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The Letter, Issue 24, Spring 2002, Pages 23 - 29 THE ENVERS OF PSYCHIATRY: PSYCHOANALYSIS AND PSYCHIATRY SHOULD BE FRIENDS * Mary Darby Freud's Introductory Lectures on Psychoanalysis, lecture 16 is entitled Psychoanalysis and Psychiatry, and in it Freud castigates psychiatrists for making minimum contact with their patients and paying little attention to what they say. He goes on to say, however, that 'in the not too distant future, it will be realised that a scientifically based psychiatry is not possible without a sound knowledge of the deeper-lying unconscious processes in mental life'. 'Psychoanalysis' he says 'is related to psychiatry as histology is to anatomy. One is the continuation of the other'. In 1926, in his Question of Lay Analysis he introduces and defends the role of the non-medically trained psychoanalyst. He asserts that doctors have no claim to the sole possession of analysis and he accuses those who practise it without learning or understanding, of quackery. He warns that those doctors who do engage with psychoanalysis will attempt to make things easier for themselves and will 'pull out its poisonous fangs and make it pleasant'. He adds 'we do not consider it at all desirable for psychoanalysis to be swallowed up by medicine and to find its last resting place in a textbook of psychiatry listed under 'other methods of treatment'.

The Letter, Issue 24, Spring 2002, Pages 1 - 22 THE NEW TYRANNY OF KNOWLEDGE: SEMINAR XVII (1969-70) - BACKGROUND AND OVERVIEW * Cormac Gallagher Introduction Almost halfway through the year, Lacan makes a caustic reference to the just published 50 anniversary issue of the International Journal of Psychoanalysis: If you read the body of work that makes up this anniversary issue of the International Journal, you can understand why the authors congratulate themselves on the solidity displayed over the past 50 years. I would ask you to put it to the test. Take any issue whatsoever in the past 50 years - you will never know its date. It always says the same thing. It is always just as insipid, and since analysis is a preservative, it is also always by the same authors. They congratulate themselves, in short, that these 50 years have clearly confirmed these primary truths: that the mainspring of analysis is goodness, and that, happily, what has become obvious throughout these years, with the progressive effacing of Freud's discourse is, in particular, the solidity and the glory of a discovery described as the autonomous ego, namely, the conflict-free ego. This is the result of 50 years of experience, in virtue of the injection of three psychoanalysts who had flourished in Berlin, into American society where this discourse about a solidly autonomous ego certainly promised attractive results. In terms of a return to the discourse of the Master, in effect, one could hardly do better. [1]

The Letter, Issue 24, Spring 2002, Pages i - ii

The Letter, Issue 23, Autumn 2001, Pages 109 - 125 INHIBITION: 'I AM BECAUSE I DON'T ACT' Stijn Vanheule Introduction Experience indicates that patients often enter into analysis with the complaint that they can't manage to do the things they want to do; they feel reluctant or unable to act within one or more domains of life, notably in fields such as love and work. According to Freud in Analysis Terminable and Interminable, analysis often - but not always - results in overcoming these kinds of inertias. In this paper we will discuss inhibitions as an obsessional strategy for dealing with desire. Like other obsessional neurotic symptoms, for example compulsions, inhibitions have a structural function in the obsessional strategy of denying desire. Along this line of reasoning both the absence of activity (inhibition) and excess of it (compulsion) are attempts at avoiding a confrontation with desire. Desire is an issue the obsessional neurotic puts under a taboo. Furthermore, we will contrast inhibitions, which are typical for obsession, with symptoms, which are typical for hysteria. Symptoms always express a struggle with a desire the subject tries to ignore. The subject tries to ignore a desire, but this strategy fails since the repressed impulse continuously returns. Inhibitions are a much more radical attempt to efface desire as such, and at a more fundamental level they are an attempt to erase the drive. Inhibitions are attempts to nip desire and drive in the bud and as such are exercises in control.

