Young - Petitioning for Involuntary Hospitalization and The Involuntary Petitioning of Psychoanalysis
Petitioning for Involuntary Hospitalization and
The Involuntary Petitioning of Psychoanalysis
by Linda J. Young, Ph.D.
Using the concept of the "involuntary petition" as a semiotic vehicle, I attempt to illustrate how society attempts to maintain and reinforce fundamental assumptions of the modern episteme which were importantly challenged by the discoveries of psychoanalysis. I describe how the "involuntary petitioning" of patients in state psychiatric hospitals can be viewed as a metaphor that articulates on simultaneous levels of discourse, the "involuntary petitioning" of the unconscious, of psychologists, and of psychoanalysis, generally. Such "involuntary petitioning" can be viewed as an attempt to appropriate, socialize and normalize that which would otherwise threaten to subvert the master discourse of the individual, the psychiatric institution, the disciplines of psychology and psychoanalysis, the social order, and ultimately, the era of the 'modern'.
Insofar as this paper raises crucial questions about the practice and art of psychoanalysis-- its goals, its presuppositions and its philosophical premises, I consider it to be a contribution to the mission of the Academy. In particular, the practice of psychoanalysis in institutional settings such as the one I describe in the paper, is a particular interest of mine.
I’d like to begin by thanking the MSPP for inviting me to present my paper today. This paper is a revised version of one I presented this past October at the International Federation for Psychoanalytic Education Conference in Ann Arbor.
The present, by definition, has no choice but to be seen as modern. But our modern time revolutionarily destroys its own self-definition, for in asserting its unique vision of the world , it dramatically undermines the very essence of its identity. Our modern times show us that we are not "modern" anymore, as discoveries in the sciences, arts and humanities have eroded nearly all of the major tenets of the last 400 years , collectively viewed as the modern era. Our new modern era is defined by its limitless interrogation and displacement of known truths of the modern era. Its true definitional essence lies in its capacity to reveal the falsity of such concepts as definitional essence and truth. It exists to undermine the very thing its own representational existence must be based on. It is what it is not. And it is not what it is. Welcome to psychoanalysis. Welcome to the modern times of the no longer modern. Welcome to a view of psychoanalysis as necessarily paradoxical, contradictory, dialectical and radical. For psychoanalysis is, as I will argue, not an is but rather an incessant interrogation of the is -- a dynamic overturning and underturning of the constructions of conscious meaning making --- a conversation between a self and an ‘other’ that reveals the otherness within self, and reveals the necessary, but at the same time necessarily illusory, identity of the univocal ‘I’ that supposedly speaks the ‘truth’.
Psychoanalysis, wherever it takes place, is a process whose very essence is to subvert, question and challenge the foundations of its contextual surrounds. As psychoanalysis has developed over the last half a century, there have been numerous attempts both from outside and from within to destroy the discipline of psychoanalysis by disciplining it, and by appropriating its discoveries in such a way as to co-opt its radicality, transforming it from an interrogation of the status quo to a tool for the maintenance of the normative. One of the most powerful and insidious threats to the practice of psychoanalysis is for its practitioners to lose sight of its inherently radical, interrogating stance and to fail to appreciate its necessarily contradictory dialectical nature. Today I will be addressing certain attempts made to destroy psychoanalysis--attempts aimed at resolving the contradictory features of psychoanalysis. I will refer to these attempts as the petitioning of psychoanalysis, denoting maneuvers aimed at bringing its contrary otherness as a radical discourse into line with itself, and into line with the master discourse of the prevailing socio/political culture. These petitioning maneuvers attempt to dislodge psychoanalysis from its position of dissent, always askew to the manifest discourse, to a position concentric to society -- a place where it is used as a tool with centripetal power, pulling behaviors and attitudes closer to the center of the societal norm. I will be focusing on my experiences working for over a decade at a psychoanalytic teaching hospital , describing my experience of a socio/cultural/political system in which psychoanalysis was petitioned by a prevailing ideology which strove to coopt its radical and dissonant voice. I use it to exemplify, in the particular, my belief that psychoanalysis, generally as a discipline has been and continues to be petitioned in the service of fortifying the incumbent ideology of our culture.
I’d like to begin by briefly summarizing the radical discoveries of Freud's psychoanalysis, illustrating how, in part, it is the relationship of these discoveries to the historical context in which they were made, that speaks to their radicality. In doing so I will utilize Barratt's (1993) exposition of what he describes as the "immanifest" aspect of free associative discourse, in which he shows how there is always a contradictory, libidinous desirous otherness to communication which is somehow in the manifest associations, but not quite of them, as it is not constituted by or possessed by the manifest structurings of that consciousness. I will be suggesting that Freud's discoveries too, can be viewed as being in but not completely of the historical societal scientific context in which they gained expression.
Freud's psychology, illuminating as it did new and mysterious territories not previously explored, is nonetheless bound by the prevailing cultural rules of his time. These rules, denoted by Foucault as discursive formations, are tacit rules of discourse which delineate the possibilities for that which is to be considered ‘knowledge’ and ‘truth’ in a particular culture. In Freud’s time, the modern era, coexistent with the enlightenment, served as historical context not only to his discoveries but to the discoveries of Copernicus, Galileo, Newton, and others who contributed to the expansion of empiricism, positivism, rationalism, capitalism, industrialism, and individualism. Jane Flax (1990) describes some important aspects of the "Enlightenment story" as the following: "A coherent, stable self (male self) who himself is capable of privileged insight into his own processes and into the laws of nature." A belief that the process of reason can ultimately provide us with an objective, reliable foundation for knowledge and for judging truth. Replacing the more medieval notion of a single omniscient God who knows and judges, now rational enlightened man is in the position of knowing and judging, as long as He has reason and knowledge as his guide. Truth is understood to be value-free knowledge about something real and unchanging, whether this ‘something’ refers to our own minds or to the structure of the natural world. This "something real" is presumed to have an existence independent of knower. Language is assumed to transparently refer to these real objects in the real world, corresponding with more or less accuracy and precision to that which it illuminates , but playing no role in creating the subject of such illuminations.
