Among Freud's papers on technique there is one entitled "On beginning the treatment" where he mentions his habit of taking on the patient "at first provisionally, for a period of one or two weeks", which he calls "preliminary experiment" or "trial period". His reason for employing this "experimental treatment" is the following: "If one breaks off within this period one spares the patient the distressing impression of an attempted cure having failed". He does not explain why the treatment could fail; however, as we shall see further on, the treatment's continuation depends on transference.|
In this same paper Freud asserts that the analyst's first objective is to attach the patient to his treatment and not to the analyst himself, as a person. Although Freud doesn't explore the theme of transference thoroughly during this "experimental period", he is very clear about another of his tasks - diagnosis, and in particular the differential diagnosis between neurosis and psychosis.
Lacan's expression "preliminary interviews" corresponds to Freud's "preliminary treatment". The expression indicates that there is a threshold, an entry into analysis that is not the same thing as the entrance giving onto the analyst's office. It is a preliminary working period, prior to analysis proper, which begins not in continuity to this initial work but, as the name "experimental treatment" itself suggests, after a rupture, a cut that qualifies a change and determines a before, a preliminary, and an after. This cut corresponds to the crossing of the threshold into a new social bond, which in our case would be the analytical discourse.
In our everyday practice of analysis it is not always easy to detect this turning point, this passage. Why is this so? Because in both phases, during the "preliminary treatment" as well as in analysis, free association is at work and commands. "This preliminary experiment" says Freud, "is itself the beginning of psychoanalysis and must conform to its rules". We might make a distinction, however, in that during this initial phase one may allow the patient to do nearly all the talking and explain nothing more than what is absolutely necessary to get him to get on with what he is saying. Thus we have an indication that at this moment the analyst's chore is merely to keep the patient's discourse going. We must not, however, forget that, according to Freud, there are diagnostic implications that this "preliminary treatment" is necessary. It is at this moment that the question of the diagnosis is at stake.
The "preliminary treatment" may have the same structure as analysis but yet it is not the same. From the very beginning there is a paradox which we may express as follows;
P T = A <--> P T # A
which we may read as: "the preliminary treatment is same as analysis" implying that the "preliminary treatment is different from analysis". From this we conclude that:
1. free association maintains the identification of the preliminary treatment and analysis (PT = A);
2. this period of diagnosis renders the preliminary treatment different from analysis (PT # A).
The analyst must submit to this paradox, wherefrom he will decide whether or not to accept the demand for analysis. From the analyst's point of view the preliminary interviews may be divided into two periods: a to comprehend and a moment to conclude, when he makes his decision. It is during this moment of conclusion that the psychoanalytic act is performed and assumed by the analyst, the act which transforms the preliminary interviews into analysis proper.
The cut which this passage implies is an act which can be signified to the subject by the analyst when he indicates that the analisand should lie down. This cut is the analyst's way of manifesting to the candidate that the analyst accepts him for analysis. It is an important indication since the fact that the analyst has accepted that someone should come to his office does not mean that he has. accepted him for analysis. The subject knows he is a candidate to be an analisand, and hopes the analyst he has chosen will in turn accept the subject for analysis. In constituting this double choice the subject is impelled to elaborate a demand for analysis, which can be verified, as we shall see, in practice, as a hystericization factor (Sbarred --> S1) in the production of the analytical symptom (symptom of analysis).
We can divide the preliminary interviews, into three functions, which have a logical rather than a chronological order.
1. The "symptomal" (sympto-mal) function
1st - the "symptomal" function;
2nd the diagnostic function;
3rd the transference function.
In analysis the demand should not be accepted in its raw form, it should be questioned. The analyst's reply to someone who arrives with an explicit demand for analysis cannot be, for example, the proposition of a contract and a fee. Lacan tells us there is only one true demand which leads to the beginning of an analysis the demand to be rid of a symptom. Someone who asks for an analysis to know himself better, would receive a clear answer from Lacan: "l send him off." Lacan does not consider this, "wanting to know oneself better" as deserving the same status as a demand deserving an answer.