The Letter, Issue 23, Autumn 2001, Pages 96 - 108 TO THINK DIFFERENTLY: MICHEL FOUCAULT AND THE STATUS OF PSYCHOANALYTIC THEORY Olga Cox-Cameron In the extreme, life is what is capable of error. Error is at the root of what makes human thought and its history. The opposition of true and false, the values we attribute to both, the effects of power that different societies and different institutions link to this division - even all this is perhaps only the latest response to this possibility of error which is intrinsic to life. If the history of science is discontinuous, that is if it can be analyzed only as a series of 'corrections', as a new distribution of true and false which never finally once and for all liberates the truth, it is because there, too, 'error' constitutes not overlooking or delaying a truth but the dimension proper to the life of man and to the time of the species. [1] Almost a year ago, Cormac Gallagher took as a starting point for an overview of Michel Foucault's History of Sexuality the anonymous, unattributed assertion that Foucault had cut the ground from under psychoanalysis. [2] This assertion was not contexrualized, and was neither proven nor disproved by the article, which went on in an interesting manner to outline the central arguments of this remarkable but unfinished work. At the end of the overview, the author returns to the original, anonymous and unsubstantiated assertion and opines not unreasonably that he can find no evidence for it in the book in question. The reader is left wondering what such a statement might mean, or where in the rich body of Foucault's published work this effective demolition of psychoanalysis has taken place. Should one go sleuthing for it? One would certainly find a cogent critique of the relative impotence of psychoanalysis vis-a-vis madness in The Order of Things; one would also find a far more brilliant reading of the relations between paranoia and language in the 1962 preface to Rousseau's Dialogues than that offered by Lacan in his commentary on Rousseau in his doctoral thesis, and one would find in the introduction to The Use of Pleasure a penetrating examination of the modalities of desire and subjectivity which subtend psychoanalytic theory; but one would also find a constant underlay of psychoanalytic thought in this enormous body of writing which taken as a whole, constitutes a series of dazzling and illuminating forays into what George Canguilhem has called 'the unconscious of realms of knowledge'. Foucault's stated project in The Order of Things was to inquire whether, in the history of knowledge, 'errors (and truth), the practice of old beliefs, including not only genuine discoveries, but also the most naive notions, obeyed at a given moment, the laws of a certain code of knowledge'; whether it might be possible to reveal 'a positive unconscious of knowledge: a level that eludes the consciousness of the scientist and yet is part of scientific discourse'. [3] More pertinently then, and closer to the heart of the Foucauldian enterprise, one might re-phrase the question at the beginning of Cormac Gallagher's article and ask if in fact it is possible to cut the ground from under psychoanalysis. If the answer is no we are in a very bizarre position indeed, although we will at least have brought to a halt the unseemly scramble to establish psychoanalysis as a science. Clearly it cannot be science if its central tenets are beyond question.

The Letter, Issue 23, Autumn 2001, Pages 77 - 95 PERVERSION II: THE PERVERSE STRUCTURE Paul Verhaeghe In contemporary Lacanian theory, one of the accepted ideas is that there exists such a thing as the perverse structure of the subject, alongside the better-known neurotic and psychotic ones. Perverse structure means that there exists a perverse relationship between subject, Other and lack. Lacan himself did not publish all that much on this subject, and in matters of treatment, his publications are even more rare. His most quoted saying teaches us that: The whole problem of the perversions consists in conceiving how the child, in relation to the mother, a relation constituted in analysis not by his vital dependence on her, but by his dependence on her love, that is to say, by the desire of her desire, identifies himself with the imaginary object of this desire in so far as the mother herself symbolizes it in the phallus. [1] The link to Freud is obvious, that is, the denial of castration, although Lacan adds something to it, by focusing on the part played in this by identification. The perverse subject is the one that identifies itself with the imaginary phallus of the Other.

The Letter, Issue 23, Autumn 2001, Pages 63 - 76 THE mOTHER OF ALL ANXIETY Carol Owens This paper represents an attempt to unpack some of the key elements in Lacan's seminar on Anxiety [1] in the context of three clinical examples. My exploratory focus will be on the points at which anxiety appears in each case as it is framed by and within the field of the specular image via the scopic and invocatory drives; the ways in which anxiety becomes narrated as moments at which the formations of the unconscious are made immanent; and, the movements/articulations/actions made by each client which implicate the correlation between the affect and its effect. Commensurate with this focus will be a serious engagement with the particular ways in which anxiety is caught up with 'm-other-ing'. Lacan has drawn our attention on manifold occasions to the function of the mother as the first big Other in terms of the structural development of the subject. While this aspect of the mother will be pertinent to my discussion, I am also interested in creating a condition for the understanding of the mother subject as she is caught up with her own child-as-subject and who functions as an Other in whom the specular image of secondary narcissistic identification is operational. In other words, I will be arguing that the child subject can act upon the mother's subjectivity akin to Lacan's praying mantis [2] as the voracious desirer in the face of whose desire the mother asks 'what kind of an object am I for their desire?' and, 'what do they want of me?'. In addition but in complementarity, the mother is caught up with an entire world of specular images whose gaze falls upon her ability to mother, and as such bring into play questions of the mother's relation to desire and the law.

