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Transference and psychosis Anne Lysy-Stevens We have now gone beyond questioning whether it is possible to treat psychosis through psychoanalysis. That it is possible is a fact that psychoanalysts from our School testify to in their effective work with psychotic subjects and by exposing the results of this work, whether it be in private practice or in institutions of various sorts ? hospitals, residential centres, and various other consulting sites. Along with other colleagues, I have come to the following conclusion: we are receiving more and more psychotics in our consulting rooms. We could ask why. Have they become statistically more numerous in our contemporary society? Or is it not rather that, for several years now, we have had different diff erent reference points for approaching psychosis and that where we once could not arrive at a diagnosis because we were unable to find the classic signs of psychosis, with the introduction of the category of "ordinary psychosis" (founded on the late teachings of Lacan, which Jacques-Alain Miller introduced at the end of the 90s) we now distinguish the structural traits that establish this diagnosis better and in different ways? Or is it that these subjects address themselves to psychoanalysts more these days because they find something there that suits them and that they don?t find anywhere else. Whatever the reason, we are here today to elaborate something of this practice, knowing that this elaboration is inscribed within the theme of work of the NLS this year, namely the preparation for the Congress in Athens in May 2007 on "Births of Transference ? the installation and handling of psychoanalytic psychoanalytic transference." I have therefore decided to consider the question of transference in psychosis. We thus have two topics: the installation of transference and its handling, on the one hand, and psychosis on the other. The question thus arises from the outset: is the latter a particular case of transference and if so, is what we can elaborate of the structure of transference, with Freud and Lacan, also applicable to psychosis? To be able to answer this question and as a means of introducing this afternoon?s clinical discussion, I will remind you of a few major reference points concerning psychosis and transference, so that we will be in possession of the cards that will allow us to play our hands. "Transference and Psychosis" is the name of a problem, of a question. It was for Freud, for having constructed his theory of psychosis as a narcissistic state in which the object-libido abandons object representations and withdraws onto the ego, he could only deduce that the analyst could not be libidinally invested and thus that transference was not possible with psychotics. He nuanced this, but this was his position all the same. If Lacan gave psychosis an important position in his teaching, he only gave a few commentaries on the treatment of psychosis and psychotic transference. His principal text of 1958, "A
Question Prior to any Possible Treatment of Psychosis", ends with the question (which he left open) of treatment and of the transference ? I am referring to the last paragraph. It is here that he situates his text as a question prior to any possible treatment, suggesting that before speaking about the treatment you have to pose the question in the right way and have a correct idea about the structure of psychosis. The way the treatment is envisaged is determined by the theory you have of it. Just before this, Lacan remarks that "Freud?s conception (?) designates the transference the subject [Schreber] developed to Flechsig as the factor that precipitated the subject into psychosis."[1] This signals the dangerous side that can cause practitioners to recoil before psychotic transference and the idea of accepting psychotic subjects into analysis: there is a risk that the transference will get carried away and that a triggering will occur. The "Question Prior to any Possible Treatment of Psychosis" (henceforth referred to as the "Q.P.") is not Lacan's last word on the subject, as you know. I will not take up the developments of Lacan's teaching in detail, but only briefly recall a few major points where the conception of psychosis and its shifts are not without consequence for how we envisage treatment and for the position of the analyst ? thus also, for the way of approaching transference. I. Approaches to Psychosis The "Q.P." takes its starting point from the thesis that "the condition of the subject, S (neurosis or psychosis), depends on what unfolds in the Other, A."