29 de mayo de 2016

Towards the NLS Congress / Vers le Congrès de la NLS Dublin 2016 : Minute 16-20



minute


- 20 -

Du détail pictural « non significatif » aux phénomènes élémentaires discrets : un bref parcours

François Sauvagnat


France


Lacan ne voulait pas d’autre préalable à la structure que les « types cliniques » de Charcot, illustrés, entre autres, par Freud, puis par Chaslin. Et de préciser[1] qu’il existe un seul aspect du discours de l’hystérique – celui centré sur le manque, et non pas sur l’objet – qui pouvait en transmettre la logique.

Ce point a été, entre autres, remobilisé par la notion de « psychose ordinaire », qui a permis de raviver la notion, parfois oubliée, que les phénomènes élémentaires psychotiques ne sont pas des « phénomènes repérables » qui seraient « évidents », et qu’ils ont pu, dissimulés, travestis, dépister les meilleurs. Rappelons-en quelques épisodes :

1)    Le sentiment de désignation, die krankhafte Eigenbeziehung, que l’école de Breslau a établie comme phénomène élémentaire de la paranoia (C. Neisser 1892[2]) – est d’emblée présentée comme un phénomène caché, masqué par exemple par une agitation, une réticence, des phénomènes hypocondriaques voire une efflorescence de symptômes d’allure névrotique. Dans le cas de l’homme aux loups, Freud témoigne à sa façon avec quelle facilité on peut passer à côté alors que le nez est au milieu de la figure : avec le rêve des loups qu’il hésite à qualifier de cette façon, alors qu’il était tellement familier d’un autre syndrome paranoïaque qui en exhibait la structure, le délire d’observation (Beobachtungswahn) de Meynert.

2)    La non-fonction de l’objet a, que J. Lacan désigne dans le séminaire X[3] comme phénomène élémentaire de la psychose maniaco-dépressive, s’inspirant, non seulement de la fuite des idées (Ideenflucht) et du déraillement (Entgleisung) des germanophones , mais également des différents aspects discrets (certains affleurent avant décompensation) du « délire des négations » de Cotard. Freud lui-même, avec le cas de Mme G, aura montré combien facilement on peut se laisser aller à minimiser ce type de phénomène, pourvu qu’il soit masqué, par exemple par des phénomènes d’allure obsessionnelle.

3)   Philippe Chaslin a bien montré comment la discordance schizophrénique pouvait être particulièrement peu repérable, dont parfois un simple geste bizarre, un décrochage verbal à peine perceptible, pouvaient fournir la preuve. On sait à quel point ses précieuses indications ont été historiquement maltraitées[4]… elles n’en ressurgissent pas moins dans des notations de Lacan : « discord au joint le plus profond de son être »[5] à propos de Schreber, ou dans le laisser-tomber (schrebérien ou joycien) – sans compter ce qu’il laissait présager de la problématique borroméenne elle-même.

4)    Le phénomène de Séglas, de la pensée à peine proférée, — base des hallucinations psychiques de Baillarger – à une profération autonomisée, xénopathique, télépathique, en écho, jusqu’à l’impulsion verbale, exige également une autre sorte de supposition de savoir, un autre type de « refus de comprendre », dont Lacan fit un temps crédit à Clérambault. Phénomènes qui ne prennent toute leur valeur qu’avec la notion, développée par Lacan, de parasitisme langagier opposée à la doctrine chomskyenne du langage comme organe.

5)    Du côté des phénomènes imaginaires, la tradition des recherches sur les différentes formes de mythomanies et de mégalomanies a bien montré (Foville) à quel point les manifestations pouvaient parfois être indépendantes d’autres vécus délirants déclarés (notamment persécutifs ou hallucinatoires), la chose devait se confirmer avec la mise en évidence du syndrome de Capgras et de celui de Frégoli, sans parler du « signe du miroir », dont Reboul-Lachaux a assuré la réputation de discrétion[6].

