The conceptualisation of clinical facts

There has never been a fact that has not already been conceptualised. To enter into discourse as a fact, whatever the case may be in the world that is of immediate concern must always already be symbolically mediated, that is, already a specialised version of that aspect of the world. To become a 'clinical' fact, however, 're'conceptualisation is required; before then the clinician has only details. Details become clinically significant when, implicitly or explicitly, they are situated and redefined in a context of interrelated clinical narratives. These narratives are based partly on dialogue and partly on the general theories or metanarratives provided by one or another school of psychoanalytic thought. During psychoanalysis, new clinical facts continue to be conceptualised, and these often alter their own formative contexts, for they include the consequences of previous conceptualisations. Consequently, facticity is always in flux as, over time, understanding alters meaning and emphasis. Even the apparently brute fact of corporeality changes with changes of age, culture, historical epoch, gender of patient, and phase of analysis. In analysis, a central role is played by insight into the functions served by the analysand's uses of 'fact' in the course of devising, unconsciously, transferenceAcountertransference enactments. Illustrated case material is provided.