A Clinical Introduction to Lacanian Psychoanalysis - On Psychoanalysis and with Lacan

Psy-Complex in Question: Critical Review In Psychology, Psychoanalysis And Social Theory - Ian Parker 2018

A Clinical Introduction to Lacanian Psychoanalysis
On Psychoanalysis and with Lacan

Fink, B. (1999) A Clinical Introduction to Lacanian Psychoanalysis: Theory and Technique. Cambridge, MA: Harvard University Press.

Lacan is usually presented to an English-speaking audience as if he merely conjured abstract theoretical concepts out of an hallucinatory reading of Freud and into an arcane system designed to mystify and seduce his readers. Sometimes this system is described as if it were an hysterical grid that could be pressed on to the tender flesh of contemporary culture, and as if it then merely repeated its own well-worn formulae regardless of the actual shape of the things it purported to explain. Bruce Fink’s Clinical Introduction, together with his earlier The Lacanian Subject (Fink, 1995), gives a quite different grounding for our understanding of what Lacan was up to. Fink is currently Lacan’s voice on the good earth of US America, and is translating a number of the master’s seminars as well as a complete English edition of the Écrits. At a moment when there is a serious ambitious call from the Association Mondiale de Psychanalyse in Paris to conquer the English-speaking world, he is a key player in representing and redefining a Lacan that might appeal to this new world.

This is a great book, lucid, wide-ranging, and an invaluable guide to Lacan’s work as a sustained theoretical practice. But at the selfsame moment when Lacanian psychoanalysts here might breathe sighs of relief at the appearance of an accessible clinical account they should beware that their very breath is being sucked into contours which are more US American than Lacanian. It should be said that there is an opportunity as well as a threat in the text, for odd wording that might jar on an English ear may also usefully draw attention to worrying motifs in Lacan’s own work as well as Fink’s. The problem is a little different from the worry Fink anticipates when he notes in the preface that his introduction might be read as an ’unjustifiably bowdlerized popularization’ (p. xii). Rather, it revolves around the extent to which it really is the case that Lacan’s lore is or is not ’a universal rule applicable to all contexts, all patients, all cultures, and all historical periods’ (p. 224). Fink says it is not, but, aside from the fact that this squeamishness about universal truth expresses something of the postcolonial anxiety of Western liberal society and psychoanalysts trying to assuage it, the book works precisely because it is quite prescriptive and is governed by an assured confidence in the correctness of the procedures it describes. And the fact that the procedures might work does not void the fact of their cultural-historical embeddedness.

For example, in the discussion of ’Desire in Analysis’ (Chapter 1), a note takes up the issue of professional ’boundaries’, an issue which is certainly fetishized as a universal rule by therapists in the English-speaking world, and argues that ’To appeal to a universal principle like “Therapists do not socialize with their patients” is to make a false claim and miss an opportunity to bring the analyst’s desire to bear’ (p. 227). An assertion of one’s own practice may really be the best option here, but at the moment when the analyst brings their desire to bear they also, of course, present themselves as a robust role model who is able to be as assertive as the best man and they thus engage the patient in something uncannily close to the forms of identification much-beloved by US ego psychology.

The narrative of the book takes us from the process of ’engaging the patient in the therapeutic process’ to diagnosis of the three underlying clinical structures of psychosis, neurosis and perversion and then to a reformulation of what Lacanians might expect to happen at the end of analysis. Even to present Lacan in such a linear way runs the risk that he will be understood by psychotherapists as setting out the steps that should always be taken — and already this invitation is being taken up by those who claim to provide ’Brief Lacanian Therapy’ (Jerry, 1998) — rather than, at most, constructing a ladder which will provide one way up into Lacanese before being kicked away.

The ’preliminary meetings’ are one of the defining characteristics of Lacanian clinical work. These first meetings focus on history and symptoms. Like other psychodynamic approaches, there is dialogue about the nature of the problem and a sense of what the person hopes to get out of the encounter. One important question, given that symptoms give some enjoyment, is ’why now?’, what is it that has become too much to bear and what opens possibilities of change. There is also attention to the possibility that the person would be thrown into crisis by analysis — may suffer a ’psychotic break’ — and if that were the case the therapeutic work in the preliminary meetings would continue and the emphasis would be on the construction or reinforcement of a symbolic system rather than its questioning and unravelling.