The Letter, Issue 23, Autumn 2001, Pages 43 - 62

The Letter, Issue 23, Autumn 2001, Pages 33 - 42 A FEW OBSERVATIONS CONCERNING A PSYCHOANALYTICAL CURE OF AN ADOLESCENT * Dominique Simonney Based on a cure of a diabetic adolescent who refuses to take her medicine correctly, we will show how - psychoanalysis allows this patient to free herself of blocks associated with the medical discourse. The function of repetition will be highlighted through two series of recurring dreams; the link between repetition and enjoyment (puissance) will also be examined. Furthermore, this paper will call attention to the way psychoanalysis brings to light a subject's identifications, allowing him to set his sights on his desire by getting rid of certain symptoms which sign away his future. In France there are health centers for children and adolescents, called Medico Psycho Pedagogico Centers. I am the Medical-director of one of them located in Morsang sur Orge, a town near Paris. We give consultations to young people who are having problems, whether those difficulties concern language, writing, learning to read, or, psychological suffering or behavior problems. The young people are sent to us by teachers, doctors and also by their parents. From time to time an adolescent will come directly to us of his own accord. The staff is made up of speech therapists, psychomotor therapists, psychologists and doctors, the two latter groups having gone through analytical training in our center.

The Letter, Issue 23, Autumn 2001, Pages 22 - 32 THE DRIVES AND THE STAKES INVOLVED * Franck Chaumon Precocious impasses in the drive's link to the mother are common occurrences in child care. Rather than acting as the privileged vector to an outside world, ensuring the subject's inscription in the field of the grand Autre, the big Other, the drive fixates and encloses itself in a vicious and unproductive circle. An object - whether it be the breast, faeces, the voice, or look - takes on a value of exclusivity, either because it becomes the choice object, or because it is the impossible object. From that moment on it will be as if the loop that the drive makes from the child to his mother, around the partial object (Lacan's objet petit a), has been interrupted, or closed in on itself. This is the case, for example, in certain forms of child psychosis, where mother and child seem to blend into one, in an exclusive, imperious and limitless drive exchange. This is particularly present in the field of the oral drive, where the insanity of the drive relationship manifests itself, above all, in violent anorectic opposition. However, it is equally present in the anal drive, where maternal demands can be devastating. The object at stake effaces everything else, and the mother, indeed the whole family, rotates around the child's meals (which can take up most of the day), or sessions in the toilet, where the child's product becomes everybody's sole preoccupation. Sometimes there is recourse to physical violence, with force-feeding, or active extractions. It is noteworthy that generally the first reaction of those who witness these scenes - care professionals in particular - is often to attempt to separate mother and child, in an effort to break up this union which seems so incestuous. What provokes such a reaction is what Lacan terms jouissance: [1] in other words what Freud situated as being beyond the pleasure principle, and which borders on the subject's death.

The Letter, Issue 23, Autumn 2001, Pages 1 - 21 PSYCHIATRY AND PSYCHOANALYSIS: THE HEDGEHOGS * Hubert Van Hoorde Car l'exactitude se distingue de la verite, et la conjecture n'exclut -pas la rigueur. Jacques Lacan [1] Introduction A century after the appearance of psychoanalysis in the field of the medical clinic and science its position is not easy to define: received with enthusiasm, it is also equally enthusiastically rejected and maliciously misunderstood. To be more precise, in psychiatric circles it is 'good form', often on the basis of an extremely simplistic, not to say caricatured conception of psychoanalysis, to deny its right to exist in the clinical field and to relegate it with well-meaning misunderstanding to the 'general culture' box in which, to the right-minded scholar, literary theories, hermeneutics, philosophy, theology and suchlike belong. Nevertheless, general psychiatry makes eager use of a watered-down version in which a few vaguely recognizable psychoanalytic concepts are to be found and for a number of patients - sometimes as the last remedy - the address of an analyst is dug up out of the drawer. Yet psychiatrists - often the same ones - continue to smilingly cling to the contention that psychoanalysis has been dead and buried for a long time and its only value is as an antique from our general cultural heritage. This is a two-fold mistake: on the one hand a valuable - if applied conscientiously and with knowledge! - clinical instrument is debased; on the other hand the chance of building the foundations of psychiatry as a clinical science on a (scientific) theoretical basis is being rejected. With regard to the latter, today for the sake of ease only its embedment in the biological substrate, which displays lax reductionism, will be considered.

