Cecilia, or No Name for the Worst*
Born to J.P.B. (53), who wanted no other children but a "single girl", and M.B., his wife (51), Cecilia, at seventeen, is nonetheless the youngest of four children: Jean-Paul (24), Evelyn (20) and Benedicte (19). Note that between the first two children, a boy named Bernard was born and died at the age of one week. According to her mother, Cecilia's daily life since earliest childhood has been nothing but a series of calamities which she sums up by saying of the family home that it is a "funeral home."
In the maternal phantasm...
At her birth, Cecilia spent twenty-three days in an incubator. At one and a half months, she had an operation for a hernia of the left diaphragm. At one and a half years, she began walking, but teetered and could only find her balance with her legs spread apart. At two and a half years, in pre-school, she was afraid of the other children; she wouldn't speak to them but addressed herself "to objects" in an incomprehensible language. At four years, she witnessed a scene in which her mother "held in her arms Benedicte (her six-year-old sister) nearly dead from a candy she had stuck in her throat." At five, Cecilia fractured two fingers on her right hand, crushed in a door.
From the age of six, a hospital followed her case on an out-patient basis. In elementary school she walked normally, spoke a lot, learned fast, but wouldn't stay in place, aggressed her schoolmates and yelled insults to no one in particular. She screamed and cried when the adult concerned didn't pay attention to her. If she gave evidence of a sustained interest for writing, her attention span was labile in practical work, and her activities were ceaselessly interrupted. But she succeeded in more or less staying in school, oscillating between euphoric moments, when she was voluble and sang, and moments in which she was prostrate, saying and doing nothing.
Throughout her schooling, Cecilia was preoccupied with one question: "Is it mean? Does it hurt?" (She even seemed insensitive to pain, never complaining or crying when she was hurt.) Was it an attempt to research an answer that caused her to move the chair her father was about to sit in, when she was eight? Whatever the reason, Mr. B. was hospitalized for sciatica triggered by his fall. According to his wife, it was at this time that he started drinking, became violent with her and the children, then fell on the basement stairs and fractured his skull.
When Cecilia was eleven, her maternal grandmother died after a long illness, Mr. B. broke a finger when a punch directed at his wife connected instead with the wall, Mrs. B. dislocated her hip and then said she "couldn't do anything anymore," which disturbed Cecilia greatly. Mr. B. took advantage of the occasion by drinking more, showing himself more and more violent with the children, and finally, as his wife reports it, "catching an hallucination" during which he attempted to hang himself, an attempt which lead directly to the hospital for detoxification. Around the same time, on the playground, a boy embraced Cecilia and forced her to take down her panties by menacing to beat her with a stick. She, from then on, refused to go to school or to leave home without her mother, and became once again enuretic. She would then be admitted to an out-patient clinic until the age of seventeen.
Throughout her thirteenth year, one of her cousins (also thirteen) committed "suicide by anorexia." At fourteen, Cecilia dislocated her left elbow. During this time, her maternal grandfather, seriously ill, lived with the family, where he was cared for on an out-patient basis. When he died, Cecilia was fifteen, and her sister, Benedicte (17) became acutely depressed to the point that her mother had to spoon-feed her. The father threatened to throw his son out the window, which incited Jean-Paul to leave home, to Cecilia's great distress, and she, a month later, had to be hospitalized for visual and auditory hallucinations.
At seventeen she had reached the age limit for the hospital. She had an operation for a hernia. Cecilia was admitted to Courtil a little while after, on her request, as in-patient because "at home it's worse" (the hallucinations).
Object for death...