Within modern era thinking, phallocentric ideology serves to organize all manner of assumptions about the world. He who has knowledge is defined as the primary, powerful standard bearing prototype against which all others are measured, compared and defined. In such a world, binary logic and dichotomous categorization prevails and the world is seen as naturally sorting itself into such categories; the female is defined in juxtaposition to the male, darkness in juxtaposition to light, child in juxtaposition to adult. That which is secondary, is seen as lacking , for it is itself defined and evaluated within a particular definitional context which privileges the first subject in the dichotomy as being the owner of a valorized and essential something. So, a child is lacking in adultness --that comes to define what child means-- darkness is that which is lacking in light, the woman is lacking in maleness, viewed in a concretized, anatomically reductionistic way as penis. In this phallocentric world view, linearized causal thinking is naturally prevalent. Its typical form of "If this, then such and such " reasoning relies on this notion of a primary, independent variable which then is seen as causing the creation of something else, usually seen as being a dependent variable, secondary in time when organized in a linear sequence.
Freud's emphasis on the liberating power of rationality, his individualistic and phallocentric concept of the self, his philosophical assumptions about the mind independent nature of reality, his search for organizing, universal laws and theories about human nature and his exalting of the ego and reason against the "irrational" demands of desire or authority, illustrate his embeddedness as a subject in the prevailing Enlightenment narrative of his time (Flax, 1990). But if Freud's psychology, with its valorization of individualism, scientific-objectivism, empiricism and rationalism can be appreciated as the apotheosis of modern reason and heir to Enlightenment values, it is that much more striking that it simultaneously delivers a sucker punch to the very epistemological aspects of Enlightenment thinking that serve as its foundation As Jane Flax points out, "Freud's psychoanalytic notions of the unconscious undermine the belief that it is possible to have privileged access to, accurate knowledge of, or control over one's mind." (1990, pg. 228). If there is anything that we are to know about ourselves from psychoanalysis, it is the impossibility of knowing ourselves; the hidden self that Freud revealed to us and that is revealed in every psychoanalytic venture is never one and the same as the self that reflects upon itself, reasons, and believes it endures in a stable, consistent, ongoing way across time. We surprise ourselves, constantly, or should I say our self surprises us? As pointed out by Barratt, psychoanalysis moves against manifestations of identitarianism -- identitarianism referring in part to any doctrine grounded in the affirmation that the subject is as it presents itself, that things simply are as they appear, and that human desires are bound and expressed completely by the reality of our representations without the negativity of an inherent contradictoriness (1995, pg. 460). Identitarianism presumes the undivided unity of the subject of reflective awareness, an identity of the subject with itself (Barratt,1985, p467) Psychoanalysis exposes this identitarian emperor of the modern era—that subject of mentational life proclaimed by the Cartesian-Kantian tradition as a subject of reflective self consciousness—a subject clothed in the certainty of owning his representations of self , other and affect, and presuming a similar cohesion and continuity of the entire world. (Barratt, 1985 , p460)
Freud’s early works radically subvert several prevailing modern era paradigms that contextualize this particular way of viewing man. Again, as pointed out by Barratt, (1993, p3) when Freud demonstrated the falsity of the human subject’s belief in the mastery of its own mental life, he simultaneously challenged the major coordinates within which Western thinking has unfolded since the medieval era. Most important, his discoveries attacked the whole notion of man’s mastery, or dominion, and in the modern episteme, mastery of the human(male) subject over woman, over nature, over other cultures, and over his own mind has been paramount. As pointed out by Reiss (1982) the notion of dominion operates on assumptions involving the use of "reason" which authorizes certain privileged subjects, assumed to have such knowledge and power, to interpret the world and to act authoritatively upon it, in an attempt to subdue it, fix it in place and ultimately render it fully explainable. Such actions include importantly the privilege to name objects, to designate how they are to be viewed and what is to be done with them.
Freud's doctrines, remaining in part within the Enlightenment project and grounded in the analytico-referential episteme of the modern era , can certainly be seen as a continued attempt to exercise and legitimize the underlying philosophical assumptions of the modern era. But they also, simultaneously, offered the world an opportunity to question itself. Indeed they insisted upon this questioning and insisted that the "itself" that the world of individuals takes itself to be is far from the seamless, continuous, fixed, unidimensional, rational, masculine self it thought it was. Freud's discovery of the unconscious showed us that the celebrated self of man cannot be defined by the capacity to reason, as Plato and Kant asserted, for the self included unconscious wishful impulses that could not be destroyed through logic or any other attempt at ratiocination. Freud conceptualized the human mind as fully embodied, inherently conflictual, dynamic, and non-unitary. As pointed out by Barratt, "what the psychoanalytic method uniquely demonstrates is that the constructions and communications of consciousness always conceal and reveal, concurrently and concomitantly, something of their own being other than what they take themselves to be" (Barratt, 1988, pg. 236). There is another dimension of meaningfulness that persistently insists itself upon the law and order of the semiotic domain. This other dimension of meaningful beingness and desire is never consciously available to the subject as the "I-ness" of the thinker and speaker, and neither is it truly outside of the structures of consciousness. Instead, it exists somehow persistently within them but in an alienated and estranged position vis-à-vis the subject's conscious definition of self. What we believe we ‘know’ depends on consciousness and communication, but Freud’s discoveries teach us that any belief in what we know, and any belief in the mastery of this consciousness and communication is necessarily false. What we ‘know’—all that can be included within the semiotic system of the ‘I’- is not one and the same as our ‘being’—defined by Barratt as a locus of sensuality, otherness, and temporal movement. Human consciousness is always and necessarily composed contradictorily of these two dimensions of meaningfulness—that of semiosis and that of desire. The semiotic dimension, the law and order of reflective awareness which is communicated in our manifest associations, not only occludes dimensions of our estranged desire but is organized primarily to repudiate these ‘other’ dimensions. What the work of psychoanalysis does, argues Barratt (1985) is not merely add to the manifest contents and reflections of self-consciousness, but rather, it disoccludes them, deconstructing the manifest meanings. As Christopher Bollas(1995) describes it, "the analysand is turned upside down by the intrinsic subversions of unconsciously driven speech. A patient in analysis is straight man to his unconscious…. Fortunately psychoanalysis knows this and gives the patient a couch, no doubt so that he can lie down before he slips and falls."(p224)
It is this particular understanding of psychoanalysis that loosens the hold that modern-era thinking has on the legs of its human subject. Rather than solidly planting his feet on the firm soil of an earth that is the center of the universe, truly modern man now stumbles and slides about in the amorphous land of the postmodern, where what used to be seen as firm land is now viewed as temporarily static energy configurations in a universe where earth is no longer recognized as solid or as center. In myriad ways the discoveries of the 20th Century, including psychoanalysis, have de-centered man, and none has been more problematic perhaps than the insulting realization that our own selves are not even ‘owned’ by us. Most recently, over the last several decades, the Information Age of the Postmodern Era has continued to question all sorts of presumed realities and truths that had long come to constitute science and the body of knowledge of the Modern Era. As noted by Patrick Kavanuaugh, "A deconstructive questioning of the modern era notions of history, literature, art, education, physics, science, conceptualization of the self, the referents of language, logic and reasoning, the nature of reality, and other questions, philosophic in nature, have profoundly shaken if not eroded confidence in the logical-objectivist epistemological premise of the modern era." (1998, p11)
The post-modern era, in part ushered in by the radical discoveries of psychoanalysis, cannot neatly be summarized. To speak of the postmodern era as a set of essential ideas anchoring a coherent narrative for a circumscribed period of time, is to violate its message. And probably to speak of "its message" is to violate its message. For post-modernism is de-constructive in its approach to the world. Post-modernism insists that the Real is always heterogeneous, unknowable, and differentiated in ways more complicated than that of binary oppositions. Its analysis reveals that any apparently unifying story must necessarily repress that which cannot fit, and repress as well the strategy used in these acts of omission. Post-modernism, with its de- constructive aims, seeks out that which has been omitted and strives to uncover the strategies that delineate the limits and boundaries of the rules of signification, used by the authors to claim their representational authority.
