Araceli Teixidó – Clinic under transference vs. statistic correlation
Lacan points out how science was constituted by an operation of exclusion of the subject (2) (3). And so it was, that science, this powerful mode of knowledge, allowed an approach of a world alien to the human fantasies and, in medicine, an approach in which, initially, the input of the researcher and the patient did not count. Starting from the scientific input, one understands that the bacillus attacks a person – regardless if the person is a sinner or not – or that some antibiotic promotes healing – regardless of whether the doctor is reliable or not. This constituted enormous progress in the medical field at the therapeutic level, and moreover, liberated the patients from remaining submitted to the fantasies of the professionals who treated them.
Therefore, the introduction of science in medicine was an improvement at all levels. However, it did not prevent the fantasies of the professionals from continuing to operate, and nowadays we encounter them in the form of the reduction of the human to a neural network. The subject, excluded by science, is captured by the latter under the form of the cerebral causality. We could consider the neuro as a generalized fantasy, or perhaps a delusion.
When we work with patients that have suffered cerebral damage, we find ourselves immersed in an environment in which causality is without failure established between the cerebral and the subject’s reactions. For example, depression is one of the expected neurological consequences in patients who have had a stroke and are even prescribed preventive antidepressants. As Jacques-Alain Miller points out (4) the statistic correlation is imposed on the clinical criteria. It seems to me that one of the things we can do is show with our clinic under transference the cases in which the statistical criterion is contradicted thus pointing elsewhere.
I attended a young woman who had suffered a stroke, for whom the hospital team consulted me for her apathy. She agreed to see me and in anticipation of any offer, she formulated a demand: understand what had happened to her. What did she mean? She exposed the coordinates of her recent life. Her husband had died in an accident some years ago and she had remained in such a state of shock and perplexity that she went to a psychiatrist who gave her medication. She stopped taking it when she realized that it offered her an empty joy. She consulted one psychologist who told her what she should do. She left them both, they were not what she needed. She was still under the effects of impossible grief.
The narrative of the case went through her previous personal situation and the conditions of those days. The patient located a trigger for the discomfort to which she attributed the stroke. Arriving at this point, she concluded that the stroke had given her a renewed meaning to her life, a reason to fight. And she announced to me that our treatment had come to an end.
Therefore, it was not necessary to resort to the brain, nor to the signifier depression, nor to any statistic correlation in order to intervene. The stroke allowed a substitution to cover the hole left by the husband.
One other young patient that had also suffered a stroke, consulted me because she was scared: the narrative of the case gave an account for the signifying determination that linked the heart problem from which she suffered to a subjectivity in which the repression of affects left her alienated in a relationship in which she repeated the maternal ravage. The transference lodged that malaise that could be treated.
Again, nothing of the neural network, only the signifier’s network.
One other woman came with her husband, he was aphasic after a stroke but made himself understood very well. I had treated him during the hospitalization and from the beginning, he had overcome with great personal skill and decision the difficulties imposed by aphasia, being able to overcome the difficulties of the rehabilitation process, of the disagreement with the professionals and his professional reorientation. In addition, speech therapy went well and he had improved a lot. Her complaint: she could not understand him because of the aphasia. After listening to the brief narrative that followed this complaint, I said: “but have you ever understood this man?” They both laughed promptly and I interrupted the session. Later, I learned that the effects of appeasement were very important in displacing the organic causality to psychic causality, thus introducing something that had to do with castration and life.
The so-called cognitive science, current psychology, has promoted a way of understanding the human mind as a dead letter and the discomfort as a series of erroneous items that need re-programming. No one contemplates about who decides the program, what for, nor the fact that whoever intends to reprogram is doing nothing more than an exercise of imposing one’s position of power that is based on the axiom of the neuro. Axiom, fantasy or delirium: something non-proven that organizes perception and research (5). The program of personal jouissance escapes all scientific determination, as it was established with the subject remaining outside this mode of knowledge. The scientist drift – it is not the fault of science – should halt with the acknowledgment that the subject cannot say anything. The moral doctor who addressed guilty subjects has been followed by the scientific doctor who addresses those whose failure is located in the brain. It is a matter of ethics, not of knowledge. The leap between both types of approach to the world requires acknowledgment of the flaw, which only holds under transference.
In the proceedings of the Seminar in May, we will be able to move forward starting from the distinction between cerebral effects and the position of the subject in a table that will be guided by the psychoanalytic clinic as an indication of another way of coping.
Translation: Polina Agapaki
Re-read by Lorena Hojman Davis
- Paper presented at the meeting of the Seminar towards Pipol 9, which took place on February 26, 2019, in Barcelona.
- Lacan, J. “Science and Truth” in Écrits. W.W. Norton & Company
- Dessal, G. “Prefacio” de Las ciencias inhumanasRBA
- Miller, J.-A. Todo el mundo es loco Paidós pág. 145
- Miller, J.-A. “Néuro-, le nouveauréel” en Revue La Cause du Désir. Núm. 98. Marzo, 2018. Págs. 111-121
* Araceli Teixidó, is a psychoanalyst, member of the ELP and the AMP. A clinical psychologist in the Healthcare Units of the Sant Jaume Hospital (Calella, Barcelona) Coordinator of the Psychoanalysis and Medicine Network (ICF).