[2] Lacan thereby draws a clear distinction between neurosis and psychosis according to whether the paternal metaphor has operated or not. The foreclosure of the Name-of-the-Father in the symbolic is what characterises psychosis, with the failure of phallic signification as its correlate in the imaginary. It is by rereading Freud's Schreber case that Lacan shows how a hole in the imaginary responds to a hole in the symbolic, how this brings about effects of imaginary dissolution, language disorder and the return in the real in hallucinations, and how, starting from there, a reconstruction by the signifier can come to restore a viable order ? the delusion being, as Freud indicated, an attempt at a cure, a supplement to the paternal metaphor. Jacques-Alain Miller has re-written this paternal metaphor with the matheme big A over J, which marks the effect of negativation of jouissance by language and he notes the failure of the metaphor as a coextensive relation between A and J, the effect of separation having not taken place. Twenty years later, in the last years of his teaching, notably in his seminar on Joyce and the sinthome, Lacan opens up an entirely different perspective, not only for psychosis, but also for the distinction neurosis/psychosis and for psychoanalysis in general. For a dozen years or so, thanks to the path opened by Jacques-Alain Miller, we have begun to draw the consequences from these new advances in our Clinical Sections and in our Schools. As opposed to the binary clinic of neurosis/psychosis, we sometimes speak of a Borromean clinic. This approach sets out less from the question of whether there is a foreclosure or not, but rather from the various possible ways of knotting the three dimensions: R., S., and I. Let us recall that according to Lacan, the three dimensions, R. S. I., that constitute the subject ("the subject is a threefold composition" or "composé trinitaire" ) are un-knotted at the start and require a fourth in order to make the knot. This is the plus-one of the knot, this fourth, that Lacan called the sinthome. Failure is the rule here.
There are several ways that the knot can fail and many ways of repairing it. The Name-of-the-Father, which since Freud had the privilege of knotting the three dimensions, is no longer the only way of knotting them. There are other ways. This is why Lacan pluralised the Name-of-the-Father and spoke of the Names-of-theFather. As Jacques-Alain Miller proposed at the time of the Conversation of Arcachon, the function of the Name-of-the-Father is generalised to function of the sinthome. The Name-of-the-Father is one of the possible symptoms, but other forms can have this sinthomatic function. The ?sinthome? in question is no longer the symptom as a formation of the unconscious, the truth-symptom, but the letter as the site of jouissance, as the marking of lalangue on the body, outside meaning, detached from any chain. One could ask if this clinic of the universality of the symptom[3] effaces the differential clinic or renders it obsolete. Nothing of the sort! One could say, it seems to me, that the accent falls more on the particularity of the knottings, on failures and solutions that are particular each time. "We are all Do-It- Yourself jobs!" as Alain Merlet concluded at Antibes, yes, but where there is a hole, unknotting, one can either avail oneself of standard means, of ready-mades, of typical solutions, established discourses, or one has to make an effort supported by invention. Today, we are sometimes tempted to situate neurosis on the side of the standard and psychosis on the side of invention. It is perhaps not that simple; as JAM underlined in his texts on "Psychotic Invention"[4], everything is not invention on the psychotic side, "there is a dialectic to establish between invention and the stereotypical," typicality. For example, there are typical ways of triggering, where "dramatic conjunctions" are produced (which Lacan speaks about in the "Q.P.") where everything signifies and where the phenomena appear in an ordered manner, like notes on sheets of music. But the whole interest of new concepts, deduced from the last period of Lacan's teaching, ordinary psychosis (successive moments of connection-disconnection as opposed to discontinuous triggering), resides in the broadening and refinement of our ability to uncover clinical phenomena and the sometimes miniscule signs of the failure of the quilting point, signs which are not marked in such a distinct way as the canonical Schreberian model of triggering and as the classically attested signs of foreclosure. These recent developments also take into account the passage in Lacan's teaching that Jacques-Alain Miller has referred to as being from