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The Letter, Issue 38, Autumn 2006, Pages 71 - 80 A QUESTION OF RESEARCH FOR PSYCHOANALYSIS, THE HEALTH SERVICE AND THE UNIVERSITY Patricia McCarthy Introduction I am not in a position to address my original topic The state of the transference today at The Freud 150 event because of a change of circumstance. However Barry O'Donnell has prevailed upon me to talk about the question of research as it applies to Psychoanalysis, the Health Service and the University. This is in the context of my recent appointment as Director of the School of Psychotherapy at St. Vincent's University Hospital and UCD. For the moment, I cannot afford to dwell too much on the fact that technically I am succeeding Cormac Gallagher as Director of the School, simply because I feel like I have been thrown in at the deep end and have to thrash about a bit in order to take my bearings in relation to changes that are unfolding about us. Cognisant as I am of these changes purely as they impinge on the practice of psychoanalysis, they are taking place not only in the University but in the Health Service with both of these domains also having an influence on each other. And so I cannot afford to mourn a so-called gentler time, 'old school' versus 'new school' etc as the various restructurings underway in the university in particular, are currently being described by some academics. Anyway is there ever such a thing? Because of the compulsion to repeat, we are ever unchanged in relation to our reality as we find it at any given time. Surely the Chinese blessing or, indeed curse that we may live in interesting times is always relevant. And so it is for me these days.

The Letter, Issue 38, Autumn 2006, Pages 64 - 70 DRUGS+THUGS+DA+LOVES Mary Cullen Good afternoon. I am delighted to be here to present this short paper and especially so in St. Vincent's Hospital, which has its own significant resonance for me being a hospital where my father worked at one stage in his life (the old one in St. Stephen's Green) and later where he died. I cannot claim responsibility for the title of my paper; it comes from the graffiti on the wall of the building where I work and I will return to it anon. I trained here in the School of Psychotherapy, starting the course sixteen years ago, and I am currently back in training in the same school doing the group analytic course feeling the need for some learning about groups and organizations. I originally trained as a social worker in the days when social-work training had a psychodynamic component. My job in the then Eastern Health Board was in the Fostering Resource Group where our work entailed the support of foster parents and young people in care. I learnt quickly that taking children into care from what was perceived to be a neglectful or abusive situation and placing them in what was considered to be a successful family did not always provide the happy intended outcome.

The Letter, Issue 38, Autumn 2006, Pages 53 - 56 A CHILD'S TEXTBOOK Malachi McCoy The child was described by his parents as a cheerful, straightforward child who was an amiable and active-minded young fellow. He was able to carry out his childhood researches in a state of happy naïveté, keeping nothing back. However all this was to change when conflicts arose out of those researches. It was with the outbreak of his illness and during the analysis that discrepancies began to make their appearance between what he said and what he thought; and this was partly because unconscious material, which he urns unable to master all at once, was forcing itself upon him, and partly because the content of his thoughts provoked reservations on account of his relation to his parents. [1]

The Letter, Issue 38, Autumn 2006, Pages 49 - 52 PSYCHOANALYSIS AND SCHIZOPHRENIA Claire Hawkes The psychoanalytic approach to psychopathology assumes that all symptoms are meaningful and are related to the life history as subjectively experienced. Freud's study on Schreber represents his attempt to form a theory on psychosis psychoanalytically on the basis of the patient's own report of a delusional system. For Freud, psychosis represents the withdrawal of libidinal cathexes to the outside world and their redirection inwards to the ego. Schreber's delusional system worked for him to the extent that it made sense of his world. As Freud commented in his work on Schreber, 'What we take to be the pathological production, the delusional formation, is in reality the attempt at recovery, the reconstruction'. [1]

The Letter, Issue 38, Autumn 2006, Pages 45 - 48 THE POSSIBILITIES OF PSYCHOANALYSIS IN PSYCHIATRY Emer Rutledge In the year 1917 Freud gave a lecture on the topic of psycho­ analysis and psychiatry. On that occasion he asked his listeners to ‘endeavour to allow the psycho-analytic view to grow up quietly in you alongside of the popular or psychiatric one, till opportunities arise for the two to influence each other , to compete with each other and to unite in leading to a conclusion.' [1] During the first half of the twentieth century, psychoanalysis revolutionized our understanding of mental life. It provided a remarkable set of new insights about unconscious mental processes. However at the beginning of the twenty-first century the influence of psychoanalysis is somewhat in decline. In the same paper in 1917 Freud anticipated that 'in the not too distant future it will be realized that a scientifically based psychiatry is not possible without a sound knowledge of the deeper-lying unconscious processes in mental life.' [2] Yet there is a difficulty in accommodating the evidence- based, scientific, biological discipline of psychiatry with the insights of psychoanalysis.

