Neurose versus psicose: um tensionamento diagnóstico frente à história clínica de SERGEI Konstantinovitch Pankejeff

Abstract

The clinical history of Sergei Konstantinovitch Pankejeff, Freud's mythical patient, continues to intrigue and spark discussions about the validity and limits of interpreting diagnoses in psychoanalysis. In 1910, Sergei visited Freud's clinic, after several attempts with other psychiatrists. This visit resulted in a long treatment, lasting four years, and the diagnosis of a severe case of obsessive neurosis. The influence of traumas on the formation of childhood sexuality stood out among the memories reported by Sergei during the treatment, and it was based on these memories that Freud carried out more detailed theoretical work on sexuality and the stages of libido development. In the context of the psychoanalytic community, it is true that Freud's diagnosis was the first; however, although original, Freud's conception was not the last word on Sergei's illness. Another interpretation became well-known, that of Ruth Mack-Brunswick, who diverged from Freud's position by diagnosing Sergei as a case of hypochondriacal paranoia. The aim of this dissertation was to revisit the clinical history of this patient in order to map the traumatic events and psychic processes that led Freud to the diagnosis of obsessive neurosis, and Mack-Brunswick to the hypothesis of a psychotic condition While both analysts converge in emphasizing suffering of an ideational nature, there are theoretical and clinical conduct differences that soon become evident. But perhaps here, there are transferential differences, above all. While Freud investigated the repercussions of an infantile neurosis, highlighting the impasses of psychosexual development in adult illnesses, Ruth found herself faced with the difficult task of paving the way for the elaboration of the transferential remains of previous analytical processes that seemed to lack elaboration, and whose relationship with reality went beyond a neurosis.