, are
never revealed.
Freud clearly addressed the matter of confidentially and disguise in his
1915 “A Case of Paranoia”: “I have altered the milieu of the case in order
to preserve the incognito of the people concerned, but … I have altered
nothing else” (p. 243). While Freud did consider it “wrong practice … to
alter any detail in the presentation of a case,” he provided an example of an
acceptable distortion in a 1924 footnote to Studies on Hysteria of “shifting
the scene from one mountain to another” (Breuer and Freud, 1895, p. 134).
Freud often addressed the fine line between disguising his patients and
essentially creating fictional portraits. Goldberg (1997) picks up on this
dilemma, writing that “we run a risk of essentially writing fiction if we
become firm protectors of confidentiality, while we run a risk of moral
transgression if we insist on a truthful presentation of our work” (p. 438);
Stein argues that by protecting the patient’s identity, analysts “risk losing the
individual by creating a fictional character” (p. 110). As Dupin solves the
mystery by donning a costume and stealing the letter himself, does it render
the resolution and narration of the case any less truthful or reliable?
This issue remains controversial. According to Renik (1994), clinical
facts, although deliberately altered, can still be considered to be factual.
Michels (2000), in contrast, states that there is no consensus on how far a
disguise should go. The ambiguous descriptions on how to accomplish con-
fidentiality provided in the ethical guideline literature further complicate the
70 TITLE

issue of disguise. For example, The Principles of Medical Ethics with

Annotations Especially Applicable to Psychiatry, from the American
Psychiatric Association (1995), states that “[clinical] and other materials
used in teaching and writing must be adequately disguised in order to pre-
serve the anonymity of the individuals involved” (quoted in Scharff, 2000,
p. 429). As Scharff also notes, it becomes apparent that there is no general
rule about procedure; descriptions such as “adequately” leave clinicians
attempting to write case histories much room for speculation and doubt.
The question of patient consent dovetails with that of confidentiality.
Although clearly an ethical issue, consent generates clinical repercussions
as well. A case history that is published without consent could be seen as the
revelation of details that might harm the pride of the patient and “bring to
question the honor” of the analyst (Poe, p. 8). Publication of a case, there-
fore, without patient consent could be thought of as a sort of theft — an act
thus rendering the contents of the case purloined.
As such, the analyst deciding to reveal rather than disguise his intentions
must consider the effect that seeking consent has on the patient, the analyst,
and the analytic process. Freud (1905) claims that “[it] is … certain that to
ask [patients] themselves for leave to publish their case would be quite
unraveling” (p. 8). If brought up during the analysis, it clearly intrudes in the
process, and yet if raised afterward impinges into the patient’s life (Michels,
2000). Others, such as Stoller (1988), question the viability of truly
informed consent; Lipton (1991) wonders what the effect of consent would
be on the patient’s transference, while Goldberg (1997) notes the difficulty
of determining “just what ‘informed consent’ consists of here, inasmuch as
one can never fully determine the consequences of such a request” (p. 435).
Some analysts always ask permission prior to writing, while others do
not. Those who ask on a case-by-case basis make their decision based on the
analysand’s psychopathology, the state of both transference and counter-
transference, the extensiveness of the proposed case report, and their ethical
position (Scharff, 2000). As no clear ethical guidelines exist, most analysts
decide for themselves whether to request permission (Levine, 1990, quoted
in Scharff, 2000). The legal privilege of the privacy of a treatment could be
said to belong to the patient. But that begs the question of who does the
treatment itself belong to? With such ambiguity involving ownership, the
boundaries between privilege and pilfering may become blurred and lost.
The introduction of a third party — the reader — potentially disrupts the
 AUTHOR 71

