“L´Amour Médecin” (Medical Love)

Photo above: Teatro Argentino (Opera theatre), La Plata, Argentina

Summary

Is there a medical Knowledge about Love? In ancient times, Medicine found no obstacles to consider and include subjectivity and its disconforts (indeed, shouldn’t Love be regarded as a passion?) as we can observe in Eryximachus’s speech during the Platonian Symposium. When Freud mentions love – to which his hysteric patients inevitably lead him – the separation of discursive structures already begins to take shape as a definitive one. Beyond scientific universality – that Medicine cannot avoid as its permanent, solid reference – lies its remainder: subjectivity, the waste-object that only psychoanalysis can deal with. A couple of examples from the clinical practice of Liaison-Psychoanalysis – including a brief encounter with physicians affected by the impossibility of explaining “what does not cease to write itself” – show the perennial shortcomings, even impossibility of any “interdisciplinary” approach.

Freud and Lacan spoke and wrote about Love –  as Paul Verhaeghe (1999) tells us 1, and he goes on to point out how strange this may seem to anybody expecting a “scientific description”. Indeed, we’d rather place love within the poetic world than in a discursive order that excludes subjectivity. Even considered by “human sciences” – he keeps asserting – emphasis is always laid on “relationship disorders” or “communication problems”.

How different things were in centuries past! At the Platonic Symposium, the medical guest, Eryximachus, has no problem taking his turn when called to lecture about Love from his highest position as a Doctor, thus embodying Medicine’s outlook. Although distinctions exist, there is at least no discord between tekhne, praxis and episteme. Neither is there any conflict with the poises, that is, the results.

A.Feuerbach, Das Gastmahl des Plato - Plato's Banquet /Paint./Feuerbach/ 1869 -

Anselm Feuerbach, “Plato´s Banquet”, Alte Nationalgalerie, Berlin

If – as Lacan has pointed out in his extended interpretation of Plato’s text – all the discourses unfolded during the peri erotos share a comic atmosphere, we won’t be surprised to find the medical doctor’s academic haughtiness attempting to convince us of the existence of a Universal Harmony, as well as of the far-reaching, un-withholding grasp of Science in all matters.

As Iannis Sykoutris (1955) says, the first lines of Eryximachus’s speech 2 already show the assertion of comprehensiveness, as he criticises the former (Pausanias’s) address as insufficient. Love shouldn’t be considered as the talking-being’s privilege, but rather expanded to the entire cosmos: the filling and emptying of the body find correspondence in the harmony of macrocosmos and its meteorology. However, considering the happy and loving confluence of Herakleitos’s arch and lyre, or Empedokles’s hate and friendship, is there not an inexactness, an embarrassing, far too wide-ranging broadness that leaves us slightly ill at ease?

What would a doctor do nowadays, invited as a guest at a Banquet, if asked to deliver his thoughts on love from his viewpoint as a practitioner of Medicine?

No connections should be attempted with any nostalgic, romantic reminiscence: at one or another spot of their practice, love is there waiting to meet them, to question them, even touch or injure them.

Some physicians would – perhaps – be seized by a sudden attack of hiccups; others would argue that a “psychologist” should rather deal with those matters. Or – following Eryximachus’s footsteps – they might describe the visible, physical, bodily signs of love’s excitements…

Sergio Benvenuto (1998,p. 33) narrates that in the XVIIth Century, a series of images were distributed throughout the German and Flemish regions for popular entertainment: a man – clad in the severe, bizarre and obscure habit doctors wore those days – examines a pale maiden’s heart rhythm, regardless of the fact that her other hand clutches an open letter. Likewise, in Molière’s comedy from which we borrowed this draft’s title, Sganarelle appoints not less than five doctors to examine his melancholic daughter Lucinde; however, only the chambermaid Lisette accurately interprets a territory unfamiliar to the scientists 3. And then – if the doctors do know, neither would they be able to say it out loud nor to admit it, as remembered by Freud of his medical masters Chrobak, Charcot and Breuer. Acknowledging this might be not so much a gesture of indomitable courage (as post-Freudian hagiographic epics would like to make us believe) but rather the passage to another structure, where the constituent elements have already changed their relative positions.

 Moliere lucinde

Molière, “L´Amour Médecin” (Lisette and Lucinde), Pont-à-Mousson, 2011

In the daily surroundings of the Hospital’s corridors I meet – for example – two gynaecologists. Some moments before, I was actually looking for them in the Gynaecology Unit, to discuss a Liaison-consultation they had precisely requested.

The patient was brought to the Emergency Ward, and had to be immediately operated (her adnexa were removed). Her history featured a pelvic inflammation, and an ectopic pregnancy was inferred. She had to remain an in-patient until confirmation or refutation of the hysto-pathologic report.

