Photo above: Proa Foundation Art Gallery, Buenos Aires
Depression? Indeed, what can psychoanalysis, psychoanalytic practice, and – last not least – the psychoanalysts make out of this word, the so-called “pervasive illness of our times”? Does its overtly descriptive character act as a helpful aid or rather as an obstacle for a structural inquiry?
A noted British analyst used to say that the meaning of “depression” does not need to be elucidated – up to this extent might it be claimed to be unequivocal. Perchance this fits perfectly with current psychiatric outlooks – the explicit aim of classification manuals, be it the DSM or the ICD system, avoiding any theoretical discussion in order to reduce the meaning spectrum. A thoroughly successful endeavour? The irresistible ascent of the SSRI (or other) antidepressants should prove full positive an answer…
Every development of modern linguistics could reply, however, that no single word is able to avoid a universal polysemic character. And certainly, when used by the patients we usually see, meanings do multiply in an endless progression, until analytic working-through produces a different, transference-centred and metapsychologically supported (but ever unstable) “diagnosis” – which, in turn, should be again de-constructed.
Indeed, Serge Cottet (1985, p. 68-86) asks himself whether the “disturbance” could not be considered during the achievement of analytic experience for the simple reason that it did not show up, or whether the confusing assembly of the so-called “depressive states” is liable to become a part of the Freudian field (and to be interpreted as an effect of the Unconscious) as soon as a little ordering, tidying-up task is attempted. Even if he resolutely adopts the second hypothesis, perhaps the first alternative should not be set aside altogether…
I. Approaching the sources: Freud, the logic of experience
Besides the descriptive and frequent use of the commonplace term “depression” regarding several clinical phenomena, every scholar immediately refers to the big texts on melancholy: Trauer und Melancholie (Freud, 1915a) and Das Ich und das Es (Freud, 1923a) – as Eric Laurent (1988, p. 3-17) sensibly ascertains.The shadow of the object has fallen on das Ich, yes, where it should be wise to render the latter as the subject. This identification effect would bring us back to the first logical moment of the subject’s production, i.e. alienation; the unachieved separation which thus fails to follow would account for the painful experience and its similarity to mourning – as Lacan (1962-3,1964) establishes during his Seminars X (on Anxiety) and XI (on The Four Fundamental Concepts of Psychoanalysis). Of course, this determines not only the signifiers the subject identifies with, but the way a specific kind of jouissance – psychic suffering, self- indictment – associates itself with its particular fundamental fantasm as well 1.
The second Freudian text – the setting in motion of the 2nd topographic chart – deals with the difference that separates this particular identification with the hysteric type: the “object” of identification ensuing its loss is a particular one, the Dead Father. As well known, Lacan has dealt extensively and particularly with this instance, demonstrating its function as the Symbolic agency κατ΄ εξοχήν.
Fortunately, an additional – and seminal – metapsychological text has been recently published, and that is Übersicht der Übertragungsneurosen, where Freud (1915b) further explores the structure with a reference to “another turn of the screw” on the Totem and Taboo myth:
„Die Trauer um den Urvater geht aus der Identifizierung mit ihm (her)vor, und solche Identifizierung haben wir als die Bedingung des melancholischen Mechanismus nachgewiesen“.
To regain the context of the former writings, Freud does not consider “depression” as a separate entry in his metapsychologically-sustained nosography (transference neuroses encompass only hysteria and obsessional neurosis, with anxiety hysteria as the hinge between the two former)), while manic-melancholic psychosis does occupy a significant place within the “narcisstic” categories.
Even if Laurent does not mention it, it would have been possible to determine the clinical resonances of these developments in a later text, the very much-neglected Teufelsneurose (Freud, 1923b). Christoph Haitzmann’s melancholic marasm and lethargy immediately follow the death of his father, and the visions of the Devil should bring him the succour of an adequate substitute.
