Evolving Lacanian Perspectives for Clinical Psychoanalysis: On Narcissism, Sexuation, and the Phases of Analysis in Contemporary Culture

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This book presents an evolving Lacanian reading of the psychoanalytic theory of narcissism, of the phases within Oedipus, transference, and within different types of analytic treatments. Sexual difference between psychical masculinity and femininity is formulated as a negative dialectic: both sexes are not without having and not having the phallus across levels of logical organization and the three registers of experience. Many clinical examples and vignettes are offered to illustrate Lacanian theory, the permutations within sexuation, as well as the various principles of Lacanian clinical practice.The Lacanian multiform criterion for the practice of psychoanalysis is presented as an alternative to the post-Freudian notions of a standard frame, or a holding environment. The criterion extends the use of psychoanalysis to a larger group of clinical, socio-economic, and multicultural populations. Finally, the book explores the criteria used for the authorization of the analyst, and how supervision differs from analysis, and from the teacher-student and lover-beloved relationships.

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1 Forms and Transformations of Narcissism: The Partial Object, the Ideal Ego, the Ego Ideal, and the Empty Subject

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Overall, Freud's theory has a built-in tension and ambiguity between a developmental and a structural concept of narcissism. On the developmental side, Freud (1911) first conceived of narcissism as a phase of sexual development where the individual begins taking its own body as a love object. In line with this perspective, Freud defined primary narcissism as corresponding to the ego-representation involved in this sexual phase of development, where the ego loves the image of his/her own body.

Secondary narcissism was then defined as a regressive and pathological return to the primary narcissism of early childhood.

Narcissism in this account is a primitive and temporary phase of development that, if unchecked, becomes ultimately pathological.

The narcissistic or ego-centred phase of development in which an object relationship does not exist needs to be abandoned in favour of a more advanced object-oriented phase of development. However, the limitation of establishing an absolute developmental difference between a narcissistic and an object phase of development is that subject and object co-arise or mutually determine each other.

 

2 Sexual Difference and Social Equality in the Phallic Function and the Three Registers of Experience

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Before the child knows sexual difference as the anatomical difference between the sexes, s/he knows or recognises the lack in the mother's desire for something that the father is perceived as having. The anatomical discovery of the difference between the sexes (“Show me yours and I will show you mine”) will be placed within this symbolic context. Thus, more than a penis and before it is a penis the phallus is a signifier of a lack within the mother's desire. Within Lacanian theory, the symbolic and imaginary significance of the phallus have ascendancy over its anatomical function.

On the one hand, it behooves the child to occupy the place of the object of the mother's desire. A good–enough mother is one who loves or desires her child in a very personal way. On the other hand, if the mother does not desire anybody else other than the child, the desire for the child also becomes problematic for the child. Unfortunately the problem does not end when the mother desires the father, because it is precisely this desire that triggers sexual difference and the perception of the mother, and femininity, therefore, as lacking something that the father is perceived as having. It is the defence against this perceived lack and the struggle to have what the father is perceived as having that contributes to the rejection of femininity by both sexes. Feminine simulacrum and the patriarchal phallic parade both represent hysterical and organised attempts within human culture to defend against what is perceived as a negative lack within the mother. Within the Imaginary, and particularly in consumer-oriented capitalist societies, the ego does not realise the constructive function of the lack within desire and the being of the subject. Within society people think that the rejection of femininity is solely based upon the low status of women within the culture. In actuality, and according to Freudian and Lacanian theory, the low status is due to both the phallic defence against the lack (which debases women and makes women identify with masculine attributes) and the misapprehension of the lack as having a low and expendable status.

 

3 Love, Transference, and the Emptiness of the Agalma

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I n his seminar on transference, Lacan (1960–1961) resorts to a commentary on Plato's Symposium in order to examine the questions posed by love and its object. In the Symposium, Alcibiades contrasts Socrates’ vulgar exterior with the beauty of his interior and compares this to boxes on which surface you can see an ugly figure of a satyr, but inside you find the agalma of unsurpassable beauty which pleases and fascinates the gods. The agalma is a name for an enlightened mind, a state of being, or a spiritual and/or sexual delight equivalent by metaphor to an ornament or a jewel. In the Symposium the agalma represents the object of Alcibiades’ desire, or what his being lacks, the imaginary phallus that he wants to receive from Socrates and that makes him succumb to love's frantic frenzy. Love goes out to the beloved who appears to posses the object of the lack. Alcibiades produces lack in Socrates himself because Socrates, although praised, cannot give him the object. Socrates does not have the imaginary phallus that he appears to have. Alcibiades loves Socrates and demands that Socrates give him a knowledge that he lacks and that Socrates appears to have. Here the imaginary phallus is signified/represented by knowledge. However, for Lacan the agalma is only a semblance of having a jewel inside the body or the mind. The master of knowledge and the hysteric appear to have the jewel by withholding it, and making it appear absent. The difference between ego knowledge and knowing in the analyst is that the analyst knows that this semblance is imaginary because in Lacan's view, following Socrates, there is nothing to the agalma, there is nothing in it, the agalma is empty of content. “There where you see something in me, I am nothing” (Lacan, 1961, session of February 8, p.10). These two sides of the agalma (having something that I don't have) are coextensive to two dimensions of the love object or objet à: Imaginary and Real. On the one hand there is a specific list of objet à (the gaze, voice, phallus, breast, etc.), on the other hand, the objet à is merely the index of a void. The imaginary phallus is one among other objet às whereas, in relationship to the symbolic phallus, the objet à is a numerator that fills the gap of the symbolic phallus as a denominator.

