Urgency, History & the Totalitarian Vocation

The following is taken from a presentation at a conference by the Lacan Circle of Australia in Melbourne, 16/2/19. The conference was organised in response to this edition of The Lacanian Review, featuring a new translation of Lacan’s Preface to Seminar XI, and Jacques-Alain Miller’s extensive commentary thereof.

The Ethics of Psychoanalysis

 

The following is taken from one session in a series of introductory seminars as part of the Lacan Circle of Melbourne’s activities.

 

There is an interesting remark by Miller, in a paper from 2012 on the aims of psychoanalysis. ‘The psychoanalyst’s routine is therapeutic. His business is with the symptom that has to be cured.’ Psychoanalysts can put on airs, and ascribe lofty goals to their practice, but people come to consult with an analyst because something is causing them suffering. As Miller says, ‘If somebody goes to see a psychoanalyst for the sake of knowledge and not to get rid of a symptom it is not very certain that his demand can be received’.  So, whatever one may learn of oneself in the course of analysis, analytic praxis is not reducible to a quest for knowledge.

On “Borderline” Diagnoses

In retrospect, it is ironic, perhaps, that it was within psychoanalysis that the category of the ‘borderline’ was invented. More specifically, it derived from the ego psychology of the US, which situated the borderline as a category of exclusion between neurosis and psychosis. There are strong grounds for concern about the aims, ethical underpinnings and conceptual rigour of ego psychology (see here for a brief summary). As I’ve tried to point out elsewhere, the blunders of ego psychology did not prevent it from having a formative influence on many other forms of North American psychotherapy, including those that prevail in the Anglophone world today. In general, for an idea to have emerged from ego psychology constitutes a serious objection to it; if it is also taken up by bureaucrats and panel-beaters of the psyche, this amounts to a refutation.

The problem with diagnosis is not diagnosis, but discourse

In the UK and elsewhere, there is a growing movement to abolish diagnosis in psychiatry and clinical psychiatry. Leading the movement are a group of clinical psychologists and a range of critics of mental health practice. I would like, once more, to revisit the question of diagnosis from a psychoanalytic perspective, in the hope that it may shed some light to those without an analytic approach.

One of Freud’s Asides

I recently had occasion to re-read Freud’s case of the Ratman, and was struck by a passage in which Freud attempts to educate his obsessional neurotic patient in the underlying principles of psychoanalysis:

Ordinary Psychosis

There are no shortage of psychoanalytic theories of psychosis. The Lacanian account of psychosis that derives from the 1950s – and which we may think of as ‘classical’, in Lacanian psychoanalysis – can be found best expressed in Seminar 3, and the paper entitled ‘On a question prior to any possible treatment of psychosis’ in the Écrits. To put it very simply, psychosis is conceived of as a structure, not a checklist of symptoms, or a particular phenomenological condition. Where neurosis is characterised by the fundamental operation of repression, and perversion by disavowal, in psychosis, foreclosure is paramount. To illustrate: in repression, signifiers and thoughts become unconscious. It is as if they were swept under a carpet; out of sight, but leaving a lump, nonetheless. In foreclosure, not only is the same material not swept under the carpet, but it is never admitted entry in the first place. This has ramifications for a subject’s entire place and function within the symbolic order (i.e. the order of discourse and law). It is as if a set of organising principles are lacking, at least, relative to those found in neurosis under repression.

Understanding Psychosis

The British Psychological Society has released a major report on psychosis, which pushes the debate on this topic further than anywhere else in mainstream psychology in the Anglophone world. The report calls for, among other things, listening to psychotics themselves; seeing psychotic experiences as ‘understandable’ responses to distress, on a continuum with ‘normal’ phenomena; a rethink of bioreductionism and the medical model more generally; advocacy of ‘formulation’ rather than diagnosis, and advocacy of patient rights more generally; and finally, the provision of psychotherapeutic treatments alongside pharmaceutical approaches. There are numerous online responses to this report already, some supportive, some hostile. I would like to offer a few words from a critical, psychoanalytic perspective.

The Other, clinical and empirical: A review of Fonagy et al. on Affect regulation, mentalisation, and the development of the self

The following is taken from a presentation delivered late in 2011. Despite the age of the piece, I thought it worth sharing, as it touches on issues from more recent debates such as the nature of psychosis, the meaning of neuroscientific data, and the ethics of treatment. My views on certain matters below, such as phobia, or the nature of signification, have changed since then, but my views on Fonagy are more or less the same.

