“When we are dealing with a truly great philosopher the real question to be raised concerns not what this philosopher may still tell us, what he may still mean to us, but rather the opposite, namely, what we are, what our contemporary situation might be, in his eyes, how our epoch would appear to his thought.”—Slavoj Zizek - First as Tragedy, Then as Farce.
“How Psychoanalysis Works”. This is not a question, this is an assertion. Because psychoanalysis indeed works, contrary to what some noisily object o nowadays. Still, we need to account for it.
The word ‘work’ (opèrer), used in an intransitive way, is a strong word. Coming from the Latin ‘operari’, which means ‘to work’, ‘to operate’ or ‘operation’, it involves an action that produces an effect, an “ordered sequence of acts that effect a transformation” (according to ‘Le Robert’). To say it in a matter of fact way: psychoanalysis changes something, it yields results. By what means and with what aim is what we will show.
At the end of his teaching, Lacan said that for all these years he did not stop questioning his ‘co-practitioners’ “on the subject of knowing how they could possibly operate with words – I don’t say cure, one does not cure everybody. There are operations that are effective and that only happen with words.”(1) The power of the word was also what Freud, inventor of psychoanalysis, patiently gave account of to the supposed ‘impartial person’ who did not know anything of the ‘peculiarities of an analytic treatment’, whom he addressed in 1926 on Lay Analysis. The specific use of words in the meeting of a psychoanalyst with his patient is neither suggestion nor magic. The way words are used cannot be captured by other practices or any previous knowledge. Freud says: “analysis is a procedure sui generis, something novel and special, which can only be understood with the help of new insights - or hypotheses, if that sounds better.”(2) Freud considered that the hypothesis of the unconscious and the importance of sexuality in the determination of neurosis were the two ‘cornerstones’ of psychoanalytic theory, deduced from the experience.(3)
To give our own account of how psychoanalysis works today, let us start from what our daily practice teaches us. Let us not hesitate to take things from the level of the phenomena. Let us ask ourselves what in a given case took place and what was at work. By doing this we will prove that this ‘how’ neither goes back to, nor culminates in a practical guide that prescribes procedures to follow for foreseeable and generalisable results. We verify again, as at the Congress of the WAP in 2004, that Lacanian practice is without standards, but that it is for all that not without principles.
In order to orient ourselves, let us return to the ‘fundamental concepts of psychoanalysis’, as Lacan chose them from Freud in 1964, to revive them. Seminar XI is a very particular moment in his teaching, a rupture and a new departure, the stakes of which have often been illuminated by Jacques-Alain Miller. Lacan puts a series of four concepts in order: the unconscious, repetition, transference and the drive, with which he responds to the question of what founds psychoanalysis as ‘praxis’ (4), by speaking to an extended audience beyond the psychoanalysts who followed his teaching at that point.
For the unconscious to speak it needs someone who listens to it, said Jacques-Alain Miller in London, at the ‘Rally of the Impossible Professions’. A psychoanalyst distances himself from the dominant contemporary ideologies who do not believe in the unconscious.(5) He is interested in the things that are wrong, that fail, that defy mastery, and of which Lacan made the manifestation of the truth of a subject. This unconscious that ‘opens and closes’, that presents itself as hindrance and failure, how is it gotten hold of? How do we offer the possibility of surprise by proposing this special mode of speaking that is free association? What is our responsibility in an interpretation?
Repetition, in its insistence, is the missed encounter with the real, with what is inassimilable in the signifier, with what Freud called trauma. How do we bear it?
This real is at play in transference, in as much as it is defined as ‘enactment of the reality of the unconscious’, which is sexual. What place do we occupy in transference? What function do we have in it?
The drive circles the lost object, the object a, and yields in this same circuit its satisfaction; this is in no way equivalent to the good of the subject. The analytic operation allows the subject to detach himself from the identifications he was subjected to, and to recognise the jouissance that is his own. Under which conditions is this possible?
These basic concepts, says Lacan, are “what makes us certain of our practice”.(6) But there is something more. The whole seminar is traversed by the initial question: “What must there be in the analyst’s desire for it to operate in a correct way?” Contrary to the discourse of science, where the desire of the physician is not questioned, “the analyst’s desire can in no way be left outside our question”.(7) This desire is the spring of the operation. Lacan will respond in 1967 with the formalisation of the end of analysis and his concept of the act of the psychoanalyst. Thus, to the question of what could put someone in the position to support the analytic act he responded that a psychoanalyst is the product of his analysis, taken to its end.(8)
(1) Lacan, J.; « Le phénomène lacanien », conférence à Nice (30.11.1974), in Cahiers cliniques de Nice, 1 June 1998, p. 14. (not translated/published in English)
(2) Freud, S.; The Question of Lay Analysis , Standard Edition (SE) vol 20, trad. Strachey, J., Hogarth Press, London, p.189/190
(3) Freud, S.; On The History of the Psychoanalytic Movement , SE 14, p.16
(4) Lacan, J.; The Seminar, Book XI, The Four Fundamental Concepts of Psychoanalysis, tr. Sheridan, A., Penguin, London 1994, p. 6
(5) Miller, J.-A.; ‘Closing Remarks at the Rally of the Impossible Professions, Against the False Promises of Security’, in Hurly-Burly, issue 1, 2009, p. 211
(6) Op.cit, p. 263
(7) Ibid.; p. 9 + 10
(8) Lacan, J.; Proposition of 9 October 1967 on the Psychoanalyst of the School (Autres écrits, Paris, Seuil, 2001, pp. 243-259) published in English on the website of the London Society, tr. Grigg, R.: http://www.londonsociety-nls.org.uk/pdfs/Propositionof9October1967.pdf
“Herein lies the paradox proper to capitalism, its last resort: capitalism is capable of transforming its own limit, its own impotence, in the source of power—the more it ‘putrifies,’ the more its immanent contradiction is aggravated, the more it must revolutionize itself to survive.”—Slavoj Žižek, The Sublime Object of Ideology (via velvetrobots)
It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for it. The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007—from one in 184 Americans to one in seventy-six. For children, the rise is even more startling—a thirty-five-fold increase in the same two decades. Mental illness is now the leading cause of disability in children, well ahead of physical disabilities like cerebral palsy or Down syndrome, for which the federal programs were created.