The demand for analysis stands in correlation to the elaboration of the "analytical symptom" as such. What is at stake during the preliminary interviews is not whether or not the subject is analyzable, if he has a strong l or a weak one to support the hardships of the analytical process with. The analyzability is a function of the symptom and not of the subject. The "analyzability" of the symptom is not an attribute or quality such as something which appertains to the symptom: it should be sought after in order that the treatment (cure) may begin, transforming the symptom the subject complains about into an analytical symptom.
The subject may present himself to the analyst to complain about his symptom and even to ask him to rid him of it, but this is not enough. This complaint must become a demand which is addressed to the analyst and must move from the status of an answer to the status of a question for the subject in order to impel him to decipher it. In this preliminary work the symptom must be questioned by the analyst who will try to discover what the symptom is an answer to, what jouissance the symptom is there to delimit. In Freudian terms this problem may be set forth as follows: why did the repression fail and the repressed return allowing the symptom to be formed?
The "Rat Man's" debt, for example, presents itself as a symptom which comes as an answer to the subject when the jouissance emerges upon hearing the story of the punishment recounted by the cruel captain. It is upon this factor that the whole question of the debt and the impossibility of paying it is established.
In the case of a patient who presents himself to the analyst with an obsessive idea which makes him suffer, it is necessary that this symptom, which is a signifier for the subject, once more acquires its significant dimension and implicate both the subject and his desire. The symptom which appears as the signifier of the Other, s(A), is addressed along the chain of signifiers to the analyst, who is himself in the place of the Other (A) and must transform the symptom into the question Lacan presents as "Che vuoi?" (in Italian), the question called desire. Desire is, thus, a question which the analyst must introduce into the symptom's dimension.
The constituting of the analytical symptom occurs simultaneously to the establishment of transference which brings forth the SSS, which is the pivot of transference. This moment, when the symptom is transformed into an enigma, is a moment of hystericization, since the symptom thence represents the subject's division (Sb). As long as the symptom is part of the subject's life the life he was accustomed to before meeting his analyst it can be considered a sign (or signal): that which represents something to someone. When this symptom is transformed into a question, it appears as the expression of the subject's division. It is at this moment that the symptom, upon reaching the right address, the analyst, becomes explicitly analytical. This is what Lacan means when he says that "the analyst completes the symptom" which corresponds to the hysteric's discourse (hysterical discourse, discourse of the hysteric.
Bearing this symptom the subject turns to the analyst with a question what does this mean? What does this signify? In order to assume such a position one requires a certain knowledge, for one supposes that the analyst detains the truth about one's symptom in the form of a production (product)-the hysterical subject pushes the master (S1) up against the wall so that the master will produce a knowledge (S2), a knowledge about the jouissance at stake and which comes to show the truth dodged by the symptom. The maneuver is destined to fail, due to the impotence of the knowledge to explain the truth about the jouissance (a), constituting, nonetheless, a social bond according to the definition of discourse which Lacan gives us.
---- --> ----
The enigma (Sb) is directed to the analyst (S1), who is supposed to withhold the knowledge: the analyst is thus included in the symptom, completing it. During the preliminary interviews it is therefore a question of provoking the hystericization of, the subject, since the hysteric is the name given to the divided subject, the exercise of the unconscious itself.
2. The Diagnostic Function
The question of a differential diagnosis in psychoanalysis presents itself only as regards the direction of the analytical cure: diagnosis and cure (in the sense of "treatment") stand in a logical relation to one another of implication: D --> C (if D, then C). The diagnosis in psychoanalysis makes sense only if it serves to direct the analysis. Thus the diagnosis can only be made on the symbolic level, where the fundamental questions of the subject are articulated (sex, death, reproduction, paternity) at the moment of the crossing of the Oedipus complex: the effect of the inscription of the Name of the Father in the Other of language is the production of phallic signification which allows the subject to inscribe himself in the division of the sexes.