 
Anglophone psychology has long objected to the alleged individualism of Freud and
psychoanalysis. Psychoanalytic theory, they say, focuses on the intrapsychic, not the
intersubjective. Adler was one of the first to add a “social‟ element to psychodynamic
theory, positing a lack of “social interest‟ as the cause of every neurotic illness (Adler,
1928/1998). Later, a number of largely US-based psychoanalysts, led by Heinz Kohut,
championed an “intersubjective‟ or “relational‟ psychoanalysis.

Notes on Fantasy

 

The following are some brief notes of reflection on Freud’s 1908 paper on hysterical phantasy, delivered at a meeting on 16^th August 2014:

 

1. Speaking very broadly, in the early Lacan, there is an emphasis on desire and its interpretation. Later Lacan focuses on jouissance and knotting. (I have discussed some of this elsewhere). Fantasy is the bridge between them, and is theorised extensively between Seminars 10 to 14. The fantasy contains an element of desire or wish, but in later Lacan, also corresponds to Imaginary consistency, something which holds the world together for a subject. Freud’s insistence on the ‘bisexuality’ of (some) fantasy seems to me to merely suggest that a fantasy can contain multiple points of view.
2. Fantasy is a formation of the unconscious, and can be interpreted as such, but not necessarily in quite the same way as dreams or parapraxes. Fantasy – especially in th form of worldview or ideology – has a hard time of surviving analysis and interpretation. Both Freud and Lacan are clear on the point that the fantasy precedes the symptom, even though this is the reverse order in which things are addressed in an actual analysis.
3. There is a question about the nature of fantasy and enjoyment. Certain forms of jouissance – a self-administered addiction, for instance – is held by some analysts to be without fantasy, an example of pure narcissism. We can infer a distinction between a ‘discrete’ fantasy, of the sort discussed by Freud (where fantasy accompanies specific enjoyments, masturbation, etc) and a fundamental fantasy. To clarify – administering substances to oneself for jouissance may not require any discrete fantasy, perhaps, but may nonetheless fit within the coordinates of a fundamental fantasy (eg. of oral jouissance, identification with the ‘addict’, etc).
4. Lacan significantly extends Freud’s theory of fantasy, in that ‘reality’ itself is fantasmatic (that is, consists by way of the imaginary). Again, this is somewhat different to Freud’s notion of discrete fantasies for specific wishes and enjoyments. Fundamental fantasy constitutes the coordinates within which a subject can manoeuvre. These are the unspoken assumptions that allow ‘reality’ to cohere.
5. Following Freud’s logic, fantasy is diagnostic. The fantasy/delusion distinction allows one to differentiate between neurosis and psychosis. (Lacan’s work on fantasy also allows for a structural distinction regarding perversion, as evidence in Seminar 14, for instance). Beyond structure, however, an analysis of fantasy can show one’s trajectory within a set of subjective coordinates. To analyse things in this fashion is to move from general diagnostic categories to what is absolutely particular to a given subject.
6. Fantasy – especially of a sexual nature – can be understood in terms of the later Lacan as that which covers over the lack of sexual rapport. By situating the subject relative to objet petit a, fantasy gives the subject an entry point into sexual enjoyment in the face of radical non-rapport. Or, to put it differently, if a subject could not derive enjoyment from a masturbatory fantasy, they may find it nearly impossible to obtain enjoyment from sex with a partner also. This is a Lacanian rather than a Freudian position.
7. The failure of the fundamental fantasy – whether this is in the form of incompleteness, or inconsistency – is one of the causes of anxiety. When the imaginary and symbolic is ripped away, one is left with the gaping maw of the real. Specific, ‘discrete’ fantasies tend also to be accompanied by anxiety. It is generally easier for somebody to disclose their sexual acts than their sexual fantasies, since it is the latter which carry more subjective implication.

The Lack of a Lack in ‘Evidence-Based’ Practice

Psychoanalysis teaches that subjectivity is an organised response to an absence, be it a lack, void, or frustration. In a sense, to progress through an analysis is to gradually assume this lack (and its unconscious influence), and to practice as an analyst oneself it is therefore necessary to have undergone an analysis.

Consider how things stand in the rest of the psy disciplines.