A large survey of randomly selected adults, sponsored by the National Institute of Mental Health (NIMH) and conducted between 2001 and 2003, found that an astonishing 46 percent met criteria established by the American Psychiatric Association (APA) for having had at least one mental illness within four broad categories at some time in their lives. The categories were “anxiety disorders,” including, among other subcategories, phobias and post-traumatic stress disorder (PTSD); “mood disorders,” including major depression and bipolar disorders; “impulse-control disorders,” including various behavioral problems and attention-deficit/hyperactivity disorder (ADHD); and “substance use disorders,” including alcohol and drug abuse. Most met criteria for more than one diagnosis. Of a subgroup affected within the previous year, a third were under treatment—up from a fifth in a similar survey ten years earlier.
Nowadays treatment by medical doctors nearly always means psychoactive drugs, that is, drugs that affect the mental state. In fact, most psychiatrists treat only with drugs, and refer patients to psychologists or social workers if they believe psychotherapy is also warranted. The shift from “talk therapy” to drugs as the dominant mode of treatment coincides with the emergence over the past four decades of the theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs. That theory became broadly accepted, by the media and the public as well as by the medical profession, after Prozac came to market in 1987 and was intensively promoted as a corrective for a deficiency of serotonin in the brain. The number of people treated for depression tripled in the following ten years, and about 10 percent of Americans over age six now take antidepressants. The increased use of drugs to treat psychosis is even more dramatic. The new generation of antipsychotics, such as Risperdal, Zyprexa, and Seroquel, has replaced cholesterol-lowering agents as the top-selling class of drugs in the US…
“Lacan used to say, ‘To love is to give what you haven’t got.’ Which means: to love is to recognize your lack and give it to the other, place it in the other. It’s not giving what you possess, goods and presents, it’s giving something else that you don’t possess, which goes beyond you. To do that you have to assume your lack, your ‘castration’ as Freud used to say. And that is essentially feminine. One only really loves from a feminine position. Loving feminises. That’s why love is always a bit comical in a man. But if he lets himself get intimidated by ridicule, then in actual fact he’s not very sure of his virility.”—JAM - On Love.
POR UNA PSICOPATOLOGÍA CLÍNICA, QUE NO ESTADÍSTICA (spanish)
MANIFEST A FAVOR D´UNA PSICOPATOLOGIA CLÍNICA, QUE NO ESTADÍSTICA (catalan)
MANIFESTE POUR UNE PSYCHOPATHOLOGIE CLINIQUE NON STATISTIQUE (french)
MANIFEST FOR A CLINICAL NON-STATISTICAL PSYCHOPATHOLOGY (english)
MANIFESTO POR UMA PSICOPATOLOGIA CLÍNICA NÃO ESTATÍSTICA (portuguese)
By this manifest, the undersigned professionals and institutions, want to declare ourselves in favor of clinical diagnostic criteria, and therefore against the imposition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, as the sole criterion in the clinic of psychological symptoms. We would like to share, discuss and agree on the clinical knowledge -logy- on mental pathos, understood as symptomatic suffering, and not a disease. We wish to question the existence of mental health, statistical or normative, as well as the clinical and intellectual imposture of the notion of mental disorder or mental illness. We also want to denounce the imposition of one sole therapy treatment for typified disorders. These being formatted to the detriment and contempt of other theories and treatment strategies, as well as the contempt of the patients’ right to choose. At present, we witness how clinical practice is becoming less dialogist and more indifferent to the manifestations of mental sufferings, clinging to the protocols and palliative treatments, which only address the consequences, but not their causes.
As stated by G. Berrios (2010) ”We are facing a paradoxical situation in which clinicians are asked to accept a radical change in the way of developing their work, (ie leave the advice of your own experience and follow the dictates of statistical and impersonal data) when in fact, currently, the basis that are used for evidence are no different than what the statistics, theorists, managers, companies (such as the Cochrane Institute) and capitalist investors say, being these who precisely say where you put the money.” We thus want to uphold a health model, where the speech is a value to promote and where each patient is considered in its particularity.
The defense of the subjective dimension entails to value and consider what each one brings into play to address what remains unbearable, stranger to oneself, but yet familiar. We express our rejection to the welfare policies which prioritize security at the expense of freedom and human rights. Policies that, under the guise of good intentions and the search for the good of the patient, reduce the patient to a performance calculation, a risk factor or a vulnerability index which ought to be removed, nearly by force.
For any discipline, the approach to the reality is done through a theory. But this limited knowledge should not be confused with The Truth. This would act as an ideology or religion, where any thought, event, or even the used language would serve to promote the re-ligare between knowledge and truth. Any clinician with a true scientific spirit knows that his theory is what Aristotle called anOrganon, that is a tool to approach a reality, which becomes always more plural and changeable, and whose categories are only an expression of its diversity, making it become wider from both a theoretical and practical perspective.