Jane Flax refers to the assumptions of post-modernism as death announcements. She points out that Post-modernism destroys ideas about man as a transcendental being, insisting instead that human beings are social, historical or linguistic artifacts who are, and must be, contextually defined. Man is "decentered" in that his attempts to impose structure on experience are constantly preconstituted and undermined by desire, language and the unconscious. Man may speak language, but man is also spoken by language. Man is merely another position in language, forever caught in chains of fictive signification. He does not simply use language to describe the world, he is used by that language in its creation of him and his world. This language serves to inscribe him in the world, and provides for him, certain possibilities not only for how he is to think and conceptualize, but for how he too is to be thought of and conceptualized by the world. Postmodernism destroys ideas about history, about progress, and ultimately ideas about metaphysics, or the notion of a real external unitary being, beyond history, that exists "out there" independent of the knower. Postmodernism views History itself as a masternarrative, justifying fictionally, man’s existence and exalting the notion of Progress, or movement by man through history toward some pre-given goal. Post-modernism offers the claim that all features of mental life are pre-constituted by linguistic and social practices, and that the mind's grasp of "truth" is merely a consequence of discursive formations which limit contextually what can be seen and known. The Real cannot stand outside the mind or outside language. What is seen as Real falsely appears as unitary by our reducing the heterogeneity of experience into binary and supposedly natural or essentialist oppositions, e.g., light/dark, man/woman.
Postmodern discourse, signaling as it does the death of such notions as history, progress and metaphysics, most importantly demonstrates how any unifying system of thought necessarily utilizes death to accomplish its goals -- that is, it necessarily repressively forbids or kills off what Barratt refers to as the "enunciation or exchange of a genuinely otherwise otherness" (Barratt, 1993, pg.166) and is indeed organized primarily to renounce such otherness. (Barratt, 1985). Psychoanalysis, as an expression of post-modern discourse, demonstrates the hegemony by which the prevailing episteme forbids the articulation of that which is considered to be dangerously other. Examples from clinical practice are plentiful, and I will use one referenced in a previous paper describing my work in a hospital setting with an individual diagnosed as catatonic. Speaking reductionistically now, for the purpose of explication, this individual was a recently laid off machinist who was consciously protesting against what he experienced as a lack of control over his life. Typically, he would behave obdurately, refusing to participate in activities, standing by his closet for hours on end, taking minuscule steps down the hall when called to an activity. Manifestly, this man was protesting against that which was being expected of him in his present day setting. His behaviors and verbal communications spoke the message of "NO" to all whom he encountered. However, understood from the vantage point of a psychoanalytic inquiry, it appeared as if other less conscious motivations were also being expressed and gratified, wishes which were somehow expressed thorough the very behaviors just mentioned, but wishes which nonetheless were foreclosed consciously by these manifest obdurate behaviors. Such wishes included the desire to not have to have any control, the wish to invite others to take care of him, to help him to dress, to force him to dress, the wish to slow down time and turn back the hands of time to a time when he could take baby steps down the long hall, with the future still laid out ahead of him, rich with possibility. Hidden in the manifest garb of a man who obstinately refused to march to the tune of the staff, was also a man who desired to be a robot who could be controlled and programmed by another so that he could be re-formed as a new kind of child-man beginning his life over again, as a new and improved product. A burgeoning psychoanalytic discourse began to appreciate how his conscious constructions of self were necessary both to ward off and to unconsciously fulfill conflictual unconscious desires which were manifestly both belied and betrayed by his consciously purposive maneuvers. In such an analysis it can be appreciated how hidden messages exist only by virtue of their being able to live surreptitiously within the interstices of manifest semiotic meaningfulness and at the same time such hidden messages, when brought to light can be appreciated as radical seditious saboteurs of the manifest structures of order and meaning.
Analogously, what I would like to suggest about psychoanalysis as a unique deconstructive venture, is that in important ways it firmly legitimizes itself within the modern era’s implicit standards of scientific, philosophic inquiry while at the same time laying the ground work for churning up or de-constructing that very foundational ground. It is itself a form of postmodern inquiry which demonstrates the hegemony by which the prevailing episteme attempts to forbid the articulation of that which is considered to be dangerously ‘other’. Freud's work challenges essential assumptions about the mind's rationality, the metaphysical status of the external existing world and man's capacity to objectively come to know and establish dominion over this world. It also, I believe challenges the possibility that universal theories, developmental assumptions and generalizable truths about humankind are useful or relevant , for these serve essentially to deny the incessantly and insistently unique and individual nature of experience. And yet, Freud legitimized his discoveries by inscribing them within the very normative structure that his work serves to undermine. This, I would argue, puts psychoanalysis in a unique position, giving it its unique disposition as a de- positioner of the very thing that is its medium. Similar to the way in which the clinical example mentioned above illustrates how unconscious communications are somehow IN but not quite OF the manifest discourse, Freud’s discoveries too, can be seen as being IN and not quite OF. That is, they take place in his era of modern times but they are not quite of this era. They are intriguing not, I would argue, because they seem to have validity despite or notwithstanding their outmoded 19th Century assumptions but rather, because their truth stands within these outmoded assumptions while simultaneously displacing their assertions of certainty and identitarianism.