an axiomatic of the Other to an axiomatic of jouissance. As he underlined in Antibes, the Q.P. was founded on a great divide, on the one side of which we find the big Other, language, the signifier; and on the other the imaginary, the body and jouissance. [5] The "vital thread of the Borromean Clinic" is "a much closer link between jouissance and the signifier, the placing in continuity of these two domains". It is in his "Topological Supplement to the Question Prior to any Possible Treatment of Psychosis" of 1979 that Jacques-Alain Miller[6] introduced and accentuated the jouissance at stake in the reading of Schreber, where in the Q.P. Lacan had promoted the dimension of the Name-of-the-Father as the quilting signifier. Taking account of the evolution of Lacan's approach towards a pluralisation of the Name-of-the-Father, Jacques-Alain Miller already in 1979, opened "another Q.P." based on a consideration of jouissance and in particular the object a. The movement through which God did not stop abandoning Schreber (the "letting drop") only to return and penetrate him is a "pulsation of jouissance". Schreber is stuffed and emptied of jouissance. In relation to this Other who is his god, he occupies the place of object a,
between dejection of the world and the surplus enjoyment of the divinity. When he thinks, Schreber offers himself to God so that God can enjoy his body; when he thinks of nothing, he falls, quite literally, into dereliction where he is no longer a subject. In 1966, Lacan conducted a re-reading of the Q.P. himself, when he prefaced the French translation of Schreber?s Memoirs.[7] In a new way, he opposed the subject of the signifier and the subject of jouissance and at the end of his text he indicates the position where the clinician is located, like Flechsig in relation to Schreber: "as the object of some (kind of) mortifying erotomania." The clinician is lived by the psychotic as a subject motivated by a will to jouissance as was Flechsig, the soul murderer, in Schreber?s delusion. [8] Lacan?s remark poses an acute question: if the transferential relation puts the psychotic subject in this position, how can he be dislodged from it ? and this from the very place that the analyst has come to occupy for him? In other texts from the same period, at the end of the 60s, Lacan reconsiders psychosis in relation to the object a. Here, I will only cite the "Note on the Child,"[9] where he evokes the status that the child can have in realising the presence of the object a in the maternal fantasy. It is this that gets produced, let's say, when the paternal metaphor has not come into effect, when the subject as want-to-be [ manque-à-être] has not emerged from the status of object, as cause of the mother?s desire. How can he be dislodged, in the transferential link, from this position? How can one "produce the subject"?[10] Lacan does not give precise and detailed indications on the treatment or on the handling of psychotic transference. By contrast, throughout his teaching, one finds clear remarks about both the psychotic?s position insofar as it is a subjective position, one that reveals a choice made by the subject, and on the position of the analyst when he encounters such a subject: it quite clearly concerns a clinic of the subject, and in this it is a psychoanalytic clinic. Lacan also gave a very clear answer to a question which he was asked in 1976: yes, all the concepts that he had elaborated for the psychoanalytic clinic are applicable to psychosis![11] The indications that he gives on the position of the analyst are very precious. Of course you know them: they concern the "complete, albeit enlightened, submission to the patient?s properly subjective positions." [12] This indication formulates the more well-known exhortation from Seminar III, to become "secretary to the insane", in a different way. Eric Laurent has often spoken about this phrase in our clinical study days in order to accentuate its active side ? namely, that of punctuating and editing the text of what the subject says. It is in the conversation of Antibes,[13] which is passionate about this point, that the terms we are perhaps familiar with now first appear, but we must nevertheless preserve them in their freshness in order to continue to reflect in each case: how to be "docile," how "to make oneself be used by the subject who prescribes our position"; and how to be the addressee or the address of the real; how to be the partnersymptom. There are also more "active" formulations, like "being an aid to invention" or again an "aid to translation" - which I will return to later. But let us say already that this is to pose the question more in terms of jouissance than in terms of communication. It is a reformulation of the "secretary to the insane" in
