Lacanian Psychoanalysis in Practice

Insights from Fourteen Psychoanalysts

Diego Busiol, Diego Busiol

• Editorial: Routledge
• Año: 2021
• ISBN:
  9780429777868
• Edición: 1
• Categoría: Psychologie
• Categoría: Psychoanalyse

In this book, fourteen Lacanian psychoanalysts from Italy and France present how they listen and understand clinical questions, and how they operate in session. More than a theoretical 'introduction to Lacan', this book stems from clinical issues, is written by practicing psychoanalysts and not only presents theoretical concepts, but also their use in practice.

Psychoanalytic listening is the leitmotif of this book. How, and what, does a psychoanalyst listen to/for? How to effectively listen, and thus understand, something from the unconscious? Further, this book examines the evolution of psychic symptoms since Freud's Studies on Hysteria to today, and how the clinical work has changed. It introduces the differences between 'classic' discourses and 'modern' symptoms, with also a spotlight on some transversal issues. Chapters include hysteria, obsessive discourse and phobia, paranoia, panic disorder, anorexia, bulimia, binge-eating and obesity, depressions, addictions, borderline cases, the relationship with the mother, perversion, clinic of the void, and jealousy.

Despite possessing the same theoretical reference ofSigmund Freud and Jacques Lacan, the contributors of this book belong to different associations and groups, and each of them provides several examples taken from their own practice. Lacanian Psychoanalysis in Practice is of great interest to psychoanalysts, psychotherapists, students and academics from the international psychoanalytic community.

Part 1

Chapter 1

The evolution of psychic symptoms from Freud’s Studies on Hysteria to today

Diego Busiol

DOI: 10.4324/9780429432064-3

The unconscious, this unknown

When I first arrived in Hong Kong in 2010, I was very surprised to see how little psychoanalysis was known here. Something that in Italy and in many Western countries has long been part of common knowledge (the psychoanalyst has been represented, even caricatured, in many movies; today, there are even many memes circulating on the internet depicting the psychoanalyst at work in his office, next to his couch), seemed to never have arrived in Hong Kong. I then decided to conduct research into what has hindered the reception and practice of psychoanalysis in this city (especially among local counselors, psychologists, and psychiatrists), and I discovered that one of the main reasons, although not the only one, was a difficulty in understanding what we mean when we talk about the unconscious: what it is, how it shows itself, and also how to use it in therapy (Busiol, 2016).

What can we say about the unconscious? The unconscious is not a concept, but something alive. Therefore, it cannot be explained, but only experienced first-hand. This is what makes psychoanalysis untransmissible to some extent. There are many psychoanalysis manuals; these may provide some form of knowledge about the unconscious. But one can only discover something that is unconscious through one’s own lapses, free associations, slips of tongue, dreams, or forgetfulness. This is a knowledge that comes from the unconscious; as such, it is not universal, but unique for each person, and can be accessed primarily through one’s own personal analysis. It is rather the scientific discourse that proceeds by accumulation of knowledge: a universal knowledge to which everyone can add a little piece, like when completing a puzzle. But an analysis does not continue from what others have discovered in their analyses. The unconscious is precisely a hole in the knowledge. What one discovers in an analysis are associations of words, fragments of memories. These discoveries can be illuminating for the speaker, but not necessarily for others. It is common for an analysand to be asked, “what do you talk about in session?” But it would be impossible to answer. The unconscious works for associations of signifiers, which is precisely what subverts the manifest, intended meaning. Therefore, it is impossible to generalize or decontextualize what is said in session. Any answer might only be disappointing.

There is no psychoanalytic knowledge that goes without analytical practice, unlike other psychologies/psychotherapies. Psychoanalysis is a primarily a practice of speech. Thus, there can be psychoanalysis only if there is practice of psychoanalysis. It is not a coincidence that in a place like Hong Kong only psychoanalysis is missing, while dozens of other psychologies, psychotherapies, and forms of counseling are practiced.

Practicing psychoanalysis in Hong Kong, with patients from all over the world, I realized that regardless of the country in question, the unconscious is always more unknown, misunderstood, and ignored. This is quite surprising after more than a century of psychoanalysis. There are probably several factors that can explain this phenomenon. These are not only individual, cultural, and economic factors, but also social and environmental factors that have to do with modernity. Today, the scientific discourse, which reduces the language to a tool for communicating and the signifier to sign, also dominates in Europe. But then, if distinctions are lost, if everything becomes univocal, the unconscious will also be lost. Conformism will prevail, and therefore: where is the unconscious, if everything means the same for everyone?

