The Constitution of the Psychoanalytic Clinic: A History of its Structure and Power

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This book provides a detailed examination of the historical roots of psychoanalysis from ancient Greece to the late nineteenth century, focusing on social practices that were related to the founders of psychoanalytic theory and maintained within contemporary treatment. Alongside the reconstruction of an evolutionary accumulation of healing practices, the book includes linked discussions of current issues pertaining to psychoanalytic treatment and its working structure as elaborated by Freud and Lacan.There are vital political consequences for psychoanalytic practice - here articulated with an acknowledgement of these practical derivations of early pre-psychoanalytic treatments of the soul. The book demonstrates that these are neither mere techniques nor concepts of the world and the human subject, but they concern the way the problem of power is articulated.The historical establishment of psychoanalytical practice becomes legible through analysis of the traces of the elements of a political ontology, an account of the roots of those traces and the elaboration of the conceptual structure of psychoanalysis as theory and treatment, a praxis which maintains its own distinctive identity.

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Chapter One: The doubt of Ulysses

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These things never happened,

but they will always exist.

—Sallustius

Ulysses is alone on the battlefield, far from his comrades, and finds himself facing an army that is moving towards him. He wonders about his situation:

If I run away in fear it will be a disaster; if I am captured alone, it will be terrible. But why does my thymos tell me these things? I know that the bad (kakos) flee from the battlefield but the virtuous (arete) firmly resist. (Homer, 1950, p. 191)

This is a rare scene for a hero from the pages of Homer or Hesiodus, as it shows two different planes in perspective. The first plane is the objective action as the hero awaits an attack, continuing the horizontal nature of the narrative. But on the second plane there is a vertical conversation of the hero with himself, generated in his hesitation and surprise as he becomes aware of his thoughts. This process is unusual in Homer's poetry, where the present generally does not open up to the past as something to be interiorized, but rather to the past as genealogy or as narrative that seeks to explain who the char-acter is and why he is there. In sum, Ulysses’ doubt is expressed in the following question: Why do I wonder about what to do, since I know who I am? Faced with the question about how to act, Ulysses remembers a story that tells him of his lineage, his ties, and the commitments that explain who Ulysses is. His keenness and creativity come from his ability to unite what he is, what he was, and what he will be. This is why, in Homer's narratives, there is only a first plane, uniformly illu-minated and objective. In the Iliad as well, in the midst of the burning ships and the providential arrival of the Myrmidons, there is time for a comparison between the urgent situation and the life of the wolves, the genealogical order of the Myrmidons, as well as precise information about the lives of his rank-and-file men (Auerbach, 1989, p. 5).

 

Chapter Two: The return of Empedocles

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From land we see land,

with water we see water,

with the divine air we see air,

with fire we see destroying fire;

by love we see love

and by sad hatred we see hatred.

—Empedocles

Sometime around the fourth century BC certain discourses arose in Greece that was opposed to the Eleatic thinking from which Socratic-Platonic philosophy was born. One of the lead-ing exponents of this opposing current was Empedocles of Argent (490–435 BC), a physician, politician, and dramatist. He proposed a system of thought that fitted better with his medical practice than the static metaphysics of being. That type of metaphysics was founded on the idea that everything that exists comprises a unity (logos), but it does not adapt well when one tries to think in terms of variations of this being, such as in the case of illness. In response, Empedocles and others developed a metaphysics of plurality, based, at one and the same time, on the accuracy of observation and on speculative solidity. Being is not a unit; it is divided into four principles (arche): earth, fire, water, and air. The cosmos is made of these principles in varying proportions and they are subject to cosmological regula-tion. In this sense, there are times when the strength of philia (friend-ship) prevails. It joins the different elements according to the law of “Like joins with like”. In other words, the portions of water join with more water, those of earth with more earth, and so forth, until the moment when the cosmos is divided into four entirely different and uniform regions. At this point a paradox emerges. The continuous action of the union of the same elements culminates in the maximum degree of separation of the principles one from another. This results in an inversion of the law of philia and in the beginning of a new era, now governed by neikos (the spirit of discord, or strife), whose approximate statement is: “Like separates from like”. The strength of neikos separates fire from fire, earth from earth, water from water, and air from air, bringing about an expanding movement of mixture between the elements to a maximum degree of dispersion. At this point a new inversion occurs, from neikos towards philia, and alter-nates indefinitely (Empédocles de Agrigento, 1973, pp. 219–253).