terms of the new Borromean clinic: in response to the universal clinic of delusion we find the notion of the analyst as "multifunctional object", an enlightening term proposed by Jacques-Alain Miller in 1997 in an intervention appearing in Mental 5. "The object-psychoanalyst is surprisingly versatile, available, multifunctional", "he lends himself to uses that are very different to those conceived under the term ?pure psychoanalysis?". "The encounter with a psychoanalyst can be of great value, even if it is a case of impossible psychoanalysis". It is here too that Jacques-Alain Miller says that "there is no a priori contraindication to psychoanalysis" ? but he adds, there is nonetheless "at least one condition ? the condition of the symptom. There must be an analytical symptom and a suffering from the symptom: that this jouissance of the symptom presents itself in the guise of displeasure. And this is already enough to imply transference." [14] Here is a precious guiding remark for the question that concerns us, the birth of transference. The clinic with psychotics is a clinic of the subject. It is also a clinic under transference. Let us now try to set out a few markers with which to approach the question of transference in psychosis. II. Approaching Transference in Psychosis It would be possible to outline the development of the concept of transference in the same way that I have done for psychosis, but this is not what I will do here. I want to simplify things as much as possible and set out from the algorithm of the subject-supposed-to-know. This algorithm is Lacan's first formalisation of transference and he introduced it at a particular moment in his teaching: the concept is introduced above all in Seminar XI, in 1964, and is developed as an algorithm in the "Proposition of October 1967 on the Psychoanalyst of the School".[15] "At the beginning of psychoanalysis is transference," writes Lacan in the "Proposition" and he proposes to formalise this with the algorithm:
What do you need to begin an analysis? The algorithm writes, in signifying terms, that what constitutes the beginning of an analysis is a question: what does it mean? As Jacques-Alain Miller underlines in an article that was published some time ago, "Clinic Under Transference",[16] something must constitute a question; there is already a moment of perplexity for the subject about what is happening to him, prior to his addressing himself to a psychoanalyst. The subject experiences something which fails, his routine is shaken up; in other words, "he has encountered the real". At that moment a non-sense has occurred which is at the same time the moment that the subject-supposed-to-know is installed, which is a call to the subjectsupposed-to-know ? a "what does it mean?" It supposes that "it means something", which the subject then addresses to a psychoanalyst who makes himself the support of the subject-supposed-to-know. Lacan wrote this in the form of a signifier, which represents the subject (s) for another signifier: Sq. Capital S, "the signifier of transference", i.e. the signifier which represents the subject as divided, written under the bar (s); it is "that about which the subject asks himself what it means," as Jacques-Alain Miller says (in another article, "Come iniziano le analisi"[17]). He addresses himself to someone, who Lacan writes here in the
form of a second signifier, which is anticipated in order to give meaning to the first enigmatic signifier.
In the "Proposition", Lacan notes it Sq, " signifiant quelconque" , "any old signifier", because "if it can be named with a proper name, it is not because it distinguishes itself in terms of knowledge", it does not incarnate this other signifier, it only acts as its support. "It knows nothing about the supposed knowledge." In fact, it should be noted that supposed knowledge is not written on the side of Sq, but under the bar, on the side of the subject: the signifying chain S1, S2, ?Sn is the chain of "knowledge present in the unconscious", a supposed chain, in the two senses of the term: situated beneath; and a hypothesis. At the start, it is a "pure signification of knowledge". In the course of the analysis, through the successive emergence of signifiers in the moments of opening of the unconscious, in the succession of "subject effects," a knowledge accumulates, in the position of truth. This line beneath the bar inscribes an "I don?t know what I am saying" and the analyst, by virtue of the fundamental rule, invites the subject to say?: "speak, it will bring something out." It is