This conception is opposed to the idea of a canon, in the sense of what necessarily things are and that they must perform in a certain way. We all know the consequences of this kind of position that goes from being indicative to set a rule and become prescriptive, and ultimately coercive. This is where knowledge becomes the exercise of a power that sanctions as per what obeys or disobeys this canon. It also means the subordination of subjectivity to the management of social order, as per what markets demand. Everything is for the patient but without taking the patient into consideration. We know that any knowledge dismissing the subject constitutes an act of power on this subject. J. Peteiro calls it “scientific authoritarianism”. For all this, we want to express our opposition to the existence of a Sole, Compulsory and Universal Diagnosis Code.
Furthermore, the a-theoretical model that the DSM boats about, claiming to guarantee any objectivity, only talks about his epistemological failure. Suffice is to recall its inability to define what a mental disorder and mental health are. The contents of this psychiatric taxonomy respond more to political reasons and agreements than to clinical observations, leading to a very serious epistemological problem.
Regarding the classification method applied at the DSM, we find that even though many things can be sorted, stacked or grouped, there is no nosographic entity that can be established in a given field. Finally, and in the same line as above, the statistics used in the DSM have a weak point of origin: the ambiguity of the object on which it operates, that is, the concept of mental disorder. Statistics are presented as a technique, a tool that can be used for multiple causes, of any kind. Items and basic values of the statistical curve are handled by persons, and they are responsible to quantify and interpret the data.
In this context of poverty and confusion, the forthcoming DSM-V constitutes a clear threat: no one is sheltered from what is fixed as illness. There is no room for health in terms of change, mobility, complexity and multiplicity of forms. All of us are patients and we all suffer from a disorder. Any manifestation of discomfort will be quickly transformed into symptoms of an illness that needs to be medicalized for life. This is the big leap that has been done without any epistemological net: from prevention to the prediction. Frances Allen, head of Task Force of the DSM IV, warn us in his article “Opening Pandora’s box” about lower diagnostic thresholds for many existing or newly diagnosed disorders that could be extremely common in the general population. He also lists some of the new conditions that are to be included within the DSM-V: the risk of psychosis syndrome (“It is certainly the most disturbing suggestios. The false positive rate would be alarming, going from 70 to 75%”).The mixed depressive anxiety disorder. Minor cognitive disorder(“is defined by specific symptoms … the threshold has been arranged to include a massive 13.5% of the population”.) Binge eating disorder. Dysfunctional disorder character with dysphoria. Paraphilic coercive disorder. Hypersexuality disorder, etc. As a result, it does not only increase the number of disorders but also the semantic field of many of them, as it is in the case of the ADHD. The DSM-V promotes a diagnosis based on the sole presence of symptoms, and doesn’t entail any disability. Furthermore, it reduces to the half the number of symptoms required for adults. The diagnosis of ADHD is also provided in the presence of autism, which would involve creating two false epidemics and would foster an increased use of stimulants in a particularly vulnerable population.
If we combine these statistics with the heterogeneity thematic working groups that have proliferated, ranging from gender identity, through the adaptation of the pulse, hyper-sexuality, mood swings etc., we cannot ignore the pursuit of a full autonomy with respect to any theoretical framework and any epistemic rigor control by the international classifications. We, nevertheless, do not believe that the classifications and treatments can be neutral with respect to etiology theories, as it is intended. They can neither be neutral with respect to the ideology of social control, and other extra-clinical interests.
Paul Feyerabend, in “The Myth of Sscience and its Role in society”, writes: “Basically, there is hardly any difference between the process leading to the formulation of a new scientific law and the process that precedes a new law in society ” It seems, continues this author in “Farewell to Reason” that: “The world we live in is too complex to be understood by theories that obey to epistemological (general) principles. And scientists, politicians, -anyone trying to understand and / or influence the world and, taking into account this situation,- are violating universal rules, abusing of developed concepts, distorting the knowledge already obtained and constantly thwarting attempts to impose a science, in the sense used by our epistemologists. “
Finally, we would like to draw attention to the danger it involves to the treatment of psychological symptoms the fact that new clinicians are deliberately educated in the ignorance of classical psychopathology. Clinical psychopathology responds to the dialectic between theory and clinical practice, between knowledge and reality, but it is no longer taught at our universities. And yet, they are instructed in the paradigm of a pharmacologic approach that has become universally prescriptive for everybody and for any condition. It is not much different from a label vending machine, which restocks medication. What we denounce is the complete ignorance of the foundations of psychopathology, a fundamental tool when exploring patients and, consequently, a considerable constraint when making a diagnosis.
Since knowledge may the most ethical way for approaching our plural reality, the coexistence of different theories about the complexity of human beings should be respected.
Therefore, we propose to take actions in order to stop the increasing spread and growth of international classifications, and alternatively work with classification criteria which are based on psychopathology fundamentals and exclusively stem from the clinical practice.
Para las firmas de adhesión a los Manifiestos, pulsar aquí.
The unconscious is extra-psychological. As Freud is at pains to point out when he comes to write his metapsychological paper on the unconscious in 1915, the unconscious is not simply the negative or underside of consciousness but something that works by entirely different rules. And this is the point that Lacan wishes to stress in response to Valebrega’s presentation on the metapsychological chapter in The Interpretation of Dreams:
“This is precisely what I am telling you – the psychic locality in question is not psychic, it is quite simply the symbolic dimension, which is of another order” (p.131).