analytic dyad. The reader of a case history is perhaps analogous to the per-
son who stole and read the letter not intended for his eyes — a thief and co-
conspirator with the author/analyst. Shaprio (1998, in Scharff 2000) claims
that the analyst’s need for the material the analysand provides functions in
conjunction with the external reader as a third element that contaminates the
space of the analytic dyad1. The analyst, then, is also a thief, presenting the
reader with stolen goods. The presence of a research atmosphere and instru-
mentation further serve as disturbances of the analytic pair that may “intro-
duce transference complexities which are at the very least difficult to eval-
uate” (Stein, 1998a, p. 109). It could be said that even mentally holding the
intention, conscious or unconscious, of writing a case could intrude upon the
psychic space of an analysis. Like Dupin, the analyst becomes intricately
woven into the story, thereby altering the very fabric of the narrative itself.
Dupin’s desire to solve the case drove him to literally enter into the narra-
tive and rewrite the ending as he deemed fit.
Writing and presenting case histories present further occasions for coun-
tertransferential disruptions to arise. Michels (2000) claims that any writing
or even planned writing comprises the “countertransference theme of enact-
ment,” and that any good case history is a “crystallization of the analyst’s
countertransference” (p. 371). The case history can “enrich an audience’s
understanding of what really happened in the treatment being recounted,
and can convey more than the analyst knows” (pp. 371-372). Morrison
(1990) further equates the impulse to write with a “countertransference reac-
tion” and claims that the interest to write “serves to distance [the analyst]
from the patient and the difficult affect she experiences” (p. 410).
As a result of these complications, what repercussions exist for the ana-
lytic community? As clinicians we must continue to consider the impact of
writing case histories upon our patients. Yet Scharff (2000) believes that too
much concern might hamper analysts’ wishes to contribute to analytic liter-
ature, teach students, and provide colleagues with material for debate (p.
422).

1 The presence of a research atmosphere and recording instrumentation could also serve

as disturbances of the analytic pair that may introduce transference complexities. See
Stein, 1998 for a further discussion of the subject.
72 TITLE

Part II. Philosophical Peculiarities in Case Histories

“What is true of relation — of form and quantity…?’”

— Dupin, in E.A. Poe (1844), “The Purloined Letter,” p. 18

Case histories come to embody the philosophical paradoxes inherent in

psychoanalysis itself, and as a result become problematic in their recount-
ing. Is it possible to present a coherent narrative of one’s clinical experience,
while at the same time account for the multiple dimensions and ambiguities
inherent in such real-life interactions? Furthermore, how would reading a
case history be different from being in the consulting room, watching a
video recording, or reading a transcript? A narrative without confusion or
contradiction might mask the uncertainty and ambiguity of the real world,
Michels (2000) argues, while the more intellectually, emotionally, and aes-
thetically satisfying a narrative, the less space it leaves for the audience to
conceive alternative levels of narrative (Tuckett, 1993).
The move from the consulting room to the world of publication highlights
the subjectivity of observation. Renik (1994), for example, views clinical
facts as composed largely of idiosyncratic inferences and are essentially
interpretations. Though arrived at by logical inferences, clinical facts remain
products of the authors’ subjectivity; they are influenced by the dynamic
unconscious and are thus only detected by its impact on the author and then
on the reader (Scharff, 2000, p. 425). The Prefect and Parisian police were
not able to solve the case of the purloined letter through the process of
objective ratiocintation; rather, they required Dupin to use his own subjec-
tive personage as the compass to guide and interpret the case. Dupin is only
able to “right” the problem by “writing” the problem himself. Similarly, a
psychoanalytic clinical report is nothing more than the writer’s subjective
interpretation of what transpired during the here-and-now of the analysis.
Freud (1925b) comments that “the reproduction of a perception as a pre-
sentation is not always a faithful one; it may be modified by omissions, or
changed by the merging of various elements” (p. 237). No matter how an
analyst presents the material, they undoubtedly filter it through their mem-
ories, prey to selective recall, distortion, and the limitations of comprehen-
sion. Freud (1925a) further highlights the connection between perception,
memory, and permanence in the metaphor of the mystic writing-pad. He dis-
cussed how
 AUTHOR 73

devices to aid our memory seem particularly imperfect, since

our mental apparatus accomplishes precisely what they cannot:
it has an unlimited receptive capacity for new perceptions and
nevertheless lays down permanent — even though not unalter-
able — memory traces of them. (p. 227)