 

4 New Lacanian Perspectives on Depression: From the Presence of Emptiness to the Emptiness of Presence and Development

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According to the World Health Organisation, 121 million people suffer from depression, which is the fourth greatest cause of death and disability worldwide. In psychiatry and the mental health disciplines, depression is an affective state or symptom characterised by sadness, a general sense of loss or failure, pessimism, low self-esteem, and a negative outlook on life.

Depression affects the vegetative system in the form of an increase or decrease of appetite, and an increase or decrease of sleep. In addition, it also impacts the motor system in the form of a reduction of activity and vitality. The person has difficulty concentrating and loses the desire for life and for sexuality.

The Diagnostic and Statistical Manual of Mental Disorders (DSM IV) differentiates and classifies various forms of depression under affective disorders. However, depression, as a symptom, also appears under different diagnostic categories. In addition to bereavement, there is adjustment disorder with depressed mood, and depression also appears in anxiety disorders, personality disorders, and even psychosis.

 

5 The Multiform Criteria and the Practice of Psychoanalysis

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This chapter introduces basic notions of Lacanian clinical practice, paying equal attention to Lacan's reformulations of Freudian principles as well as original Lacanian contributions to Freud's work —for example, the notion of cure direction which Lacan outlined in The direction of the treatment and the principles of its power (Lacan, 1979). In Lacanian psychoanalysis, the two elements of direction and power are correlated: for there to be a direction to the cure the analyst has to not use the power granted to him/her by the analysand's transference. Lacan in France, and his followers in Argentina, have emphasised the need to call the analysand “analizante“ instead of “analizado“ (analised). The English word “analysand” implies a position of empowerment, analytical activity, and responsibility. The unconscious of the analysand knows the textual truth (the signifying chain resembles a latent text) manifesting through the symptom, but due to repression and concomitant disguises the subject appears to ignore it. From this place of ignorance the analysand searches for a master in the analyst. Once this transference has been resolved at the end of an analysis, the subject could be called the analysed, in the past tense, without implying a master analysing analyst and a passive “analysed”(by the analyst). The analysed is the product or effect of the transformative power of the unconscious.

 

6 The Question of Time: Phases of Analysis and Oedipus in Analytic Treatments

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Lacan developed what I call a multiform criterion for the practice of analysis. This does not mean that the Lacanian field has no practice standards but that psychoanalysis cannot be practiced according to the “one size fits all” criteria. Lacan's clinical practice was consistent with his early theoretical cry for a return to Freud. Post-Freudian classical psychoanalysis attempts to be more Freudian than Freud and follows him in his sayings but not in his practices with patients. Typically, Freud's unconventional or nonstandard frame is attributed to him being the first analyst and not having been analysed himself. It is said that Freud was overly active and educative with patients, that he spoke too much, fed them, lent them money, did couple sessions, and conducted analytical sessions in people's houses, walking, on horseback, and in cafés. Freud also advocated having sessions almost every day, or more often than not. His analyses lasted up to one year but certainly not the ten and twenty years that became the norm in the psychoanalysis practiced under the standard frame.

 

7 The Supervisor Supposed to Know: Lacanian Perspectives on Psychoanalytic Supervision

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Clinical supervision, as a training requirement for psychoanalysts, was formalised with the development of the International Psychoanalytic Association and the creation of the Berlin Institute. At first the practice of supervision, just like the practice of analysis, was non-standard. Supervision was intertwined with the teacher/student relationship and the collegial or peer professional relationships. To Freud, Breuer was a teacher and supervisor, whereas Fliess was his supervisor, confidant, and colleague. In turn, Freud was a teacher/supervisor to both Steckel and Jung (Safouan, 1995).

Max Eitington, who opened the first psychoanalytic clinic in Vienna, did a singular form or a non-standard didactic analysis with Freud walking through the streets of Vienna. Eitington conceived of a psychoanalytic clinic as having three functions: therapeutic, formative, and research. The initial function of supervision was not only to deliver adequate professional services to the public, but also to preserve the integrity and internal coherence of psychoanalysis. The International Psychoanalytic Conference of 1925 sought to prevent the premature amalgamation and synthesis of psychoanalysis with other fields, research methods, and clinical practices.

 

8 Cultural Difference and Lacanian Psychoanalysis: From the Master's Discourse to Post-Colonial Analytical Practice

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It is important to periodically examine the assumptions that, consciously or unconsciously, determine the course and results of psychoanalytic work; unexamined and unrecognised assumptions establish the parameters of what may be possible or impossible within the scope of our professional practice and activity as analysts.

Ethnic minorities have figured highly in the use of mental health services, as well as having high drop-out rates from the same. Thus the question regarding the role of culture in psychoanalysis and in the field of mental health has arisen around the practical problem of providing effective mental health services to ethnic minority populations. Within the majority, dominant culture, the stated or unstated assumption is often made that many ethnic minority groups, as a result of economic, cultural, and educational deficits, are simply not “good candidates” for the mental health services available within Western culture (i.e. “insight” forms of psychotherapy or psychoanalysis). Within psychoanalysis, such an assumption has followed from the criteria of “analysability”, whereas outside psychoanalysis it has found confirmation in psychotherapy outcome research data that support the view that intelligent, verbal, attractive, and successful upper-class individuals tend to benefit the most from psychotherapy. It goes without saying that White majority subjects are over-represented within those defined as ideal candidates for psychotherapy and psychoanalysis. In addition, until recently the psychoanalytic literature in the United States has not been known for addressing the concerns of the minority mental health literature or those of minorities in general.

 



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