Even without the support of such accurate example, Laurent makes here a wide leap and approaches this identification type with Lacan’s preclusion of the Name-of-the-Father, the basic mechanism at work in psychosis (let us remember that from Seminar III onwards, “preclusion” had become the current translation of the Freudian term Verwerfung, extensively discussed during the Wolf Man’s clinical narrative). It follows that the excess of jouissance that this identification involves, empties the world of its pleasure (thus reversing the Lustprinzip) and determines the melancholic state’s inertia.
Arriving at this point, should it not be wise to continue the clinical examination and find out what our times of turmoil –and incessant progress of technology – have made out of, or even split apart, this carefully established structure?
II. Moving away from the sources: the DSM-system’s background and its effects
A psychoanalyst, working as a Liaison-Consultant at a Public Hospital, stands between different worlds; an incessant confrontation between Psychoanalysis and Medicine, between the field where subjectivity may briefly appear as a glimpse, and Science which necessarily excludes the individual. Let us comment a handful of clinical vignettes, arising from our daily chores:
A Liaison-Consultation is demanded in an inpatient department; the patient has a former diagnosis of “bipolar disorder”.
The interview takes place in her room, where she lies in her bed, her sister at her side. Between both stands the small night table; on top of it, a display of the medicines she takes. These are in adequate correspondence with her diagnosis: torrents of lithium, streams of carbamazepine, waves of chlonazepam.
– I have some periods of euphoria followed by periods of depression – she says.
– The psychiatrist insists that it’s convenient for her to remain always “at the same level”, without those ups and downs – her sister adds.
– How’s that “euphoria” like? – I start to inquire.
– Well, everybody insists that I speak too much, too fast, and I certainly feel happy.
– But – I insist – does that mean any trouble to you?
– No – is her answer- none at all.
– And the “depression”?
– Ah, when it comes, I like to stay in the dark until midday.
– And after midday?
– I go out to do my everyday shopping, as usual.
A few days afterwards, I narrate the case to an expert psychiatrist. He explains to me that there are two different psychiatric criteria: the “categorical” one, in which signs of a “category” (e.g. “bipolar disorder”) are looked for, and the “dimensional” criterion, in which a “minimum-sign bipolarity” is supposed to exist, and this must be attacked with medicines to prevent the development of the full “illness”.
I have depression – a patient says – and went to see a neurologist. He diagnosed Major Depressive Disorder.
Vincent van Gogh: Sorrowing Old Man (At Eternity´s Gate), 1890, Kröller-Müller Museum, Otterlo
Naturally, he exhibits several small boxes of an ever-changing series of antidepressants, currently or formerly used. There hasn’t been any change with them; due to his age, he was removed from service and lowered in category. From driving the General Manager’s automobile, he had to sink to steer the vehicle of lower employees. Retirement came soon afterwards, involving a feeling of futility, the frugality of a minimum income. A predicament that fluoxetine, designed perhaps strictly for energetic yuppies, does not reverse.
Another patient utters: – I’m a Bipolar. The psychiatrist urged me to join a self-help Bipolar Group.
A crucial point during the medical act is the communication of a diagnosis. In the psychiatric field’s swampy territory, torn between the enclosure of Medical Order and the opening elicited by a subject’s demand, does not a nominative sentence involve its risks? For the analyst, a please doctor, what do I have? as an expression of the irreducible aspect of demand, impossible to be questioned any further if it is suppressed or muzzled with a hasty, premature answer, sets him before his task: to persevere as an analyst, without any ready-made recipes taken from established (“known”) Knowledge.
Neither abstinence nor neutrality are a concern for the psychiatrist, when he delivers a label to his patient. The fact that neurosis establishes a pseudo-identification with this signifier, and that anxiety (either diminishing or increasing) shall be henceforth associated with it, does not worry him. Small talk: words are but superficial phenomena, without any material substance, a mere, superficial by-product of the Ball of the Neurotransmitters; these are regarded as the material and efficient cause.