Il va de soi que cette première esquisse de la notion de structure – le type clinique de Charcot – a été profondément remaniée par Lacan. D’un paradigme neurologique, il fallait tirer des mathèmes qui rendent compte des choix paradoxaux, des « insondables décisions de l’être »

Extrait ( Texte complet ici)

[1] Lacan J Préface à la traduction allemande des Ecrits, in Autres Ecrits, Seuil 2005.
[2] Sauvagnat F: Traduction et commentaire d’un article du psychiatre allemand C. Neisser: “Discussions sur la paranoia”, in Psychose naissante, psychose unique, sous la direction de H. Grivois, ed. Masson, 1991
[3] Lacan J : Le séminaire X : L’angoisse, Paris Seuil, p 411.
[4] Sauvagnat F:”A propos des conceptions françaises de la schizophrénie: de la discordance à la problématique RSI”, in Synapse, Journal de Psychiatrie et Système Nerveux Central, n°169, Octobre 2000, p.49-58
[5] Lacan J. D’une question préliminaire à tout traitement de la psychose, in Ecrits Seuil 1966.
[6] Sauvagnat F:”Réflexions sur le statut de la mythomanie délirante», L’Evolution Psychiatrique, 68 (2003) p. 73-96.


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Ordinary Psychosis and Melancholia

Natalie Wülfing


Great Britain

No other clinical picture resembles more the features of subjectivity that have entered our common discourse as “ordinary” – like sadness, depression, lethargy, defeatism, etc. – than melancholia. In La Psychose Ordinaire, (La Convention d’Antibes, Seuil 2005), one of the contributions turns around this question. Melancholia resembles ‘normality’, and if we are speaking about what discreet signs in Ordinary Psychosis we can illuminate, the discreetest, most difficult to differentiate, of signs must be those of melancholia. 

Let us bring out the central idea that Jacques-Alain Miller (in Psychoanalytical Notebooks 26, Ordinary Psychosis Revisited), has singled out from amongst Lacan’s classic teaching, and relate it to the question of the clinical picture of melancholia. The idea of “a disturbance that occurred at the inmost juncture of the subject’s sense of life” (Ecrits, p.466 [fr 558]), in a way, circumscribes the melancholic’s position, in a structure stripped to a minimum. What is a disturbance of the sense of life? It is the absence of something vital, but the status of this something vital is the important psychoanalytic contribution as such – for it is not an organic vitality, the vitality of the organism, but the feeling of being alive that the Name of the Father instils in the subject. In the absence of this function, the signifier returns in the real – however in melancholia, it is not the signifier, but jouissance – what is rejected in language – that returns in the real. The foreclosure of the Name of the Father lays bare the relationship to the Thing. (Laurent, Ornicar 47) It is the being of the subject itself, as object, that turns against itself. This marks its specificity and difference to the paranoid or schizophrenic clinic.

What is this jouissance that returns in the real? Eric Laurent refers to mania when he says “The manic disorder can be grasped like a return in the real of the mortification that language imposes on the living.” It means that in melancholia and in mania as its counterpart, what is not mortified in the Other, mortifies the subject. It returns in the real as a jouissance linked to the being of waste. Lacan says it in a development prior to any formula: “That [the meIancholic’s suicide] occurs so often at the window, is not by chance. It marks a recourse to a structure that is none other than a fantasy.” (Sem. X, p.336 [3.7.’63]) This recourse to a fantasy is not the neurotic fantasy, but the structure of being in the place of object a. It is not the object of the cause of desire, but the object of exclusion, the Thing, that the melancholic is always in danger of being identified with. It marks “…[the] sudden moment at which the subject is brought into relation with what he is as a.” (Sem X, p, 110 [16.1.’63])

In today’s world, where the object is at the zenith of the social, what is rejected from language is precisely returned into commerce, technology and addictive circuits that surround us. It thus functions as a great generalisation, this object a at the zenith. Does it mean that melancholia, and the precision of the other psychiatric clinics of psychosis, are all disappearing into this generalisation?