It is therefore from the standpoint of the symbolic that the structural differential diagnosis can be made, considering the three ways of denying the Oedipus denial of the Other's castration which corresponds to the three clinical structures. One type of denial denies the element but conserves it, manifesting itself in two ways; in the neurotic's repression (Verdrängung), a denial which denies the unconscious; in the perverse denial (Verleugung) which denies but maintains the fetish. The forclusion (Verwerfung) is a type of denial which leaves no trace or vestige: it does not conserve, it wipes out. Both types of denial which conserve the traces imply the admittance of Oedipus in the symbolic, which does not occur on the forclusion.
Each way of denying has a concomitant form of return of that which is denied. In repression (Verdrängung) proper, the that which is repressed in the symbolic returns in the symbolic itself in the form of the symptom the neurotic's symptom. In denial (Verleugnung), that which is denied is concomitantly affirmed in the symbolic, returning in the form of the pervert's fetish. In psychosis, the denied in the symbolic, returns in the real in the form of mental automatism, whose main form of expression are hallucinations. Since the return is carried out in the real, away from the symbolic, one uses the neologism "forclusion" coming from the French where the term designates a legal process which has prescribed, which we can no longer mention because legally it no longer exists. The term "forclusion" as a form of denial indicates in itself the place where the return occurs, an "inclusion" outside the symbolic.
How does this structural differential diagnosis manifest itself in practice?
Freud tells us that in neurosis the Oedipus complex is the victim of a shipwreck which corresponds to the hysterical amnesia. The neurotic does not remember what happened in his childhood. We have the example of the Rat Man given to us in the phrase: "if I see a nude woman my father must die". The repression of the representation of his desire, that his father should die returns in the symbolic, in the form of the symptom: the obsessional thought expressed in this phrase indicates his Oedipal structure, the prohibition of seeing a nude woman as connected to his father. The symptom thus furnishes an access to the organization of the symbolic which represents the subject.
In perversion castration is admitted in the symbolic along with a concomitant refusal, a denial. This mechanism, as well as the other types of refusal, occurs in relation to the female sex: on the one hand there is the inscription of the absence of a penis on the woman and, therefore, of the difference between the sexes, but on the other hand this inscription is denied. The return of this particular type of refusal becomes crystallized in the fetish, whose symbolic determination can be apprehended in the language structure as we can see in the example with which Freud begins his article on Fetishism. It is interesting to note that Freud does not use the classical examples of fetishists, those who venerate the foot, underwear or any other object closer to common sense; Freud exposes the case of a patient who had, as a condition for his desire, a link to a certain "glance at the nose" of the other. Analysis revealed a translinguistic play of words which allowed the link to be understood: shine in German "glanze" is homophone of "glance" which in English signifies "look". The secret of this fetish resided in the fact that in the first years of his childhood this subject had lived in an English-speaking country. This was the clue which led to the constitution of his fetch, which demonstrates how it was determined by symbolic elements present in the subject's history and denotes, as all fetishes, the drive object in question (the look).
In psychosis, however, the significant returns in the real, pointing out the relation of exterior the subject maintains with the significant, and with troubles of speech in general, as can be verified by any clinician who comes across a psychotic patient. The psychotic paradigm are the hallucinated voices. One can also find delirious intuitions where the subject attributes an enigmatic signification to a certain event, without being able to make explicit what it is; echo's of thought, where the subject hears his thought repetitively, going as far as to attribute resonance to someone; imposed thoughts, where the subject does not recognize the chain of signifiers which acquires an autonomy as his and refers to it as the work of another in short, the whole train which Clérambault denominated "mental automatism" and which renders certain ideas unfit for dialectics. They are ideas. which impose themselves as monolithic blocks since they are unfit for dialectic pondering, since they cannot be questioned nor submitted to doubt. Doubt is a characteristic of the neurotic because it denotes the division of the subject, who has a yes and a no. In psychosis, certainty, delirious certainty par excellence, already shows a disturbance in language. On the other hand, the forclusion of the Name-of-the-Father implies the "zeroing" of the phallic significant (NPO --> mo), rendering it impossible for the subject to take a place in the division of the sexes as a man or a woman an effect which may manifest itself through a series of phenomena, going from the experience of construction (vivência de construção) as far as the transformation into a woman.
