13 de febrero de 2007

Reports on Clinical Study Days 2

On a beautiful sunny and warm January weekend in Miami Beach, the Members of the World Association of Psychoanalysis in the United States hosted our Second Clinical Study Days. The weekend began with a Lecture by Marie-Hélène Brousse, our featured guest, on "Art, the Avant-garde of Psychoanalysis." This was followed by an all-day workshop "Lacanian Orientation in Practice" introducing seven key developments of the WAP in the last decade. Finally, we held our Study Days on "Psychic Suffering and the Treatment Challenges of the Postmodern World," including a lecture by M-H Brousse and five case presentations and discussion. In addition to a large group from Miami, the Study Days brought together Members of the WAP and clinicians, academics, and others interested in Lacanian psychoanalysis from throughout the United States. We present here reports by Noemi Kohan, Noa Farchi, and Yael Baldwin on the three events of the Study Days weekend.
M.-C. Aguirre, A. Arenas, T. Svolos--Coordinating Committee, Clinical Study Days


Lecture by Marie Helene Brousse

The Clinical Study Days weekend opened with a lecture on Art and Psychoanalysis that took place at the Miami Art Central (MAC) in the beautiful South Miami District, which was open to the public. Dr. Brousse stated that art sets the pace of things to come and functions as an analyst of the unconscious of our time; in that sense, art is the precursor of psychoanalysis and art is the analyst of the unconscious. Marked by history and its relation to the Master Discourse, although apart from it, art is an interpreter and a discourse in itself. Its function is to give the consistency of a discourse to an object.
In art, an object represents a subjective idea that reveals jouissance and knowledge. It reveals the truth in relation to the sensitivity of the epoch. In the discourse, the analyst and the artist are situated in the same place in relation to the object. The difference is that the discourse of psychoanalysis is organized by signifiers based on the subjective division of a subject and psychoanalysis deals with the object of satisfaction that belongs to a subject that lost it, which constitutes his symptom. Art on the contrary, has to do with knowledge as such. The artist does not operate from fantasy or the symptom and his production is in itself knowledge.
The artist, through the process of creation, subjectively cancels the loss of the object and recovers it in his work, and, therefore, the loss is placed on the side of the observer. Clinically it is not necessary to know what the artist’s psychic structure is in order to interpret his work; as far as art is concerned, both neurosis and psychosis are neutralized in the artistic production. The artist arrives at the truth by canceling his subjective division and consequently divorces himself from the ideal.
In the past, art could have been conceived as the representation of a master signifier; in post modern times the object of desire is separated from the master discourse and is less and less compromised by an ego ideal. What art and psychoanalysis have in common nowadays is that both relate to the object as an element to be discarded, not to be considered an essential to function. In the new forms of art, like installations, which took a long time to be accepted as art, are characterized by a new “world order” where hierarchical succession and universality are annulled as a means to produce an element of surprise in the observer by its lack of universal meaning.
---Noemi Kohan, NEL-Miami


Facing the clinical challenges of today and the stakes involved for psychoanalysis in doing so was the main theme of of the workshop. I will begin my review of the day with the concluding remarks by Marie-Hélène Brousse. Her remarks reflect the different approaches and interventions related to the clinical challenges of today. First, interventions pertaining to diagnosis. Psychoanalysis uses diagnosis according to structure rather than statistics. We diagnose the structure of the unconscious, i.e. the relations between the desire and the signifiers. Indications for the structure can be symptoms, phenomena and transference but not behavior—for psychoanalysis the speech of the subject is the working material and, thus, the crucial indication. Further, for psychoanalysis, as much as diagnosis is useful, it does not become a template for transforming the destiny of the subject. Second, an interesting angle to the question of treatment is the recounting the history of Lacan’s concepts, which enables their use in relation to contemporary discourse. These methods of panoramic view show us how theories by Lacan do not cancel each other but integrate previous stages, for example: the transition from the Name-of-the-Father to its plural form or the transition from the unconscious of the family (the Oedipus) to the unconscious in the structure of the discourses. These transitions serve as clinical orientations. Nowadays, we are in the clinic of discourses, and we can discern in language two functions, lalangue and a social link. Our main tool for treatment is the materiality of language; what is the proportion and relation between language as lalangue and language as a social link? We can formalize this tool in the following manner: lalangue à social link and to follow up with the investigation of how to modify this relation and promote lalangue to the social link.