The Letter, Issue 38, Autumn 2006, Pages 39 - 44 WHERE THERE IS NO COUCH: THE POSSIBILITIES FOR PSYCHOANALYSIS IN THE PUBLIC MENTAL HEALTH SERVICE Angela Noonan The public mental health service in Ireland consists of mental health teams which are increasingly becoming multi-disciplinary. Child and adult services are separate. In many areas there are old age teams that provide a service to people over the age of sixty-five who develop mental illness. The vast majority of teams are general adult mental health teams but there are some specialist services in the area of learning disability, rehabilitation, liaison, forensic psychiatry and substance misuse. Each mental health team serves a geographic sector. Teams are community based in the sense that people are seen in their own communities in health centres or their homes. Those requiring admission usually go to the psychiatric unit of a general hospital though there still exist stand-alone psychiatric hospitals. Those that require ongoing support attend day hospitals, day centres or live in supported community residences. Teams consist of a consultant psychiatrist and junior doctors, community mental health nurses and to varying degrees social workers, psychologists and occupational therapists. (Several teams may share these professionals). Junior doctors rotate to other teams or services after six to twelve months. Members of teams may have qualifications in psychotherapy, usually cognitive behavioural therapy. Most psychotherapy is practiced by psychologists or nurses with varying degrees of training. Consultant psychiatrists often have qualifications in psychotherapy or psychoanalysis but their practice is limited by a lack of protected time.

The Letter, Issue 38, Autumn 2006, Pages 22 - 38 FREUD IN THE TWENTY-FIRST CENTURY: A CHINESE PUZZLE Gerry Sullivan Newton, Marx and Freud are the three emblematic figures commonly credited with shaping the psycho-cultural world of advanced industrial modernity, our sense of where we are in relation to the cosmos, as it were; Newton in relation to the outer (physical) world, Marx in relation to the social (and economic) world, and Freud in relation to the inner (psychic) world. Nevertheless, not only Einstein, but quantum mechanical GUTS, and superstring and M-brane multidimensionality have given us a very different picture of the physical universe for the twenty-first century. In the post Soviet (and post Mao) era there is a widespread view (which I only partially share) that Marx's historical and dialectical vision is redundant. With respect to Freud, it is held that the psychopharmacological developments of the twentieth century, and the emergence of neuroscience, have bypassed his approaches. Furthermore, the social effects of feminism and of gender blurring social lifestyles have combined to judge the foundations of his theories as both patriarchal and significantly limited in the scope of subjective gender positions which it can allow. Even within psychoanalysis, Kleinian, object relations, ego psychology, neo-Freudian, and later approaches, such as those associated with Kohut and Kernberg, all see Freud as a founder, rather than a resource for, and a contributor to current dynamics and dilemmas.

The Letter, Issue 38, Autumn 2006, Pages 10 - 21 SIGMUND FREUD: THE TIME FOR UNDERSTANDING [1] Helen Sheehan On September 2nd 1901 when Sigmund Freud was forty-five years old he at last found himself in Rome, something which had the highest emotional significance for him and one which he called 'the high point of my life'? [2] In a letter of October 1898 he had written to his friend Fliess, 'I am studying the topography of Rome, the yearning for which becomes ever more tormenting ' [3] , and four months later he spoke of a wish, which would mature, 'if only I could get to Rome'. [4] When he finally conquered his resistance of going to the Eternal City and realised his dream he tells us, 'Not only did I bribe the Trevi Fountain as everyone does. I also - and invented this myself- dipped my hand in the Bocca delta Verita at Santa Maria Cosmedin and vowed to return'. [5] On the fourth day of that visit in 1901 he caught sight of the statue of Moses carved by Michelangelo for the tomb of Pope Julius II. He wrote to his wife that same day, 'Plötzlich durch Mich verstanden', w hich Ernest Jones translates as: 'I h ave come to understand the meaning of the statue by contemplating Michelanglo's intention'.[ 6]