 

Chapter Three: The act of Antigone

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Hold to your pretexts.

As for me, I will give my brother

a grave.

—Antigone

Antigone is the daughter of Oedipus, King of Thebes (Sófocles, 2000). Four children were born of his incestuous marriage to Jocasta: Polynices, Eteocles, Ismene, and Antig-one. When Oedipus retreats to the desert, holding his own eyes towards the sun in punishment for the sin he has committed, Creon, brother of Jocasta, rises to the throne of Thebes. His act is contested by Polynices but supported by Eteocles. These two brothers strug-gle at the gates of the city and, when the fight is over, their bodies lie unburied. Creon decides that Eteocles should be buried with full honours, whereas Polynices should be condemned to the worst of all fates for any Greek man. He is to be left unburied. Consequently, not only is he to be forgotten; he is not even to be remembered; it will be as if he had never existed. Funeral rites marked a person's inclusion into the symbolic Greek community and, without them, he or she became a symbolic outcast. We should recall that one of the ideals of Greek life was to have an early death and, if possible, on the battlefield. Only in this way could an individual be remembered for-ever by the community as a virtuous man or women. Creon's edict corresponds dramatically to Oedipus’ own desire when he goes into exile in the desert. At that moment, Oedipus had said: "Me phunai" [It would have been better never to have existed]’. Creon threatens Polyn-ices with his father's desire.

 

Chapter Four: Rhetoric of space, rhetoric of time: paradox and interpretation

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If you say what you like,

you will hear what you don't like.

—Terence

Gorgias (487–380 BC), a disciple of Empedocles, has been considered to be hewho introduced rhetoric to Athens. Being a foreigner he was mindful of the great relativity of customs, the fragility of universal principles and the humanity of the gods. Gorgias was seen as a sceptic and a relativist who asserted, for example, that: “Nothing exists. Even if there is being we cannot know it, and even if we could know it, we could not communicate and explain it to others” (Barili, 1979, p. 15).

As a practitioner of language and a specialist in defending and undoing positions, no matter what they might be, Gorgias lived from a tragic perspective, while also appreciating the comical side of life. If the real is lacerated by contradictions, human fate is uncer-tain and yet to be fashioned. Even though human fate can only be grasped symbolically in the structure of fiction and through oracular metaphors, we tend to forget the importance of language in the construction of this fate, or truth. Despite the old metaphor that fate consists of what has been written, our fate is lived out as something independent from the way we narrate it or tell others about it. Invent-ing a possible and fair position for man is a poetic task. If poetry is a desirable and positive illusion, sophistics is an extension of this project. Its correlative technique was termed psychagogy, that is, the art of leading the soul, and the study of the receptivity of the soul to music and to the rhythm of words. Psychagogy is often referred to as the precursor of the psychotherapies, as it involved transporting the soul by producing three effects, related to both means and ends: pistis (belief or conviction), agape (love or generosity), and elpis (hope or certainty). Through the conjunction of these three aspects, the word takes on a special type of power, making it able to “frighten away fear, banish pain, inspire joy and increase compassion” (Jackson, 1999, p. 100).

 

Chapter Five: Taking care of oneself

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Give up on your pain

before it gives up on you.

—Seneca

So far we have examined a number of specific aspects of Homer's epics, of Judeo-Christian texts and of myths surrounding holis-tic modes of social organization. In the process we have isolated a number of healing strategies based on integration and disintegra-tion of meaning (tragedy), community bonds (shamanism, narrative commitment), techniques of speech influence (rhetoric), diagnosis and prognosis (medicine). Tragedy adds centrality and dimension to conflict in the narrative strategy of recomposition. Here the conflict no longer involves separation between worlds but the recognition of conflict in the immanence of this world in its legal, social, and epistemic present. It is in this context that integrative and disinte-grative tactics of harmonization can be associated with catharsis. This new type of relationship between law and truth creates a surface of problems concerning the unification of knowledge-power with desire. Now, we can name this discourse articulation as the thera-peutic surface. We can see the matrix of another surface in Empedo-cles, Hippocrates and Philosophical medicine of the soul, namely, the clinical surface. It is characterized mainly by the abstraction of a causal sequence and by the questioning of the issue of authority in the curing, or healing, process.

