A psychoanalyst’s day at the Public Hospital

Photo above: Teatro San Martín, Buenos Aires, Argentina

Roberto P. Neuburger

Invaded by relentless anxiety, even anguish, a middle-aged man tells us about the beginnings of his dreadful pains. These began some days before, the exact moment he was diagnosed as a diabetic. He was instantly struck as by lightning; an overwhelming abyss opened below his feet, eager to swallow him entirely, setting him on an inescapable path – he asserts – to irreversible madness. He cannot stop crying and weeping; in unending tears he succeeds to mention that – although had taken no care whatever to watch neither over his food intake habits nor his weight until that very minute – since the fatal message he started to consider strictly his doctor’s and nutritionist’s indications and suggestions, to a literal detail. Nevertheless, he sustains that his unfortunate end in insanity has already been decreed and sealed with absolute, unfailing precision.

His sorrow seems impossible to calm down. Most evidently, no medical information, optimistic and soothing as could be, is able to relieve him at least a minimum; this compels the listener to infer that his unease stems from another, yet unknown origin.

The symptom is usually connected to a thread that leads to a “navel” of truth, cryptically registered – sometimes as an absence – in a remote or even mythical history. The examination of the array of signifiers that have been successively loaded upon as a cover may provide some hints to a possible reconstruction, a trace to unravel. The “trauma”, Freud tells us, is not just a single moment: its significance might be analogically unleashed when a representative signifier indicates or points at a still hidden, unsaid and untold past 1(we shall return to examine this mechanism later on).

The patient had been referred to us by the Emergency Ward, as its psychiatrist there was either absent or far too busy at the moment, but his disarray was too intense to be able to enlighten any of us any further.

Only in a second interview he becomes capable to add some indicative recollections; his father appears as an insisting, iterative, even determinant memory.

He knew him, and remembered him correspondingly, when he was a child. The man used to announce enormous enterprises with which he would accordingly earn huge fortunes, whilst carelessly squandering big amounts in disproportionate adventures. Indeed, probably persecuted by inexorable debts, he abandoned his family to flee and settle abroad.

Some time afterwards, his mother informed the subject that his father had died; thus it was recorded at his school admission and all other written proceedings. However, years after and due to other people’s accounts or statements, he managed to know not only the fact that his father still lived, but also the country and city he had moved to. Then he planned to travel abroad to meet and know him.

The reunion took place, indeed. He stayed at his father’s abode to spend some time with him, in an attempt to recover the loss. In fact, they shared some mutual satisfactions, like watching sport matches on television, some drinks – he came to the hasty conclusion that they both were “the same”.

However, there were serious limits to make their shared joy stumble upon. As his parent went on to perform his grandiose and instable business ventures, he severely endangered his health: he was… a diabetic, and took not the slightest notice whatsoever of any recommendation a physician would provide him with. His sudden end, clearly foreshadowed, was as quick as abrupt.

Back in his homeland and years afterwards, the diagnosis our patient receives shatters and hits his entire identification scaffold. His recollections foresee the return of the repressed, as the transference allows a different opportunity to unfold. Indeed, it’s the only means to calm down the emotional turmoil and thus give way to the possibility of an insight.

Let us turn back to Freud’s text: the “Project” demands two scenes for a symptomatic manifestation to take place 2. The second one refers retroactively to the first, with analogical features that either establish or allow the metaphoric substitution. The ensuing event’s “traumatic” character obtains its significance due to its link with past-time signifiers, mythically overlapping like the layers of an onion. The counter-transferential obstacle for practitioners, however, is a usual tendency to consider the subject as a mere victim – an object and nothing else – without any possible choice.

In the excessive actions that only yield pure loss – either economically or vitally – as well as the abandonment of his family, the father figure casts a devastating shadow. Besides this event plus the frenetic road to death, it may be observed this was not the only time he disappeared, as the mother enunciated the news of his passing away after remaining without any news since long, having this recorded even in documents. Our subject was thus left “between deaths4 until another woman – the diabetes specialist – utters again an ominous sentence. Mourning does not manifest itself in painful narcissistic retraction but as a silent undercurrent, until the anguished outburst with which he presents himself to us.

If this brief narrative could seem like setting back the psychoanalytical clock to the times of “abreaction and catharsis”, we should also stress the parallel fact that the presence of psychoanalysts in a Public Hospital might signal a hopeful detour to the relentless advances of marketing-psychiatry. The latter uses psycho-active drugs to muffle and stifle chemically “incorrect”, unwanted phenomena in order to generate the “adequate behavior” the Social Ideal demands. The Freudian unconscious does not hide buried in unfathomable depths for a Master to interpret setting his Knowledge in motion, but lurks in the folds of everyday life 5; subjective history and the truth at play do not cease to exist, so we may expect its insisting efforts to be constant enough to drill themselves a way.


1 Freud. S., Entwurf einer Psychologie (1895), http://www.lutecium.fr/Jacques_Lacan/transcriptions/freud_esquisse_de.pdf, pp. 34-39 (Aus den Anfängen der Psychoanalyse, Fischer, Frankfurt a. M., 1975, pp. 297-384)

2 Freud, S., op. cit.

3 Verhaeghe, P., Trauma and Psychopathology in Freud and Lacan: structural versus accidental trauma, in: Beyond Gender: From Subject to Drive, Other Press, New York, 2001, pp. 49-50


5 Lacan shows us this in his comments of Poe´s “The Purloined Letter”, where the efforts of the too-much-knowing police officers are mockingly disabled by the cunning Minister, who leaves the highly treasured paper in the most evident, undisguised spot, being absolutely sure they will never find it despite all their “scientific” endeavors (Lacan, J., Le Séminaire sur “La Lettre Volée”, (1954-55), Le moi dans la théorie de Freud et dans la technique de la psychanalyse, Seuil, Paris, 1978 (see also http://www.ecole-lacanienne.net/pastoutlacan50.php ); see also Écrits, Seuil, Paris, 1966


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