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The Letter, Issue 37, Summer 2006, Pages 144 - 151 ON BEING NORMAL AND OTHER DISORDERS: A MANUAL FOR CLINICAL DISORDERS by Paul Verhaeghe [1] Cathal Morgan Historically, psychotherapy began with the aim of consciousness- raising and insight; later, the emphasis shifted towards..... insight and cognitive restructuring. [...... ] Where the focus is solely on insight and knowledge, it will result in a caricatural subject who "knows" perfectly well why it is doing certain things, but without this knowledge effecting the slightest change in daily life. [2] Introduction I begin with a short quote from the final passages of Paul Verhaeghe's book, On Being Normal and Other Disorders, which perhaps presents us with a note of caution concerning what clinicians of all creeds need to be alert to and which indicates the book's primary aim. This is to develop a much-needed metapsychology for the field of clinical psychodiagnostics. This one argues that psychic identity is created through one's primary inter-subjective relationships. The ramifications of such a proposition are wide-ranging not just at the level of clinical practice: it also strikes at the heart of some contemporary debates within the fields of psychoanalysis and psychiatry and at the plethora of psychological approaches to the treatment of mental suffering in use today. [3] Time does not permit me to cover the vast range of material presented within this four hundred and sixty-four page manual, so it will suffice for me to take only a small number of the more salient points raised and elaborate their implications for clinical practice, whether in the fields of psychology, psychiatry or psychoanalysis.

The Letter, Issue 37, Summer 2006, Pages 120 - 143 STYLE IS THE MAN HIMSELF [1] Christian Ingo Lenz Dunker Introduction I would like to begin our dialogue by briefly recounting the path that led me to this moment. I believe it may be used as an example for the proposed objective, which is to introduce some Lacanian concepts and place them within a context. Therefore, the questions are: Which context? Context for whom? Six years ago I was completely at a loss at a psychology conference being held in Venezuela. I don't know if you have had the opportunity to participate in one of these mega conferences. There are hundreds of things going on at the same time and none of it is leading anywhere. It's almost like a supermarket of lectures, strictly controlled by the flow of time that is coordinated by speech and activity between one meeting-room and another. It was under these circumstances, taken over by inconvenient red tape typically found at universities, and by exaggerated consumption, typically encouraged by the hype of masses, that I had a strange experience. I came across Erica Burman criticizing developmental psychology. All of a sudden I heard familiar references: Lacan, Benjamin, Freud, Derrida, and Foucault. It was also there that I met Ian Parker and 7 discovered that there were people who were interested in Lacan s school of thought in the United Kingdom. Each new encounter and each of my rereadings of the work of the group from Manchester allowed me to perform an exercise in awareness and versatility, one that offered alternatives to issues and the forms by which they are generally dealt with in the Lacanian universe. Some elements were known, others not so well known, but, above all the relationships were new and, mainly, there was something that later on I could recognize as style. It is a style of thinking and dealing with theoretical relationships, and with their clinical and political implications.

The Letter, Issue 37, Summer 2006, Pages 114 - 119 COMMENTS ON THE PRESENTATIONS GIVEN BY IAN PARKER AND KAZUSHIGE SHINGU [1] Christian Ingo Lenz Dunker The text written by Kazushige Shingu examines the relations between the symptomatic expressions of anorexia and eating disorders with certain mythical narratives from the Japanese Buddhism. Thus a curious association between eating and mourning is brought up, especially that of a mother mourning the loss of a child. The argument's clinical details are very persuasive. They show thematic and discursive similarities between the trajectory of unresolved mourning and the saga of mythical heroes. An analogy is suggested between the present experience of a Japanese young woman and many ordeals or obstacles faced by the gods, considering that they both aim at resolving an initial state of unbalance and conflict with the same type of narrative resort. The article written by Ian Parker apparently follows an opposite line when addressing the topic of translating Lacan's texts both to linguistic and cultural universes - distant from where psychoanalysis was originated, such as Japan and the Far East - and to current English. The motion picture, Lost in Translation, works as a sort of allegory for the problem showing how translation always loses something. The trust in the permanence of sense and in the semantic fidelity of concepts is, in some way, tensioned by the same psychoanalytical principles extracted from Lacan on language and transmission of culture. This is confirmed by closely reviewing the references made by Lacan in regard to the famous case of the Fresh Brains Man, treated by Ernst Kris in the forties. There is also something lost in the translation of Lacan's reading, albeit it does not invalidate the reading's originality.