 

Chapter Six: Montaigne, the most sceptical of the hysterics

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We have in philosophy a very pleasant remedy

because, through other ways we feel well-being

only after we are healed. Philosophy does us good

and heals us at the same time.

—Montaigne

Louis XIII was crowned King of France in 1610, and he himself modified part of the traditional liturgy of the crowning ceremony. For at least four hundred years each French king had begun his reign with a pilgrimage to the small abbey of Corbeny, where he would pray before the remains of St. Marcoul. By being anointed and sanc-tioned through the saint's intercession, the king received the power to heal the sick. This tradition went all the way back to Clovis, the founder of the Merovingian Dynasty in the fifth century. Clovis received the gift of healing in a dream and passed it on to his direct descendents, but not without the religious sanction that turned the potential to heal into the power to heal. Traditionally, upon leaving the monastery, the king would touch a few victims of scrofula, a type of inflammation of the lymph glands in the neck region, caused by the tuberculosis bacillus. But the cure was not immediate: to validate it the person had to fast for nine days and then drink some of the water in which the king had washed after touching the sick.

 

Chapter Seven: The meditation of Descartes

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To heal, sometimes,

to help, often,

to console, always.

—Seventeenth-century French saying

We have seen that the discursive strategies inspired on St. Augustine and Plutarch developed a line of psycho-therapy based on conversion and submission and that Montaigne is a point set somewhat off this line and represents a complex of reflections closer to the idea of healing, or curing. After him, Descartes (1596–1650) goes on to construct a uniform surface between the line and the excluded point.

Montaigne's doubt is a sceptical doubt. Descartes responds to Montaigne by converting this doubt, which was a type of anthro-pological attitude and an exercise reformulated from the quaestio, into a criterion for finding new types of evidence based on clarity and distinction. Descartes realized that the organization of medieval knowledge, based on constituted authorities, was sustainable only in a closed order of the world (the cosmos). He was also aware that the discoveries in astronomy and mathematics of his day brought on a new form of knowledge that was compatible with the infinitude of the universe. He therefore had to find a solid and indubitable point that would define this new order (mathesis) of knowledge, which was to become the modern form of knowledge.

 

Chapter Eight: The structure of psychoanalytic treatment

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What do analysands come looking for in analysis?

The only thing there is for them to find is, par excellence,

The trope of tropes, which can be called their fate.

—Lacan

We saw that Descartes joins two different types of concept on a single surface. On the one hand, there are strategies of conversion and submission that derive from the therapeutic lineage and, on the other, meditative scepticism, a notion that is related to the theme of healing according to Montaigne. As of Descartes it became possible, under the aegis of a new notion of method, to separate therapy and healing, on the one hand, from the very modern notion of treatment, on the other. Treatment implies finitude, order, and transformation related to causes. In a method, one practices a discipline of the will and a purification of the sub-ject that one needs “to rightly conduct one's own reason and seek the truth in science,” in the subtitle to Descartes’ central work. The method consists of a discourse and a practice that connect the exercise of one's own reason to the exercise of private domains through universal reason.

 

Chapter Nine: Kant and the pathological

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This is practical, not pathological love.

It is love seated in the will, and not in propensities toward feeling.

It is located in principles of action and not those of debilitating compassion,

and it is this love alone that can be classified.

—Kant

Immanuel Kant (1724–1804) lived a long and interesting life. Born in Königsberg to a family of humble origins, he was encouraged by his mother to study the classics. At the university he studied mathematics, the history of philosophy, and, especially, Newtonian physics. Following the death of his father, he took on a job as a private teacher for aristocratic families in Eastern Prussia for nine years. In 1755 he became a professor at the University of Königsberg, where he continued for the rest of his life.