As we well know, the discoveries of psychoanalysis have been challenged by non-believers from the time of their inception. But of equal or greater importance and interest, at least to me, is to witness the ways in which psychoanalysis has been attacked from within, by those who enthusiastically claim to subscribe to it. For the remainder of my time I will explore one manifest thread of such attack-- a movement described by Russell Jacoby (1979) as "conformist psychology." I will focus on the expression of this psychology within one particular context, that of a psychiatric psychoanalytic hospital setting. What I will try to demonstrate is that the prevailing trend in American psychoanalysis over the last several decades can be viewed, in part, as an attempt to deny the liberating, radical implications of Freud's discoveries and to reassert the very essential tenets of modern-era thinking which Freud's post-modern discoveries necessarily fatally interrogate. These trends strive to negate the necessarily contradictory nature of psychoanalysis by overlooking, denying or attempting to resolve its own contradictory identity as well as its stance contra to society. Much of psychoanalysis is now aimed at acculturating deviancy -- that is, regulating and controlling personal functioning in the interest of socio-cultural adjustment. It has become an enterprise of social eugenics rather than an opportunity to explore the ways in which the ruling party lines of the individual and the society are informed by and simultaneously dispossessing of their dissonant, desirous, out-of-line voices. Clinical practice has slipped quietly into an attitude which has prioritized adaptation to the norm, and psychoanalytic clinicians for the most part are reduced to the status of "social technicians." (Barratt, 1993, pg. 17) Psychoanalysis has been appropriated by a society which has needed to do the same thing to it as it has done to its deviant citizens -- namely, to institutionalize and domesticate these frightening and unacceptable others until they are repositioned more securely within the nexus of reality and power as defined by the legitimizing authors of social discourse, attempting to make them not only IN but also OF the system.
For now, I will focus on describing a central organizational dynamic evident in a state psychiatric hospital renowned as a psychoanalytic institution. I will be illustrating how all that is defined as deviant-- which will include the patient, the analyst, and psychoanalysis itself -- is subjected involuntarily to treatment aimed at aligning these entities more centrally within the prevailing master discourse. These treatments will be referred to collectively as petitioning -- a process by which that which is deemed dangerously ‘other’ is targeted, incarcerated, diagnosed, and ultimately ‘rehabilitated.’ The concept of petitioning derives from a central and organizing process that lies at the heart of any public psychiatric facility's longevity, ensuring that patients will be perpetually pumped through its chambers. It is a system whereby the probate court is petitioned by individuals who are seeking to hospitalize an individual against his/her own will. When a patient first comes to the hospital, he or she has usually been petitioned by a family member, police officer—any interested third party. In conjunction with corroborating psychiatric evaluation, the petition is used by the probate court as a basis for sentencing the individual in question to treatment in the hospital for a period of time generally no longer than 60 days. During this time, the individual receives an array of treatments, including psychoanalytic therapy aimed ostensibly at determining and working through underlying unconscious conflicts presumably contributing to the individual patient’s particular symptomatology. When the initial court order is approximately thirty days underway, it is the responsibility of the treatment team to determine whether or not the court will be petitioned again to mandate further involuntary hospitalization for the patient, this time with an order of even lengthier duration. It is customary hospital procedure, that the primary therapist express the consensus of the treatment team by being the person to complete the petition for an additional court order. In other words, it is mandated by the hospital that the therapist him or herself who is allegedly serving as confidante and analytic psychotherapist, also be the legal representative of the hospital in representing the patient’s disturbance on paper, documenting justification for its request that the court sanction further hospitalization. On such a petition, the psychologist is classified as the "authorized representative" of the institution and asserts that the individual is a person requiring treatment and in need of hospitalization for a period of time possibly up to one year. The "allegation" of requiring treatment must be substantiated by the claim that it is the petitioner’s "belief that the individual has a mental illness and as a result" falls into any or all of the following categories. The first two categories state that the individual in the near future can reasonably be expected to intentionally or unintentionally seriously physically injure another person or the self. The third category states that as a result of mental illness the individual is unable to attend to basic physical needs such as food, clothing or shelter that must be attended to in order to avoid serious harm. The last criteria for hospitalization, and perhaps the most interesting and problematic, involves the assertion that the individual is unable to understand the need for treatment because of impaired judgment. For many years, this assertion alone could be used as justification for incarceration until it became necessary to also assert the likelihood of harm as a consequence of such an inability. I will attempt to show how the assumptions and implementation of this process can be viewed as retrograde and reactionary attempts to reassert modern era tenets and to petition psychoanalysis itself, disciplining it until it is less of a dangerous threat to the status quo.
Psychoanalysis, as practiced in most institutional settings, is a psychoanalysis which one might argue, has already been successfully petitioned. It is a psychoanalysis whose radical nature has been subverted. It is a psychoanalysis now very much shaped by American ego psychology. Whereas Freud emphasized the persistence of the primary unconscious processes, Rapport’s rendition of Freud's "general theory of the mind" was heavily weighted in its emphasis on the development of the ego -- its structures and its capacity for delay and control of drive discharge. Heinz Hartmann paved the way for concepts regarding conflict-free spheres of ego development, neutralization of sexual and aggressive drive energy, and ego energies totally independent of instinctual needs. Psychic health, according to ego psychology, is considered to be measured by the healthy ego's autonomy from the id. And as described by Rapaport (1951) , in healthy development the emergent ego organization obeys its own laws, distinct from and independent of the elements from which it emerged. It is espoused that to the extent that the ego is independent of the id, it is better adapted to reality and more capable of functioning in its external environment. Conversely, the extent to which the ego is unable to achieve this autonomy is the degree to which it is considered enslaved by it (Summers, 1994).
It is not difficult to recognize several modern era tenets which mainstay such theory. Biological reductionism, rational objectivism, the exaltation of reason, the valorizing of mastery and control, developmental sequencing assuming a natural, universal and expectable sequential course of growth , the assumption of there being a real, objective world which ideally is viewed without distortion and adapted to, are some. Note how the modern era notion of possessive appropriative intentionalities toward the world is now aimed at the self, where ego psychology exalts the achievement of domination over one's own inner world (Barratt, 1993 ). What I would like to suggest is that in the institutional hospital setting, the inhabitants of the "inner world" are semiotically designated by the system as inpatients and that nearly all procedures of hospital treatment are aimed at obtaining control over these inpatient ‘deviants,’ or, to borrow language from Barratt, "the otherwise contradictory otherness that exists within but not of the system." It is important to the system that these inpatients do not exert too much power or control over the ruling, executive system, and quite frequently maneuvers to insure autonomy from and ascendancy over such inpatients appears to be a primary goal. There are constant reminders of who is boss in making decisions about all sort of matters--passes outside the building, visitation, which T.V.channel will be on, what time bed time is, who goes into seclusion or is forced to take extra psychotropic medication.
