Therapeutic Effects Following an Institutional Experience

The debates currently taking place in mental health are evidence of the efficacity of the normative, prescriptive approach. Yet the principle of normalization is not a psychoanalytic notion. Its origins are Scandinavian. Dr. Wolf Wolfensberger defined this approach as the use of culturally normative means to establish and maintain personal behavior and characteristics that would also be as culturally normative as possible. This conception is a reference for the behaviorist approach, whose ideal consists in improving the conditions of life until they resemble as closely as possible the dominant cultural standards. An individualized educative program is drawn up, one that sets the objectives according to the requirements of society and aims at an integration into the community. The objectives are defined in terms of behavior, i.e. as observable and measurable traits. The procedure is intended to be prescriptive, and a result that would augment the quality of life of the individual is expected.

Psychoanalysis is interested in what does not consist of a prescribed measure but in what might emerge, through the detour of the unexpected, as a creation. Does not Lacan introduce his Ecrits with the Buffon-esque aphorism, "The style is the man himself"¹?. He adds later that "the style is the object"².

The author Yves Clot, a professor of work psychology working from concepts developed by Bakhtin, brings up an interesting distinction between style and genre. He defines genre as a collective reference indicating the admitted or displaced social and professional practices in a given in-group and style as constituting the individual distance that each member introduces in relation to the genre³. In this perspective, the behavioral approach convokes the genre whereas psychoanalysis preoccupies itself with the style.

Let us examine what, in a life, can be written in terms of style by examining the institutional trajectory of a young woman.

She has a long institutional history. She arrived at the institute nearly ten years ago with a rag doll – an imaginary double that she had carried with her for a long time – and a flute. She was fifteen years old and had just left the hospital where she had been interned for the last few months.

She was raised in a musical family. Her older brother played the guitar and her mother played the piano. Her parents described her as having been a difficult child who adopted a position of systematic refusal, crying frequently and reacting with spectacular fits of anger. She always had difficulty learning but showed herself to be an assiduous student of solfège. Encouraged by her parents, she took piano lessons that she later gave up in favor of the flute, her chosen instrument.

Adolescence precipitated this psychotic subject into a state of breakdown. She began to refuse school and found refuge on her bed, where she sucked her thumb while rocking back and forth. Her relationship with boys became eroticized; she no longer manifested any inhibition (pudeur) and began to exhibit her body. The doctors at the hosptial where she was treated oriented her family towards a specialized establishment where she could stay during the week in order to introduce a physical separation from her mother, a separation that was lacking in the symbolic.

When she arrived at the institute, she presented herself as someone who liked art and played the flute. She responded to the questions that were posed to her by saying, "The art of the flute can't be explained". She had the certitude that "even before starting she had known that she would be capable of playing the flute because she had the right kind of lips".

Her arrival in the group was very disruptive. She tolerated neither demand nor frustration. She claimed to be persecuted and was aggressive with the other children. When she spoke – and she spoke often – the timbre of her voice would go up and up until it eventually dissolved into strident cries. This voice was omnipresent, speaking, singing, or shouting. Despite all of her efforts she had no friends because she incessantly got herself excluded whenever she attempted to set up a bond. She would offer gifts or loan out objects in an attempt to avoid being dropped, which happened to her regularly. Everything that surrounded her talked to her and threatened her. She would isolate herself, staying in her room rocking herself and making sucking noises.

She spent two years in a group at the institute that welcomed children. Her days alternated between classes at a special school and participation in the workshops organized at the institute's day center. Outside of her moments of agitation, she found support in the forms that made up the social code. She showed herself to be polite and used a courteous language that calmed her relationships with others. She was also recognized for her musical skills and asked to sign up in a local marching band. The regulated sounds that she produced by playing the flute contrasted with her persistent cries.

Although her symptoms had lessened in intensity she began to complain about living together with the younger children. Their noises were intolerable for her. She wanted things to be calm and hoped to enter the Courtil Young Adults center, a residence that was in town. As soon as she arrived, she asked to sign up for the music conservatory and the theater. In doing so she introduced, straightaway, a doubling of the location that assured circulation. Inside the group she shared her daily activities and outside she engaged in her various personal occupations. Although music remained a success, the theater put her in difficulty. Being "the one who went to the Conservatory" became for her an identification with which she supported herself and which also assured her of a particular place in her family, who occupied a certain place in society.

When she turned eighteen she underwent a new destabilization. A thought imposed itself: "At eighteen one does what one wants". Her drives came unfastened and an episode of erotomania irrupted. She felt like she was loved by a certain young man and solicited him by exhibiting herself to him. She had come unstuck and the institutional frame no longer formed a limit. The same thing happened when she turned twenty, and from then on any contact with the other sex would be interpreted as rape. She no longer succeeded in managing her relationships with the other young adults, reproaching them and accusing them of theft. She continued to complain about the noise and the proximity of bodies encountered in communal living. She fell back on writing and wrote letters in which she denounced disorder. Although she tried to name what persecuted her through writing rather than through her cries, this attempt proved nonetheless to be insufficient. It was in this chaotic context that she formulated a demand to be put in a studio.