If it is possible, what are the discreet signs of melancholia, that it is to isolate, to distinguish them from other clinics of psychosis? There is always of course the self-reproach, that Freud already singled out. “The self-tormenting in melancholia, which is without doubt enjoyable, signifies [ ] a satisfaction of trends of sadism and hate, which relate to an object, and which have been turned round upon the subject’s own self.” (Mourning and Melancholia, 1917) 

The turning on itself is shown, by Freud, to be a consequence of the loss of ego: “Thus the shadow of the object fell upon the ego, and the latter could henceforth be judged by a special agency, as though it were an object, the forsaken object. In this way an object-loss was transformed into an ego-loss and the conflict between the ego and the loved person into a cleavage between the critical activity of the ego and the ego as altered by identification.” (ibid) 

The self reproach can also appear in more discreet forms though, such as a heightened sensitivity to the perceived criticism of others. This sensitivity is sometimes part of a more perplexed relationship to language, when the words of the other become difficult to assimilate and leave a residue in which a whole day or several days are spent going over what was said and what it might mean. Here the idea of language as parasitic, as jouissance itself, refers us to the late Lacan. (Seminar XXIII, The Sinthome) The parasite of language in the speaking being may play itself out at the level of persecution (question of the Other), of fragmentation (question of the body) or of a radical rejection (question of being), to evoke the three ‘externalities’ that Jacques-Alain Miller separated to distinguish between different psychotic substructures. (OP Revisited, PN 26) 

It seems to me that mourning has disappeared from the melancholic clinical picture. What is left is the radical impossibility of shifting the certainty that everything is in vain. Nothing to be gained from the Other. Freud (somehow cruelly) in fact thought that the melancholic had an uncharacteristic access to the truth, in his self reproaches, which separated him from ordinary human beings who did not have such lucidity. It would cast him as a non-dupe. Thankfully, with Lacan, we think that the non-dupe errs…
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The “Borderline” Issue

Alan Rowan


Great Britain

The idea that psychosis could be ordinary, lucid, latent or normal and thus more or less compatible with everyday life was not such a strange idea to many early pioneers of psychiatry. For example, Eugene Bleuler spoke of latent schizophrenia as, “the most frequent form” adding “these people hardly ever come for treatment”. However if they do, one may discover Bleuler states, “concealed catatonic or paranoid symptoms” behind what in everyday life may pass as minor oddness, unusual moodiness or some discreet exaggerated behaviour or trait. Moreover he noted how a subject might be well aware that others do not share some of his beliefs and thus engage in what Bleuler termed “double book-keeping” by simply concealing – despite a sense of inner conviction -such thoughts from others, including of course their psychiatrist or therapist.

For reasons that are no doubt complex but certainly entail the need, as Foucault notes, to clearly segregate, socially discipline and treat “madness”, rationality and social capacity were soon seen as incompatible with psychosis, in stark contrast to De Clerambault’s idea that, in some instances at least, the psychotic can be a master of rational deduction. However, if subjective disturbances were in this way to be subject to psychiatric classification it was not possible to do away with forms of suffering that exceeded a neat categorisation of such disturbances into (florid) psychosis and neurosis. Thus the concept of the “borderline” emerged, first with Stern, and then more definitively with Kernberg whereby, thereafter, it became incorporated into psychiatric diagnosis as the “axis two” disorders of personality. Indeed the question of how to understand and treat so-called borderline disorders remains an on-going major theme within contemporary psychiatry (Bateman& Fonagy), even as the diagnosis itself is considered incoherent by many, given the extremely high levels of both internal and external comorbidity for all axis two disorders (Zimmerman & Mattia).

This wider context thus represents one potential way to situate our work programme on ordinary psychosis alongside the fact that for Lacan there exists a “differential clinic” – meaning that the treatment of repression/neurosis and psychosis necessitates a radical difference in approach. Up to this point Lacanian analysts saw the majority of “borderline patients” as having a psychotic structure and thus already had a theory grounded way to approach treatment – in contrast to IPA analysts – like Kernberg or Bateman, who struggled with pragmatic adaptations (e.g. avoid regression, genetic interpretations etc.) to so-called classical modes of interpretation. Today as we focus on this clinic of “discreet signs”, where language treats jouissance, we are thus confronted, as Laurent puts it, with the fact that: “What had been established … as a radical distinction between madness as a result of foreclosure and that which is not affected by foreclosure was now being displaced. Between neurosis and psychosis, which hitherto stood apart like two distinct continents, there emerged a passage of generalisation”. What is foregrounded here is not just that the first paternal metaphor of Lacan is one solution among others in terms of how the subject “knots” the Real, Symbolic and Imaginary but that there is no once and for all adequate solution that would do away with the problems of jouissance in life – with the fact that the “body event” always invariably exceeds its symbolic envelope. It is why today the end of analysis focuses not on some final interpretation but on the subject’s relation to his or her sinthome, on the isolation and reduction of the subject’s “jouissance program” to a question of S1’s.