In the context of the hospital a fascinating and essential paradoxical situation is maintained. Namely, the existence of the patients, identified by the system as "deviants" informs the manifest mission of the hospital, and at the same time the institution’s very existence is necessitated and justified by the repressive need to foreclose recognition and legitimization of such inadmissible agents of discord. Consequently, we see how a necessary dialectic again makes its appearance -- a dialectic which I am suggesting lies at the heart of psychoanalysis -- a dialectic which can never be resolved but whose vivacious iterations can be noted and appreciated. Putting it simply, the psychiatric hospital is kept alive by the presence of patients whose existence allows, and indeed necessitates, the entire system of signification upon which the hospital lives out its mission -- a mission aimed at foreclosing and occluding the semiotic meanings otherwise communicated by these ‘otherwise’ and crazy people. In this way, it is not that different from what we witness everyday in psychoanalytic practice when we come to see and appreciate how the individual’s conscious system of defining self and ‘other’ is inevitably (and paradoxically) dynamically informed by unconsciously motivating constellations of signification, the denial of such constellations being a primary contributor to the formation of the conscious systems of representation in the first place! Sadly, I believe, a truly psychoanalytic process, which might allow for the understanding and examination of this voice of difference within the hospital, including an exploration of the reasons why such an exploration might be so frightening and painful, is effectually forbidden. What results is a programmatic calcification of a state of alienation between staff and patients, in which the communications of patients are not heard in a way which might otherwise enrich and expand the self understanding of either the patients or the hospital. The only sanctioned mode of exchange between the staff and patient lies in the successful petitioning and assimilation of the patient in attempts to fortify the master discourse and perpetuate the myth of cohesiveness, continuity and self same identitarianism within the hospital system.
While this systemic dynamic is exemplified continuously throughout the course of a typical hospital day, I am drawing special attention to the process of petitioning as it is the mandate to be the petitioner, that makes it particularly difficult if not impossible for a treating clinician to engage in an alternative dialogue with an individual. All of the supposedly "free associative" communications made within the course of treatment are necessarily used, not for the purpose of more deeply understanding the contradictory, unknown aspects of a patient's psychic life but used instead for a reversed kind of understanding -- used to secure the patients and analysts standing under the sanctioning authority of the hospital and the larger society. In addition to what I believe is an outrageous and unethical betrayal of ones patient, when associations are invited for the ostensible purpose of "understanding" and then used instead to control and subjugate, there are many additional messages being communicated which illuminate fundamental philosophical assumptions that are brought to bear in any process of listening. Let’s say, you as a patient tell me that you see your mother’s face manifested in different people on the ward. It is a painful yet reassuring sight as she is a woman whom you experienced as warm, albeit in a controlling and infantilizing way, and deceitful —her overtures toward you were welcomed and yet not to be altogether trusted. Let’s say that in the therapy, I as the therapist invite you to talk with me about these perceptions, implicitly reassuring you that it is safe to do so, even safe to express fury toward me, when I too, in your perceptions inevitably take a turn at being your mother as well. So what happens then, when several weeks later, you learn that you have been petitioned, by none other than your own mother, oh, I meant to say your therapist. Freudian slip. And let’s say that in the petition which I signed, it claims that I believe that you are mentally ill, that you are a schizophrenic, and that you are unable to leave the hospital because you are unable to care for yourself and need further treatment, most notably, my psychoanalytic uncovering therapy. Let’s say I have claimed that you see things that really aren’t there, using as evidence your visual hallucinations of mothers, and that you delusionally believe things that aren’t true, like others are controlling your mind. Perhaps, as ‘factual’ data, I quote you , taking out of context, your angrily denunciatory words toward all the goddamn mothers in this place who you would like to get rid of. With such a petition I am assuming all kinds of things—about the nature of reality, about my superior expertise in perceiving reality and evaluating reality i.e. I can see that your Mother is no where on the ward and that no one is controlling your mind, about who is able or unable to take care of themselves, about what taking care of oneself even means, about what the right kind of thinking and perceiving is, about which semiotic system of meaning your words are to be contextualized within and about the rules for when that context can suddenly change.
As pointed out by Foucault, the use of "reason" authorizes certain privileged subjects to interpret the world, name it, determine how it is to be viewed and what is to be viewed as correct and proper. (Foucault, "Truth and Power," in ‘Foucault, Power/Knowledge,p119) Is it not true, that within the particular power structure of the hospital, by virtue of my status in being able to "reason"—a status by the way, given conditionally, on the basis of my continued ability and willingness to "reason" the way the system prescribes, that I can determine what your words mean, intend and signify. If this just so happens to resonate with your experience of a mother who claimed to know all, then we’re in business, but you may not share in the profits.
The hospital system, like any system, operates according to a master or foundational discourse which prescribes meaningfulness according to general standards of truth, propriety and rightness. As pointed out by Saussure (1960) no one individual produces the rules and relations that constitute pathways for the enunciation of meanings. Instead, all subjects are the products of the semiotic system within which they live and by which they are themselves constituted. Within the existing semiotic framework of normativity are prescribed and proscribed possibilities for thinking and acting. It is not difficult to see how this is evidenced in the mission statement for the hospital, which speaks to the goal of restoring mental health and effecting rehabilitation to facilitate maximum participation in the community. It can also be easily seen in the treatment plans of all disciplines within the hospital which include "increasing reality testing and reality orientation" while "decreasing delusional thinking and response to internal stimuli." Certainly, it is apparent in the description of the Psychosocial Rehabilitation Program" (PSR) premised on the assumption that individuals in the hospital are lacking in skills that "normal" citizens in the society demonstrate, skills which are believed to be severely compromised by "mental illness." Notably, there is no mention in this PSR manual of psychodynamics, or conflicts, nor is there any appreciation for the possibility that individuals may not be making their bed in the morning, or flushing the toilet behind them for reasons other than that they lack the skills to do so. Consequently, classes which literally teach such skills, comprise the program. In the manual it is plainly and honestly stated that one of the principle goals of PSR is "normalization".