Fink does not locate Lacan in the context of French psychiatry, something that is quite important given that Lacan trained first as a psychiatrist and practised as one throughout his life. This might be because the Clinical Introduction is not an historical review of the development of Lacan’s work, but The Lacanian Subject (Fink, 1995) does not provide this context either. As a result, this psychotherapeutic Lacan is able to address readers who might be wary of medical discourse and institutions even though the three clinical structures are presented as given taken-for-granted entities. Mitigating this is the openness to forms of experience that would be thoroughly pathologised by Anglo-American psychiatry.

The phenomenon of ’auditory hallucinations’, for example, which is treated as a first rank symptom of schizophrenia by the DSM of the American Psychiatric Association, is discussed more sympathetically. Lacanian psychoanalysis will not distribute experiential phenomena like the hearing of voices into one of the 550 or so DSM categories, and Fink points out that Freud’s neurotic patients (particularly the ’Rat Man’) did hear voices. Fink is quite insistent, then, that ’Taken in its widest sense … hallucination is not a criterion of psychosis’ (p. 83), and that ’What certain patients and nonpatients describe, for example, as a kind of running commentary that accompanies them in their daily lives … can be understood on the basis of Lacan’s work on the mirror stage’ (p. 85).

A little trap has been set here, however, for Fink still employs his own version of psychiatric dividing practices: ’It seems to me justifiable to distinguish psychotic hallucinations — what I’ll call bona fide hallucinations — from the run-of-the-mill voices and visions that so many nonpsychotics report’ (p. 83). And then, of course, the reference to the mirror stage, which did seem at one moment to normalize the hearing of voices as one of the varieties of experience in human cultures, is mobilised to drum home the warning to analysts that psychotics can pass as normal and clinical skill will be needed to detect them: ’the imaginary continues to predominate in psychosis, and the symbolic, to the extent to which it is assimilated, is “imaginarized”: it is assimilated not as a radically different order which restructures the first, but simply by imitation of other people’ (p. 89).

Moments when Fink opens up a little and displays a little doubt are quickly sutured in order to privilege an all too certain psychoanalytic storyline and the kind of culture that provided its conditions of possibility. So, in a reference to Jaynes’ (1976) historical study of hearing voices, Fink comments that ’if “bicameral man” attributed them to God, he did so in the absence of any psychological understanding — just as religious people of many ilks continue to do even in our own day’ (p. 248). Again, there is a balance between a cautious liberal tolerance of systems of understanding in other cultures and an insistence on the absolute necessity of a link between certain forms of child-rearing and clinical phenomena outside the frame of psychoanalytic treatment. So, on the one hand, Fink acknowledges that ’Hysteria and obsession are “structures” that, in a Western societal context, constitute a sort of great divide in subjective positions, but they are not universal, transcendental necessities. They are contingent structures based on a particular point (but quite widespread) form of society’ (p. 158). On the other hand, this is then followed by a worrying string of associations to ’psychosis’ which include ’a tendency toward transsexualism, repeated requests for sex change operations, and homosexual activity’ (p. 98), ’the rising percentage of single-parent families today’ (p. 110) and the plaint that ’more and more lesbian couples are raising children, seemingly eschewing or downplaying the importance of the father’ (p. 110).

Fink does indeed worry about these implications of a Lacanian understanding of gender (and his next book promises to focus on exactly these issues) but they are implications we just have to knuckle down to and accept. After all, ’Lacan comes to see that unconscious desire is not the radical, revolutionary force he once believed it to be. Desire is subservient to the law!’ (p. 207). Fink, perhaps, comes to see that Lacan is not the radical, revolutionary force he once believed him to be. Lacan is subservient to the law.

What of the analytic sessions themselves? Like other psychoanalytic approaches, the task of the patient is to free associate, to say anything that comes to mind however stupid or unpleasant. The overall course of analysis is not fixed in advance with a determinate number of sessions, and analysis may be thought of as ending when the analyst and patient stop meeting, though Fink discusses the various ways this can be conceptualised in the final chapter ’From Desire to Jouissance’. Fink presents a lucid account of the Lacanian position against the standard therapeutic wisdom that it is the patient who must want to change. On the contrary, the very nature of symptoms and our attachment to them is such that ’If there is desire in therapy that serves as its motor force, it is the analyst’s, not the patient’s’ (p. 4). As is well known, if not notoriously so, in Lacanian practice the length of each session is not fixed, but the end of a session, with a certain average length, will be at a point where something important is said or left unsaid. The end of the session is a kind of interpretation.

