After I began my analysis, when I was listening to clinical case presentations at the first Seminar I attended in New York, I was able to distance myself from my own belief that it was impossible to work with a Lacanian orientation in a mental health institution within the United States. The cases reflected the way in which each clinician invented a way to work, in spite of the mental health system.
Following my enthusiasm in realizing that it was possible to work from a Lacanian orientation, I found myself confronting situations in which I stumbled and began to question: can I work in an institution of mental health in United States without deviating from the ethic of psychoanalysis?
This question led me to work with others in a cartel we called “Lacanian Psychoanalysis and institution in North America”. In discussing the term “School,” Lacan states, “it is to be taken in the sense in which in ancient times it meant certain places of refuge, indeed bases of operation against what might already be called the discontent of civilization”1. Through my own analysis, control, participation in cartels, and other spaces that offer the opportunity to learn Lacan’s teaching, I have been able to resist the discontent that I experience in working at a mental health institution.
Many of the referrals to a mental health agency are associated with “risk” and “victimization.” How does one direct the cure in order to make it possible for the patient to move away from the place of ‘patient of risk’ or ‘victim’? How does one avoid reconfirming the patient in that position where the institution ratifies it? In reflecting upon these questions I will present the following clinical case.
Amy is an adolescent cut off from everybody except from her mother. While Amy is silent, it is her mother who initially talks: “I don’t know what is going on with my daughter, I ask her but she does not say anything. We are very close to each other and I do all that I can for her, but anyway she is down, depressed.” When her mother was snooping through her things, she found a note written by Amy: she did not want to live any longer, she thought of cutting her wrist.
As soon as she starts attending sessions, she breaks her silence to tell me that she has been molested by her step-uncle for around one year. This man carries a visible mark on his body as a result of a cut with a knife.
The beginning of the experience of the cure is characterized by long periods of silence interrupted by a few words. She complains of being forced to talk by others. I struggle with her silence: between being in the position of an Other who forces her to talk or letting her be down in her silence.
The initial sessions are filled with the only card game she knows how to play: Uno. These are repetitive silent sessions with an only word: “uno.” My utterance, which mostly highlights this repetition, seems to fall down in the emptiness. At some point she asks me to teach her a new card game from my country. Then she addresses this demand to me that may be thought as the beginning of the transference. In terms of the algorithm of the transference, I can consider the signifier “game” as the signifier of the transference. This isolated signifier is addressed to me: to teach her a game of my country. She supposes that I know and I can transmit this knowledge to her. My response is teaching her a game in which I point at the signifier “cut” in the dimension of the letter, an undifferentiated signifier extracted from the knowledge of the subject. With this game I introduce myself in her “cut” and propose a movement away from the cut of the body towards the cut in the game.
Amy starts to talk about wanting to see her father again. She knows she can see him in “court.” In Spanish the same word is used for “court” and “cut.” This time the “cut/court” would appear as a call to the father. Amy wonders why her father neither talks nor looks at her.
Amy finally meets her father in the court, stands up in front of him and asks him why he had left her. He looks away and does not answer anything. There is a repetition of the traumatic encounter with her father who neither holds her with the gaze nor the voice but rather lets her fall. It is after this failed encounter that Amy “cut” classes.
Amy cuts classes and her mother considers the possibility of sending her away to a boarding school. Amy remains silent. I do not accept her silence and as a response to cutting classes I offer her to come to session twice a week: if she is cutting classes something else is happening to her and she needs to talk: I bet on the unconscious. This may be thought of as an analytic act and what follows is a subjective change.
Thus Amy would enter a second moment in the experience of the cure, which at the core is the construction of the fantasy.