Maria Cristina Aguirre, in her talk “Diagnosis and new symptoms,” reviewed the challenges of clinical practice today, and developed some lines of argument for situating psychoanalysis under these constraints. Some of the phenomena discussed were: consumerism, the loss of ‘sanctity’ under the discourse of science, and the divorce of procreation from sexuality in contemporary family structure. All these can be placed under the umbrella of the individualistic approach to jouissance, a theme that was touched upon in several of the presentations. Maria Cristina Aguirre emphasized the power of psychoanalysis in insisting on the presence of the unconscious even under discourses that negate it, and the importance of collaborations within the institution that enable the psychoanalytic approach to become an active dimension of the array of treatments available.

It seems that a very good example of such insertion of psychoanalytic orientation within the institution is the clinic of “Autism.” Maria Lopez opened her discussion on autism with the raw datum of a large increase of autistic patients nowadays. The institutional reply to this increase, in financial terms and research efforts, is dedicated mainly to the study of cause and prevention rather then treatment. Currently, behavioral treatment is geared towards correcting/controlling behavior. In contrast, the psychoanalyst encounters in face of autism the position of not knowing, and sustains this position—for Lopez, this is the only chance to open a space for an encounter. The possibility of an encounter separates the body of the autistic subject from its identity with the world, with the Other. Lopez advocates a very clear clinical methodology: First, to observe the linguistic binary the child is involved with [yes-no enunciations/switching the light on-off etc]. Then, the clinician is able to insert herself into the solo performance, while keeping the Other at bay. It is not the subject whose behavior is controlled or regulated, but rather the Other’s presence. These insertions can occur, for example, by extending the child’s gesture or voice in anticipation that it will cross at one stage the mirroring effect to an encounter with the difference.

This question: how to insert oneself into the solo performance of the autistic subject, is actually very relevant to the handling of transference in the clinic of neurosis. In his talk, “Transference: Private practice, Institutional practice,” Juan Felipe Arango points to current difficulties with this performative aspect of transference, the performance of the reality of the unconscious mediated via the sujet-suppose-savoir. First, the installation of the supposition of knowledge is less immediate nowadays. In both cases of institutional as well as private practice, Arango raises his worry of the limited ‘freedom’ to choose psychoanalytic treatment due to third party interventions – i.e. insurance company, governmental legislation etc. Nevertheless, one can view applied psychoanalysis as a reply to such restrictions, opening up to other therapeutic formats such as group therapy, family therapy or as we’ve just discussed in the treatment of autism. Moreover, the place sustaining the demand that has been abandoned in our days by the physician’s word in favor of technological medicine may be re-occupied by psychoanalytic discourse. In other words, to find within the institution the conditions that enable to lend a body, instead of a machine, to the demand of the subject.

Making a shift to the structure of psychosis and particularly “Ordinary psychosis,” Thomas Svolos recounted the development of ‘untriggered Psychosis’ in Lacan’s teaching up to the introduction of ‘ordinary psychosis’ by Jacques-Alain Miller and its relevance to contemporary clinical work in public settings. One can mark at the onset of Lacan’s writings the corner stone in the trajectory of the status of paternity in psychosis. The paternal imago of the 1930’s will turn in the 1950’s to a symbolic realm, i.e. the foreclosure of the Name-of-the-Father. The last formulation of psychosis is made in the 1970’s in the study of Joyce’s particular solution to ‘untriggered psychosis’, i.e. a foreclosure of the Les Noms Du Pere without an encounter with the One-Father. The shift to Knot theory rearranges the Name-of-the-Father to be one possible kind of the general form—the sinthome, which as the fourth ring, holds the three registers—the Symbolic, the Imaginary and the Real—together. Joyce’s psychosis turns out to be a model for a more typical form of psychosis, and yet—case by case each ‘sintomatic’ particular solution should be established.

Taking a parallel panoramic view of Lacan’s teaching on “Jouissance and the Real,” Alicia Arenas followed the emergence and developments of jouissance and its relation to the Real in Lacan’s teaching. She mapped this history by showing how jouissance emerged as an imaginary residue of a non-invested libido, which later returned to the field of language with the satisfaction of signification and a consequent mortification of jouissance by the symbolic order. Only later does Lacan attributes jouissance to the Real in the name of ‘The Thing’, the impossible to signification, and consequently invents Object a, as a new alliance between the symbolic and jouissance. The four themes of discourse depict the different forms of inserting the signifier to a body of jouissance, with too little or too much of it. Lacan’s late teaching focuses in on the relationship of Jouissance to the Real, the jouissance of the speaking body, and distinguishes two forms of Real: Realitat, internal to the fundamental fantasy, to the psychic reality and Wirklichkeit, an external Real that is raw, meaningless. We can summarize the trajectory of Lacan’s teaching on Jouissance beginning with it’s imaginary emphasis, to the symbolic relations with satisfaction and at the moment of conclusion as raw, lawless, meaningless Real. Marie-Hélène Brousse placed this trajectory as analogous to the pathway of analysis itself: entry with the repetitive encounter, continue with the effort to write the impossible during analysis, and end when that Real becomes meaningless.