The semiotic system does not just exist in program descriptions, in mission statements, in reams of paper mandatorily read by the staff and "recipients" of treatment, or in the forest of paper completed by staff in the form of behavioral, goal-oriented treatment plans and "progress notes" documenting with specified, measurable criteria a patient's progress toward pre-determined and unilaterally conceived goals. The semiotic system of signification also breathes in the pauses between words, in the blank spaces within written documents. The institutional discourse determines every single aspect of life within the hospital. Certain of its subjects are designated as "patients" and are named by those in power with a specified, diagnostic label, guaranteeing that such individuals are fixed, secured, and subjugated within a particular place in the hierarchical order and assumed to have an ongoing enduring identity over time-- e.g., Schizophrenic." Other subjects are designated as the "providers" of services. Manifestly , they are the ones who have the keys to enter and to leave. But it can be argued that this apparent freedom is illusory. It is as real as the institutional discourse allows it to be, for even those with the powerful authority of doctorhood, directorhood, etc., are also coercively defined and constituted by the system. Everyone is indeed an inpatient, inscribed by the definitional system which prescribes all possibilities for thinking, feeling, acting and being. So for instance, if a particular patient is choosing not to bathe, it is the expectation of the hospital that all staff, including the therapist, will participate in getting this patient to bathe. Private discourse, exploring the meaning of such behavior without the express goal of eliminating the behavior, is itself seen as dangerous ‘dirt’ which threatens to sully the otherwise limpid unitary vision of mental and physical hygiene advocated by the hospital.
It is not difficult to identify the templates of modern-era thinking in this hospital discourse-- the exalting of reason over madness, the belief in man's ability to know and ultimately control himself and his objects, the notion of the real externally extant world assumed to be observable in undistorted ways by those appointed as expert witnesses within the system, the prescribed goal of adaptation to this independently existing world with progress toward this goal measured according to numerical and linear schemes of manifest units of observable behavior, the assumption of essentialist notions of all sorts -- personality traits, gender categories, disease entities. These are all taken as real, naturally dichotomized groupings of external things, existing independently of the observer’s method of systematizing his world. And once identified in this way, certain universal properties are attributed to them. If a person is identified as A schizophrenic then he or she is located within a category of persons who are assumed to share similar traits. Having been identified as being one in a category of such persons, certain treatments are then prescribed with certain outcomes expected. Within the templates of modern era thinking within the hospital, it is presumed that all manner of behavior, will ultimately be able to be reduced to the level of biochemical causation and explanation. This is not simply to say that an experience of depression for instance has certain physiological corollaries, but rather, that these physiological corollaries are depression; certain patterns of neurotransmitter interaction are schizophrenia; ultimately, these particular patterns are THE depressive or THE schizophrenic. Already, in the hospital one can witness myriad instances in which a patient says or does something and the reflexive response is for someone in charge to write an order for an IM injection of medication as if to say, "There’s that schizophrenia again!" No longer is there a person who has something to say worth listening to, but instead the utterance itself is seen as a verbal symptom of a central nervous system disease which is then treated biochemically. Perhaps ‘mental’ patients have indeed, as Dr. Dauphin might put it "lost their minds"… at least in the eyes of the practitioner who is seeing only brain.(Dauphin,1997) The person, if existing at all, is merely the inconsequential intermediary between practitioner and disease.
In the hospital, modern era identitarian notions abound for both THE PATIENT and THE STAFF. And within these identitarian notions, there is little opportunity for the recognition of difference, differentiation or uniqueness. In the PSR manual it is stated, "Staff members must be concerned with all aspects of the lives of clients…rather than adopting the perspective of one discipline." The Treatment team is seen as an unit so indivisible and cohesive that the inpatient manual states that "all of the staff on an inpatient unit is to be involved in the planning and implementation of every patient's treatment." The grammatical error, of pairing a plural noun with a singular form of the verb ("All" of the staff "is" ) speaks clearly to what can be felt at all times by anyone who does not automatically step to the tune of the master discourse, namely, that no true multiplicity of perspective or intention is allowed.
On the inpatient unit, staff are "teams," and "teams" are univocal choruses speaking a message of identitarianism, adaptation to the norm, domination and control. If, for instance a patient is behaving in a manner that is problematic to those around him, it is assumed and expected that the therapist will be united with the team in its efforts to obliterate the behavior and to this end, it is expected that the therapist not only join efforts to behaviorally direct the patient toward such a goal, but spearhead the campaign to do so. For instance, it was nearly always assumed that therapists would confront their patients in therapy sessions about behavior on the ward that the team found problematic. Nearly unnoticeably, the notion that the therapist might talk with the patients about all kinds of things the patients were dealing with, was exchanged for the notion that it was the therapist’s job to TALK TO the patients about their behavior. No one was taking issue with the idea of talk therapy, just as long as it was a particular kind of talking, with a particular goal in mind. As a therapist as well as supervisor of therapists on my ward, I have personally been witness to countless "team" discussions in which not very subtle pressure was placed on the therapist to join in, in coercing the patient into behaving in ways that the milieu determined to be "appropriate". I am not talking here solely about behaviors that threatened the physical safety of others. I am referring to examples which include a patient carrying a doll on the ward, which the team considered inappropriate for an adult male to be doing, or patients of the same sex hugging or holding hands together. In these and countless other situations, it was expected that the therapist share the attitude of censure embraced by the team. If the therapist dared to not join the group hug and wished to not hold hands with the other team members in their joint efforts to change the patient’s behaviors, there was often a price to be paid. Even in the most optimal of settings, it was assumed and expected I believe, that the goals of all disciplines were shared goals, albeit perhaps arriving at them through different means, with such goals being the indoctrination or rehabilitation of the patients so that they behave in more conforming ways sanctioned by the ideology of the ward and societal culture.
On the ward, the ‘team’ is the authoritarian purveyor of doctrines of adjustment within the inpatient unit. Its identity as ‘I’ is founded on the existence of the ‘not I’-- the designated patient, who is subject to the binary logic and phallocentric discourse of the hospital. In such a system , the patient as inferior ‘other’ lacks access to the institutionally universal signifier or phallus -- meant here in the Lacanian sense of culture, language and generative source of significatory meaningfulness. The patient can only be spoken by the discourse of the system. Again , the specific process of petitioning exemplifies this. Patients’ utterances and behaviors, hypothetically understandable within the context of their own idiosyncratic chains of signification and symbolic equations, are taken at manifest and face value, again to legitimize the decision for further commitment. Nearly anything that the patient says, especially those utterances used to convey a dissenting position, are placed reflexively within a semiotic context aimed at demonstrating the individual's lack of sense. And within the binary logic of logocentrism, the ‘other’ is captured within its systematized world of dichotomous hierarchical categorization. Placed within this particular semiotic position, the patient is viewed in much the same way as the "id" is viewed within the context of psychoanalytic ego psychology. That is, the patient, like the instinctual impulses, must be acted upon, tamed and mastered. Dominance over and autonomy from the id (a.k.a. patient) is seen as an indication of a healthy functioning ego( a.k.a. healthy executively administered hospital system). The terror of patients overrunning the hospital and inciting libidinal and aggressive anarchy is ever present and can be seen in myriad examples. One such example involved a nurse informing me that if a patient who was masturbating publicly was not severely censured for his behavior, the Day room would soon be given over to the entire group of patients masturbating openly and continuously. Perhaps she was telling me, in her own way that the day room would be given over to night activities, and that which is normally allowed to be seen by day --- those activities deemed acceptable according to values deriving from enlightenment dictates, would be overtaken by that which should only exist in the occluding darkness. Day would be turned to night and light would be shined on that which is not permissible to see.