At her arrival, Cecilia, who had just celebrated her seventeenth birthday, had the stature of a child of twelve. Thin, floating in her black clothing, she stooped, hunched up her shoulders with her hands in her pockets. Fleeing the gaze of her interlocutor, she smoothed out her bust with the flat of her right hand from the left breast to the pubis, or rubbed her eyes with the backs of her hands as if the get rid of something bothersome. Her elocution was barely intelligible; she garbled her words, inverted letters and syllables in a rapid and jerky pronunciation; she alternated between phrases in a too-loud, almost forced voice with indistinct or almost inaudible murmurs. She kept her distance with the other children and only with difficulty was she separated from her black overcoat and stocking hat. She did nothing with her ten fingers and only consented to eat if an adult would help bring the first mouthful to her lips. But once this difficult first step passed, she stuffed herself, head down in her plate. Without the least politeness, she sometimes asked for seconds in a dry tone of voice that one usually reserves for bad waiters (she then had to be helped again with the first bite). The only activities permitted her were writing (a letter to someone) and observation. "I'm watching," she would say, or, "I observe a lot." Nothing escaped her vigilant eyes.
Even in the admissions interview, Cecilia asked that we help her to get rid of her hallucinations: "The figures keep me from living," she would say, or, "They have to be made to go away." She had known enough "psy" of all sorts in her time that she repeated, without believing in it, the formula she borrowed from them: "If I talk about it, it will go away." She is the fascinated prey of these spoilsports who "angoise" her, as she puts it, by forbidding her to drink, to eat, to pick up an object, to move.
As time passed, we were able to distinguish, from these multiple "figures" that she calls "apparescences" which proliferate under the names of different, but uniquely masculine, variety singers, the pale, thin features of an image with black eyes and hair; the very figure of death which watches her, immobile and silent, who paralyzes an instant the movement of Cecilia. One might recognize here the "anti-life, anti-movement function...of the fascinum... in which the power of the gaze is exercised directly."1 These "bad images" electively erupt in her visual field when she prepares to take a meal. The vision then is super-imposed on the face of whoever is sitting across from her. At the beginning of her stay at Courtil, after having been fixed for an instant in an "Ah!" of horrified surprise, she would bound from her chair to leave the table (when it concerned an intervenant) or took up her knife to throw it in a flash at the face of whoever sat before her (when it concerned a child). We thus got into the habit of leaving the place across from her empty.
However, these "bad images" could surface at any moment - such as when she antagonized with insults a girl who, since her arrival, she had held in friendship (they had shared a room at the psychiatric hospital). Moreover, according to her, certain objects "evoke the bad images." First of these are what she calls "borders": the edge of the table, of her plate, of the window, or a book ("I'm afraid of corners."). Then the black points of the tiles in her family home, the clock, and more precisely, the "black numbers," the knobs on the door of a piece of furniture belonging to her parents (which remind her of filthy things). It should be noted that she recalls having been afraid, when very little, of the end of her grandfather's cane, the spokes of her father's bicycle, and the white of toilets.
Armed with her "If I talk about them, they'll go away", Cecilia spoke willingly of "bad things" to anyone, but preferred to address herself to women, whom she seemed to situate as "nurses'aides." Her first tranferential criteria was effectively material aid. She made an equivalence between "help" and "love" that she expressed with this inversion: "I like her because she helps me" – which at the same time excludes those who are on the same team as the beloved, but who are occupied with other children – "I don't like So and So", "I don't trust him." And joined to this "I don't like..." is a facial flaw which no doubt "evokes the bad images," since these flaws might be the paleness of skin, a wrinkle, creases near the eye, or the irregular alignment of teeth.
Little by little, however, Cecilia established herself and organized her tranferential team according to functional criteria: Dr. Kellerman (whom she called 'Clement') was understandably named medicine manager (he is seconded by Sandrine, also psychiatrist), Francoise to the post of personal secretary and director of exterior relations (personal interviews and contacts with the family), Anne to publicity (beauty, jewelry, clothes) and myself to interior relations and communication (at Courtil) as well as financial manager (I'm the one who dispenses her allowance).
On the contrary, she designated Bernard (the director of the institute) as the living incarnation of all that she loathed. She literally couldn't bear the sight of him and went crazy whenever he appeared. For example, she called him to ask for an interview – "I want to see him face to face, like I see you" – invitation which he prudently declined. Then, having hung up, she asked me, "What's with his nose, Bernard?" (no doubt he can't smell her). She adds, "He has a flaw in his eyes, a flaw there" indicating the crease and the outer corner of the right eye. Remember that the brother, also named Bernard, died at the age of one week and reposes in the cemetery where she and her family had just visited on All Saints' Day, the day before this conversation.