Psychiatry knows in advance what is Good or Beneficial to the Organism. The Pharmacon is the gadget that promises to alleviate or cancel “suffering”. There is no need to ask whether this alleged suffering does or does not fall together with the demand, or even if the latter acts as a screen for desire. (Naturally, the responsibility of the subject is not lesser: seeking a safe hideout may comply with the Master’s commands). Returning to Freud is also a risk, if its signifiers are placed in a dominant position. The analyst can only have the place of a “wise ignorance” (ignorantia docta) to produce a questioning subject: Timaios asks Socrates: I wish you to give us the best, and most perfect pharmacon, that is, Knowledge 2.
Let us close this small chapter recalling Freud’s Teufelsneurose . We have the sensation of not having discovered anything new: in fact, Haitzmann the inhibited painter shares pretty much with our mentioned patients, in his surrender and dependence to the Other that do not allow doubts as to his position.
Times have changed, and the renowned M.D. now comfortably occupies the omnipotent site the Devil had once and before; nonetheless, the depressed’s requirement from the Other, for which he is eager to pay with his own enslavement, is by no means less evident.
III. On the road to Lacan: some aspects of transference
The problem of Psychiatry – and, indeed, of any psychiatric diagnosis – is its hybrid character. On one side, it has to deal with the subjective aspect of the symptom, while at the same time it has to deny this aspect entirely (and with it, subjectivity as such) to gain its access to the Medical Order 3.
Lacan’s theory of the Four Discourses might be useful here. According to it, there are only four possible discourses 4, each one indicating a definite type of social bond. All discourses share the same constitutive elements, but these elements are arranged differently within each particular discourse.
As well known, the Medical Order has the structure of the Master Discourse, which forecloses the subject 5, and with it any social bond that does not pertain to the Master’s supremacy. A further narrative may illustrate this:
I once attended a psychiatric “interactive” course. The audience was not allowed to ask questions directly to the lecturer –, as it was usual in pre-technological, vanished times. These outdated habits of the past were replaced by multiple-choice questions that appeared ready-made, projected on a screen. Each member of the audience was provided with a remote-control unit to answer with, by dialing the corresponding number. Any dialogue was excluded, technology had eliminated it (The “multiple choice” type of questionnaire may portray the essence of the Master Discourse altogether: you’re supposed to answer exactly what the Master requires).
A lecturer was at odds with statistics which indicate that there is still a small part of the inquired individuals who prefer not to have any psychoactive medicines prescribed: a remainder of the dark ages. Fortunately, the rest of the population says yes to medical discourse and even demands the pills. Our new Knock 6 realized that there is still a lot of work to do to rectify public opinion and attain complete conversion. Extra medicinam nulla salus.
This excludes another aspect of the symptom, at least as psychoanalysis understands or even considers it. To Medicine, a symptom may be an isolated phenomenon, universally equal at any time or any place, it’s the M.D. who may relate it to his Knowledge, and the patient is but a mere data provider. To psychoanalysis instead, knowledge (un-known) is of the Unconscious, and even if the analyst is “supposed to know’” the fact is that he is wholly ignorant when listening to a patient the first time. Further still, all his “knowledge” and “expertise” wouldn’t help him much: his skill should be to suspend it altogether and wait for the exquisitely particular signifiers to unfold. These will soon show that any “symptom” relates to the Other, and cannot thus be isolated in any way. Disappointingly as it may seem, the individual’s symptom has no universal value, only a particular significance for that singular subject. Of course, there are several other differences: e.g. the important phenomena for psychoanalysis – the sites where anything pointing at a truth might be suspected – are precisely those that Science rejects to the waste-basket (“noise”, “errors”, etc.): dreams, slips of the tongue, jokes.