Although in such a system the patient is necessarily designated as the other and in this way is in the significatory discourse of the hospital, we can see how the patient in important ways is also occluded from and by the system and is not truly able to be ‘otherwise other’ in any way other than what the system allows. Anything the patient speaks is designated from the start as suspect, as irrational, and must necessarily be ignored and/or listened to solely within the defining parameters of the diagnostic, evaluative and rehabilitative model. This is true, even on the most enlightened of teams such as one which decided to invite the patient to participate in the development of his treatment plan. In doing so, in the most egalitarian of ways, they escorted the patient into the room, and proceeded to ask the patient what he felt his problems were. When they were told that he did not believe he needed to be in the hospital and was not going to be taking their medication, it was patiently pointed out to him that he was demonstrating one of his identified problems, namely, that he did not recognize that he did have a mental illness. And, in response to his anger upon hearing this, the treatments for his anger management were clearly spelled out to him. In this example, the patient was indeed IN the discussion and participant IN his treatment plan. The team was trying its best to also make him OF them. There was little if any opportunity for his communications to be understood in a context other than one which had already defined him in a particular way and one which predisposed the staff to hear his utterances according to the already determined diagnosis, treatment plan, treatment goals and treatment outcome. He was not going to be in a position to influence the contextual rules by which his utterances were to be viewed and understood.
There is no way out. There is no way out of the hospital and there is no way out of the institutional discourse. But that's only half the story. Because there is also no way in. And here's how we return again to the dialectic. The patient is other but only other within the prescribed dichotomized legimitizing system of signification. There can be no genuine otherness to this other. For that reason, an argument can be made for the idea that nearly all of the procedures within the hospital are designated for the purpose of not making contact with patients and for not allowing the patient to get into the hospital. Quoting again from the training manual for the PSR Program, a so-called exemplary "empowering" statement is the following: "Ms. Smith, while a client here, all are expected to participate in centralized PSR. This will help you deal with your illness and enable you to deal with the rest of the world. This means getting up and dressed before breakfast. Do you have any questions?" I have some questions. Why is it to be assumed that Ms. Smith is ill and unable to deal with the world ? Why is it assumed that there is a " the world" and that she must be taught to adjust to it ? Why is it not possible to assume that she is adjusted to the world as in her world ? And that there is much to be learned about this. But these interrogations are not permitted. Contact with Ms. Smith is made to the extent that she can be coaxed or coerced into the world but only on its terms as defined by those in power. Meanwhile, she and her world, to the extent that they exist on other terms , cannot be seen, and in fact, cannot exist.
On one level of discourse, Ms. Smith as ‘other’ is needed, otherwise there would be no hospital mission at all. But on another level of discourse, the "I" of the hospital semiotic system maintains its reflective consciousness and self- certainty only by defining her in such a way that reflects back to the system its own identicality with itself, and by actively excluding and foreclosing any remainder of her which refuses such appropriation. There can be no truly otherwise to the patient's designated role as ‘other’ as defined and as necessitated by the system whose identity depends on it. The patient herself must be petitioned to assimilate her to the semiotic discourse. The psychoanalytic therapist too -- in being required to reiterate Ms. Smith's utterances in a petitioning process aimed at continued hospitalization-- is petitioned, as is psychoanalysis itself, for the possibility of listening to anything as otherwise to the law and order of the master rhetoric is foreclosed. The patient is unthinkable and unspeakable, as is her system of meaning, as is a truly psychoanalytic process which would otherwise interrogate the conscious representational system of the patient or the hospital.
In such a setting, the milieu cannot afford to allow a psychoanalytic process to exist in which the normal and usual ways of understanding, interpreting, evaluating and responding to behavior might be questioned. And importantly, it is not just that the system cannot afford to have its own thinking questioned and challenged,--it also cannot afford to allow a different way of thinking and interpreting to exist simultaneous with it, for the very presence of this ‘other’ discourse with its own different set of rules, implicitly throws into question the unquestionable, seamless, identitarian and normative set of assumptions upon which the existence of the entire hospital is based. As a result, it becomes impossible for the system to allow a therapist to decide for him or herself whether or not it is advisable to be the petitioner for his or her own patient. Because to choose to opt out of that particular institutional discourse, is to suggest that there are alternative ways of understanding, of working, of existing with the patient. It means, that there may even be different goals involved, other than those that are prescribed in the mission statement of the hospital. And most important, it communicates that there may be something OTHER than just one mission statement in the hospital. (Maybe there is even more than one hospital, but that’s really getting crazy.)