In his final interjection in this chapter, Lacan raises the question of the place of regression as a concept when considering the psychical apparatus as Freud had theorised it at the time of The Interpretation of Dreams. We will look at this in more detail in our discussion of this next chapter, but at this stage let us just note the fact that where Freud asserts that the dream supposes a hallucinatory satisfaction of a biological wish (for example, hunger) he is obliged to introduce the concept of regression to account for it in the schema of the psychical apparatus he uses in this chapter. Now there is clearly some kind of failure of Freud’s metapsychological theorisation here if we attempt to marry the dual hypotheses of dreams as satisfying hallucinated wishes, and dreams as being a text that expresses a desire. The desire present in dreams only exists in the actual text of the dream – it is not a desire for something, which you lack the having of, just as a repressed desire is not a desire that we cannot admit to ourselves, or something that is incompatible with other claims or intentions. What the dream, as other manifestations of the unconscious, shows us is that there is a message and that message is transmitted autonomously, regardless of whether you know about it or do not want to know about it. Indeed, if what is produced in the dream is extra-psychological, we might wonder in what sense can we think of our desires as being our own?
Reading… Seminar II, Chapter XI – Censorship Is Not Resistance.
“‘Subject’ is not a name for the gap of freedom and contingency that infringes upon the positive ontological order, active in its interstices; rather, ‘subject’ is the contingency that grounds the very positive ontological order, that is, the ‘vanishing mediator’ whose self-effacing gesture transforms the pre-ontological chaotic multitude into the semblance of a positive ‘objective’ order of reality. In this sense every ontology is ‘political’: based on a disavowed contingent ‘subjective’ act of decision…”—Slavoj Žižek, The Ticklish Subject.
Psychoanalysis is a practice of speech. It involves two partners, the analyst and the analysand, brought together in a single psychoanalytic session. The analysand speaks about what brings him there, his suffering, his symptom. This symptom is hooked into the materiality of the unconscious, made out of things that have been said to the subject, that have hurt him, and things that are impossible to say and cause him suffering. An analyst will punctuate the words of the analysand and enable him to weave the thread of his unconscious. The powers of language and the truth effects that it enables, what is called interpretation, is the actual power of the unconscious. Interpretation is apparent on both sides, analysand and analyst. They do not both have the same relation to the unconscious, however, since one has already carried this experience through to the end whereas the other has not.
• Second Principle
A psychoanalytic session is the place in which the most stable identifications by which a subject is attached can come undone. A psychoanalyst will authorize this distance from one’s customs, norms, and rules to which analysands constrains themselves outside of sessions. He will authorize a radical questioning of the foundations of each one’s identity. He is able to temper the radical nature of this questioning by taking into account the clinical specificity of each subject who addresses himself to him. He takes nothing else into account. This is what defines the specificity of a psychoanalyst’s place when he upholds this questioning, opening and enigma in any subject who has sought him out. He therefore does not identify with any of the roles that his interlocutor wants to make him take on, nor with any place of mastery or ideal that already exists in civilization. In a sense, an analyst is one who cannot be assigned to any other place than the place where desire is in question.
• Third Principle
An analysand will address an analyst. He will attribute sentiments, beliefs, and expectations as a reaction to what he says, and he wishes to act upon the beliefs and expectations that he anticipates. The deciphering of meaning in the exchanges between analysand and analyst is not the only thing at stake. There is also the speaker’s intention. It is a matter of recuperating something lost from the interlocutor. This recuperation of an object is the key to the Freudian myth of the drive. It founds the transference that binds the two partners together. Lacan’s formula that the subject receives his own message from the Other in inverted form includes both the deciphering and the wish to act upon whom it is that one is addressing. Ultimately, when an analysand speaks he wishes, beyond the meaning of what he says, to reach the partner of his expectations, beliefs and desires in the Other. He aims at the partner of his fantasy. A psychoanalyst, enlightened by analytic experience about the nature of his own fantasy, takes this into account. He restrains from acting in the name of this fantasy.
• Fourth Principle
The transference bond presupposes a locus, the “locus of the Other”, as Lacan puts it, which is not ruled by any other in particular. It is the locus in which the unconscious is able to appear with the greatest degree of freedom to speak and, therefore, to experience its lures and difficulties. It is also the locus in which the figures of a fantasypartner can be set out in the most complicated of their mirror games. This is why a psychoanalytic session does not permit of any third person, with his gaze external to the actual process that is underway. A third person will be reduced to this locus of the Other. This principle therefore excludes the intervention of any authoritarian third parties seeking to assign both a place to everyone and a pre-established aim for psychoanalytic treatment. The authority of the evaluating third party, who fits into the series of third parties, is affirmed from outside of what is at stake between an analysand, an analyst and the unconscious.
• Fifth Principle
There is no standard treatment, no general procedure by which psychoanalytic treatment is governed. Freud used the metaphor of chess to indicate that there were only rules and typical moves at the beginning and the end of a game. To be sure, since Freud the algorithms that have made it possible to formalize chess have grown in power. When connected to the calculating power of a computer they make it possible for a machine to beat a human player. This does not change the fact that, contrary to chess, psychoanalysis cannot be presented in the form of an algorithm. We can see this in Freud himself who transmitted psychoanalysis with the help of particular cases: the Rat Man, Dora, Little Hans, etc. With the Wolf Man the case history entered a crisis. Freud was no longer able to contain the complexity of the processes unfolding within the unity of a case. Far from being able to be reduced to a technical procedure, the experience of a psychoanalysis has only one regularity: that of the originality of a scenario through which all subjective singularity emerges. Psychoanalysis is therefore not a technique but a discourse which encourages each person to produce his singularity, his exception.