At the same time, as Miller notes, this “excluded third” of ordinary psychosis is to be placed on the side of psychosis and thus differentiated from the “very definite structure” of neurosis – in Freudian terms the presence of an ego, superego and repressed unconscious. When this structure exists problems of jouissance are handled via this structure and in a way that allows the subject to remain, one could say, a character in their story – if inevitably one that will have its tragic dimension. It means that there is a binary difference between those subjects where object a, as cause of desire, is governed by a fantasy construction which ties jouissance to the Other and where this tie is absent.

In florid psychosis the subject proceeds by way of an often massive delusional work something that in ordinary psychosis is avoided. Typical indications from the so-called “borderline clinic” – paralyzing levels of dread or anxiety, a lack of mutuality, the urgency of impulses, the fear of annihilation with its arousal of aggression towards self or others etc. all suggest difficulties that exceed the category of neurosis. However, it is only via a clinic of “discreet signs” that go beyond phenomenological descriptions that we may feel confident in making a diagnosis. This points to a dimensions of our current work program which has potentially significant contemporary relevance to both psychiatry and the mental health field in general, with, it should be said, interesting links to the (largely forgotten) history of both.

Bateman, A. & Fonagy, P. (2004). Psychotherapy for Borderline Personality Disorders: mentalization-based treatment. Oxford University Press.
Bleuler, E. (1911). Dementia Praecox or the Group of Schizophrenias. International Universities Press, 1950.
De Clerambault, (1942). Oeuvres Psychiatrique. Universitaires de France.
Foucault, M. (1971). Madness and Civilization. Tavistock Press
Kernberg, O. (1967). Borderline Personality Organisation. Journal of the American Psychoanalytic Association, 15: 641-685.
Laurent, E. (2014). Lost in Cognition: Psychoanalysis and the Cognitive Sciences. Karnac Books, p. 4.
Miller, J-A. (2013). Ordinary Psychosis Revisited. Psychoanalytic Notebooks, Issue 26
Stern, A. (1938). Psychoanalytic investigation and therapy in borderline group of neuroses. Psychoanalytic Quarterly. 7: 467-489
Zimmerman, M.& Mattia, J. J. (1999). Axis 1 diagnostic comorbidity and borderline personality disorder. Comprehensive Psychiatry. 40: 245-252


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To Diagnose: An Effort of Poetry

Gil Caroz

Belgium

Clinical Phenomenon or Diagnostic Dispute?

During an afternoon of discussion and debate with the CPCTs[1] and related institutions in March 2015 (reported by Patricia Bosquin-Caroz and published by FIPA), Jacques-Alain Miller underlined that diagnosis is no longer applicable in a clinic that has taken note of the Lacanian notion that ‘all the world is mad’. In this context, he added, diagnosis is no longer spoken, but is understood. Elsewhere, what is brought to the fore is clinical questioning in so far as it allows us to see the phenomenon, to specify it, and to describe it succinctly. This concise description is of the order of a nomination.

For those clinicians unable to give up their knowledge of the catalogue of true psychiatry, as opposed to the DSM, their competence to describe the clinical tableau will depend upon their talent to speak well; clinicians who are able to name the phenomenon without effacing either the subject (the patient) or the clinical relation between them. The genius of Clérambault is here a source of inspiration. Speaking of the reports which Clérambault compiled each day by the dozen, Paul Guiraud, (in his preface to Clerambault’s Œuvre Psychiatrique), qualifies these as “certificates, works of art as much as science”. In one or two pages, Clérambault knew “how to flawlessly, seamlessly trace the personality of the patient, without recoiling from the neologism that was always the genuine foundation. We can say that he almost created a literary school, one that should be the school of all administrations.”[2] 