Hong Kong is a modern, business-oriented city with a very fast pace of life; a vertical city, full of skyscrapers and with a very high population density. It is a society that mixes capitalism and traditional Chinese values. And like any capitalist society, Hong Kong is a city that rewards efficiency, long working hours, and the ability to “function” smoothly. In this sense, it is a paradigmatic society of today. Indeed, in some ways it anticipates the times, and therefore can represent a privileged point of observation. Historically, it is a city built on business and commerce, and much less on arts and culture. We could say that in Hong Kong material values have always prevailed over immaterial and spiritual ones. It is not surprising that in such a context the space to think, to articulate a question, is limited. This obviously affects the reception and practice of psychoanalysis: I am one of the very few analysts in town. Conversely, there is a wide range of practices for the “well-being” of the individual: physical and mental. Once the question of the word¹ has been expunged, what remains is the dualism of body/mind, the first being the prerogative of medicine, the second being left to new-age practices, yoga, mindfulness, meditation, and to a various range of psychotherapies, but not psychoanalysis. This means that the response to the ‘discomfort of civilization’ takes place on two levels: reducing or removing the symptom, so as to get back to work as soon as possible, and promoting new enjoyment, fun, and carefreeness, so as to contrast the cause of discomfort and regain a good level of comfort. What is wrong on a personal level is fixed with some technique. What is not known on a social level, is sought in the discourse of science: procedures, standardized research, statistics. Science applied to commercial and human relations.

Today’s patients

Working in this context, I soon noticed the lack of a demand for analysis in many patients. Some people came to my office asking to “try”; a bit like one can try a first class in the gym, before signing up. Others canceled appointments at the last moment, as if it were not something they are really committed to. Or, as if psychoanalysis could be an activity to do in their spare time. Initially, I was very surprised by this “one foot in and one foot out” or “seeing how it goes” approach. In the last century, patients went to analysis four or even five times a week. Today, one session a week seems already a lot. Things have changed a lot since Freud’s time!

Melman (in Melman and Lebrun, 2018) notes that young people who go to therapy today do not know where they have come from or where they are going. He speaks of atopic subjects, who cannot find their place or their voice. Their path is fragmented, hesitant, and their identity (even sexual) restless. They carry with them a discomfort that they can hardly express in words. Costa and Lang (2016) observe that a large part of their patients “can hardly move past the complaint. Their demand is scattered, lacks implication, and people that seek psychotherapy almost never reach the level of communicating their desire” (p. 119). Verhaeghe (2008) compares yesterday’s patients with those of today: “About 30 years ago I saw my first patient. My classic education and training meant that the following clinical characteristics were to be expected: a patient would have symptoms that can be interpreted; these symptoms are meaningful constructions, although the patient is unaware of this meaning due to defense mechanisms; the patient would be aware that these symptoms were connected with a life history”; today, however, “we meet with an absent-minded, indifferent attitude, together with distrust and a generally negative transference” (p. 1). At the same time, these patients may show excessive attachment, separation anxiety, and difficulty entering into a meaningful relationship. He then observes how this can frustrate the therapist who expects a patient with a certain psychological mindedness and that, not finding it, he can label the patient as resistant or oppositional (Verhaeghe, 2008). According to Hartocollis (2002), since the second half of the century, psychoanalysts have begun to see an increasing number of patients with poor symbolization skills, who struggle to link their symptoms to their story, are unable to process conflict on a psychic level, and find it difficult to express themselves, or perhaps do not have the words to do so.

Vienna in the late nineteenth century and the world presently

Psychoanalysis was born in a context different from the current one. Vienna in the late nineteenth century was an aristocratic, bourgeois, patriarchal, conservative, and counter-reformist society. At the same time, however, it was also a city of artists, musicians, philosophers, architects, intellectuals (beside Freud: Karl Kraus, Arthur Schnitzler, Robert Musil, Egon Schiele, Gustav Klimt, and Arnold Schoenberg, to name just a few). A city that appreciated culture and scientific knowledge, and that was famous for its cafés, where men and women of different social classes met to read, discuss, and converse (Schorske, 1981). The vibrant intellectual life was counterbalanced by the immobility of the administration, the bureaucracy, the social compromise to quell any hypothesis of revolution and prolong the life of the empire (it would be interesting to analyze this, knowing that Hitler was raised here precisely in these years). Freud (1914) denounced “the hostile indifference of the learned and educated” (p. 40) for psychoanalysis that he found in Vienna as nowhere else (he was probably mainly referring to medical societies). However, it was in this context that he operated, treating mainly patients of the rich bourgeoisie. And the research allowed Freud to describe the unconscious and transference, as well as hysteria, obsessional neuroses, and phobias.