A Lacanian theoretical framework enables the analyst to make sense of what is going on, rather than leading to dramatically different interventions. Books like Fink’s function best when they are used as theoretical frameworks rather than as guides to action, and it is particularly important that Lacanians should not advise, interpret or guide their patients. Interpretation is designed to keep free association going and to open the unconscious to further elaboration. This means that comments which link ideas should be ambiguous rather than trying to fix things. This also means that transference (and counter-transference as part of transference) is not interpreted directly; there is no interpretation of the transference because this would close things down, but the notion is used by the analyst as a frame and so there is interpretation in the transference.

It is when we come to the process of change that we run up against an account which looks a lot more like common happiness than what we might have come to expect from Freud or Lacan. Analysis should enable the person to loosen their strong attachment to the symptom, and to find another position in relation to their symbolic world. The ethos, then, is one of questioning how we have come to be the way we are, understanding something of the key points in which we have become a subject, what our desire is, for what, and whose it is. Through this process analysis explores what relation we adopt to others. Fink’s take on this in The Lacanian Subject is relayed through the image of the subject being brought to life by language: ’the subject as spark that flies between two signifiers in the process of subjectivization, whereby that which is other is made “one’s own”’ (Fink, 1995, p. 173). Lest this already seem overly voluntaristic, Fink takes the idea further in the Clinical Introduction where the promise of Lacanian analysis is not so much that it provides a theoretical framework to conceptualise the subject but that it may actually give birth to that subject, however unprepared the analysand may be for this: ’He may, at the extreme, come to wish he had never been born, but at least there will be a place from which he can formulate the wish! This place is the subject, the Lacanian subject’ (p. 202).

The cover of The Lacanian Subject has a photograph of a flash of lightning crackling down to the ground, and there again is that little electric motif highlighted on the spine of The Clinical Introduction. This certainly brings this Lacan down to earth but now through US American culture which is structured by images of lightning as the spark which may bring life to a being, evident in the preoccupation with physical monsters made out of bits rather than individuals taking themselves apart in therapy, and a spark which will bring life to an end which is the fate of those in an electric chair in the States rather than on a couch. And there is also a powerful frontier image at work to describe where the sparky new Lacanian subject may be heading: ’The traversing of fantasy leads the subject beyond castration, beyond neurosis, into largely unexplored territory’ (p. 195).

This means that Fink’s introductions also read, like so many therapeutic systems and self-help manuals, as an advertisement for an individual process of taking responsibility — one-by-one but reduced to only this as a point of principle. Where there is a glimmer of social critique it is refracted through an account of alienation as always at the level of the individual’s relation to others, to one or the Other. In some respects the version of Lacan delivered to an American audience here is neither Lacanian nor Freudian, for it deliberately presents what Fink (1995, p. 69) terms ’Lacanian metapsychology’ as if it were a final state system.

The idea that Lacanian psychoanalysis might bear forth ’the Lacanian subject’ then seems to give rise to a concern for Fink that the path we trace through the different characterisations that Lacan gives of the end of analysis may not actually have arrived at the final destination yet. Fink tries to solve this by reading backwards and then assembling the different points on Lacan’s career into a coherent trajectory in which it seems as if stages in his work are mapped by ’three stages of the subject’ (p. 210): ’(1) the subject as constituted in relation to demand or the subject as demand, (2) the subject as desire, and (3) the subject as drive’ (p. 210). The developmental narrative — of Lacan’s thought and then each subject in analysis who follows him — thus serves to confirm the idea that there is a coherent Lacanian system. This rather static picture obscures the tactical subversive character of Lacan’s interventions, for the contradictions between and within the various seminars and the papers in the Écrits are the very stuff of Lacan rather than their accidental surplus.

Fink’s book provides a prescriptive and sometimes conservative description of Lacanian approaches, but it is the clearest most comprehensive account so far addressed to psychotherapists in a language they may understand and it includes detailed case studies which illustrate the playing out of different clinical structures. That clarity is itself its undoing. This is not at all to say that we should simply try to return to Lacan and romanticise an originary French source of his work, nor that we should let the English off the hook for we could match the pragmatic upbeat tone of US American Lacan with a version of our own which sits easily with empiricist discourse (Easthope, 1999). The odds are that ’clinical introductions’ here will also trace their ways through forms of representation which distort and adapt him to local psychiatric or therapeutic cultural and institutional imperatives. Perhaps it is all the better that we are able to see the cultural specificity of Fink’s account. Only by striking a critical distance from any account of the subject, after all, will it be possible for us to strike a critical distance from assumptions about our own subjectivity and thus, asymptotically, to come closer to Lacan conceptually if not clinically.