Emphasizing the Real as the orientation of the praxis, Liliana Kruszel examined in her talk “Short-term Treatments” the possibility to maintain this orientation under short term treatments. How to construct brief therapy in light of the later teaching on the symptoms’ relation to the Real? To address this question, Liliana Kruszel developed the Master discourse for the subject of the unconscious. S1 is the unconscious at its function of repetition; S2 is the unconscious at its function of interpretation. Thereafter, on the one hand the divided subject is completely absorbed by the master signifiers, while on the other hand, there is a residue that fails to be absorbed, objet a. Based on this schema, the way to participate in this discourse in the form of identification is "I am the way I enjoy." Along this schema, Kruszel presented an analysis of the movie Talladhega Nights in which the father of the protagonist, Rickey Bobby, tells his son : "Remember son, if you ain't first, you are last". The crucial moment(s) in Lacanian analysis is (are) the intervention(s) of the analyst, which captures pieces of the Real, which may lead to a separation from this kind of enslaving identification.

Manya Steinkoler took a different approach to discuss the increasing consumerism of childbirth. In her talk “Biblical Annunciation Narratives: The Ethics of the Series and the Jouissance of the End,” she studied the gap between Judaism and Christianity in terms of the annunciation type scenes of childbirth in the Old Testament versus the incarnated gift in the Gospel of Luke. Steinkoler used this comparison to examine and diagnose the contemporary shift to technological means of reproduction. Judaic tradition ties reproduction to transmission via the power of God’s speech upon the barren woman; there is an annunciation of the conception and/or of the pregnancy itself. “Barrenness is made by Yahweh in order to subdue the possible threat it would pose, namely, that there would be nature not all subject to the Signifier.” While the Judaic series of annunciation narratives privilege a symbolic effect over the barren, Christianity halts this series and founds community by means of conversion—filling the body of the virgin with the Holy Spirit. Therefore, the shift in the "Master Discourse of Paternity” revolved around the shift from symbolic transmission to imaginary conversion. It seems that technological means of reproduction continue the line of conversion, by accentuating the separation of reproduction from sexuality.

What I found enlightening about this first day of Clinical Studies in Miami was the rich variety of approaches within psychoanalysis to the treatment demands of today. These ranged from the phenomenology of the praxis in institutions, use of cultural analysis, panoramic views of Lacan’s teaching and application of literary analysis of the paradigms in traditional texts. This plethora of singular approaches within the Lacanian orientation may be indicative of an enacted reply to contemporary demands of brevity and efficiency.
--- Noa Farchi


Marie-Hélène Brousse began the day with a very interesting and informative lecture entitled “The treatment challenges of today.” She took up the question, “what is post-modern?” and discussed how the master discourse today responds to and is organized by scientific discourse, and how science has changed our objects and the way we live our lives. She focused on and gave examples of how our current time gives less power to the symbolic and more power to the real; we see manifestations of this in the culture and in the clinical field. With this cultural shift, we encounter changes regarding the limits of jouissance. Brousse discussed how our time is marked by limits set not by prohibition, but rather by what is possible or impossible. Our particular cultural milieu is also marked by burgeoning possibilities. Rather than one Name-of-the-Father we are dealing with “the Multiples,” as described by Jacques-Alain Miller. Brousse discussed the effects of there always being another possibility. She took up these changes and how they manifest in people’s suffering and the current state of treatment. Finally, within this context, she spoke on the role that psychoanalysis can play regarding the cure.

This lecture was followed by five case presentations. Each case was followed by a response from both an invited guest and the guest speaker, Marie-Hélène Brousse, as well as questions and comments from the audience. Alicia Hadida Hassan presented a case from her clinical practice with children. An eight year old girl was brought to Hassan because she was “causing trouble at school” and was involved in various incidents including vandalism and violence. Hassan went further than to offer social skills to the girl, which was requested, and rather worked with the little girl’s position within the family and her fantasy of being the only one for her father, as well as the signifiers of being “alone” and “only one.” Indeed, certain signifiers came to the forefront of the treatment. By listening to the child, especially to the elaborate stories that she told, Hassan helped the child find a place of her own, a niche for herself, especially at school. We saw that the treatment helped her shift her subjective position. The response by Heloisa Caldas illuminated what was both unique about the case regarding the specific signifiers and emphasized the psychoanalytic methodology of the case. Broussse highlighted the work of the child’s stories to invent a useful individual myth for the child, and how this is a useful technique when working with children; it particularly allowed a structure to appear and be reorganized.