The great crisis of the celebration of the dead
This dialogue took place during a vacation, on Cecilia's return from the All Saints' Day weekend. She was in the most alarming state. Invaded by hallucinations in spite of treatment with Haldol, she let fly chains of insults at her friends, or sudden screams; she found it impossible to swallow food; she cried and complained; all this interspersed with brief moments of respite during which she remained silent and immobile, or else followed me around like a worried shadow. So I had to consecrate the largest part of my time to her. I will give some extracts of the capricious dialogue which took place through her unbearable anxiety.
At first, this dialogue installed itself along the lines of hypochondria: "I'm afraid I'm sick again... Oh, my heart!" (She rubbed the flat of her hand the length of her body.)
"Again," I said, "You've been sick already?"
"Sick in my head, when I was hospitalized. I don't want to go to the hospital. At the hospital, I'm afraid of falling into a coma. I'm afraid of dying."
Later, she would affirm, "I'm sick. My brain is sick. The water bypasses my stomach, maybe?"
"No. Is that what you believe?"
"My body is full of yeau.2 I have cancer. I'm going to die. I have blood cancer."
Or again, "I'm going to get thin. My mother won't recognize me. I'm thin. I'm sick. When you have cancer, you're thin. They're going to feed me with a tube."
While I have already noted Cecilia's hypochondriac complaints, which flourished at several moments in her discourse, the "language of the organ," according to the Freudian expression, is demonstrated here in all its purity, concentrated on the organs of life (heart and brain). But what seems to me the most significant is the function of the organ seen in reference to her mother, who "won't recognize" her, and in the extraordinary neologism "My body is full of yeau," which sums up the whole problematic of the subject Cecilia.
What were her hallucinations about? Until then, what we'd been able to get from Cecilia was a progressive reduction of the multiplicity of male faces bearing the names of diverse singers which said "filthy things", but these "images" hindered her from repeating the words she heard. These "images" were reduced progressively to pale, skeletal faces, immobile and silent, which I discussed earlier.
On the day in question here, as I obstinately insisted, the dialogue followed like this:
Cecilia often brought her hand to her throat, saying, "I'm afraid of bad images that angoishes me."
"What do they say to you?"
"There's one voice."
"What does it say?"
"I don't understand what it says. The voices. They speak and I don't understand."
"You don't understand, but what do they say?"
"You're going to die! Bang! You're going to strangle yourself!"
One grasps that it's paradoxically for survival ("I don't want to die!") that she obeys the injunctions of this mortifying and omniscient Other, depriving herself of nourishment in order not to strangle herself. Remember the scene that her mother recounted (Cecilia never spoke of it) of her sister Benedicte "nearly dead, strangled by a piece of candy." It was also Benedicte who was spoon-fed by her mother during a profound depression after the death of the maternal grandfather. And it seems to me that it is at this point that, for Cecilia, the Other who gives food and love – the Other of the request (request to the Other) that we love her and prove it by helping her bring the first bite to her lips – hinges on the mortifying Other who threatens her with strangulation and death, and entreats her to make the criminal gesture of throwing the knife which serves to cut up her food. In this way, this latter Other manifests itself electively at meal times.
However, the symbolic being the real for Cecilia, the hallucination can surface at the slightest imprudent word spoken by her interlocutor. Thus she tells about a nurse at the hospital: "She said that I had grandmother underpants."
I replied, thoughtlessly, "Oh! They're very pretty, grandma underpants!"
"She said it out of meanness. Dirty bitch! I'm gonna plant a kitchen knife in you!" She then fixed her gaze on the wall to her left and sketched the gesture of throwing a knife. It is clear that to tell her that she is wearing the underpants of her dead grandmother is to signify to her that she is already dead, or deadly, death being what she is indeed incapable of subjectifying, a horror to which she responds with a deadly gesture. And doubtless the stick with which she was threatened at eleven has imprinted its mark on her delusion (even though she has never spoken of this event except to say, "They hit me.").