• Sixth Principle
The duration of a treatment and the unfolding of sessions cannot be standardized. The duration of Freud’s treatments varied. There were treatments that lasted a single session, as in the psychoanalysis of Gustav Mahler. There were also analyses that lasted four months, as in the case of Little Hans, a year as in the Rat Man, several years as in the Wolf Man. Since then the variation and the diversification have not stopped growing. Moreover, the application of psychoanalysis outside the consulting room in mental health settings has contributed to the variation in the duration of psychoanalytic treatment. The variety of clinical cases and the variations in the age at which psychoanalysis has been applied make it possible to consider that the duration of an analysis is now, at best, defined as “tailor made”. An analysis continues to the point where the analysand is sufficiently satisfied with what he has experienced to end his analysis. The aim is not the application of a norm but an agreement on the part of the subject with himself.
• Seventh Principle
Psychoanalysis cannot decide what its aims are in terms of an adaptation of a subject’s singularity to any norms, rules, determinations, or standards of reality. Psychoanalysis has above all discovered any subject’s impotence to achieve full sexual satisfaction. This impotence is designated by the term “castration”. Further, psychoanalysis, with Lacan, has formulated that it is impossible for there to be any norm in the relation between the sexes. If there is no satisfaction and if there is no norm, it is up to each person to invent a particular solution, one that builds on his symptom. Each person’s solution can be more or less typical, more or less established upon tradition and common rules. It may on the contrary wish to draw upon rupture or a particular clandestinity. It remains no less true that, at bottom, the relation between the sexes has no one solution “for all”. In this sense, this relation remains marked with the seal of the incurable, and there will always be something that fails. In speaking beings, sex stems from the “not all”.
• Eighth Principle
Analytic training cannot be reduced to the norms of university training or of the evaluation of what has been acquired in practice. Analytic training, ever since it was established as a discourse, rests on three legs: seminars of theoretical training (paraacademic); the psychoanalyst in training’s undertaking a psychoanalysis to its endpoint (from which flow the training effects); the pragmatic transmission of practice in supervision (conversations between peers about practice). Freud at one stage believed that it was possible to determine a psychoanalytic identity. The very success of psychoanalysis, its internationalisation, the multiple generations that have followed one another for over a century have shown how illusory this definition of a psychoanalytic identity is. The definition of a psychoanalyst includes the variation in this identity. It is this variation itself. The definition of a psychoanalysis is not an ideal, it includes the history of psychoanalysis itself, and of what has been called psychoanalysis in the context of distinct discourses.
The title of psychoanalyst includes contradictory components. It requires an academic, university or equivalent, training, deriving from the general conferring of degrees. It requires a clinical experience that is transmitted in its particularity under the supervision of peers. It requires the radically singular experience of a psychoanalysis. The levels of the general, the particular and the singular are heterogeneous. The history of the psychoanalytic movement is a history of disagreements over and interpretations of this heterogeneity. It forms a part of this Great Conversation of psychoanalysis which makes it possible to state who is a psychoanalyst. This stating is brought about through procedures in communities that are psychoanalytic institutions. A psychoanalyst is never alone, he depends, as does a joke, on an Other who recognizes him. This Other cannot be reduced to a normative, authoritative, regulatory, standardised Other. A psychoanalyst is one who affirms that he has obtained from the psychoanalytic experience what he could have hoped for from it and therefore that he has crossed over a “pass”, as Lacan called it. Here he testifies to having crossed over his impasses. The interlocution by which he wishes to obtain an agreement over this crossing over occurs in institutional settings. More profoundly, it is inscribed within the Great Conversation between psychoanalysis and civilization. A psychoanalyst is not autistic. He does not fail to address himself to the benevolent interlocutor, enlightened opinion, which he wishes to move and to reach out to, in favour of the cause of psychoanalysis.
By Eric Laurent in Preparatory Seminar Series -“Towards London”
Love, the love of the person who desires to be loved, is essentially an attempt to capture the other in oneself, in oneself as object…
The desire to be loved is the desire that the loving object should be taken as such, caught up, enslaved to the absolute particularity of oneself as object. The person who aspires to be loved is not at all satisfied, as is well known with being loved for his attributes. He demands to be loved as far as the complete subversion of the subject into a particularity can go, and into whatever may be most opaque, most unthinkable in this particularity. One wants to be loved for everything –not only for one’s ego, as Descartes says, but for the colour of one’s hair, for one’s idiosyncrasies, for one’s weaknesses, for everything.
”—Jacques Lacan, Seminar I: Freud’s Papers on Technique.
“Depression! Sacrosanct depression! The word is spreading, at a gallop, and rinforzando, the rumor is making its way, the devil, it’s spread all over, and for some days now it’s been haunting the Elysée Palace. From Lisbon, the journalist from Le Monde who covers him, Mr. Philippe Ridet, wrote “Another life is beginning for the chief of State. What president will he be now that he is alone? Depressive, weakened?” One of his counselors wants to reassure us: “The exercise of power”, he says, “will triumph over the depression.” But no, the harm has been done: whatever his entourage might say, the public eye will no longer let him be, it will scrutinize the shades of his pallor, the luster of his eyes, his complexion, the tilt of his head, his gait, the circles under his eyes… Woe to him at the first sign of fatigue! We are henceforth living in a world where good old tiredness no longer exists: it’s the blues, depression, darling, where are you? Quick, my anti-depressor!”—JAM -Depression.