Amy tells me her first dream: “I go to the movie theater with a boyfriend. There are 3 movies: “The eye”, “Step up 2”, and I do not remember the 3rd one (she will remember later: “Jean Pierre”). There are 3 bathrooms: one bathroom for each movie. I go to the bathroom. I meet a boy that I like and we talk until my boyfriend shows up looking for me. I do not like my boyfriend but I go back to see the movie with him. In the movie theater I run into the boy I like again but I do not remember his name. We forget in which bathroom we met. I come up with an idea: if we go into the same bathroom in which we met I would remember his name. So we try but we go into the wrong bathroom. Some men come into the bathroom after us and start to beat me. If the boy I like erases me from his memory, the men would stop beating me. I request for him to refuse that, I ask him to keep me in his memory, and I tell him that I will bear the beating. He cannot stand seeing me suffer and he agrees to erase all traces of me from his memory. So he does not know who I am. I realize that I failed. I leave the bathroom crying and find my brother crying outside because our father forgot to pick him up…”
In her associations she talks about her father who seems to have forgotten about her and denies that he is the father of her brother. Amy also refers to her mother: when she fails, her mother gets disappointed in her and does not look at her or talk to her. This is unbearable for her; she states, “my world falls down.”
Amy alludes to fluctuations between the extremes of being glued to her mother or being removed from her. Her mother left her in the care of her grandmother in her family’s country of origin. Amy explains, “when my mom left me I was down, I thought my mom was going to forget me.” A few years later she came back to the United States to reunite with her mother. At the airport she learned that her mother was pregnant and had a husband. But her mother assured her that if she had to choose between her husband and her, she would stay with her. Her mother repeats: “I prefer my daughter over the man.” This phrase would give a clue regarding her mother’s jouissance.
Amy’s dream resembles the second time of “A child is being beaten”: “I am being beaten”. I might add: “I am being beaten to exist/to have a place in the Other.” She offers herself as an object of sacrifice to the Other. This may be an interpretation of the desire of the (m)Other. If she is not being beaten she loses her place in the Other. The gaze is here a privileged object: she is being seen while she is being beaten. In Seminar XVII, Lacan observes, “the You are beating me is this half of the subject [subject divided by jouissance] whose formula constitutes his liaison with jouissance. He receives, to be sure, his own message in inverted form- here this means, his own jouissance in the form of the Other’s jouissance.”2
I ask about her idea of going back to the same bathroom in order to remember. She associates with “retracing her own steps” and she brings a second dream: “I go to a party with my family. It is 3.00 am and we are going to go back home. I go outside thinking that I will meet my family there, but I do not find anybody. I do not know how to go back by myself, it’s dark and I am scared. I look at the watch again and it is 5:00 am, nobody comes looking for me. I am scared. I hear steps. I see somebody passing: a shadow. A friend from school arrives and he tells me that he is waiting for his father. We wait together. Suddenly we see the devil. Then we see his father carrying a black book. We do not know if he is the true father or a fake one. Then we see the ‘Veladora’.”
Amy heard her family talking about people who after death return at night as a shadow to retrace their steps due to pending issues or revenge. The “Veladora” protects people when somebody comes back from death. Amongst the stories that she heard in her childhood she keeps in her memory the one of “The weeping woman”: a woman who killed her children in a river to be with a man. She regretted what she did and went back to look for her children who had drowned in the river. She drowned herself in the river and it is said that people can still hear her crying and looking for her children. Amy was warned not to go out in the dark because the Weeping Woman snatches children to take them with her. Might the Weeping Woman be a name for the maternal ravage?
In her third dream “$a girl is being beaten$”: “I am working at a school. It will be a competition between my school and another one. I feel sympathy for a young girl, but she is a gossiper and tells to her brother a secret related to the strategy to win in the competition. Because she reveals this secret our school will lose. People at school get angry with her and take her to a room. They will beat her but I cannot do anything. The girl screams and cries. I sneak a look and see a lot of blood. The room remains silent. I think that maybe the girl is dead. When everybody leaves the room I go inside and see the girl disfigured with the jaw broken. I hug her and my mother comes in. When I realize that my mom is looking at us I feel ashamed. I wake up.”
In her dream Amy would be both a witness and the girl being beaten. The girl is being beaten almost to death in what would be an indication of an unlimited jouissance. Both the scopic and the invocatory drive appear. She hears and she sees a girl being beaten because she speaks up unveiling a secret. Amy told me a secret that she kept over a year: she was being molested by her step-uncle. There was another secret in Amy’s life: her brother did not know who his biological father was. It was a secret that Amy shared with her mother.