The theme of death – evidently revivified by her visit, the day before, to the cemetery – deployed itself during the two following days:
"I went to the cemetery. I like skeletons. I'm afraid of skeletons."
"You've seen one?"
"A skeleton of what?"
After a pause, she responded. "I don't like churches and all those things, crosses, Jesus and that. I'm afraid."
And the next day, she said, "Do you know Skeletor?"
"No. Is it a toy?"
"No. It's a real skeleton that travels."
Cecilia, in effect, drags along with her this image of death that cannot be symbolized and so appears to her in the real without cease.
She cannot apprehend this death except in the form of an insupportable immortality that she expresses in this way:
My grandfather is in heaven. When you die, can you help people?...When you die, does your soul leave your body and go in another body? I would be afraid of coming back in my old body...What was my name before I was Cecilia? Maybe I was a man?...I like snails. I like slugs. I like spiders, but not insects! I don't like insects! I like seashells, mollusks.
The next day, at the strongest point in the crisis, standing there when I went to give her a cookie, she screamed, eyes turned back in her head, in an ecstatic attitude, "Jesus! Jesus! Take me to heaven! I want my soul to go in another body! I want to die!" Alarmed, I brought her to the office to telephone the psychiatrist. An augmentation in the dose of neuroleptic was then decided upon.
From then on, Cecilia would subside, reducing her complaint to the fear of a new psychic cataclysm and focusing on her request for help at dinner time.
An attempt at historicization
The hallucinations having given way under medication and her anxiety having been appeased by our permanent assistance, Cecilia then acted as if asleep. It was at this point that her mother spoke of reducing the doses of medicines. Alerted, Cecilia questioned me in a repetitive fashion, but she didn't trust my reassuring responses. I then said to her, "No one will change your treatment. The medicine helps to keep away the 'bad things,' but in order for them to truly disappear, you need to make an effort. You have to help us by gathering together your memories."
"I don't have a memory," she responded. And immediately, I got my baton back. I heard savage screaming in the hallway. I ran. Cecilia was caught in a panic, in tears. She had seen a "bad image" there, on the wall.
In the conversation that followed my efforts to reassure and calm her, she would try to specify the chronological evolution of her hallucinations.
Lacan says it is the scopic drive "that most completely eludes the term castration."3 But for this psychotic subject, it indeed concerns the foreclosure of castration. During this long interview, Cecilia would demonstrate it by trying to specify the moment her hallucinations emerged. During a first period, before the crisis, she situated the psychic catastrophe around her eleventh year. "Before I was eleven, everything was fine," she had confided to us. (Her eleventh year saw the death of her grandmother, the bad encounter with the bully who aggressed her sexually and threatened her with a stick, and the dislocation of her mother's hip.) This was when she started seeing "things you shouldn't see", "pieces of skeleton" and there were "voices that spoke words that cause fear – 'fly' 'mosquito' and strange names of countries and towns." She then remembered that at a fair, her sister Benedicte had acquired a plastic fly on a string that she hung in Cecilia's face murmuring affectionately, "Little fly!"
During a second period, after the crisis, she indicated that when she was fourteen the visiting nurse who cared for her dying grandfather had shown her a book about insects. She then said, "Insects give me the creeps...their antennas...their eyes..." At this time of her life, it was insects that appeared in her visions. She added that the "bad images little by little replaced the insects." And when I asked her what these bad images looked like, she told me, "They have wrinkles on the forehead."
I asked, "Like an old man?" (I was thinking of her grandfather.)
"Do you know someone who has wrinkles on the forehead?"
And there we are. To the series of skeleton pieces at eleven is superimposed at fourteen – the moment, properly speaking, of the triggering off of her psychosis – those of insects which come to their term at seventeen in wrinkled figures of the father. The phallus, foreclosed in the symbolic, returns in the jubilant gaze of the Other in the real, who enjoins, "Die!" This was how I accounted for what Cecilia had grasped of her father's desire to have "only one girl," in a desperate effort to hook up to the symbolic, to make herself only one in psychosis. She also endlessly repeated, "I'm alone," and "I'm not like the others." This is also why she presents herself like a grieving phallus, silent or ejaculatory, appearing-disappearing in the frames of doors, watching and waiting desperately for a gaze that won't become a dagger.