“It is no surprise that Coke was first introduced as a medicine - its strange taste does not seem to provide any particular satisfaction, it is not directly pleasing and endearing; however, it is precisely as such, as transcending any immediate use-value (like water, beer or wine, which definitely do quench our thirst or produce the desired effect of satisfied calm), that Coke functions as the direct embodiment of “IT,” of the pure surplus of enjoyment over standard satisfactions, of the mysterious and elusive X we are all after in our compulsive consumption of merchandise. The unexpected result of this feature is not that, since Coke does not satisfy any concrete need, we drink it only as a supplement, after some other drink has satisfied our substantial need - it is rather this very superfluous character that makes our thirst for Coke all the more insatiable: as Jacques-Alain Miller put it succinctly, Coke has the paradoxical property that, the more you drink it, the more you get thirsty, the greater the need to drink more of it - with its strange bittersweet taste, our thirst is never effectively quenched. So, when, some years ago, the publicity motto for Coke was “Coke, that’s IT!” we should discern in it the entire ambiguity: “that’s it” precisely insofar as that’s NEVER effectively IT, precisely insofar as every satisfaction opens up a gap of “I want MORE!””—Zizek - Surplus-Enjoyment Between the Sublime and the Trash.
“An important proportion of the historical research in the domain of medical sociology has repetitively followed the “paradigm” of “institutional motives”. Ignoring the fact that clinicians will usually try to heal their patients, and inspired by Kuhn’s triumphant theories, theses researchers have decided that the use of clinical categories or therapeutic techniques is mainly a question of power. Individual motives were thus considered as being of little relevance, as compared to the idea that competition between “scientific groups”. and downright ambition will always structure the personal implication of a man, no matter what his scientific engagements may be. As a result the history of clinical categories, for instance monomania, has been drained of their practical significance; the human conflicts have been seen solely as conflicts of power, to such an extent that the succession of concepts has become an inconsistent series, “full of noise and fury”. It doesn’t seem to occur to some of these historians that the original definition of monomania, i.e. partial madness, could have some sort of practical and clinical meaning. The history of clinical research and practices is now seen as a evolucionist domain, and the survival of the fittest is conceived as its only prevailing law. History, at the turn of the 19th century, had become a critical domain, in the sense of the Neo-Kantians; a century later, it seems to have become the mere justification of industrial strategies. Amazingly few clinicians (for instance Berrios) dare to counter these unwarranted pretensions.”—François Sauvagnat. Recent Challenges of Psychoanalytic Therapies.
“The idea of men’s receiving an intimation of their connection with the world around them through an immediate feeling which is from the outset directed to that purpose sounds so strange and fits in so badly with the fabric of our psychology that one is justified in attempting to discover a psychoanalytic—that is, a genetic—explanation of such a feeling. The following line of thought suggests itself. Normally, there is nothing of which we are more certain than the feeling of our self, of our own ego. This ego appears to us as something autonomous and unitary, marked off distinctively from everything else. That such an appearance is deceptive, and that on the contrary the ego is continued inwards, without any sharp delimitation, into an unconscious mental entity which we designate as the id and for which it serves as a kind of façade—this was a discovery first made by psychoanalytic research, which should still have much more to tell us about the relation of the ego to the id. But towards the outside, at any rate, the ego seems to maintain clear and sharp lines of demarcation.”—Das Unbehagen in der Kultur (1929) - S.Freud.
“What I say regarding the place that the psychoanalyst can occupy is currently the only place where a doctor can maintain the originality of his position, that is, what he has to know, although this can only be done by directing the subject to reverse his thinking to make this demand.” The position of being the one who takes care or takes charge (the demand) corresponds to the space of supposing knowledge of the truth about what happens to a subject. Today, this place is emptier than ever.
We can deduce that the foregoing makes the psychoanalyst’s practice more necessary than ever if this position is empty. Our work is to take this empty space and lend somebody (different from a machine) to occupy it; this place is the basis of transference.
The normal, and morally acceptable, way of overcoming low self-esteem was to struggle with oneself and with others, to work hard, to endure sometimes painful sacrifices, and finally to rise and be seen as having done so. The problem with self-esteem as it is understood in American pop psychology is that it becomes an entitlement, something everyone needs to have whether it is deserved or not. This devalues self-esteem and makes the quest for it self-defeating.
But now along comes the American pharmaceutical industry, which through drugs like Zoloft and Prozac can provide self-esteem in a bottle by elevating brain serotonin.
Women, women in love, are anxious. They are anxious about their man’s desire. Following Lacan’s comment after his quotation of one of his women analysands, this would be the definition of feminine love.
What did this woman say ? She told her analyst that she didn’t mind her husband desiring her « as long as he desired no other » ! « Qu’elle y tienne, c’est ça l’amour » (1)was Lacan’s comment on these words . She cared for her husband’s desire and prized it. This caring for and prizing the desire of the Other, which may be expressed in English by ‘being anxious’, is love.
Now, what does such a definition of a woman’s love have to do with anxiety, or with anguish ? In French, apparently nothing. Because ‘y tenir’ only means caring for and prizing something.
