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The Letter, Issue 48, Autumn 2011, Pages v - vi

The Letter, Issue 47, Summer 2011, Pages 95 - 97 BOOK REVIEW by Marion Deane The Centre Cannot Hold: A Memoir of My Schizophrenia Elyn R. Saks. Virago Press, London 2007. Elyn Saks lives with her husband in California, where, after a brilliant academic career in some of the world‘s most acclaimed universities on both sides of the Atlantic—Vanderbilt, Oxford and Yale— she is now a professor of law specialising in mental health. She works also as a research scholar in psychoanalysis. In the final chapter of her memoir The Centre Cannot Hold she expresses her gratitude to the many people and events that have assisted her to have a 'life worth living‘ despite decades of suffering from schizophrenia. Accepting the fact that she will never be cured, she illustrates how through their influence, she gradually gained a measure of stability that allowed her to manage her illness and achieve her expressed desires, most notably, success in love and in work. The authenticity of her account, drawn from a combination of her acquired expertise as a professional and the life-long torment that is the trademark of the illness itself, finds expression in the almost documentary precision, with which she writes about the full range of her condition, from its little 'quirks‘ to the full blown psychosis.

The Letter, Issue 47, Summer 2011, Pages 85 - 94 THE TOOL OF DIAGNOSIS AND OPERATION OF THE MATHEME To know, to do, know-how, to construct knowledge Christian Fierens This is the unedited text of a talk, given to the ―Matinées de psychothérapie institutionnelle, at Facultés Universitaires de Saint-Louis, Brussels on the 24th September 2010 dealing with the problematic of diagnosis in terms of a particular structure of psychosis, neurosis, or perversion. This approach while facilitating communication between clinicians loses sight of the human who is the objectified in the process. Psychoanalysts need to think in terms of what theories/structures they are using as a basis of their knowledge and be aware that these are the scaffolding and not the building. The only thing that can be transmitted in analysis is what you can construct yourself vis use of the matheme. Keywords: diagnosis, communicate, treat, do no harm, knowledge, structure, courage to know, operation of the matheme, symptoms. What can I do? The freedom to intervene. What should I not do? The deontology of intervention. What can I fail to do? The right to intervene. What ought I do? The ethics of intervention. All that in function of a knowledge and a know-how. An informed knowledge to act competently. Knowing what to do.

The Letter, Issue 47, Summer 2011, Pages 67 - 83 Guy Le Gaufey LACAN’S NOTALL Logical consistency, clinical consequences Translated by Cormac Gallagher SCHOLION A MISUSE OF METAPHOR The final part of Guy Le Gaufey‘s book ―Lacan‘s Notall – The Scholion: A Misuse of Metaphor, translated by Cormac Gallagher, deals with Lacan‘s treatment of the Borromean Knot and his attempt to use logic to deal with the problematic of sexual non-relationship of the inexistence of such a relationship. Le Gaufey traces Lacan‘s efforts to make a distinction between the two but to our surprise he concludes that Lacan felt his attempt ended in a failure – thus calling topology, or one aspect of topology – knot- theory into question. Keywords: sexual non-relationship; inexistence of relationship; non-enan tiomorphic; consistencies; Borromean knot; reversal of perspective Quite imperceptibly, between 1972 and 1975, Lacan brings about a slippage in the negation regarding sexual relationship, going from 'there is no relationship‘ to 'there is a non-relationship‘, from the inexistence of such a relationship to the existence of such a non-relationship. The nuance might appear rhetorical if there were not grafted onto it a change of perspective which takes support on the key instrument in the teaching of these years of the seventies: the Borromean knot.