Freud describes the function of the diagnosis in his text "On beginning the treatment", precisely as regards the cure of psychotics. "l am aware that there are psychiatrists who hesitate less often in their differential diagnosis, but l have become convinced that just as often they make mistakes. To err, moreover, is of far greater moment for the psychoanalyst than it is for the clinical psychiatrist, as he is called. (...) Where the psychoanalyst is concerned, however, if the case is unfavorable he has committed a practical error; he has been responsible for wasted expenditure and has discredited his method of treatment. (...) He cannot fulfil his promise of cure if the patient is suffering, not from hysteria. but from paraphrenia, and he therefore has particularly strong motives for avoiding error in diagnosis". We agree with Lacan when he says that a subject as such cannot be cured, in relation to the cure as the expected effect of an analysis: he cannot be cured of his unconscious. In as much analysis as one can go through, even when one crosses one's fantasy (goes through) reaching the end of one's analysis, the unconscious will not cease to manifest itself the subject is barred (SB), as the persistence of the slips of the tongue, dreams and jokes in analyzed subjects demonstrate.
Nonetheless, which promise of cure is the analyst unable to sustain in psychosis? There is only one answer to this question. the analyst cannot promise to insert the psychotic in the phallic norm; he cannot make him "normal", insert him in the male norm. The norm is ruled by the Oedipus and castration complex, whose product is the primacy of the phallic significant for both sexes. The forclusion of the Name-of-the-Father (NF) excludes the subject from the phallic norm (NF > mo), crossing out any hope the analyst may have of making the balance tilt for the patient to the side of neurosis. One cannot therefore change a psychotic into a neurotic. This is what one can deduce from Freud's warning, as confirmed in the continuation Lacan provided of his teaching, as well as from the analytical experience itself.
If the subject is psychotic, it is important that the analyst knows it, for the direction of the cure (treatment) cannot have the Name-of-the-Father and castration as its reference. Thus we have the importance of detecting the subject's clinical structure during the preliminary interviews.
Another way of interpreting the Freudian text is to consider that Freud was against psychoanalysis for psychotics. In Lacan we find certain indications which point to the need for caution, although he leaves it up to each analyst to decide whether or not to accept a psychotic for analysis. "It happens that we accept pre-psychotics for analysis, and we know what the result will be psychotics." Analysis, being the place where speech is grasped, may lead to the triggering (setting off) of a psychosis which had hitherto been undeclared. We also find, nevertheless, other indications. "Paranoia, or rather psychosis, is absolutely fundamental to Freud. Psychosis is that which the analyst must not shy away from, under any condition." In these cases we may interpret that when confronted with a psychosis which has already been triggered there is no reason for the analyst not to accept the subject's demand. Lacan gives other indications concerning the structure of the psychotic's transference which at least show that his position is not one of thinking that analysis is not inadvisable.
As regards the direction the cure (of the treatment) during the preliminary interviews it is important to go beyond the level of the clinical structures (psychosis, neurosis, perversion) to reach the level of the two clinical types (hysteria and obsessional neurosis), although there should be some hesitation, in order that the analyst may establish a strategy for directing the cure, to avoid its being ungoverned.
The basis of the analyst's strategy in the direction of the cure (treatment's direction, directing the treatment) regard the transference, to which the diagnosis must be correlated.
Since the analyst will be called upon to occupy the subject's place of the Other the place of the Other given by the subject) to whom the demands are addressed, it is important to detect in the preliminary work the modality of the subject's relation to the Other.