But the English ‘being anxious’ allows the question to be raised. Not only does this expression acknowledge a close relation to anxiety. It reveals moreover, beyond its worry and unease, a being ‘earnestly desirous’ … desirous of the Other’s desire ! (And then, why not remember here the Freudian point of view ? Freud explicitly linked anxiety and love in women by stating that castration anxiety can certainly find no place in them, but that its place is taken by that of loss of love.)
So we may consider that this English translation of the definition of feminine love points out the Lacanian connection between Angst and desire : what a subject is concerned with in anxiety is desire, the desire of the Other. Lacan would have better said it in English !
Women are not subject to castration but they are subject to anxiety and anguish. In a different way than men. In his seminar on anxiety, Lacan underlines women’s ease concerning the desire of the Other, which often gives them more freedom in the handling of the transference. This ease has to do with their not lacking anything and thus not depending on the object for their own jouissance. That is why, When lovely woman stoops to folly/and paces about her room again alone/She smoothes her hair with automatic hand/ and puts the record on the gramophone (2).
Nevertheless anguish does get a hold of them. Whenever they discover themselves as being nothing more than a. That is to say, either when they experience themselves as really being at the centre of the Other’s desire. Or when, being in love, the desire they so earnestly desire really turns away from them.
1. Lacan, Seminar on anxiety, 20 March 1963. 2. T.S.Eliot quoted by Lacan, 29 May 1963.
“Psychological history of the concept “subject.” The body, the thing, the “whole” construed by the eye, awaken the distinction between a deed and a doer; the doer, the cause of the deed, conceived ever more subtly, finally left behind the “subject”.”—Nietzsche, The Will to Power - 8. Against Causalism, 547 (1885-1886).
“This tension between an ethics of desire and an ethics of drive further determines Lacan’s shift from distancing to identification. That is to say, up to the last stage of his teaching, the predominant ethical attitude of Lacanian psychoanalysis involved a kind of Brechtian gesture of distancing: first the distancing from imaginary fascination through the work of symbolic “mediation”; then the assumption of symbolic castration, of the lack constitutive of desire; then the “going through the fantasy”: the assumption of the inconsistency of the Other concealed by the fantasy-scenario. What all these definitions have in common is that they conceive of the concluding moment of the psychoanalytic cure as a kind of “exit”: as a move out, out from imaginary captivation, out from the Other. In his very last phase, however, Lacan outlines a reversal of perspective, unheard of as to its radicality: the concluding moment of the psychoanalytic cure is attained when the subject fully assumes his or her identification with the sinthome, when he or she unreservedly “yields” to it, rejoins the place where “it was,” giving up the false distance which defines our everyday life.”—Tarrying With The Negative (1993) - S.Zizek
How to define mental health in a scientific way? Let’s say it at once: it’s impossible. That’s why speaking about “mental disease” like one does in psychiatry has always been an abuse of language. Disease implicates the idea of healing as the return of health. If healing means a return to a primal, normal, state, how to define that primal state of the mental one should reach through the process of healing? Who will judge about it? And how? In medicine one can judge sanity objectively because the real of the organism, computable, measurable, obeys to scientific laws. And, the arterial tension or the blood sugar level for instance, are constants of the real of the organism that cannot vary without unchain a cardiovascular disorder or a diabetes, etc. But what would be the constants that define mental health? They don’t exist. To pretend the opposite by using questionnaires is a deception. Because the real of the psychism, of the mental, is enjoyment of the speaking being. So enjoyment is without laws but it is not without a cause. This means that it doesn’t obey to the scientific laws but, for each subject it obeys to a singular causality and is computable nor measurable. Can one believe that the mark on a CBT questionnaire will lead astray for long? According to Lacan, who posed that question seriously, the problem with the definition of mental health comes within an undecidable logic.
The moral of help
If mental health escapes from science, it is first of all because the mental is not of its not within its province. How to define the mental? If one trusts the dictionary, the mental results from the mind and its intellectual functions. It is the whole of the habits and the beliefs that command the thought. It is also the state of mind, the psychological and moral dispositions. Judgement, belief and morality are intellectual faculties that result from freedom of thinking. This liberty is incompatible with the strict determinism of science. This means it is a question of belief, we leave the field of science behind us. One can always define the mental, but this definition cannot be scientific. And the same counts for the mental norm. One can define it but its definition won’t be scientific neither, it will be moral. “Mental health is thus no more than the sum of the moralistic prejudices that preside over the establishment of questionnaires. Designed as such, it excludes, for the human being, every liberty of thinking, judging and deciding.
The unicorn and the centaur
How did the CBT experts respond to this impasse? They covered up this impossibility by turning mental health into a statistical concept. In that way, statistical reality has to keep “mental” health in consideration. This means that our empiricists have substituted the calculations to the facts that have to be observed. They have replaced the reality of the facts by that of statistics as if the calculations would be sufficient to make the reality of what is calculated come true. Do the statistics concerning the unicorns bring them to life too? One can agree about how many lims a centaur has, but it is not sure that this will make them exist. Calculating the prejudices won’t change anything about the fact that they are prejudices. The average man doesn’t exist, apart from a statistic fiction that one owes to Quételet2 and that Lacan has denounced3. Canguilhem has according to him, objected to the concept of statistical reality. He didn’t hesitate to criticize this deviation even concerning the definition the biological norm. For he judged that it is life in itself that is a concept of value and not a medical judgement4. The keystone of the CBT structure is based on the efficacy of the belief in the existence of a “mental health”. Without that, neither calculation nor shifts that these calculations result in.
