Obsessional Neurosis

Lacanian Perspectives

Astrid Gessert

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781000157383
• Topic: Psicologia
• Subtopic: Emozioni in psicologia

Despite the important place it occupies in both Freudian and Lacanian nosology, obsessional neurosis has received far less attention than its erstwhile companion hysteria. This book elaborates and deepen research into questions of obsession, going beyond the usual clichés which reduce obsession to the question "Am I alive or dead?". Emphasis is given to the structure of this neurosis, as distinguished from its symptomatology, and to clinical questions of work with obsessional subjects. The chapters provide discussions of some of the following themes: the creation of the category of obsessional neurosis and of obsessive-compulsive disorder (OCD), the fate of desire and the inability to act in obsession, debt and guilt, obsessional manoeuvres and their implications for the treatment.

The book will be of interest to readers with academic or clinical backgrounds who wish to deepen their understanding of obsessional neurosis from a theoretical or clinical point of view. Newcomers to the subject will find signposts here that guide them through the complex landscape of obsession and lead them to avenues they may wish to pursue further.

CHAPTER ONE

Guilty cognitions, faulty brains

Obsessive-compulsive disorders in the age of the condition-of-autonomy (1980–2010)

PIERRE-HENRI CASTEL

Obsessions express a generalised disorder of activity, that is all they do: one day we will reach the point of appreciating the value of obsessional individuals and their psychological states because of the wide range of insight they offer us. (Pierre Janet, 1926, p. 43)

This chapter appears under the sign of a paradox. It will not tackle the consequences of the emergence and the domination of a new form of affective sensitivity; on the contrary, it will address the decline, or in any case, the relegation to a subordinate position of something whose pre-eminence since the seventeenth century had been highlighted elsewhere.¹ “The end of the guilty ones” obviously does not signify the end of guilt itself, either as a moral feeling or as a normative principle, but denotes its declassification within the scale of values. From this follows a change in the relation to the self, from the point of view of the spiritual, moral, psychological, and medical care that for a long period of time was associated with excesses of guilt. If guilt has lost its primacy in our moral economy, it is because a new form of individuation has been imposed on us. It is quite possible that this is barely perceptible to those whom it affects. As always in a “society of individuals”, each one tends to believe that the processes of individuation, including all the accidents and impasses that contribute to them, only concern individuals taken one-by-one. No-one seems spontaneously to conceive that being an individual is a social form, and this failure in comprehension occurs not because people are stupid or blind, but because it is precisely what it means to belong to “the society of individuals”: to attribute to oneself, as a value, the status of creative agent within society ... which, in fact, socialises you as an individual-who-thinks-he-produces-himself. This new form is what we call the condition-of-autonomy The aspiration-to-autonomy gave primacy to guilt, but that is no longer the case with the condition-of-autonomy.