Most obviously, these gynaecologists need to talk (the meeting extends itself significantly), as well as to sustain an ideal that would make sexual relationship consistent. The two ends of the Freudian tunnel, drive and desire, must meet, never diverge, never clash: God has created us and made us men and women, one of them adds. Solid convictions are these, with which undesired, unwelcome phenomena are set aside or done away with: all the patients deny, disavow or even repudiate the mentioned “sexual relationship”.

To be exact, the in-patient had emphatically ruled it out: when the gynaecologists insisted, she admitted that this happened only two or three times. They go on associating some puns, anecdotes, stories about other patients: one of these complained about lack of libidinous impulse. A most clumsy colleague had suggested her to see a psychologist, disregarding – what an unpardonable blindness! – the presence of a severe hormonal deficiency.

Indeed, Love must have a Real support, a substance with an identified, established chemical formula to sustain itself, unyielding, perpetual, steadfast and unbending. It must be so: should anyone find out that its materiality is but the signifier’s, its failure might cry out loud…

However, let us turn back to the questioned and questioning patient. She is visited daily – thus do the Unit’s nurses narrate – by her psychiatrist.

We interview her placing a chair next to her bed. She meets us, overtly pleased and well inclined. She tells us her own version of her relationship with her visitor. He is a well-known sexologist, frequently seen on TV or other media, who gives her Prozac and Clonazepam on account of her panic attacks. He doesn’t charge her any fees, knowing her lack of resources due to an ongoing legal suit (she’ll explain this afterwards); besides, she usually works for him, keeping his consulting room clean. However, she mentions her determination to take less of those pills.

At the same time she slightly rises up – removing the sheet she covers her legs with – she mentions that the attacks started after her former partner distributed a photograph of her, taken during an intimate encounter, among the drivers of the car rental agency she had at the time. The image showed her with naked breasts. She starts to shed tears, and goes on to say that, in order not to be recognized, she attempted to disfigure her face by means of self-mutilations. Her employees had begun to sneer at her, and she was driven to close the agency. She sued her man, and the legal procedures still continue, after many twists and turns.

The interview comes to an end. An incoming patient enters not only the ward’s spatial environment, but becomes subject to its structure, its hierarchies, organisation and mechanisms. She will be examined not by a single physician, but by several professionals who will recognize in her the objective support of a supposed “illness” (the reverse order – a patient remembering her examiners – does not always apply, as the curious phenomenon named “institutional transference” frequently omits names and individualities). Residents, staff doctors, the head of the Unit, different specialists alternate to constitute a continuous pageant which stops only with the patient’s dismissal.

Indeed, when I return the following day, she is no longer there. The staff physician has given her an appointment for a follow-up. The purpose of the required consultation, i.e. clearing out, even erasing the strangeness of the “psychiatric aspect” – a body foreign to Gynaecology – is considered already appropriately documented as well as unravelled.

Some other day, I enter the Internal Medicine Unit. A diagnosis is required for a thirty-year old woman who suffers from convulsions, suspected to be actually conversions. She hardly speaks at all – or insists that she does not remember anything – her general condition is not good, and it’s her mother who bathes her. The elder woman narrates a story where men only play the role of offspring-providers (the patient has a three-month child) in flight, and the women either that of lonely governesses (as herself) or rivals (as, for instance, the social workers who want to seize the baby, sole objects of her scorn)

The resident who comments on the case to me stops and hesitates, then adds: and she sexually harassed the night resident. Immediately, she corrects: no, it wasn’t so, don’t listen to me, please, erase that event, it just didn’t happen.

We meet the victim – the young, harassed doctor – who tells us that indeed, the patient insinuated sexual behaviour when alone with him. Does not the requested diagnosis start to take shape?

The event-to-erase is located in the borders, or better, outside Science’s perceptive field: a waste, irrelevant gossip, unworthy of the valid examination procedures.

The Real at stake in love, the bodily abyss of the drive, must be kept still, obedient to the discourse that pretends to be its Master. The doctor should keep under control that which must be, the Sollen (see Canguilhem, 1966, p. 136) 4, to fulfil his ideal of domination. This becomes a necessity, and so does the resulting impossibility: an unattainable, ever-fleeing remainder.

And what about the analyst? What happens to him when he attempts to be active within the medical field and its hierarchies? Freud warns us regarding Love – even if only should be transference-love – no one should summon the Demons only to show them the exit door. Moreover, Lacan demands the analyst to have breasts, like Teiresias or Therèse 5. Torn between the doctor’s and the patient’s transference, his position might be similar to Madeleine’s 6, asking herself: is there any conclusion at all, which isn’t trivial?