For the obsessional neurotic the other goza (sustains, relishes), a terrifying and mortifying jouissance as illustrated by the cruel captain brought to the forefront, through his story of the punishment with rats in the case of the Rat Man.
For the hysteric, the Other is the Other of desire, marked by the absence and the impotence to reach a jouissance (orgasm), as is demonstrated by Dora's father whose desire she sustains through the symptom of loss of voice (determined by the fellatio fantasy):
SB a --> s (A).
This connotation of the hysteric's sexual orgasm (jouissance) of a lesser pleasure and of the obsessional's greater pleasure is pointed out by Freud, as far back as the notes taken in draft K of his correspondence with Fliess. With the intention of establishing an etiology for neurosis he attempts to differentiate hysteria, obsessional neurosis and paranoia beginning with the mode of jouissance felt during the first sexual encounter and the vicissitude of the representations linked to this experience. This form of qualifying the clinical type's mode of jouissance is a diagnostic criteria which is determined by the fundamental fantasy which should not be disregarded during the preliminary interviews.
3. The Transference Function
"In the beginning of psychoanalysis is transference", Lacan tells us, and its pivot is the SSS.
The subject's appearance under transference is what gives the signal of the entrance into analysis, and this subject is linked to knowledge. This is what may be apprehended through the. formulation of the rule of free association by Frau EMMY VON., when she asks Freud to keep quiet: she sustains a knowledge which is present in what she has to say herself.
The decision to find an analyst is related to the hypothesis that there is a knowledge at stake in the symptom or in that which the person wishes to be freed from. It is what Jacques-Alain Miller calls the pre-interpretation formulated by the subject regarding his symptom.
The establishment of transference is necessary in order that the analysis may begin-this is what we call the transference function (transferential function) of the preliminary interviews. The transference is not conditioned nor motivated by the analyst. "It is there", says Lacan, "in the Proposition accorded by the analisand. We do not have to present reasons for what conditions its existence. Here it is, right from the beginning." The transference is not, therefore, a function of the analyst but of the analisand. The analyst's function is to know how to manage it.
The first formulation of this question can be found in Lacan's article called "The Function and field of speech and language", when he refers to the transference of knowledge. It is an illusion in which the subject believes that his truth is already present in the analyst and that he knows it beforehand. This "subjective error" is inherent to the entry into analysis. The subjectivity in question is in correspondence to the constituting effects of transference, which are different from the effects already constituted previous to that moment. This subjectivity correlated to knowledge as a constituent effect of transference is what Lacan will formulate under the term of .......................... sujet supposé savoir. "Each time", he says in Seminar XI, "that for the subject this function of SSS is incarnated by someone, whomever he should be, analyst or not, this means that a transference has already been established."
The SSS is defined by Lacan at the beginning of his teaching as, "the one who is constituted by the analisand in the figure of his analyst", and later on Lacan will make him the equivalent of God the Father. To identify with such a position is to transform the analysis into a practice based on a theory (or a theology) which does not include error.
The separation of the function of gag from the analyst will appear clearly in Lacan's formalization of the entry into analysis, a formalization which is elaborated using algorithm of transference:<
S --------> Sq
The algorithm of transference is the matheme of the entry into analysis; it is the formalization which is in resonance with what Freud postulates at the beginning of his text "On beginning the treatment", when he makes the famous comparison between psychoanalysis and a game of chess: "Anyone who hopes to learn the noble game of chess from books will soon discover that only the openings and end end-games admit of an exhaustive systematic presentation and that the infinite variety of moves which develop after the opening defy any such description." Freud says he will only formulate a few rules for beginning of the treatment. The algorithm of transference is the answer, in an effort to formalize, independently of the structure each one may have, the structure of the entrance into analysis itself.