In using the DSM5, you can content yourself with noting the code 297.1 (F22) in order to indicate that the patient suffers from Delusional Disorder. All that then remains is to specify whether it is erotomaniac, grandiose, jealous, persecuted, somatic, or ‘mixed’. In opposition to that, Clérambault’s literary descriptions in his short ‘certificates’ give a living consistency to the person described. It is not only a clinical picture but also has a presence, a materiality, which is seasoned by the patient’s words. Thus, you can believe that you can hear the voice of Amélie, seamstress in a religious house, describing the strangeness of the parasitic mental automatism that affects her. To quote her: “When one says ‘one’, one has the air of speaking of two people… There is something that speaks when it wants to, and that stops when it no longer speaks.” Much later Clérambault notes that “her eroticism is manifested in smiles and prolonged blushing” or again that she “starts and stops from impulsive gestures. She says out loud what she supposes we think.” The reader feels as if they participate in the interview when they read Clérambault: “A part of her is getting tired at the end of the examination and this inclines her not to reply, and another part of her, which is favourable to us, is irritated by this, and she rebuffs the former part out loud: “we want to answer; you leave; we can wait a little” (ibid, p. 457-8). We think of L’amante anglaise by Marguerite Duras[3], which allows us to put our finger on the psychotic reticence that forms the basis of the staging of the link established between the author of the crime and the person investigating it, who tries to identify the inexpressible hole of her motivation. And then, when Clérambault writes, in his laconic fashion: “In conclusion: Automatism. Erotism. Mysticism. Megalomania”, these words, which belong to a universal classification, are transformed, in the case of Amélie, into nominations of phenomena wholly particular to her.

The présentations de malades given by Jacques Lacan testify to the teaching of Clérambault, who he regarded as his sole master in psychiatry. Jacques-Alain Miller portrays how these presentations remind us of Greek tragedy, except that the participants at the presentation, simultaneously the chorus and the public, are waiting not for a catharsis, but for a diagnosis that will be the last word on the patient.

Lacan dodges this expectation, he makes a sidestep. He ends up affirming the diagnosis, but at the same time suspends it and problematises it in order to lengthen the study. His reference to classification is there in order to speak of the normality of the psychotic subject who does not fail to recognise the Other in the mental automatism that traverses him. For the rest, Lacan follows the Freudian thread of naming the singular jouissance that is carried along by the psychiatric nomenclature. So, Ernst Lanzer has entered into the history of psychoanalysis under the name of the Rat Man rather than as a case of obsessional neurosis. And again, we think of Sergei Konstantinovich Pankejeff as being the Wolf Man, before considering him as a case of infantile neurosis (a diagnosis that has since been contested).

Thus, psychoanalysis agrees with the psychiatric nosography but tries to follow more closely not only the personality but also the jouissance of the subject. The nomination of phenomena requires a literary competence more than a scientific one, and there is nothing better to shape and form this effort of nomination than the analytic experience itself. To know how to name your own jouissance is a precondition to being able to speak about that of another. To diagnose is to make an effort of poetry.

Translated by Janet Haney
Text published in The Hebdo Blog, No 64 (21 Feb 2016), dedicated to the FIPA Study Days, 12 March 2016

[1] The Centres for Psychoanalytical Consultation and Treatment (CPCTs) are one of the many forms of the Federation of Institutions of Applied Psychoanalysis (FIPA), seehttp://www.causefreudienne.net/connexions/fipa/
[2] Clérambault, G., Œuvre psychiatrique, PUF, Paris, 1942. 
[3] Duras, M,  L’amante anglaise,  Transl. Barbara Bray, Pantheon Books, New York, 1968.
 
 
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Pour que les signes restent discrets
Dominique Holvoet

 
Belgique

La notion de psychose ordinaire nous permet de fait le joint entre la psychose extraordinaire, celle qui se lit à partir de la forclusion du Nom-du-Père, et la dimension du délire généralisé qui relève de la clinique qui se construit au XXIè siècle et dans laquelle le Nom-du-Père n’est plus qu’un symptôme parmi d’autres possibles. Le Nom-du-Père est mis en place par Lacan dans le Séminaire III comme un signifiant qui, tel un anneau, « fait tenir tout ensemble »[1] alors que c’est au symptôme comme tel, rebaptisé sinthome, qu’est dévolu cette fonction dans le Séminaire XXIII. 