As Renik (1994) argues, we have to respect Einstein’s special theory of rel-

ativity as it applies to psychoanalysis: every observation involves taking
into account the observer’s activity in relation to the thing observed (p.
1248). A purely objective clinical case report is thus not possible; previous
experiences, biases, and theoretical orientation influence the analyst’s expe-
rience of the patient, and therefore shapes the subject matter portrayed.
The concept of “narrative truth” within analytic writing has been utilized
to justify some of the inherent issues of subjectivity and authenticity that are
peculiar to the writing of case histories. Hanly (1996) argues that the term
“narrative truth” necessarily means that the coherence of the analyst’s inter-
pretations is the only criterion for validating a case history.
However, this categorical denomination of case writing seems a particu-
larly convenient way to sidestep the question of subjective validity within
analytic writing. This hermeneutic perspective implies that in the process of
analysis the analyst should aim to achieve a “story” agreed on by both the
analyst and the patient. The result is that “ ‘narrative’ truth and ‘historical’
truth have been set up as mutually exclusive ideals” (Hanly, 1996, p. 44).
However, does this imperative imply that historical truth is not a suitable
criterion for interpretation in psychoanalysis? Hanly (1996) answers by
claiming fiction and literary theory are inappropriate tools to answer ques-
tions regarding the uses of the past or of reconstruction in psychoanalysis;
Kermode (1966), however, believes that meaningful patterns and a sense of
cause and effect exist only in fiction. Fiction and literary theory, in other
words, are problematic mechanisms of validation for psychoanalysis, in that
the analytical process is inherently not rational, coherent, or linear. All we
can glean is the subjective experience.
To use the term “narrative” to denote clinical case histories provides
another problematic element associated with the writing of clinical materi-
al. According to Hanly (1996), psychoanalysts who have most discussed
“narrative” have not adequately described the debate on the topic as it has
been conducted in the humanities and social sciences (see the works of
Scholes, 1966; Genette, 1976; Mitchell, 1981.) Pure narrative, as described
74 TITLE

by Genette (1976), does not employ the first person and has no obvious bias
on the part of the narrator. Pure narrative gives the impression that the tale
told is what happened, and “in the strictest sense is distinguished by the
exclusive use of the third person and of such forms as the preterit and plu-
perfect” (Genette, 1976, p. 11). Can we trust Dupin as a reliable narrator,
particularly given that he writes the tale from the inside out? One must also
question the possibility of this type of absolute coherence and consistency
within the analytic experience, given the nature of the unconscious and of
the analytic process.
Using the word “narrative” to describe psychoanalytic case histories blurs
many of the defining features of an analysis. Moreover, the term’s insistence
on the third person and lack of bias is diametrically opposed to many of the
totems of psychoanalysis. These include free association, with its disorga-
nized, disconnected, and fragmentary components, the lack of a clear begin-
ning-middle-end sequence, and silences and gaps whose content lie in the
unconscious and the deeper structures of the psyche that are glimpsed
through disjunctions in the associative processes (Hanly, 1996).
The impulse to fit case histories into the designated genre of “narrative”
requires manipulating associations that are not coherent into a cogent narra-
tive (Spence, 1982). Ogden (1994), in a clear, logical, and chronologically
ordered manner, recounts his “reverie” during an analytic session: he regis-
ters a letter — an “envelope that had been in plain view,” similar to the pur-
loined letter. He notices the “vertical lines” at the bottom of the letter, pon-
ders their significance, notes his feelings of “disappointment” as he associ-
ates to the friend who had written the letter, and later emerges out of his
mental wanderings and consciously considers how his thoughts “might be
related to what was currently going on between [himself] and the patient”
(p. 5). His associations are logical, his connections clear, and the stream of
thought proceeds uninterrupted and coherent. Is this description an accurate
portrayal of what occurred psychically during the analytic hour? Were the
inner workings of Ogden’s mind so coherent and linear? The fluid writing
within case histories may resemble dream work, particularly “secondary
revision,” in which the mechanisms of compression and disguise dominate
in order to satisfy the mind’s demands for some coherence in the tale as it is
finally experienced by consciousness (Stein, 1988a, p. 111). The narrative
becomes the manifest dream. As such, the text has intrinsic value as a deriv-
ative of the latent material, but cannot substitute for it.
 AUTHOR 75

Part III. Literary Peculiarities in Case Histories

“You have precisely what you demand to make the ascendancy complete —
the robber’s knowledge of the loser’s knowledge of the robber.”
— Dupin, in E.A. Poe (1844), “The Purloined Letter,” p. 9