The next case, “Queen of Petra: a girl without a name,” was presented by Dinorah Otero. This was a case of four years of treatment with an autistic child, who was also referred by her school for disruptive behavior. Otero discussed the role of the child’s name and how the lack of a name upon birth represented a lack of a symbolic place for the child within the family. Otero also discussed how she worked with the gaze and the voice in a particular way given the child’s autistic diagnosis. Drawings also played an important role in the case. The case focused on the child’s telling a story through pictures and how this telling made up a construction in analysis. The case portrayed stunning therapeutic effects and showed a big shift in the child’s relation to Otero; the child was able to speak with, indeed confide in, and to gaze at Otero by the end of treatment. Carmen Navarro’s response to the case illuminated the way in which Otero was working in the clinic of the real. She also discussed how Otero managed to create much needed social ties with her patient and how new signifiers emerged via the work. Brousse’s response highlighted Otero’s work with the object, and the shift in the subject from autism to paranoia, and how the patient built a symptom via the treatment.

Yael Baldwin presented “It’s a family affair: A case of bulimia nervosa,” which documented how Baldwin worked analytically within an eating disorders treatment team setting with a college aged woman suffering from bulimia. Baldwin described how the treatment worked at the level of the signifier, and how via speech the patient was able to connect her symptom to her family history, to repetition, and to various identifications with family members. The case also highlighted how the symptom was also linked to the patient’s relationship to knowledge. The case discussed how one can work at the level of speech and desire even when the setting tends toward working at the level of demand. Pam Jespersen responded by questioning and discussing the role of jouissance and the drives in the case. She also highlighted the ways in which the treatment repositioned the subject from the role of victim into a stance of responsibility. Brousse’s response brought up a lively discussion about the differences between Dialectical Behavioral Therapy and CBT models and psychoanalysis, especially the role of the Other in relation to the subject. She also highlighted how the treatment allowed the young woman to build the bulimia as a subjective symptom, an analytic symptom as it related to truth and history, that could then be worked through.

Noemi Kohan’s case “De-stigmatizing psychoanalysis” looked at the demand for medications that provide quick solutions versus the demand for psychoanalysis, and offered a look at the therapeutic effects of a psychoanalytic treatment that lasted eight weeks. The patient discussed his depression and how it related to a career he disliked, the loss of his father, a failing relationship, his lack of a sense of place due to moving, and his progressive social isolation. Kohan showed how via some analytic interpretations that illuminated repetitions in the patient’s life, the patient, in eight weeks, moved from a position of whining demand to a different stance. Mirta Liliana Tedesco’s response to the case highlighted how Kohan’s position as the analyst and her interventions helped the patient move from the imaginary realm to the symbolic realm, and then created differences within the symbolic. Tedesco helped analyze each cut of the session and its effects. Brousse, commented on how Kohan woke her patient up and how the use of scansion disturbed his defenses. An interesting discussion ensued that related to the patient’s diagnosis. Was this a case of an ordinary psychosis? What about the Lacanian orientation would allow us to call this an ordinary psychosis as opposed to, for example, an obsessive neurosis? This brought up the topic of the relationship to knowledge and the unconscious as it relates to structure.
The final case, “Johnny and why is the devil chasing me?” was presented by Tracy Favre. The treatment was with a middle-aged schizophrenic male in a continuing day treatment program who suffered from devil delusions. Favre described how the major and important questions that emerged from the case were why Johnny demanded treatment as he did, what he needed from treatment, and how she was to work with him in a useful way without him feeling like she was persecuting him, as he often felt others were. Favre discussed how for her, the treatment was a learning process in working with psychosis. In her response to the details of the case, Karina Tenenbaum picked up on how Favre managed not to become the Other that would be a threat to the patient. Tenenbaum also discussed the role of an invading jouissance in psychosis and in the case. Brousse responded by picking up on the patient’s transference and how he was asking Favre to give some order to the chaos of the real in which he lived. Brousse focused on the patient’s demand for knowledge concerning his history and saw this as a positive sign and direction for the treatment. Favre and Brousse spoke about what it means for a patient to construct a personal history with the analyst.
In all of the cases the question of diagnosis arose and was discussed, as was the direction of the treatment and what was specifically Lacanian about each treatment was highlighted. Theory was wedded to the concrete reality of cases.

To conclude the successful day, Thomas Svolos announced that the third Clinical Study Days will be held in 2008 in Omaha, Nebraska, and the topic will be on the object of psychoanalysis, that is the object relating to object a, to the goal or aim of psychoanalysis, and to what psychoanalysis objects to, that is, the subversive side of psychoanalysis. The first two events have been illuminating, and I encourage all to attend the third.
---Yael Baldwin