Since then, there have been huge changes in our societies. What we witness today would have been unimaginable in Freud’s Vienna: a family crisis, a change in parental roles, an increase in adoptive families (Irtelli, 2018); continuous technological and media development (the internet and mobile phones in particular), continuous growth of markets and the supply of consumer goods (especially online), climate change, environmental disasters, greater pollution, global migration, an aging population (Cianconi et al., 2015); artificial insemination techniques, loosening of borders (Melman and Lebrun, 2018). The scenario has changed radically, and today we find ourselves listening to a different population. According to several studies (Kessler et. al., 2007; Steel et al., 2014), the most common symptoms in today’s population, worldwide, are: anxiety disorders (panic disorder, agoraphobia without panic disorder, specific phobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder, and separation anxiety disorder), mood disorders (major depressive disorder, dysthymic disorder, bipolar disorder I or II, or subthreshold bipolar disorder), impulse control disorders (intermittent explosive disorder, oppositional-defiant disorder, conduct disorder, attention-deficit/hyperactivity disorder), and substance use disorders (alcohol and drug abuse with or without dependence). These studies also report a higher frequency of anxiety and mood disorders among women, and a higher incidence of dependence on alcohol or other substances among men. Less frequent symptoms include anorexia and bulimia, which are relatively low among the general population, but more frequent among young people, especially women (Qian et al., 2013), psychosomatic disorders, social isolation, aggressiveness and anger, and various types of addictions (e.g., gambling, shopping, sex).

My first consideration is that today we live in a society of symptoms. While for most of the last century we reasoned in terms of psychic structures (e.g., hysteria, obsessional neurosis, perversion, psychosis) or discourses, today we focus on symptoms, but without questioning their function for the subject, and without being able to read them as part of a personal story. That is to say that the reading/construction of the case, as Freud did, has been replaced by the medical-statistical model, the list of symptoms. Not only among mental health professionals, but also among patients. Many patients today do not seem to be able to link their symptoms to their personal history; to most of them, symptoms seem to occur in an absolutely random and unpredictable way. Today, we refer to symptoms as if they have universal meaning, as if they all speak the same “organ language”. But psychoanalytic practice shows that each case is unique and comes with its own logic, different from that of the previous one. And each chapter of this book testifies the attempt to grasp (through psychoanalytic listening, which is listening to the unconscious) precisely the uniqueness of each case, and to reinvent the practice each time, starting from that case.

Another interesting consideration is that modern symptoms or disorders encompass for the most part enactments (‘passages to the act’ or acting-out), often together with abuse of substances and (acts of ) self-harm. This may be a consequence of what was said above: if the word is expunged, then we have enactments (passages to the act and acting-out are not really actions; they are the non-reflective playing out of a mental scenario). And if the word is expunged, then it is replaced by the substance.

One may say that alcohol, drugs, substances have always existed, yet the phenomenon of addictions is relatively recent. How is this possible? Svolos (2018) observes that the use of drugs in antiquity or in some Aboriginal cultures is ritualized and takes place within a particular symbolic context; therefore, it supports the Other and the social structure, it does not break with them. For Canabarro and D’Agord (2012) “drug addictions resist social ties because they refuse to participate and denounce the illusion contained in social ties. The capitalist discourse sells the promise that lost enjoyment can be recovered, so that the subject, by acquiring an object, becomes self-sufficient without having to establish any other type of relationship” (p. 490). The symptom is co-constructed according to the dominant social discourse. It is therefore essential to listen and analyze what is the dominant social discourse today, and what are some of the most recurring signifiers.

The dominant social discourse today and its clinical consequences

I have found it interesting to take a look at the phrases we hear every day in commercials, slogans, the most common slang expressions: “just do it”, “no limits”, “the sky is the limit”, “work hard, play hard”, “if you want, you can”, “believe in yourself ”. There is an emphasis on the individual, and on the infinite possibilities of doing, without limits of space and time: if you want, you can, at any time. It seems to me that this lack of limits is reflected in modern symptoms. While the “classic” neurotic person had problems transgressing the limit, modern symptoms (substance abuse, eating disorders, panic, self-harm behaviors, anger, impulsiveness, just to name a few) rather show the absence of limits. Another very common problem today is the lack of direction in life. It is probably another consequence of the fact that “there are no limits” and that “everything is possible”. If everything is possible, if everything is at hand, it is also less desirable. If there is no law (even a law to go against; a law to fight), there is no direction. A society is “rigid” when it limits the expression of individual desire for the benefit of the group. But if on one hand this seems to limit the freedom of individuals, on the other it is what anchors them to a group or a place and gives them direction in life. It is possible that a century ago, in many societies, people occupied more clearly defined positions than they do today; their goals and purposes in life were clear from birth and were rarely questioned. Today there is much more freedom, but at a price: it is much more difficult to find something that gives one direction. In an age w...