Amy recalls a childhood memory: she listened to conversations between her mother and her aunts, in which they talked with “broken words” in order to maintain something hidden. She tried to discover these secrets among women. When I ask about the “broken words” she states: “they cut the words.” I echo: “they cut the words” and end the session. Throughout the experience of the cure the signifier “cut” takes different forms, such as the cut introduced in the game, the cut related to her father in court, cutting classes, and now cutting words.
Amy talks about events in which the gaze occupies a central place. She describes the following scene: “my dad (stepfather) and Paul (a boy she likes) are looking at me looking at a girl”. She hesitates, “I don’t know if I am bisexual or not.” She knows she likes boys and she wonders why her gaze was attracted to this girl.
Amy discusses situations in which she likes boys but she ends up sacrificing the possibility of these relationships for her mother. In my interpretations I point out her choice. She explains: “she fears that I might get pregnant as she did.” Amy assures me: “there is no risk that I will get pregnant, what happens is that I am too ‘attachada’ to my mom.” I ask: “’tachada’?” (which is Spanish for “barred?”) and she replies: “I wanted to say too attached…” I repeat, “You said, ‘attachada’”, and she responds, “well, like a tack (‘tacha’) stuck (‘pegada’) to the wall.”
My question, “’tachada’?” (“barred?”), aims at what I considered her position regarding her mother and the relationships she has with boys: her moving forward with a relationship with a boy is barred in order to remain with her mother. Similarly to her fainting from the school scene, when confronted with a boy she is not able to stay in the scene. However she adds an interpretation of her position: she is too attached to her mother; she is this tack that is stuck to the wall (her mother). Hence, while Amy remains stuck to the Other she is effaced as a subject of desire.
The S1, “attachada” appeared here. The construction, “being beaten,” would allude to her “being attachada”. In Spanish “beaten” and “attached” are used with the same word ‘pegada.’ Either she is too “attachada” or she does not have a place in the Other and falls down. On her entrance to treatment Amy wanted to cut her wrists: May this cut be linked to her attempt to separate from the (m) Other? The death drive would be acting upon her without a limit. Amy seems to be calling for a limit to it. What might be a limit for her? Amy appears to be assuming a hysteric position. Would she be able to renounce the phallic identification and access to femininity? Let us recall Lacan’s statement in Guiding Remarks for a Convention on Female Sexuality: “Castration (…) presupposes the subjectivity of the Other as the locus of its law. The difference between sexes is denatured by its alienation. A man serves here as a relay so that a woman becomes this Other to herself, as she is to him.”3
Amy is one of the patients classified as a “patient of risk”. The ethic of psychoanalysis points toward a change in the subjective position that implies an assumption of responsibility for the position of jouissance. This is only one extract from the experience of the cure, of which many questions and challenges remain. However, it reflects the possibility of working in a practice oriented by the psychoanalytical ethics that allows a space for the emergence of the subject in its singularity.
In the institution I count with the analyst’s desire; the analytic act is supported by it. I used to think that my discontent and the obstacles to work in the Lacanian orientation were caused by the “mental health system in the United States”, but I now think that one of the main barriers comes from the way I position myself in relation to this system. Thus, beyond the influence of the institution or the mental health system, it is my own responsibility to prevent myself from becoming caught by the discourse of the institution. For that I hold onto my analysis, control, and spaces to train in the Lacanian orientation.
1Lacan, Jacques. Founding Act (1964). In Television. A Challenge to the Psychoanalytic Establishment. English trans. J. Mehlman, WW Norton & Company, 1990, p. 104.
2Lacan Jacques. Book XVII. The Other Side of Psychoanalysis (1969-1970). English trans. R. Grigg, 2007, W.W. Norton & Company, p. 65.
3Lacan Jacques. Guiding Remarks for a Convention on female Sexuality (1960), In Ecrits. English trans. Bruce Fink, W.W. Norton & Company, 2006, p. 616.