Throughout this interview, she also specified that she saw the hallucinations "in my head." "I imagine them" she said, describing those hallucinations "evoked" by borders (they were then signs for her to interpret). Or she saw them "on the wall" or on the face of her interlocutor -- these were hallucinations, properly speaking. And on the topic of dreaming, she had nightmares that pushed her to leap out of bed, out of her room, even out of the building.
What to do?
The following week, I again insisted, reproaching her for not even being able to ask me to serve her with a full sentence. "Lemonade!" she said dryly, like a hurried surgeon demanding a scalpel. However, good girl – or rather, she took me for good, I even think she took me for her maid – she succeeded, in supporting herself on the encouragements of her chosen intervenants, to serve herself and to eat by herself, bravely. Returning the following Monday, I said that I'd read "good news" about her in the journal kept by the intervenants of the group. She smiled, apparently content with my contentment. But catastrophe! Once at table, having shrugged off her overcoat and hat without a hesitation, while I supported her with my voice after having helped bring the first mouthful to her lips, she froze, eyes fixed on her piece of bread. Having perfectly understood that she wanted me to take the bread, put it in her hand and help her to bite it, I abstained, while continuing to encourage her. But she left the table in tears. Francoise then took over, caught-up with her and said, "Nobody at Courtil wants you to be bothered by anyone."
And Cecilia decided, "I want to eat, but beside you."
"Get your plate and silverware," Francoise answered.
Cecilia, with a smile a little bit ironic to my mind, without equivocation grabbed the objects in question and went to sit by Francoise.
That was last Monday. Tuesday, I went in reverse, doubling my attentions to her. And Cecilia started to observe me attentively, putting my patience to the test remorselessly with her exigencies. But this week, she came back from the weekend, her face covered in red blisters and skin peeling like a psoriasis, saying, "It's because I didn't have my period [regles]." Had I to this point departed from the rules [regles] established for aiding her? Had she deduced that I was after her hide? However, she confided that she had had a nightmare featuring a face, "white, white like cigarette paper," pointing to the cigarette in my hand. It must be noted that her father, a smoker, has serious pulmonary problems which worry Cecilia greatly. I then proposed to bring her a personal diary with a lock and key so that she could, with our help, write her history and clarify what happened to her. She was enchanted with it – but she got dental abscesses!
I upset her too much, yes, but what can I do? The diagnosis of schizophrenia leaves no room for doubt, but what can be prognosticated?
Cecilia will soon be eighteen. Writing letters seems to appease her, but her missals, addressed in every direction, only repeat the same poor litany. It isn't a question of the letter; she moreover refuses to draw "because you have to make a mark." She wants to learn to cook, but, at the school where she's enrolled part-time, she is content to watch the stove without touching anything. And besides, how can we encourage her in this when we know to what use she likes to put the knives! She doesn't like to read books "because it takes too long." Her grandfather is in heaven. Consequently, she doesn't want to know anything about astronomy. The only books that interest her concern anatomy...
Finally, it seems that she's fixed in a subjective position from which she "calls for" hallucinations. After the remission in November, she questioned me, "Are they going to come back?" And without waiting for a response, she fixed the wall with a confident half-smile. The medication hasn't changed a thing, moreover, in the set-up she's constructed for assisted living at Courtil. She calls for hallucinations to help her assure herself of our aid. However, she did concede to me this expression of her good will: "I must succeed in eating by myself."
Can she, from this "by myself" make a nominative prosthesis – a Cecilia-only-daughter from which to found her history, elsewhere and otherwise that in the fright of a destiny of eternity?
*The original title of the article in french is "Cecile, ou le sans-nom-du-pire", which plays on the homophony between nom-du-pere (name-of-the-father) and pire (worse), a homophony Lacan often played upon, le pire being the foreclosure of the nom-du-pere. [trans. note].