The Letter, Issue 47, Summer 2011, Pages 59 - 66

The Letter, Issue 47, Summer 2011, Pages 33 - 57

The Letter, Issue 47, Summer 2011, Pages 1 - 32 PSYCHOANALYSIS AND THE FORMATION OF THE PSYCHIATRIST[1] Jacques Lacan This talk [1] given by Lacan as a contribution to a program of lectures for trainee psychiatrists deals with the place of psychoanalysis in the formation of the psychiatrist, with the treatment of the psychotic as its central theme. The anxiety experienced by the psychiatrist when confronted by 'the madman‘ is seen as a factor in the poverty of contemporary psychiatry in the production of new nosological categories of mental illness. Hence a reliance on the 19th century classifications of Kraepelin and de Clérambault and an increasing dependence on pharmacology – this already in 1967. Other aspects of psychoanalysis which Lacan deems as being important to the clinic are discussed with an emphasis on listening to – rather than understanding- the discourse of the psychotic. Keywords: formation; madman; anxiety; mass effects; o -object; unconscious; language. I thank you for having come, like that, in such numbers. I am going to try to make this temporary cohabitation not too disagreeable, given this kind of collective attention that you are good enough to give me. Nevertheless, in principle, this evening I will not have especially encouraging things to tell you. In any case, it was not with this intention that I accepted to speak, like that, almost first, because at the very least this is how things were presented to me. And if I chose, because I am the one who chose it, this title: Formation of the Psychoanalyst and Psychoanalysis (sic) it is because it seemed to me to be an especially important theme, but in connection with which, I was led to begin, by God, with what can be seen, be touched, what to every appearance is already there, as result, namely, a rather disappointing finding.

The Letter, Issue 47, Summer 2011, Pages v - vi

The Letter, Issue 46, Spring 2011, Pages 57 - 71 Evidence–based practice and psychoanalysis: thought disorder and the dream Patricia McCarthy Post-modernism, quantum theory, psychoanalysis-buzz words of the twentieth century likely to be misunderstood by the non-specialist – are domains that are governed by abstract sets of laws whose effect cannot be predicted and, into which, participants have to make their way. To acknowledge such domains is to broaden the definition of science and perhaps allow for a better understanding of one of them - psychoanalysis, which is governed by the laws of the unconscious. Freud discovered these laws, Lacan formalised them. How they work is the ‘evidence base’ of psychoanalysis which uniquely serves subjectivity and thereby excludes the objectifying eye of measurement. My argument is that to ignore this ‘evidence base’ is a loss to psychiatry and psychiatry’s patient – especially the psychotic. The implications of this loss will be further discussed by examining the parallels between thought disorder and the process at work in forming that simple ‘given’ of our psychical lives – the dream, continuous as it is with waking thought. Keywords: evidence-based practice; quantum theory; thought disorder; the dream; subject –effect; schizophrenia In the half hour allocated to me to speak to you, I am confronted with an immediate difficulty. In addressing a mixed audience of psychoanalysts and psychiatrists I am aware of the gaps in knowledge that define both groups differently. To impute a gap in knowledge to such august groupings is to risk alienating both sections of my audience all at once, but of course that is not my intention on this April Fools' Day [1] where it has already emerged so far from the papers and the questions arising, that the gaps in knowledge displayed are more badges of honour, equivalent to the participants, like knights of old, having handed in their individual weapons of knowledge at the registration desk this morning and trusting that they will emerge unscathed at the end of the day.

The Letter, Issue 46, Spring 2011, Pages 47 - 56 PAEDIATRIC BIPOLAR? Lionel Bailly Between 1994 and 2003 the number of outpatient pediatric psychiatry visits associated with the diagnosis of Bipolar Disorder in the USA apparently increased 40-fold. Such an increase was not supported by any new research evidence and illustrated a shift of professional towards a purely organic model of child behaviour. The preparation of DSM 5 showed a return to a more psychological model of disturbances in children with the introduction of a new disorder: Temper Dysregulation Disorder with Dysphoria. However, psychoanalytical models can provide a deeper understanding of the process leading to the observed symptoms. Key words : Paediatric Bipolar; Temper Dysregulation Disorder with Dysphoria; paternal metaphor; enjoyment; psychoanalysis. This presentation is going to be marked by my scepticism towards some aspects of what has been called Paediatric Bipolar, a Disorder that will not be included in DSM 5 and I'm going to try to justify this scepticism through the examination of clinical features described in children. This attitude is probably a consequence of my training as a clinician, a child psychiatrist and a psychoanalyst.