the epistemological side of transference. You can see that on this axis, this could lead to an infinite deciphering. But what is in play in analytic transference is totally different to an internet search, for example! Lacan underlined that there is something more than a demand to know; in 1975, at the time of his seminar on Joyce and the sinthome, he insisted on this: "it is necessary for something to push", and he added that if someone came to him with a demand to "know himself better", he would send him on his way! [18] It is necessary, I would say in a first approximation, for there to be suffering. And this opens to something quite other than epistemology, something which Lacan developed in the second part of his "Proposition": it concerns the other side of what animates the subject when he speaks. This other side is beyond the demand for knowledge and even for love insofar as he addresses someone who is supposed to harbour this knowledge that would bring the final word on being. If we refer to the end of Seminar XI and the second stage of the graph we see that as the analyst does not respond from the place of this knowledge or from this love in order to fill the subject, and as he always answers a little to one side of his interpretation, what arises there is the desire that lies between the lines of what is said, and from that moment on the neurotic subject is confronted by the "Che vuoi?" of the desire of the Other. The question "What does that mean?" or "Who am I?" poses itself from then on in terms of "What am I in the desire of the Other, what does he want from me?" It is there that the desire of the analyst, which advances towards the encounter with the subject's desire, provides a push towards the construction of the fundamental fantasy, which is the answer that the subject constructs and acts out in his relation to the Other. It is a response that he brings to the place that is fundamentally without any possible response in the Other
, a response where a drive enjoyment is at
work. All of this second side is not written on the algorithm, but if you add " a" beneath the bar, you will make the matheme of fantasy appear:
. The aim of the analysis of a neurotic is to go up to the point of touching
what for him comes to respond to what of the real, of the sexual non-rapport, cannot be written; not in order to push him into the abyss, but so that he can live otherwise and in a way that lightens the drive. Let us return to the algorithm of transference for a while before examining the question of psychosis. What is important to grasp is that it does not concern an intersubjective structure between two, but a ternary structure, as is shown on a schema that Jacques-Alain Miller proposed in the first session of his course, "Les Us du laps",[19] which he called the triangle of transference. He constructs it in order to answer the very simple question of where the subject-supposed-to-know is ultimately located: who is it, the analysand, the analyst or the unconscious? I quote: "it is the analyst, who knows and from whom, no doubt, interpretative knowledge can be expected; it is the analysand, as place of unconscious knowledge; but it is essentially a function which arises from an articulation and this is why we mark it in a third position alongside that of the analyst and the analysand, being neither of the two, but instead unconscious knowledge." He draws this triangle in order to situate the three positions on it and then examine the pairs.
The transference phenomena (love, hate), and also the counter-transference, are situated on the analystanalysand axis. On the axis analysand-unconscious knowledge, here (I am adding this to Jacques-Alain Miller?s commentary), we can place the barred S; he doesn?t know what he?s saying... The axis is barred. It is here that the function of the analyst intervenes, says Miller: he is only there to enable the analysand to connect up to the unconscious. He is a service provider ! I would say: the desire of the analyst operates to produce an opening of the unconscious for the analysand. In this sense one could say that what indicates the entry into analysis is this opening of the unconscious, the first dreams, slips, the effects of surprise at what one has just said, etc. On the analyst-unconscious knowledge axis, the analyst does not know the patient's unconscious, of course; nor is he equivalent to S1, S2, Sn: he rather incarnates, through his presence, the unsymbolised part of jouissance, the part which escapes S1, S2?, which one could write as small a. He must be there in flesh and blood, "the analyst must put his body on the line", says Jacques-Alain Miller, "in order to represent the unsymbolised part." Lacan takes up these terms again in the writing of the discourse of the analyst: a, and semblant of the object, provider, opens onto the unconscious and produces S1, subjective even REFERÊNCIAS