s (S1, S2, ... Sn)
The "S" in the numerator of the fraction is called the significant of transference's a significant of the analisand goes in the direction of another significant, any significant (Sq), which comes to represent the analyst. This significant which is fabricated by the analisand will make him chose this particular analyst: and may be a family name or some particular trait. Lacan formulates this choice of the analyst as an articulation of two signifiers corresponding to the establishment of transference significant transference. The effect of this; significant transference is a subject, represented in the formula by s (signifier), which is related to the signifiers of unconscious knowledge (these signifiers S1, S2, ..., Sn, set in chain formation represent a set of signifiers of unconscious knowledge). The articulation of the transference significant with the "any significant" of the analyst chosen by the analisand has the effect of the production of the subject: that which one significant represents to another significant
This subject is not real, he is produced as a signifier (s) articulated according to a supposition of unconscious knowledge. What we have here is the institution of the subject of free association inaugurated by the significant articulation (S --> Sq) which is the subject of the unconscious itself which we find represented in the formula of the fantasy (Sb a). It is this subject which will be dismissed when the transference relation ends: "the subjective dismissal", says Lacan, "is inscribed on the ticket at the entrance". This SSS, here represented by the denominator, is not necessarily imposed upon the analisand. The important factor is the relation the analyst establishes with the SSS.
---- --> S2
"The SSS, upon the foundation of the transference phenomena does not bring the certainty to the analisand that the analyst knows very much far from it! The SSS is perfectly compatible with the factor that it is conceivable by the analisand that the knowledge sustained by the analyst is quite doubtful".
Evidently the analyst knows nothing of the analisand's unconscious. We can see this clearly in the algorithm where the "any significant" (Sq) which represents the analyst is not related to the unconscious knowledge. What we have here is a formalization of Freud's statement that each new patient implies in the constitution of psychoanalysis itself: The knowledge one may have of other cases has no value, it cannot be transposed to this case. Each case is, therefore, a new case and must be thus considered.
The algorithm of transference is constructed using another algorithm which can be found in its base: the Saussurean algorithm S/s, which implies the referent of the linguistic sign, that to which the linguistic sign points to, that is the element of the world which is designated by the sign.
In the transference algorithm the signification of the unconscious knowledge corresponds to the place occupied by the referent in the Saussurean sign, except that the signification of knowledge is latent, maintaining however its status of being a reference. Lacan articulates this knowledge reference of the subject in its particularity with textual knowledge, since "psychoanalysis owes its consistency to Freud's texts". Lacan links "psychoanalysis in its intention to psychoanalysis in its extension" using the transference algorithm, for he counts on the transmission of particular knowledge via its articulation with Freud's texts.
What is the effect of the establishment of the SSS? It is love. With the appearance of love we have the transformation of the demand, a transitive demand (demands something, as for example to be freed of the symptom) becomes an intransitive demand (demand for love, for presence, since love demands love).
Love is the effect of transference, but an effect which has the aspect of resistance to desire as being the desire of the Other. Once this desire has appeared, in the form of a question, the analisand responds with love; it is up to the analyst to bring out from this demand its dimension of desire, which is also connected to the establishment of the SSS. The SSS here corresponds to a subject supposed to desire and conditions him. We have here the articulation with the symptomatic function of bringing out the dimension of desire to make it appear as desire of the Other, leading the symptom to the category of an enigma through the implicit link existing between desire and knowledge which becomes desire to know.
It is not enough to demand to be freed of a symptom; it must appear to the subject as a code and therefore something to be deciphered, through the dynamics of SSS.
What does this transference love want? It wants to know (it wants knowledge). Transference itself is defined by Lacan as "love which is directed to knowledge" (love which seeks to know). Nevertheless, its finality, as it is for all love, is not knowledge itself but the object cause of desire. This object (the object a) is what confers the real aspect of transference: that of the real of sex (sex's real). We have here a side of transference which corresponds to the putting into action the sexual reality of the unconscious. Transference as an encounter belonging to the order of the real of sex comes to counter transference as a repetition where the signifiers of the demand are addressed to the Other of Love (Love's Other) where the analyst is placed. It is the object a, which when filling the constitutive absence that is part of desire becomes the marvelous object which Socrates serves to contain for Alcibiades. Agalma.