The Letter, Issue 46, Spring 2011, Pages 39 - 46 Psychotic Symptoms– Time for a New Approach Mary Cannon, Ian Kelleher and Jack Jenner Previously-held ideas about the intrinsically pathological nature of hallucinations and delusions are being challenged by findings from epidemiology, neuroimaging and clinical research. Population-based studies show that the prevalence of psychotic symptoms is far greater than had been previously considered. Therefore it may be timely to re-evaluate our perspective on these psychotic symptoms and their meaning in an evolutionary context. These symptoms may hold the key to understanding the persistence of psychosis in the population. We discuss how these findings also have implications for the public perception of stigma and the development of new therapies that directly engage with the psychotic symptoms. These therapies have the potential to increase patient satisfaction with treatment, increase adherence and ultimately lead to better outcomes. Keywords: psychosis; psychotic symptoms; evolution; hallucinations; psychotherapy Nothing in biology makes sense except in the light of evolution. Theodosius Dobzhansky [1]

The Letter, Issue 46, Spring 2011, Pages 21 - 38

The Letter, Issue 46, Spring 2011, Pages 13 - 19 Balance and Connection: Bipolar Disorder and Psychoanalysis in Psychiatric Practice Brendan D. Kelly Bipolar disorder comprises a pattern of symptoms characterised by disproportionate changes in mood, possible psychosis and various other symptoms at different times. Biopsychosocial management approaches often involve medication (e.g. lithium), psychological therapy (e.g. cognitive-behaviour therapy) and social interventions (e.g. social work support). Psychoanalytic contributions to the understanding of bipolar disorder have come from a range of therapists, including Karl Abraham, Sigmund Freud, Otto Fenichel and others. In recent years, emphasis has been placed on identifying the defence mechanisms most commonly associated with mania, and the relationship between pharmacological and psychoanalytic approaches to the disorder (e.g. links between lithium blood levels and mental processes). It is important that, amidst such therapeutic endeavour, and in the context of emergent neurobiological approaches, the individual’s search for meaning in their experience is not lost. Psychoanalytic approaches have a unique role in this respect. Regardless of resource challenges in public mental health services, there is a strong need for a diversity of approaches to all mental health problems, including bipolar disorder, in order to reflect the diversity of individuals affected, problems faced and pathways to recovery. Keywords: Bipolar disorder; psychosis; psychoanalysis; therapy; lithium

The Letter, Issue 46, Spring 2011, Pages 3 - 11 Psychoanalysis, Psychiatry and Bipolar Disorder in the Twenty First Century Daniel Burston During the last quarter of the twentieth century neo-Kraepelinian psychiatry joined forces with non-psychiatric critics to repudiate and ridicule Freud and his followers. This paper addresses some of the causes and consequences of the decline of psychoanalysis within mainstream psychiatry, and argues that many of the reproaches once leveled at Freud by his late twentieth century critics could now be directed with equal or even greater justice to neo-Kraepelinian psychiatry. This is especially true with reference to bipolar disorder, where contemporary psychiatry would be wise to heed its own motto: ‘Back to Kraepelin’. Keywords: Bipolar disorder; DSM; Freud wars; Kraepelin; polypharmacy In March of 1987, I was an Oscar Diethelm Fellow at the History of Psychiatry Section at The Payne Whitney Psychiatric Clinic in New York City. My supervisor was Eric (“Ted”) Carlson, a specialist in the history of phrenology, hypnotism, American psychoanalysis and multiple personality disorder. After one of our seminars, I asked Ted what he thought the twenty-first century held in store for psychoanalysis. To my astonishment, he said it would probably go the way of phrenology. In addition to being surprised, I was a little offended by his remark. Weren't phrenologists charlatans, by and large? Now it was Ted's turn to be offended. He shot back that until the mid nineteenth century or so, most phrenologists were perfectly respectable physicians. No, he said, he was merely suggesting that with the passage of time, clinicians would differentiate what was valid in psychoanalysis and then discard the remainder, and that those elements of enduring value would be absorbed into a new and genuinely scientific discipline, much as phrenology gave way to neurology.

The Letter, Issue 46, Spring 2011, Pages v - vii

The Letter, Issue 45, Autumn 2010, Pages 71 - 85