“[S]trange that the case histories I write should read like short stories,”
Freud wrote in 1895, “the nature of the subject [is] evidently responsible for
this” (p. 160). Freud’s reflections linked literary fields to psychoanalytic
writing since its inception. Stemming from this same comparative vein,
Freud also contended that the poets discovered the unconscious before he
did, while later literary critics — like Trilling — complement this claim by
stating that Freud and the poets practiced on the same human nature (Skura,
1981, p. 33). Foucault, too, argues that psychoanalysis tends to fall within
the realm of literature (1979, p. 149). As Skura (1981) states, “the resem-
blance between psychoanalysis and literature lies in their dynamic interac-
tion … between the free-ranging play of mind and the organizing response
to it, and the continuing play which they contradict or confirm” (p. 208).
This relationship of literature and psychoanalysis perpetuates the issues
involved in writing case histories. The peculiar issues involved in the writ-
ing and reading of literary texts may also apply to the publication and recep-
tion of clinical case histories.
The tension between the surface narrative and the symbolic and allusive
dynamics in literature, as exemplified by Poe’s story, exists in case histories,
too. As with literary analysis, a complete consideration of a case history
must address both the explicit analyst, patient, symptoms, illness, and analy-
sis, as well as the implicit author/analyst, the relationship between the ana-
lysts and the patients, and the purpose in recounting the case. Like Dupin’s
compound roles within “The Purloined Letter,” the author of a case history
also holds a multifarious position. The multiple roles of author-analyst
emanate from an unconscious level within the text, which becomes prob-
lematic if not addressed in the reading of a case history.
Barthes (1979), commenting on the disjunction between the author-ana-
lyst and the analyst in the text, writes: “the I that writes the text is never,
itself, anything more than a paper I” (p. 79). One can never know anything
of the analyst aside from that which is presented on the written page. There
exists a three-fold analyst: the analyst in the here-and-now, the analyst as
76 TITLE

author, and the constructed psychoanalyst portrayed within the clinical

write-up. We readers have access to each of these personas only through the
text. Foucault (1979) sees the author “pointing to the ‘figure’ that, at least in
appearance, is outside it and antecedes it” (p. 141). The line between fiction
and clinical case histories blur because we cannot rely on the information
we receive. Because these case histories represent the foundations of psy-
choanalytic knowledge, the reliability of the narrator-analyst is of essence,
yet it cannot be divorced from rhetorical strategies or the author’s intentions.
The construction of meaning within the text depends upon the reader’s
response to a written case. While literary critics focus their analysis on how
the transference to the listener shapes a story, analysts are moreover simi-
larly cognizant of the way in which countertransference colors their percep-
tion of a case. In the same way that Ogden’s letter — hidden in plain view
— “had been physically present for weeks, [but] at that moment [of con-
templation] it came to life as a psychological event,” (Ogden, 1994, p. 9) the
meaning of a text changes based on the reader and the time of reading.
Reader-response criticism approaches the understanding of literature by
underlining the reader’s role in creating meaning and experience of a liter-
ary work (see Norman Holland, 1975, and Stanley Fish, 1980, on this sub-
ject). A text cannot exist objectively without taking into consideration both
how it has been conceived by the author and received by the reader. Such
factors at work when reading a clinical piece of writing include the follow-
ing: ready-made transferences to the author or the author’s psychoanalytic
position, resonance or agreement with the author’s claim, empathic respon-
siveness to the affective exchanges between analyst and patient, and the
author’s intention (explicit or implicit) in writing (Coen, 2000, p. 462).
Brooks (1994) makes the point in regards to Dora that

the relation of teller to listener is as important as the content and

structure of the tale itself…. the relation of teller to the listener
inherently is part of the structure and the meaning of any narra-
tive text. (p. 50)

In this sense, a reader must employ another dimension of interpretation in

the reading of a case history — not only what transpires between the ana-
lyst-author and the patient, but also the dynamics between the text and the
reader.
 AUTHOR 77

Part IV. Found Meaning in Insolvable Peculiarities

To admit the author’s irreducible subjectivity requires the reader consid-

er the question of meaning and accuracy in the publication of case histories.
The value of case histories comes from the author’s attempt to communicate
the here-and-now of the analytic experience (even if it is inherently subjec-
tive) in both a compelling and believable manner. Two spatio-temporal set-
tings potentially exist within the paradigm of case histories: the clinical sit-
uation and the reading situation (Mahony, 1993, p. 1031). Not comprehen-
siveness, but rather the analysts’ writing makes a case history believable; the
authors’ ability to somehow convey to readers the experience in the con-
sulting room, the analytic atmosphere, and their encounter with the patient’s
and their own unconscious lend credulity to the history. However, the innate
qualities of the unconsciousness mean that it may not be linear, one-dimen-
sional, or told by an omniscient and reliable narrator. Once the author com-
municates the off-stage experience of the analysis, he or she renders it sub-
jective, multi-dimensional, and polyadic. It is then the task of the author to
attempt to creatively express these qualities in writing.
Although the information communicated through the reading and writing
process is subjective and contains peculiarities involved in its conception,
the story communicated is an experience that has its own intrinsic value.
The question of contaminating the analytic experience, as well as that of
veracity, arise from the nature of the clinical material itself. In the end, per-
haps we must consider the peculiarities of case histories — unlike Dupin’s
purloined letter — as a case we are unable to resolve.

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