The Letter, Issue 23, Autumn 2001, Pages i - iii

The Letter, Issue 22, Summer 2001, Pages 1 - 8

The Letter, Issue 22, Summer 2001, Pages 97 - 116 THE MEANING OF PSYCHOSES IN LACAN'S READING OF FREUD* André Michels I If psychoanalysis found its starting-point as well as its reference- points with Freud in terms of the neuroses, it is no exaggeration to claim that through Lacan and his work with psychotic patients it received a renewed impetus. The early Freud considered his main field of work to be the study of the psychoneuroses. In this, hysteria served him as both guide and paradigm. It was not, however, the same as Charcot's, Bernheim's or Janet's hysteria, and it was also very different from that of the medical and psychiatric tradition; it can rightly be seen as a product of Freud's own. It allowed him to decipher and name other neurotic structures as well as to distinguish these from the psychoses and perversions. To this day this organisation has retained its validity, despite numerous and severe criticisms from the biological sciences. A start had to be made somewhere. Freud succeeded in this through his interest in dynamics and his consideration of structures beyond phenomenology and the empirical diversity of observation. In so doing he succeeded in opening up and at the same time organising a clinical field that until then had not been dreamt of. For him, too, Aragon's statement applies: 'La femme c'est l'avenir de l'homme. It was women who installed him in his practice, who shaped his way of working in such a way as to allow him to go beyond Breuer's cathartic method. It was from his hysteric patients, ' ces bouches d'or' as Lacan called them, that the theory of the Oedipus complex evolved, which provided Freud with the answer to the origin of the neurotic symptom.

The Letter, Issue 22, Summer 2001, Pages 75 - 96 ENDURING LOVE: FROM URBANE OBJECTIVITY TO PANICKED OBJECT Olga Cox-Cameron * In Lesson XXI of the seminar Anxiety, [1] Lacan observes of a particular type of anxiety that it is not possible to speak about it without provoking at least some echo of it. He was referring to his audience. For my part I can only say that it is certainly true for the speaker. The prospect of this talk has provided an excellent forum for an encounter with some of the most salient aspects emphasized by Lacan, notably the connection for the neurotic subject between anxiety and the expectation of the other. The fact that one is called upon, expected to produce something, obsesses the neurotic. In the seminar Identification, [2] Lacan suggests two ways out of this dilemma. Either one courageously refuses to feed oneself into the enigma of what the other might want, and fires ahead anyway, or else ...! What follows falls into the latter category. What interests me most in this topic is a kind of double truth, which emerges about the subject as object. On the one hand there is the possibility of finding shelter from anxiety, of palliating its corrosive bite in becoming or remaining more object than subject. On the other hand it is precisely anxiety that dismantles all shelters, and what then stands revealed is a dramatically different and radically uncomforted version of the subject as object. It is because it exemplifies something of this double-ness that I have chosen the novel Enduring Love [3] as a point of entry into an exploration of this process.

The Letter, Issue 22, Summer 2001, Pages 59 - 74 PERVERSION I: PERVERSE TRAITS * Paul Verhaeghe Introduction: the moral stance Perversion is without any doubt one of the most difficult clinical categories, both as regards its study and the possibility of treatment. If we want to say something useful about it, we need to clear up a number of obstacles beforehand, in order to be able to study perversion as such. There are at least three difficulties: first of all the habitual moral reaction; secondly, the difficulty in differentiating typical human polymorphous sexuality with its perverse traits on the one hand from the perverse structure on the other hand, as one of the three possible structures of the subject; thirdly, we have to be aware of the omnipresence of the male gaze, which amounts to a phallic magnifying glass. Let us start with the moral reaction. The so-called good neurotic does exist [1] and probably the good psychotic also. The good pervert, however, seems to be a contradictio in terminis. The sympathy that is felt for his victim implies a moral rejection of the perpetrator. This rejection has been endorsed by the connection between perversion, child abuse and incest. As a result, the possibility of sustaining both an objective gaze and an unbiased treatment is seriously impaired, and this goes for our dealings with both the perpetrator and the victim. Concerning the perpetrator, this rejection makes it impossible to see that the pervert himself presents a moral model, because he - just like any other believer - denies the lack of the Other by presenting himself as the answer to this lack. Perversion and ethics are not opposites, as one might assume. On the contrary, the pervert is extremely moral, not a-moral or anti-moral. Moreover, our rejection of the pervert turns the treatment into an ill-concealed punishment, having only one goal, that is, to stop his bad behaviour.