The Studios were created at the institute in 1999. Although the residents live in apartments, there is a thorough institutional supervision. Moving into a studio does not cap off an institutional journey, and organizing an itinerary from this point of view would inscribe our practice in a progressive procedure supported by normative values such as autonomization and socialization. Etymologically, the term "studio" was used in the 13th century in Italy to designate "the artist's studio". For everyone who lives in our studios, then, invention is thus what is at stake. Experience has demonstrated that there is no "one best style" that would authorize the admission into a studio. The limits encountered in the social bond do not appear as a contra-indication. Entry does not depend on a project but on a "calculation"⁴. "Although a framework is proposed, it is above all an unprecedented bond that the subject enters into"⁵.

This is how our patient moved into her studio. A program was drawn up with her: an activity for every day of the week, daily contact with the team of educators stationed at the studios, and a calendar maintaining regular visits with her family at home. This program came to occupy a mediating place between her and her mother and allowed her to keep her mother's impromptu visits at bay. Outside of this program, the team was discreet, avoiding intrusive demands while assuring a solid presence. Once installed in her studio, she went through some difficult moments during which she would not answer the telephone or accept any visitors, forcing the team to deploy a number of strategies to obtain the right to enter. She lived with her blinds drawn, menaced by the gaze that she supposed to be ominpresent. She continued to meet the team with cries whose messages remained difficult to decipher.

However, in the midst of all this agitation, nothing stopped her from going to the Conservatory. She often asked us to drive her there. We would agree even though she knew how to get there on her own. She decided to take lessons in declamation in addition to her flute and voice lessons. She refused to take any interest in the text and concentrated her efforts on the articulatory movements necessitated by the pronunciation of the words. She was keen on inscribing this exercise "outside of meaning" (hors sens), in this way protecting herself from the proliferation of meaning. She was an exemplary student who prepared her exams and obtained brilliant notes. She practiced her exercises in her studio, even though she would forget the time and end up confusing day and night. During her vacations she would participate in singing programs that obligated her to get up early every day, take the train to the capital, and engage in collective life. So far no bad encounters have taken place during these activities.

Let us investigate the coordinates that determine this young woman. Her mother's demands compelled her to submit herself very early to the difficulties of solfège. A few years later, when her brother chose the guitar, she opted for the flute. "It was a question of sound", she specified. But the history that she has constructed for herself tells us a little more. This interest that she designates as “a passion” was transmitted to her by her maternal grandfather, who was an oboist. He would tell her how, as a prisoner of war, he used to play the oboe in his cell. This practice allowed him to get through the unbearable waiting and lightened his suffering. “I do like him because playing helps me to suffer less”, she says. Nevertheless she chose the flute, even though she likes describing the oboe down to the smallest details. Once back from the war, her grandfather wrote her a musical score that she inherited. It is a unique object that her mother conserves preciously and that will be given to her later. Thus, her musical practice inscribes her in the maternal lineage and concerns three generations. Her father is permanently excluded and it is with derision that she exclaims, “My father doesn't have a musical ear. He understands nothing about music and never will.”

Her life thus appears coupled to her grandfather's history. This imaginary identification allows her to put a barrier between herself and the jouissance of the Other. Music, playing the flute, singing, and, more recently, declamation, constitute the anchoring points for our young artist. Let us remark that singing and flute-playing consist in practices that she has chosen for herself and that constitute her savoir-faire, inasmuch as this savoir-faire “is art, artifice, that which gives to the art of which one is capable a remarkable value”⁶. The rigor with which she she applies herself constitutes a treatment of the object-voice and limits the invasion of jouissance. After arriving with her cries and her habitual sucking she has created for herself a new relationship with jouissance. If the flute allows her to treat the object-voice, it procures a body for her as well. When the flute falls and breaks what follows is a loss of ego and troubles that appear in her body.

In the absence of the phallic function, music is what comes to name the desire of her mother. It is a support point where the real, the symbolic, and the imaginary are knotted. It pacifies her relationship with the Other and allows her to circulate in the world. She listens to variety, learns classical music, attends musical comedy, went to Verona to trace the path of Romeo and Juliet, and has begun to read Shakespeare. She scours the music stores, visits with friends to exchange CD's, has conversations about what's going on in the musical world... Music has given her a link that does not identify her with the object of jouissance of the Other, thus protecting her from being cut loose. All other forms of the social bond quickly turn bad: friends become thieves and lovers become rapists. Because of this, no professional training is feasible.

Our practice with this young woman does not aim at introducing a bond but rather a separation at the point where separation has failed and where the Other's presence is intrusive. Therefore, when she seeks shelter in her studio and refuses to give us a sign we are obligated to respect this retreat. Isolation is a response to an invasion by the Other, and when she resumes contact with the outside world it is because she has succeeded in minimally separating herself from this persecuting Other. Her institutional trajectory has allowed her to give form to a style of living centered on an art that calms her symptoms and inscribes her in the social community. In the absence of the Name-of-the-Father she has constructed a sinthom that for several years has supported her. Her symbolic determinations are spread out over three generations and she has been able to introduce her mark by choosing the flute instead of the oboe. As her mark, the flute thus has a writing function. It is a “style” in the sense of the etymological origin of the word, the Latin “stilus” that we have preserved as “stylus”.

If “the subject's singular, particular axiom – otherwise put, his fantasy – is what writes his life just as the style, for Buffon, is what constitutes the unique character of an author”⁷, then we can say that this young woman has been able to invent for herself a style of living that operates as her fantasy insofar as it “tempers jouissance”⁸.

A psychoanalytically oriented practice does not found its investigations on measures that would allow a quality of life to be prescribed but, rather, wagers on a style of living that consists of the unexpected and which has demonstrated, until now, a certain efficacy for this young woman.