The Letter, Issue 37, Summer 2006, Pages 93 - 113 JAPANESE MYTH, BUDDHIST LEGEND, AND THE STRUCTURAL ANALYSIS OF CLINICAL DREAMS IN RELATION TO THE MOURNING PROCESS [1] * Kazushige Shingu Introduction The act of eating is of great significance in the process of mourning. This point, the first of two upon which this paper relies, is reflected in myth, Buddhism, and psychoanalysis. In psychoanalysis, Freud viewed the act of eating as a stage of identification lying at the root of melancholia. [2] Karl Abraham, a direct disciple of Freud, placed particular theoretical and clinical emphasis on this understanding; according to Abraham, the mourning process includes three phases: anal expulsion, oral introjection, and metabolic reconstruction. [3] The second point is that myth and dream share a homological kinship. The two domains have long been compared in terms of similarities of content, but structural analysis reveals a close formal relationship as well. In this paper I introduce a Japanese myth and two Buddhist legends, each of which represents the process of mourning in relation to eating. I then discuss two clinical cases concerning eating disorders that occurred during processes of mourning for an aborted child, with particular attention to the dream analysis the cases entailed. In this way I wish to elaborate on the structural homology between myth and dream, which will be shown to be rooted in the mourning process as conceptualized by Freud and Abraham.

The Letter, Issue 37, Summer 2006, Pages 72 - 92 LOSING PSYCHOANALYSIS IN TRANSLATION [1] Ian Parker Buíochas daoibh as ucht an cuireadh a thabhairt sibh dom. Tá bron orm nach bhfuil mé in ann an toirbhairt a dheanamh as gaeilge. [2] I have chosen this title 'Losing psychoanalysis in translation' partly to evoke the title of a film, Lost in Translation, [3] which was ostensibly about outsiders (played by Bill Murray and Scarlett Johansson) coping with being in a place, Japan, which they could not decipher. Actually, the film was not really about being in Japan at all, except insofar as the narrative required that they were somewhere strange; that it was Japan did not figure save as a setting for some jokes about that culture. Instead, the lack of 'translation' in which the characters were lost was the impossible relation between the man and the woman. I also wanted, by way of this title, to acknowledge the presence here of Shingu Kazushige, who I was so glad to meet during a visit to Japan in 2004; [4] and I cannot help but recall an embarrassing moment there. Shingu said to me, as we were walking along, that, in his view, if we wanted to understand Lacan it was crucially important that we read him in the original French. I cannot remember exactly what I muttered to cover over or to betray the fact that my Lacan is the one translated into English, that try as I might I often feel myself lost enough in those texts, and the prospect of being lost in the French texts filled me with anxiety.

The Letter, Issue 37, Summer 2006, Pages 56 - 71 A PSYCHOANALYTIC PERSPECTIVE ON BORDERLINE PERSONALITY DISORDER[1] Aisling Campbell The diagnosis of borderline personality is one of the few categories within psychiatric classification systems which retains the aura of its psychoanalytic origins. However, even this category is going the way of others; in the past many diagnostic categories hinted at some putative underlying mechanism, but the new trend is for categories which blandly describe symptoms or behaviours (for example, panic disorder, or somatisation disorder). The correct modern title for borderline is 'emotionally unstable personality' which has a more neutral flavour - although there is still a subtype of "borderline type". For the rest of this paper, as a nod to the psychoanalytic origins of the diagnostic category, I will use the term "borderline", not least because - as I hope to show - it is a useful and apposite term. It is notable that new therapeutic "technologies" for borderline personality disorder always involve some adjustment or "tweaking" of older types of psychotherapies. So for example, we have cognitive-analytic rather than just analytic, dialectical-behavioural rather than just behavioural and so on. Clearly, borderlines defy any attempt at sticking to the use of traditional, perhaps purer, models which have to be adjusted in order to make them work. It is no accident that the borderline personality disorder patient points up the very borders between the different therapeutic modalities, and has almost forced the development of therapy as technology. In my view, this effect is symptomatic of the very structure of the borderline. As we shall see, the triangular relationships between the unconscious, the conscious and behaviour are problematic for the borderline - and perhaps this is why therapies have tried to address the tension between these elements of subjectivity as per CAT, DBT etc.. I will discuss this borderline structure from a psychoanalytic perspective, and by doing so, hope to show how a psychoanalytic understanding can be useful clinically, even if pure psychoanalysis as a practice may not be possible. Crucial to any discussion of the structure of the borderline is a discussion of the structure of the subject in general. In my view, Lacan's thesis in this regard is central, as it is in direct opposition to the structure suggested by the ego psychologists [2] . The ego psychology " world view" traditionally underwrote much of the original descriptions of borderline and therefore much of the writing on treatment of borderlines. By contrast, I will demonstrate how a Lacanian view of the structure of the subject might inform a therapeutic approach to these difficult patients.