These autonomies and distinct versions of individualism do not follow on from one another like Kuhn’s paradigms, where in practice the new replaces the old or renders it unintelligible. The condition-of-autonomy does not eliminate the aspiration-to-autonomy: quite the contrary! They overlap one another, and the new one extends beyond the old one only at the very edges; to a significant degree they are coextensive. What is more, the new one often contributes to the preservation of the old one, and even reinforces it in certain respects, by assigning new social and moral functions to it. This means that clear chronological cut-off points are made impossible. The same is of course true of the confusions concerning the great anthropological formations. Perhaps you recall the case Lacan made in the 1950s for a “scrupulous woman”, Mary of the trinity, as if she had re-emerged from a forgotten seventeenth century. Having looked at the available documentation, you might even have the feeling that Lacan was trying out his idea of the subjection to the Other on her, as well as that of the necessity of separation, given that he gave such primacy to the drama of the “vow of obedience” in formulating his version of obsessions, rather than to sexual repression, which was where a more banal form of psychoanalysis had gone astray (Lacan,1950/2008, p. 14).This is an extreme case: the possibility of a “scrupulous” life in the midst of democratic modernity makes the living horizon of obsessionality recede to its very origins — and proves that those origins have not been forgotten “in spirit”, at least where a few exceptional souls are concerned. With very good reason, at the moment when I am about to speak of the decline of obsessional neurosis and the emergence of obsessive-compulsive disorder (OCD), I want to emphasise strongly that there are still patients who are very similar to the Rat Man, not just in terms of their symptoms but in the very texture of their psychical being; in other words, there are still obsessionals for whom the Freudian Oedipus retains its full value. But for the purposes of analysis, I am obliged to favour, and unfortunately even to idealise, the limit-situations [situations-limites]: situations in which one can behave as if the condition-of-autonomy replaced the aspiration-to-autonomy. All of a sudden, the malaise of being civilised, in other words, of being constrained to be oneself [Selbstzwang],² which from the very start I have set up in opposition to the aging themes of the history of western “subjectivity” or of “self-care”, gives us a sense that another sort of human being is making its appearance. This is an exaggerated impression, and it is an artefact inherent in the methodology. Placing the accent on psychopathology serves only to augment it, and it produces a kind of anti-hero of contemporary psychical transformations, which both fascinate us and at the same time hide the extent to which the ancient practices associated with guilt still endure. So, we have continually to work against the false impression that has given rise to my quest for an ideal type of the post-guilty human being.

On the other hand, I fully accept that ancient forms of the inability to act continue to exist among the new ones. But this persistence does not prevent it from being true that the limits to change the relation to one’s self are reflected in the new psychotherapies for guilt and anxiety, or indeed in the causes that are attributed to those states (whether by popular psychology or by neuroscience). I am going to presume that those therapies respond to a functional need. In examining them, we may discern the change of meaning, and even of the psychological scope, of both anxiety and guilt. These affects will no longer be anything more than contingent disturbances of our autonomy (I am running ahead of myself here, as this is what I shall conclude later). In this respect, the eradication of psychoanalysis and the dominance of cognitive-behavioural therapies (CBT) for obsessive-compulsive disorders will become strategic wagers — which will have no less epistemo-logical dignity than the radical changes in work or family life. Where the condition-of-autonomy is concerned, let us say that the symptoms of obsessionals no longer constitute a language of distress that can be understood by everyone. They no longer haunt the psychical life of just anyone. They no longer open a window on to the mysteries of the soul. But while they are no longer the province of great literary models, neither are they psychical defects that endanger public freedoms, that afflict entire classes of persons who are too rational, too rigid. For a whole group of people, they are no different from a migraine or a stammer: a “hiccup in my brain”. It feels more and more forced, even anti-scientific, to attribute meaning to them. And when clinicians come up against the banal fact that patients overvalue their obsessions, they conclude that, in the final analysis, this is due to cognitive bias. It is a pseudo-reason born of ignorance of the true causes. Worse than that: far from making it intelligible, this ethical over-valuation is part of the symptom. Eradication is the touchstone of treatment: you just have to stop believing that you are “abnormally” guilty, responsible, etc. From the point of view of Loudun’s possessed, Kierkegaard in Copenhagen, or Freud in Vienna³, what a reversal! However, let us not fall into the trap of bewailing the decline of the clinic, or even a veiled dehumanisation of the neurotic experience. From the debris of the old language of obsessional distress, a new one is gradually re-forming. One day I may flesh out this idea — not so much in order to establish facts of an anthropological nature, in some kind of “science of OCD”, but rather to outline the ordinary moral practice of the new obsessionals.

I will begin by sketching out a number of social, political, and cultural facts that have been enmeshed in the fabrication of autonomy since the 1980s. This will enable me to establish a context for approaching the new therapies for unwellness.