Indeed, the DSM system’s procedure and method attempts to separate every symptom (be it of the “Mood disorders” that we are considering, or any other category) from its social aspect, being thus able to insert it in a medical context. This is, indeed, a necessary aspect of Medicine: otherwise any investigation (e.g. pharmacological testing with randomised control groups, etc.) would be impossible. As we have seen, however, it’s with “psychic” aspects that this structure soon shows its impossibility and/or impotence 7.
Nevertheless, the relationship with a general context where social bonds are increasingly difficult and questionable is evident. Lacan pointed at a general phenomenon, the weakening of the Father-figure in the Western world, the dissolution of authority and simultaneous ascent of nude, obscene power; needless to say, it would be useless to make a general pathogenic moment out of this, as it would amount to yet another hybrid mixture of sociology and psychoanalysis 8. However, its continuing association with the so-called “new pathologies” remain an open enquiry.
IV. Depression and the analytic experience
Lacan’s references to “depression” are scarce, indeed. Throughout the Seminars, nonetheless, most of them concern the Kleinian invention of the “depressive position”: Still further and on same thread, he relates it to the question of the termination of an analysis.
It has been, indeed, the great merit of Melanie Klein (following the steps of her mentor Karl Abraham, as both Cottet and Laurent do not fail to mention) to associate the depressive phenomenon with the possibility of a moment to conclude, die endliche Analyse. Mourning associated with a separation lies in the core of the “depressive position” where, perhaps, it is the relinquishing of past ties, of past hopes of an answer coming from the Other that would entirely satisfy the demand of one’s own Real drive – a partial and painful understanding of its impossible character, together with the necessity of a new and original starting point. Rather than imagining a fantastic ballet of sadistically destroyed partial objects that haunt the defenceless ego, Lacan terms this turning point “la destitution subjective” 9 and makes it fall together with another occurrence to be grieved, the disappearance of the “subject supposed to know” (sujet suppossé savoir) as the analyst falls from this position to that of an (un)desired – or: no longer desired – object. This also shows us the practical side of considering depression – and, indeed, any “diagnosis” in the light of transference and on the ground of metapsychology, rather than a supposed a-theoretical, purely phenomenological approach: structural lack can neither be erased nor entirely translated into signifiers, while loss – even if by “false association” (Freud’s falsche Verknüpfung) appears to relate to it on the surface – should, indeed, be tackled 10.
Not a “happy ending”, then: the candid images of an everlasting gratitude and a fully rewarding hug between analyst and patient may, of course, conceal a remaining dependence that cannot coincide with the dissolution of transference. However, the creative possibilities of the resulting “sujet averti de l’inconscient” cannot, after all the efforts, be that bad…
1 A note should be made here regarding the extreme passage, the suicidal act. While it s different meanings strictly depend on the subject’s position, the most “primitive” aspect – primitive, indeed, because not even alienation has been firmly established – is to “extract” the un-detached object from the Other, to avoid being its unlimited jouissance and let it fall in the Real: the window frame has been considered the signifying limit of this ultimate attempt, achieving a failed nothingness when most “successful”. See Anon., Scilicet (1968).
2 Plato, Κριτίας, 106b
3 It would be naughty indeed to recall that the simultaneous acceptance and rejection of a signifier (the definition of disavowal, Verleugnung) is characteristic of perversions…
34 These are: the Master Discourse, the University Discourse, the Discourse of the Hysteric and the Discourse of the analyst. See Lacan (1968-9), Verhaeghe (2001).
5 See Clavreul, J. (1973).
6 In Jules Romains’s comedy (Knock ou le Triomphe de la Médecine, starring Louis Jouvet in the first performance), Knock – a fake doctor – takes over a medical consultation room in a small country village, submitting every one of its inhabitants to the Medical Order. His motto is: Every healthy patient is an ignored sick individual.
7 These two terms are not intended here as a debasing critique of Medicine, as Lacan includes both of them in all remaining discourse’s structure. As Verhaeghe (2001) has shown, this is no sad circumstance, as it proves to have a protective nature.