* Anne Lysy-Stevens is a psychoanalyst member of the École de la Cause freudienne and of the New Lacanian School. The paper was originally presented at a "Knotting" seminar in Lausane, 25 November 2006. Jacques Lacan, "On a Question Prior to Any Possible Treatment of Psychosis," Écrits , trans. Bruce Fink (London: W.W. Norton & Co, 2006), 484
Ibid., 458 P.-G. Guéguen, "L?homéostasie symptomatique dans les psychoses", Mental, 12, mai 2003, p. 37 J.-A. Miller, « L?invention psychotique », Quarto 80-81, p. 12 La psychose ordinaire, La Convention d?Antibes , Agalma-Seuil, 1999, p. 249 J.-A. Miller, « Supplément topologique à la Question préliminaire », Lettres de l?EFP, 27, 1979, p.127-138 J. Lacan, « Présentation des Mémoires d?un névropathe » (1966), Autres écrits , pp. 213-217 Cf. J.-C. Maleval, La forclusion du Nom-du-Père , Seuil, 2000, p.365 J. Lacan, « Note sur l?enfant », Autres écrits, Seuil, 2001, pp. 373-374 The expression « produire le sujet » is from J.-A. Miller :, « Produire le sujet ? », Actes de l?ECF IV, Montpellier 1983, p. 50-52 Jacques Lacan, "Ouverture de la Section clinique", Ornicar ? no 9, 1977, p.5-14 Jacques Lacan, "On a Question Prior to Any Possible Treatment of Psychosis," op. cit., p.447 La psychose ordinaire, op. cit J.-A. Miller, "Contraindications to Psychoanalytical Treatment", Psychoanalytical Notebooks 4 (2000), p.72 J. Lacan, "Proposition of 9 October 1967 on the Psychoanalyst of the School, Analysis 6, 1995; also in Autres écrits , Paris: Seuil, 2001, p.243-259 J.-A. Miller "Clinic under Transference", [see this issue above] J.-A.Miller, "Come iniziano le analisi?", Cause freudienne , 29, 1995, p.13 Lacan, Entretiens dans les universités nord-américaines, Yale University, 24 November 1975, Scilicet 6/7, p. 33 J.-A. Miller, "Les us du laps", course in the Département de Psychanalyse, Université de Paris VIII, 17 November 1999 E.g. A. Zenoni, in "Logique du transfert dans la psychose", forthcoming in Feuillets du Courtil ; J.-C. Maleval, La forclusion du Nom-du-Père, op.cit J.-A. Miller, "Clinic under Transference", above. Jacques Lacan, "On a Question Prior to Any Possible Treatment of Psychosis," op. cit., p.481 [In the last part of this quotation, the translation has been modified in order to retain the grammatical sense of the part quoted.] A. Zenoni, "Logique du transfert dans la psychose", forthcoming Cf. A. Stevens, "La psychanalyse appliquée", Feuillets du Courtil 8/9, p. 52 A. Zenoni, " Logique du transfert dans la psychose ", forthcoming. There is also a very beautiful article by Antonio di Ciaccia on work with autististic patients, where he redefines certain notions such as the "pratique à plusiers" or "multi-person practice". Here he also speaks of the necessity of presenting an "Other regulated and limited": A. Di Ciaccia, « Une pratique à l?envers », Préliminaires 13, 2001, p. 18 Cf. A. Di Ciaccia, op. cit ., et A.Zenoni, "Pratique institutionnelle et orientation analytique", Feuillets du Courtil 20, 2002 A.Lysy, "Een ander Ander uitvinden met de psychoticus", (Inventing another Other with the psychotic"), a paper delivered at the time of the Study day of Flanders Mental Health practitioners, "Milieux de traitement pour psychotiques: utopie ou eutopie", oct. 1997, published in Metanoïa, Bulletin GGzE Einderhoven, 1999, available at www.kring-nls.org J.-A.Miller, "L?invention psychotique", op.cit ., p. 12 E. Laurent, cf. his interventions in La conversation d?Antibes, la psychose ordinaire, op. cit. and in his articles: "Les traitments psychoanalytique des psychoses, Feuillets du Courtil 21, 2003, p.724 and "Intperpréter la psychose au quotidien", Mental 16, October 2005, p.9-24
All the quotations to this point in this paragraph are from "Les traitement psychanalytiques des psychoses", Feuillets de Courtil 21, op . cit . E. Laurent, "Interpréter la psychose au quotidien" op. cit p.20 E Laurent, "Les Traitements psychanalytiques des psychoses", op. cit. p.17 Ibid ., p.19 ; on the passage to the act as nomination also see Mental 16, p.21 and La conversation d?Antibes, La psychoses ordinaire, p.366-369. Ibid., p.24 E. Laurent, "Interpréter la psychose au quotidien", Mental 16, p.20 Ibid., p.22 E. Laurent, "Les Traitements psychanalytiques des psychoses", op. cit p.24. E. Laurent, "Interpréter la psychose au quotidien" op. cit p.22 E. Laurent, "Les Traitements psychanalytiques des psychoses", op. cit p.24. www.freeencyclopediaofpsychoanalysis.com 02 Janeiro 2012