Ainsi rencontrons-nous dans notre pratique bon nombre d’analysants pour lesquels cette fonction-sinthome présente une fragilité particulière. Et cette assertion pourrait d’ailleurs être élargie à l’ensemble des sujets qui demande une analyse. Car c’est toujours vrai qu’un sujet s’adresse au psychanalyste parce qu’il éprouve une certaine discontinuité dans sa vie. La clinique de la psychose ordinaire requiert de prendre toute la mesure de ces discontinuités afin d’en inférer la fonction-sinthome qui nouait jusque-là les discontinuités successives. La question reste donc toujours de savoir ce qui vient stabiliser la langue dans tel cas, quel est le point de capiton qui préservait l’ordre de la signifiance ou pour le dire dans les termes du Séminaire XXIII, quelle écriture, quel mode de nouage est en jeu dans le rapport à la parole de ce corps impacté par le langage ? Une petite délinquance, une pratique addictive, un mode énonciatif singulier, une modalité inédite de faire couple peuvent être les signes discrets d’une psychose ordinaire, qui ne sont que les signes d’une sinthomatisation permettant de faire tenir ensemble un édifice précaire.

Cet édifice, c’est au dernier terme tout ce qui vient faire civilisation, c’est-à-dire tout ce qui est en place de répondre aux perturbations, au parasitage du langage comme tel sur le corps parlant. C’est en ce point sans doute que ce qu’on appelle ici civilisation passe nécessairement par l’art, particulièrement quand le programme de la civilisation présente des ratés. Et c’est aussi en ce point que la psychanalyse accompagne les corps parlant – tout le monde n’ayant pas vocation à rejoindre l’artiste. Quoi qu’il en soit, pour l’un comme pour l’autre ce sera « toujours à contre-courant que l’art [et la psychanalyse] essaie d’opérer à nouveau son miracle »[2]  Car il y a en effet un malaise dans la civilisation qui est « ce dérèglement par quoi une certaine fonction psychique, le surmoi, semble trouver en elle-même sa propre aggravation, par une sorte de rupture des freins qui assuraient sa juste incidence ». C’est dans cette parenthèse que Lacan reprend d’une phrase le texte de Freud. Et il poursuit par cette incise : « Il reste, à l’intérieur de ce dérèglement, à savoir comment, au fond de la vie psychique, les tendances peuvent trouver leur juste sublimation »[3]  Ce que Lacan nomme là la rupture de freins du Surmoi, c’est le caractère d’intimation que comporte la voix, qui impose au sujet sa signifiance. Car le problème n’est pas de mettre des mots sur les choses, de faire récit, mais de ne pas être poussé, précipité à subir les mots de l’Autre, révélation ineffable dont la densité de signification fait effraction et brise alors l’ordinaire de la psychose d’un parlêtre.

Eric Laurent, dans un entretien subtil avec François Ansermet et Pierre Magistreti en septembre 2011 (voir ici), donnait l’axe de la clinique psychanalytique du XXIè siècle en soutenant qu’à l’envers de ce que la vulgate veut bien retenir, la psychanalyse n’est absolument pas une herméneutique. Il relevait que ce qui caractérise l’existence du sujet est tramé d’un certain nombre de discontinuités, de trous qui ne permettent justement pas d’établir une continuité, un récit de vie.

Et c’est pour cela que la psychanalyse n’est pas une herméneutique. Faire une analyse, ce n’est pas faire le récit de sa vie. Au contraire soutenait E. Laurent c’est « faire le récit de tout ce qui ne fait pas récit, de tout ce qui fait trou, de tout ce qui fait obstacle à ce qu’on puisse se retrouver soi-même, tous les moments où on s’est perdu de vue »[4]. La clinique de la psychose extraordinaire nous a enseigné sur ces moments de cristallisation où une écriture s’impose au sujet. Le repérage des modes par lesquels un sujet tisse la trame sur le trou permet d’éviter cette précipitation dans ce qu’on nomme une hallucination, une lettre qui tout à coup fait sens, déclic, boum ! La clinique de la psychose ordinaire tient à ce repérage des signes afin qu’ils restent discrets. 

[1] Lacan Jacques, Le Séminaire, Livre III, Les psychoses, Paris, Seuil, 1981, p. 359.
[2] Lacan Jacques, Le Séminaire, Livre VII, L’éthique de la psychanalyse, p. 170.
[3] Lacan Jacques, op.cit. p. 172
[4] Laurent Eric, Entretien avec les professeurs Magistretti et Ansermet pour la fondation Agalma, mise en ligne 28/11/2011 sur https://youtu.be/cCS9vRXIin4