8 This is an extremely complex phenomenon that can’t be dealt with here. Besides the triple register (Symbolic, Imaginary, Real) that can be applied to the concept, the Freudian “father” splits at least in two contrasting aspects, the limitless jouisseur of the Totem and Taboo matrix, and the propitiatory legislator of the Moses and Monotheism variant of the former. See Zizek (1997), Verhaeghe (1999), Zafiropoulos (2002), Neuburger (2003).
9 Other instances of vacillation in Being can propel movement during an analysis and thus be decisive in the progress of the cure. This happens in the well-known case narrative of “Frieda”, Margaret Little’s (1956) psychotically melancholised patient, that Lacan (1962-3) extensively commented in his Seminar on “Anxiety”. The analyst had thoroughly practiced all the resources the books and teachers at the Institute had ordered her to use: first to interpret the schizo-paranoid “tranference”, then the “depressive position’s”, but neither of these two “technical” procedures succeeded in eliciting any change. Little’s famous intervention was to give a voice to the void, to her emptiness and disparaging desperation. The outcome is well known: the patient suddenly reacted like never before, on her road to healing experience. Lacan explains that this was exactly the point where transference actually started, and not in the imaginary false steps that the Master Discourse prescribed.
10 This involves the general context of the ethical dimension in analysis, and it may be, perhaps, one of the possibilities to give meaning to one of the most awkward statements by Lacan (1974, p. 39), his pinning of the label “lâcheté morale” on sadness or depression. Despite erudite attempts at working through the aphorism, neither Cottet nor Laurent, alas, are able to do much with it, beyond acknowledging its sacred character. Of course, the potential danger of debasing it to a moralistic affair (the kind that psychoanalysis should strictly avoid) is unmistakable.
Anon. (1968) : Essai sur la signification de la mort par suicide. Scilicet, Seuil, Paris
Clavreul, J. (1973) : L’ ordre Médical, Seuil, Paris
Cottet, S. (1985) : La “belle inertie”. Note sur la dépression en psychanalyse. Ornicar?, No. 38, Navarin Éditeur, Paris
Freud.S. (1915a): Trauer und Melancholie. G.W. 10:428; S.E. 14:237
Freud, S. (1915b): Übersicht der Übertragungsneurosen. S. Fischer, Frankfurt/M, 1985
Freud, S. (1923a): Das Ich und das Es. G.W. 13:237; S.E. 19:1
Freud, S. (1923b): Eine Teufelsneurose im XVII. Jahrhundert. G.W. 13:317; S. E. 19:67
Lacan, J. (1962-3): Le Séminaire, Livre X: L’angoisse (unpublished)
Lacan, J. (1964): Le Séminaire, Livre XI: Les Quatre Concepts Fondamentaux de la Psychanalyse, Seuil, Paris, 1973.
Lacan, J. (1968-9) : Le Séminaire, Livre XVII : L’envers de la psychanalyse. Seuil, Paris, 1991
Lacan, J. (1974) : Télévision. Seuil, Paris
Laurent, E. (1988) : Mélancolie, douleur d’exister, lâcheté morale. Ornicar?, No. 47, Navarin Éditeur, Paris
Little, M. (1956): “R” – la réponse totale de l’analyste aux besoins de son patient. In : Le Contre-Transfert, éd. Colette Garrigues-Nancy Katan-Beaufils. Navarin Éditeur, Paris, 1987
Neuburger,R. (2003) : Contra la disolución. Psicoanálisis y el Hospital, Ediciones del Seminario, No. 23
Verhaeghe, P. (1999) : Love in a time of Loneliness, Other Press, New York
Verhaeghe, P. (2001) : Beyond Gender. Other Press,New York
Zafiropoulos, Markos (2002): Lacan y las ciencias sociales: La Declinación del Padre. Nueva Visión, Buenos Aires
Zizek, Slavoj (1997): The Big Other doesn’t exist. Journal of European Psychoanalysis, Il Mondo 3 Edizioni, No. 5