In the mid-1970s, the last vestiges of authoritarianism disappeared from Europe (the death of Salazar, then of Franco, the fall of the Greek Colonels). During the night of the 9th–10th November 1989 (the anniversary of Hitler’s Munich putsch) the Berlin Wall fell — this was die Wende, the turning point. A peace treaty was signed with the Soviet Union in September 1990 — this had not happened before. Within a few months, the communist bloc was falling apart. On 26th December 1991, the Soviet Union was dissolved. The end of the Cold War was such a triumph for liberal democracies and for capitalism that many felt it was simply “the end of history”. The ascent of China (by 2010 the second most powerful economy in the world) and the emergence of a multipolar world took some time to establish themselves as givens. And as well as terrorism, other forms of insecurity (ecological accidents, the threats of climate change⁴) were added to the collective anxiety typical of the Cold War era: the idea of a nuclear holocaust.

The socio-political changes have been profound. Around 1980, the Keynesian welfare states, which had guaranteed growth and the redistribution of wealth since 1945, began to reach the end of the line. The gains in productivity, which were lower than they had been during the thirty golden years following World War II, were no longer correlated either to a rise in salaries in real terms, or to an increase in the number of jobs. Ronald Reagan and Margaret Thatcher stopped subsidising industry, curtailed the power of the trades unions, opened all markets up to competition, and introduced cuts to state bureaucracies. The post-state management style of new public management took the place of the ideal of justice of the welfare state. This led to the conjunction of widespread deregulation, the delegation of public power to private entities, and the investment of individuals with responsibility. They were allowed to get on with it in an autonomous fashion, and more and more frequently, if there was still State control, it was subsequent to the execution of the delegated tasks. Moreover, new public management aimed for good, flexible management of the fits and starts of the economic situation rather than for orderly distribution of the fruits of weaker economic growth. For those who found themselves excluded by these neoliberal policies, the welfare state shrunk to fit the format of a workfare state which enjoyed ever-diminishing support, just as much in the middle classes as in the social-democratic parties, which had spearheaded the democratic individualism of the 1960s. Indeed, a ransom was now paid for the Keynesianism of the preceding phase in the form of an explosion of budgetary deficits. The ruination of the socialist counter-model in the Eastern Bloc left the progressive parties with no alternative when they were faced with the return of the flame of political and economic liberalism, which had been virtually extinguished in the 1960s. Autono-misation, understood over a long period as political emancipation that was carried out collectively, suddenly became discredited.

It was in this context that autonomy, understood a contrario as an egotistical turning in on oneself, appeared to triumph. The condition began to spread. I refer, for example, to Lasch’s 1979 book, The Culture of Narcissism: American Life in an Age of Diminishing Expectations, which gave a bleak account of the sixties. It was read more and more widely as being prophetic: individuals were going to become more and more “narcissistic”. The 1990s were to see new kinds of psychical plagues emerging, against the backdrop of the media, which only served, apparently, to confirm his view. Late-nineteenth-century psychiatrists wondered whether kleptomania was compulsive or impulsive. Another version of this phenomenon, impulse buying (“shopaholism”), presented the dilemma anew: between two per cent and ten per cent of the population were supposed to be victims of this syndrome, and of those, between eighty per cent and ninety-five per cent were women, all of whom were anxious and depressed. To an ever-greater extent, body image was becoming a key factor in the construction of autonomy. Epidemics of anorexia nervosa and anorexia-bulimia followed from the 1980s onwards, exploding with particular ferocity in former “developing” countries where prosperity was replacing privation. A striking feature of this pathology is the sublime value that patients give to the absolute control they have over themselves. This can go as far as a complete denial of the illness as such, supported by the vocabulary of the unassailable autonomy of the relation to one’s self and to one’s body. To such an extent did the vocabulary of the ego achieve the status of normative evidence in the self-description of psychical life, that we could describe the 1980s epidemic of “multiple personality disorders” in the United States as a social symptom of the impossibility of dealing with the tug-of-war between the various poles of desire, other than by giving each one a “personality”. So, each one would have a sort of legitimacy to express itself autonomously. Was the ego collapsing under its own weight? The majority of these mass pathologies (depression being their culmination) affect more women than men. It is tempting to explain this by making the contemporary feminine condition the laboratory for the constraints of the condition-of-autonomy I am speaking, of course, of women who are politically and economically in a position to benefit from it and therefore also to suffer from it. To this we can add a striking fact — that OCD is equally distributed between men and women, whereas part of the understanding of Zwangsneurose was that it was men (sons) who were the designated victims. With the progressive equalisation of the conditions of the genders, there is no longer the slightest reason to make out that there is something especially masculine about this kind of activity.