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Notes

1 It would be hard indeed to detail all Freudian references on love (readers may recall, however, the Three Essays, the short papers “A Special Type of Choice of Object made by Men”, “On the Universal Tendency to Debasement in the Sphere of Love” and the “Observations of Transference Love) (Freud, 1905, 1910-12, 1915) – not to speak about the subject in Lacan (but we could mention “Une lettre d’âmour”, the lesson of 3-15-1973 in the XXth. Seminar – and, of course, the Seminar on Transference, where he analyses Plato’s text) (Lacan, 1975, 1991).

Verhaeghe’s whole book deals with both author’s concepts thoroughly, and the “tunnel” metaphor that we mention in our draft is found on p. 25-26:

“A normal sexual life is only assured by an exact convergence of the two currents directed towards the sexual object and the sexual aim, the affectionate current and the sensual one. It is like the completion of a tunnel that has been driven through a hill from both directions (Freud, S. 1905, p. 207);

Continuing the same metaphor, it seems that in many cases the tunnel is never finished. And even where the work is finished, you often end up with two tunnels, that is, two relationships, one for the affectionate aspect and one for sensuality. This is certainly an everyday clinical experience: tenderness gets in the way of sensuality, and vice versa…

…and continued up to the necessary conclusions from p. 59 onwards:

It will have become clear by now that, depending on the background, two different types of relationship can develop. The most painful form is the imaginary dual relationship…(which) contains a particular assumption, namely that desire and need can actually be completely fulfilled… In contrast to this, there is triangular love… These three are the self, the other person, and the lack as such, something that cannot be removed (p. 69).

2 The following words in italics refer, of course, to Eryximachus’s discourse in Plato’s Symposium, 185e – 188e.

3 Act I, scene 3.

4 Canguilhem cites Reininger, “Unser Weltbild ist immer zugleich ein Wertbild” (our image of the world is always also an image of values). The difference between « normality » and « normativity » is certainly not an easy one (the German das Sollen is usually rendered insufficiently as “should be”). Not only do both overlap frequently, but one is often substituted by the other when the distinction becomes unclear… or even impossible.

5 A character that changes from one sex to another and vice-versa, in the “surrealist drama” by Guillaume Apollinaire – set to music by Francis Poulenc, Les mamelles de Tirésias (“The Breasts of Teiresias”, first performed in Florence, 1947).

 LES MAMELLES DE TIRÉSIAS 1 foto E. MORENO ESQUIBEL

Francis Poulenc – Guillaume Apollinaire, “Les Mamelles de Tirésias”, Teatro Liceu, Barcelona

6 In the final scene of the “musical conversation piece” by Clemens Krauss and Richard Strauss, Capriccio (Munich, 1942). Countess Madeleine has two suitors, a poet and a musician. All her guests engage in a discussion concerning what is more important in opera: words or music? Alone with the lady, the poet courts her by means of a Sonnet, and she nearly faints in love – the musician doesn’t waste any time, though, and sets the Sonnet to music, which again absolutely ignites her. All the guests leave, having decided the project of an opera depicting the discussion they just had. The Countess is left alone to decide the opera’s conclusion, as well as whom to choose – both lovers shall return the following day to know her judgment. She sings the Sonnet before a mirror and asks herself again: words or music? Which of the two touches her most? The curtain falls slowly…

Capriccio-de-Richard-Strauss-a-l-Opera-de-Paris_pics_390

Richard Strauss/Clemens Krauss, “Capriccio”, final scene

Serge André (1986, p. 247), while commenting a paragraph in Encore (“l’amour, c’est de la poésie”, also mentioned by Verhaeghe 1999, pp. 70-72) points out that Socrates, between Agathon and Alkibiades, refuses to substantify the object of love. The charming Straussian countess’s position is to remain suspended between poetry and music – both are metaphors empty of any sense.

References

 

André, S. Que veut une femme?, Navarin Éd., Paris, 1986

Benvenuto, S. The Crisis of Interpretation, Journal of European Psychoanalysis, No. 6, 1998, pp. 19-46

Canguilhem, G. Le normal et le pathologique, PUF, Paris, 1966

Freud, S. (1905) Three Essays on the Theory of Sexuality, S. E. VII, p. 123

Freud, S. (1910-1912) A Special Type of Choice of Object made by Men, On the Universal Tendency to Debasement in the Sphere of Love (Contributions to the Psychology of Love), S.E. XIX, pp. 163 and 177

Freud, S. (1915) Observations on Transference Love, S.E. XII, p. 157

Lacan, J. Le Séminaire, Livre XX, Encore, Seuil, Paris, 1975, pp. 73-82

Lacan, J. Le Séminaire, Livre VIII, Le Transfert, Seuil, Paris, 1991, pp. 81-95

Sykoutris, I., Foreword (to Plato’s Symposium), edition of theAcademy ofAthens, Estias,Athens, 1995, pp.104-114

Verhaeghe, P., Love in a time of loneliness, Rebus Press,London, 1999

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