Kant's everyday life can be described in great detail. He rose at exactly five o'clock every morning, be it summer or winter. He then dressed and got ready for his day. He would have some tea and the smoke his pipe as he made plans for his day. He then proceeded to a large amphitheatre-like classroom where he gave his classes. Later he would answer his correspondence. When he announced that it was 12:45, the cook would bring him lunch, consisting of soup followed by tonic water. After lunch he would take a daily walk along the exact same route and according to the same sched-ule. Legend has it that others could set their clocks and watches by the moment Kant walked by on his stroll and that he only changed his schedule for that walk twice in his life, one of them to receive a letter from Rousseau about the events of the French Revolution. After he returned from his stroll he would read and write until dusk. He then meditated on what he had read while gazing at the tower of Lobernich. After the lamps had been lit he resumed his reading until 9:45 p.m. At 10:00 he would go about undoing any thoughts that might disturb his sleep, and then go to his bedroom where Lampe, his valet, would help him get ready for bed. He developed a very precise way of wrapping himself up in bed. With an agile movement he would vault obliquely into his lair.

 

Chapter Ten: The rebirth of the clinic as structure and as experience

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Certainly I am not favourable to abandoning

innocuous methods of treatment.

For many cases they are sufficient and,

when all is said and done, human society

has no more use for furor sanandi

than for any other fanaticism.

—Freud

The formation of the modern clinic in the late eighteenth and early nineteenth centuries consisted of a composite of very heterogeneous practices, discourses, and mechanisms. In fact, it did not develop around a common object, specifically, the body and its diseases, but on the basis of demands whose roots of social legitimization derive from legal, moral, and religious systems, on the one hand, and, on the other, empirical, institutional, and theoretical aspects of medical knowledge. In essence, the modern clinical method results from the encounter of three very traditional figures: the surgeon (practitioner, witch doctor, psychic healer, itinerant barber-surgeon of the lower classes), the physician (researcher in anatomy, theoretician of the workings of the body, medical doctor for upper-class families) and the professor (philosopher, anthropologist, and anatomist of the soul).

 

Chapter Eleven: Hegel: the real and its negative

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The ego is only real after it has been surpassed.

—Hegel

Ricciardo Minutello is in love with Filippello's wife Catella. Despite his best efforts, however, Ricciardo's love is not returned. When he discovers that Catella is extremely jealous of her husband, Ricciardo decides to take advantage of this weak-ness. After making a public display of his lack of interest in Catella, Ricciardo finds an occasion to convey the same impression to her directly; at the same time, he informs her of approaches Filippello has purportedly made to his own Ricciardo's wife. Catella is furious and wants all the details. Nothing could be easier, Ricciardo replies. Filippello has made a date to meet Ricciardo's wife the next day, at a nearby bathhouse; Catella has only to show up there instead, and she will be convinced of her husband's treachery. So Catella goes to the bathhouse where she finds Ricciardo in her husband's place. She fails to recognize him, however, as the meeting place is completely dark. Catella cooperates with the desires of the man she takes to be her husband, but then immediately begins to reproach him, explaining that she is not Ricciardo's wife, but Catella. Ricciardo reveals in turn that he himself is not Filippello. Catella is distraught, but Ricciardo convinces her that scandal would be in no one's inter-ests, and “how much more savoury a lover's kisses are than those of a husband” (Todorov & Porter, 1990, p. 27).

 

Chapter Twelve: Logic and politics in psychoanalytic healing

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In the beginning there is not the origin, but the place.

—Lacan

Let us begin this chapter with a quotation from Michel Foucault (1973–1974, pp. 13–14):

[The patient was] a young boy dominated by religious prejudices, and he believed that, to attain his salvation, he should imitate the abstinence and maceration of the ancient anchorites. That is, he should reject not only all the pleasures of the flesh, but food as well. One day he refused the soup he was served with more vehemence than usual [and Pinel was called to intervene in the matter]. The famous doctor arrived on the scene with a display aimed at frightening the patient, with a stern look on his face and a resounding voice, with a group of servants around him armed with heavy chains which they furiously rattled. They placed the soup beside the patient and left the room. The patient spent the night in torment and fear of punishment and the idea of guilt in his future lives. The fear triumphed and he accepted first the soup, then regular food and then the use of reason. During his convalescence he confessed his cruel agitation and his bewilderment during that night of trials.

 

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