The shifts: of the moral to the prefecture
By means of substituting the mental by the statistical calculation, the CBT manipulators have replaced the study object by its instrument, the mental by the statistic, which is the tool of its research. Once this substitution is accomplished, the real of the mental has disappeared, for it is no longer quantity, but quality. In this operation of reduction of the psychic symptom, there are at least three shifts taking place. The first one is the shift from what is normal to what is normative. We just saw that the psy norm, inaccessible for science, is always based on a value judgement as it is the result of the moral.
The second shift passes from the mental to the organic. The use of statistics authorizes to stick the conceptual tools that are applicable to the organism onto the mental. This operation procedes the materialistic and reductionistic theories that are dominant in the contemporary Anglo-Saxon world. For lack of the possibility of seeing the mental organ for which the dysfunctions count for all, the normof the mental is fabricated with statistics that pass for a universal truth.
At last, the artifice of the statistical calculation force the passage from the pathological to the normal, of the “mental” disease to the “mental” health. Here the use of statistical calculation permits a decisive semantic shift through which the statistic average first becomes the statistical norm, then the normand at last the mental normality.
After having admitted the idea that there exist a mental norm and a psychic normality, the CBT adepts can affirm about all who veer off course, not that they divertof the statistical average, but that they aredeviants, meaning that they are carriers of mental pathologies which have to be re-educated. The baroque category of the “hyperactivity of the child” has been fabricated with this methods. But in the name of the “scientific principle” that says that the truth doesn’t come out of the child’s mouth, what they say isn’t taken in consideration in the evaluations of them. The evaluation of the social entourage of the child and the CBT experts suffice to decree the abnormality. Here the abjectness of the “norm” includes obtaining of the mothers to agree to the consequences of the “abnormality” of their child: let them undergo the CBT re-educations and let them be prescribed medication. How much time do we have to wait for the consequences of this abuse so that the legislator realizes them and will take some measures to put an end to it, like it already is the case in the United States?
The DSM doesn’t hide that its diagnostics are constructed on the base of statistical calculations. Besides, the university adepts of the CBT managed to impose the same procedures to the WHO. Indeed, since 1978, the WHO has replaced the embarrassing notion of “mental disease” by the even problematic one of “mental health” that she defines as “a state of complete physical, mental and social well-being”. Our condition as sexuated and mortal being is at the principal of many psy sufferings. Would it be cured by the idea of well-being? And who wil judge about it if it is not the subject himself?
Let’s admit it, this type of solution consists of move the problem following the well known adagio thatit is no problem that an absence of solution cannot resolve. The seedy gaze effleurant human beings like simple things, shifting insidiously from the real to the fictive, from medicine to the moral and from subversive doctrines to business, the CBT adepts and their accomplices are departed for the attack at the politicians, hoping to convince them to legalize their doctrines.
“That is all I had to say to you about femininity. It is certainly incomplete and fragmentary and does not always sound friendly. But do not forget that I have only been describing women in so far as their nature is determined by sexual function. It is true that influence extends very far, but we do not overlook the fact that an individual woman may be a human being in other respects as well. If you want to know more about femininity, enquire from your own experience of life, or turn to the poets, or wait until science can give you deeper and more coherent information.”—Sigmund Freud, Femininity (1933).
Obsessional does not necessarily mean sexual obsession, not even obsession for this, or for that in particular; to be an obsessional means to find oneself caught in a mechanism, in a trap increasingly demanding and endless. He has to accomplish an act, a duty; a special anxiety takes over the obsessional. Will he be able to accomplish it? Once he has done it, he suffers the torturing need to verify it, but he doesn’t dare because he fears he will appear as a crazy man, because at the same time he knows well he did accomplish it; this commits him to greater and greater cycles of verification, precaution, justification. Taken in this way by an inner whirlwind, it is impossible for him to find a state of tranquillity, of satisfaction. Nevertheless, the great obsessional is far from being delirious. He has no conviction whatsoever, only a kind a necessity, totally ambiguous, that renders him incredibly unhappy, suffering, hopeless, left to an unexplainable insistence that comes from within himself, and that he does not understand.
The obsessional neurotic is common and can go unnoticed, if we are not attentive to the little signs that betray him. The people suffering from this illness occupy their social positions well, even if their life is ravaged, eroded by suffering and by the development of this neurosis. I’ve known people who held important positions, and not only honorary, but positions of leadership, people with great and extended responsibilities, that they assumed completely, but they were not in anyway less caught, all day long, as the prey of their obsessions.
“When they curiously question thee, seeking to know what It is,
Do not affirm anything, and do not deny anything.
For whatsoever is affirmed is not true,
And whatsoever is denied is not true.
How shall anyone say truly what That may be
While he has not himself fully won to What Is?
And, after he has won, what word is to be sent from a Region
Where the chariot of speech finds no track on which to go?
Therefore, to their questionings offer them silence only,
Silence — and a finger pointing the Way,”—Buddhist verse. Alan Watts, The Spirit of Zen (1958).
“Lacan used to say, ‘To love is to give what you haven’t got.’ Which means: to love is to recognize your lack and give it to the other, place it in the other. It’s not giving what you possess, goods and presents, it’s giving something else that you don’t possess, which goes beyond you. To do that you have to assume your lack, your ‘castration’ as Freud used to say. And that is essentially feminine. One only really loves from a feminine position. Loving feminises. That’s why love is always a bit comical in a man. But if he lets himself get intimidated by ridicule, then in actual fact he’s not very sure of his virility.”—JAM, On Love.