The purpose of this work is to describe a patient’s first interview at a private mental health center. The interview -during which the patient was invited to speak freely- was conducted by the patient’s analyst. As the analyst-in-training who witnessed the interview, I will try to account for what I heard from a Freudian-Lacanian psychoanalytic point of view.
Writing down that which has been gathered by listening –the so-called "clinical materials"- opens the door to another dimension, in which the theoretical framework that structures the practice of psychoanalysis is at stake. It is by writing –which gives materiality to the signifier- that, as Lacan says, the analyst gives testimony that he knows what he is doing in his clinical practice. [1]
Aware that she does not know what will happen, the analyst waits for some signifier to come up in the patient’s speech that may echo in the unconscious, given that the significance of every utterance exceeds the meaning intended by the subject. The analyst tries to rescue such dimension of the signifier, hoping that it will echo in the patient’s mind, and hence enable the subject to start doing something about her position with regard to that which ails her and which she brings as her complaint.
Estela seems self-confident. As she speaks, one can hear her belief that she has known what to do with "the hand that life dealt her". Hers is a story filled with grievances and setbacks, which she has faced by telling herself: "I can endure anything". She became a widow a few years after she got married and had to "struggle alone" by working as a nurse while raising her two sons, who were five years and ten months old respectively when her husband died.
She claims, over and over again, that that which she suffers from is foreign to her. Thus she fails to acknowledge that which concerns her subjectively: she always complains about the others, about those who refuse to accommodate her desire. This is a common complaint among neurotic patients.
Throughout Estela’s account, several characters appear as if in a parade: her husband, her parents-in-law, her brother, the doctors... and, naturally, the psychiatrists, psychologists and psychoanalysts too. She says that her husband used to "treat [me] just as he wanted to" and that he "did the things his Mummy wanted him to do"; that her in-laws "wanted to have control over me and the children"; that her brother is "an old, diabetic man, on my back as well" –and as she says so, she pats herself on the shoulder. About her eldest son’s doctors, she claims that "either they have no clue or the medication is not working, because I have come across this kind of thing before in my career". About her son’s psychiatrist, she complains that "little by little I started telling her what I see. She listens to what I have to say on some issues, but not always." Regarding male psychologists, she says that they consider women as "holes that have eyes", and that according to them, if a woman "uses her hole, she is normal; if she has sex, she is normal, if she doesn’t, she is not" -this is why she had requested a female psychologist.
Somehow, she always managed to handle these situations in the past, but now that she’s 60, she complains that she does not know how to make her sons do what she wants them to do. "I can’t manage to do so", she says, "that’s why I get sick. It wears me out."
About her eldest son, she says: "I can’t push him, I can’t control him (...) he has insomnia (...) he drives me crazy". She mentions an accident he suffered while using an electric tool, and claims: "I saw the danger coming. I used to tell him: this is not the way to do so." She only refers to her youngest son by unfavorable comparison to the eldest. She refers to their sensitivity and holds that while "the youngest has a shell, the other one is like a sponge that soaks things up." Regarding morals and sex, she says that the eldest "has my orientation, he is reluctant" but "the youngest does whatever he wants to", and adds that she told her youngest son that "if I didn’t allow myself to bring a man and if your brother does not bring a girlfriend, you are not going to be the one to do so."
After pointing out some specific situations in which her sons have failed her, she says that "mine are children that have been beaten by life" because "they have endured suffering". She adds that she used to "be demanding with them (...) because I had no choice". And she ends up wondering: "How is it possible that out of two sons, I cannot even "make" one?"
While listening to Estela, a signifier resounded: "the other". It was always the other –all the others- to whom her claims were addressed. All others were lacking and at fault, whereas she always complete, phallic and powerful, which reveals her inability to accept her castration. From the omnipotent standpoint she seemed to have taken all her life, the other –all the others- amounted to nothing without her. But it is likely that she had an inkling, however brief, that without the other –without all the others- with whom she surrounded herself, she also amounted to nothing. Maybe that is what drove her to seek help.
Up until recently, Estela seems to have believed she had an answer for everything, and she did not even entertain the possibility that she might be mistaken. Bearing her asthma as the standard of her suffering, and holding an inhaler she did not use at any time during the interview, she states firmly that "those of us who are responsible have to put up with asthma."
She explains her eldest son’s current problems by relating his hypothyroidism to his diabetes and panic attacks. About his psychological treatments, she says: "the first time, I took him for treatment, as I was the one who spotted the symptoms". She makes the diagnosis that at the age of five, her son had a "regression to the oral stage" and offers -without any hesitation- her own interpretation of such regression: the boy "used to read the numbers backwards" because he "lagged behind". She is ready to point out the lack in the other, to make sure that such lack exists in the other, so that she may find room for herself in that lack. This is why, when she describes a given situation, she always places the problem on the side of the other. The other is the problem, because she has done everything she was supposed to do. She points out, for instance, that she spent two years trying to get her eldest son to have some tests done but she did not succeed "because young people know everything, he never had the time". "That is part of the problem", she concludes.
Sometimes an early intervention by the analyst may show a patient "the subjective dimension of that which up to that moment seemed to come from the outside". [2] When our patient complains that her eldest son "abandoned his studies (...), I can’t handle him", the analyst replies: "what you cannot handle is things not getting done the way you want" –to which the patient answers quickly, emphatically and with a total lack of subjective involvement: "That’s right!"
This patient is far from being captured by any of her own statements, which the analyst might give back to her, or by anything else that may open up the possibility of a subjective involvement that might lead to the division of the subject, a necessary condition for the subject of the unconscious to work towards its analytic cure.
To get to that point, the patient will have to begin by acknowledging that her analyst has some kind of knowledge that may enable the establishment of a working transference, which is required "for the patient to become an analysand, to produce signifiers, to produce knowledge". [3] Then she might be able to "turn her complaint into a query about the meaning of her complaint". Also, she may be able to understand that although she has sought help "because the psychiatrist requested so and because I feel overwhelmed", her psychological treatment does not entail just "bringing –to the analyst- that other instead of herself (…) without her having to do anything else", on the assumption that the analyst will know "what to do with the other". [4]
In the attempt to work with the signifiers she may find in her patient’s discourse –hoping that the sliding of meaning will take away from the given meaning in order to create a new meaning- the analyst will try to shake the egoic consistency of this patient to give way to the subject of the unconscious. Thus, once her analyst’s desire is at stake, she will accompany her patient in her journey towards the act, which for Estela entails taking responsibility for her own desire.
Getting Estela to work will be a hard task for the analyst, as two circumstances which Freud considered unfavorable come together in this patient: her age -she is already into the "fifth tenth of her life"- and "the impression of a general rigidity in her spiritual life". [5]
In line with her statement that "the woman, logically, is always more long-suffering", Estela seems to have enjoyed such role of the suffering woman all her life. Will she be capable of changing the logic of suffering on which she has supported herself so far for something else? Will she be able to create new sense for those signifiers that seem to define her, to put her desire at stake and risk being a little less asthmatic and a little happier? In short, will she agree to leave aside her conceited self-assurance and use the inhaler to ease her asthma?
Difficult yet fascinating task, hence, for the analyst, who bets on an activity once defined by Freud as impossible.
Difficult task ahead also for the patient, who has to access the truth about her own self, because, as she says, in order to do so "One has to endure!" |