At the same time, everything was happening as if the individual were re-appropriating for himself the principles of the bureaucratic regulation of the 1960s (non-directive planning) and as if he were becoming a self-regulating entity assuming the calculation of his own risks. The liberal ambition to bring about the decline of the state was now beginning to resonate with the ambition to encourage the self-government of the individual by the individual — basically, self-government, once it is taken into the private domain, becomes self-management of each individual by himself. From then on, the rules of collectivism were considered to be counter-productive and clumsy, even to the extent of becoming shackles. In short, the gains of the post-war years, which enabled the mass emergence of the democratic individual through universalising access to healthcare, education, paid work and consumption, lost its legitimacy. Many privileged individuals, who owe their triumphant individuality and their autonomy to this historical process, are turning against it and disavowing it. Some of them even resent the rich institutional environment which gave them access to an unprecedented individualisation of their existence, as a burden from which they aspire to free themselves. Why should you prescribe something to an individual that he can perfectly well do for himself, and decide on for himself? In their eyes, self-constraint is so deeply rooted in the experience of autonomy, that any constraint imposed from “outside” (and the “outside” for such individuals is, of course, the social!) would be something that one had ultimately to be emancipated from, and would therefore be considered alienating. So, the old “obsessional” discipline, which was a point of honour for anyone integrated into the 1960s, could become transformed into a danger: the danger of lacking “reactivity” in a competitive universe. Richard Sennett, akin to Erikson and Riesman, saw in this a psychological threat to the contemporary individual (Sennett, 2006).

So, values, but also the great mechanisms at play in the way society is organised, reflect these economic and political twists and turns. As the hierarchical and integrative forms of the organisation of industrial society have undergone a slow decline, the worker’s status has changed. In a society in which production is the work of individuals called upon to carry out tasks which become more and more autonomous, and even to self-manage from one project to the next, the subjectivisation of economic roles has become the norm. Even the Toyota model, which has taken over from the Ford model of industrial production, rests on the responsibility accrued by the agents [kaizen]; both the engineer and the person on the assembly line now take part in diagnosing and solving problems. This accrual of responsibility has a bizarre echo in the new way that machines function, for example, stopping themselves working when the quality of the product falls too low. This is called “autonomation” ...

Table of contents

• Cover
• Half Title
• Editor
• Title Page
• Copyright Page
• Table of Contents
• ACKNOWLEDGEMENTS
• ABOUT THE EDITOR AND CONTRIBUTORS
• PREFACE
• INTRODUCTION: A brief outline of Freud’s and Lacan’s conceptualisation of obsessional neurosis
• CHAPTER ONE: Guilty cognitions, faulty brains: Obsessive-compulsive disorders in the age of the condition-of-autonomy (1980–2010)—PIERRE-HENRI CASTEL
• CHAPTER TWO: Lacanian approaches to obsession—DARIAN LEADER
• CHAPTER THREE: The signification of debt in obsessional neurosis—MOUSTAPHA SAFOUAN
• CHAPTER FOUR: The cutting edge of desire in obsessional neurosis: Lacan with Leclaire—LUCA BOSETTI
• CHAPTER FIVE: The signification of mastery of the control of the orifices in anal eroticism—MOUSTAPHA SAFOUAN
• CHAPTER SIX: The Rat Man—CHARLES MELMAN
• CHAPTER SEVEN: The Lacanian structure of obsessional neurosis—MICHEL SILVESTRE
• CHAPTER EIGHT: There is a stain on the horizon: A loop or two into obsessional neurosis—VINCENT DACHY
• INDEX