In saying all this, I do not mean to imply that there can be no room for psychoanalysis in such a system, or that this whole process cannot be subject to a psychoanalytic inquiry. Rather, I believe that what we see in such an institutional discourse can indeed be understood in light of the radical discoveries of psychoanalysis. For psychoanalysis teaches us is that all forms of contradictory otherwise otherness are subject to being disavowed, alienated or appropriated within the hegemonizing dominating aspect of the dialectic. We see this within individuals, within the hospital setting, within psychoanalysis, and within the larger societal discourse. This is not the problem. The problem is that there is less and less of an opportunity for this kind of psychoanalytic exploration to even exist. The problem is that it is becoming increasingly impossible to think in this way, let alone talk about it in public. The problem, as I see it is that psychoanalysts are rushing to embrace the very practices and ideologies which will ultimately not merely relegate us to the alienated margins of meaningful discourse, but worse, will appropriate us in such a way so as to render us non-existent. I believe that psychoanalysis can only really be IN and not OF the mainstream ideology of the culture lest it lose its unique position as interrogator of the status quo. The problem is that psychoanalysis is doing whatever it can to get itself located within the master discourse of the prevailing ideological societal structure. To highlight just a few examples of this.. Psychoanalysts are scrambling for the privilege to medicate patients. Psychoanalysts are uniting together to get themselves included in managed care plans by demonstrating the efficacy of their methods in treating diagnostic categories of people. Implicit here is the assumption that generalizations across groups of people can be made, based on essentialist and reductionistic notions of pathology, etiology and diagnosis. Psychoanalysts are devising short term treatment protocols that are "psychoanalytically informed" but always aimed at behavioral change and compliance with societal expectations for behavior. Psychoanalysts for years, have been developing all sorts of developmental theories which presume the universality of particular lines of development, types of personalities and object relations, norms for average, expectable environments and standards for good enough or not good enough mothering. Psychoanalysts for years, have adopted linear, causal explanatory theories based on modern era assumptions of independently existing ‘real world" events and linearly organized schemas of time and causality. We have embraced wholeheartedly, ideas of adaptation to the environment, and "normal" developmental sequences assumed to unfold naturally given ‘optimal’ environmental circumstances. We have adopted enthusiastically, a medical way of thinking about our "patients" based on assumptions of pathology, treatment and cure. The lexicon of health care, which for some of us used to be metaphorical , is now living in the register of the REAL and we are now REALLY trapped in its alphabet. The proliferation of rules, regulations, credentialling processes, and standards of care that have accompanied this metaphor of healthcare is quickly becoming our own hand and waist restraint and this time we’re on the wrong end of it. Somewhere along the way, we’ve misplaced the keys. And it doesn’t look like we’re finding them any time soon. As health care professionals we are expected to report on our patients, to report on each other, to report on ourselves. It is not only that confidentiality no longer exists, it is that we no longer have the freedom to even listen in the ways we might have in days past. The context for an association cannot any longer be defined by the two people who are comprising the analytic setting. There is no longer an Analytic setting. If a psychoanalyst simultaneously holds a license to practice as a health care provider, the setting is now vastly expanded to include a multitude of expectations, assumptions, rules and requirements which may have nothing to do with why these two individuals initially decided to work together. Now, associations in the clinical hour are no longer free associations. They are invisibly but mandatorily hooked into a computerized network (the very same one that now makes billing so easy)which semiotically defines them as the property of the insurance company, the state, the public. We are told, that as health care providers we have a responsibility to protect the public, and I would suggest that this goes beyond things like duty to warn in the case of a potentially violent individual. It is also our job implicitly, to help our patients to function less noticeably within society, adapting themselves more successfully to the norms of the culture and to protect the public from the experience of not recognizing itself when it looks in the mirror.
What I have attempted to do in trying to bring some aspects of hospital existence to life for you today is to demonstrate in the specific, a particular way in which psychoanalysis was petitioned by the institutional master discourse. The manner in which this dynamic unfolded is indeed unique and specific to that particular context. My decision to speak about it however is due to my belief that analogous processes are at work all over the country, within institutions, academic settings, training institutes, professional organizations, state and federal regulatory agencies, licensing boards. One might argue that in the particular hospital I described that Real psychoanalysis did not truly exist. Perhaps not, but the harder question I think is, what is Real Psychoanalysis? And have Real psychoanalysts whoever they are, lost sight of the radical implications of Freud’s earliest discoveries? It is up to each of us I believe, to decide for ourselves what psychoanalysis is, and perhaps each and every psychoanalytic experience between individuals can only be defined by them. For me, psychoanalysis itself is characterized by unresolvable paradox and contradiction, and is a unique discourse which recognizes, celebrates and inquires into such a dialectic. In current modern times it is configured inevitably, I believe, both as a technology of adaptation and as an emancipating inquiring challenge to the status quo. It is important for us, I think, to appreciate this dialectic -- to not dismiss one or the other aspect, to not insist on this bifurcated status as being necessarily intransigent and unspeakable, but to instead appreciate and study it as a present-day, post-modern iteration of the kind of dialecticism that has characterized psychoanalysis from its inception. It seems to me that, if psychoanalysis could appreciate itself as an impetus to the eroding of the very modern -era tenets which served to found it, then psychoanalysis could embrace its own inherent radicality and dialecticism. Such dialecticism could then be studied and appreciated in contexts such as the hospital I have described today. Perhaps multiplicity and contradictory perspective could then be tolerated and even welcomed without the necessity of petitioning and appropriating that which stands orthogonal to the status quo and threatens the illusory identitarian essentialist discourse. But I think that we as psychoanalysts, need to think twice before rushing to be included in the very system which we uniquely stand to question and interrogate. In rushing to be accepted by a system that is quickly trying to close its doors to us, have we unwittingly imprisoned ourselves in its lexicon, forswearing the possibility of our continuing to speak in our own unique discourse, with patients who wish to have a private, different kind of conversation about themselves and their lives. In trying to fit in, have we failed to consider the price of doing so, and have we considered fully enough other options which might allow us the space to configure our own ways of listening and working? Have we considered carefully enough, other metaphors for us to exist in --metaphors which derive from the humanities, from theater, from semiotics, from philosophy, from literature and poetry, from all sorts of disciplines each of which draws attention to the unique ways in which individuals construct meaning in their worlds and speak to their personalized understandings of this. What is most important I believe, is that those of us practicing psychoanalysis be able to carve out a domain which can continue to be IN but not OF the system—a domain in which it is possible for individuals to work together to understand the master discourse of the individual as he or she represents it--a domain in which it might be possible to explore how the individual may be living out their otherwise other aspects of self which exist In but not Of their master discourse, and doing so in a way that may feel alienated , un-enlivened, compulsory or static. To be able to speak about this, and to live this in the freedom of the analytic dialogue means that one must be willing and able to understand the meanings of the individual as he or she defines and comes to know them and for the analyst not to be there to inscribe the individual patient more securely in the master discourse of the society.
I don't think that Ms. Smith got to ask too many questions , so before concluding, I am going to ask one more. Could we not consider the idea that those individuals in our society deemed deviant and crazy would be better seen as eccentric? --eccentric spelled ex-centric--that part of ourselves, similar to what Barratt has described as the immanifest contradictory desirous otherwise whose exclusion is mandated by the conscious "I" and whose occlusion even makes possible the enduring existence of such an "I". But it is an otherness that nonetheless persists, causing the "I" to always be ex-centric to its own self. The "I" bespeaks, necessarily, a contradictory dialectic of impossible possibilities. Psychoanalysis, a radical discovery in celebration of such possibilities, invites and dares us to have a conversation with those crazy, eccentric people -- a real conversation, alternative to petitioning and appropriation -- a conversation in which both parties might just dimly perceive that there , but for the terror of recognition, go I. I suggest that we do what we can, before it is too late to keep ourselves in the conversation, to keep the dialectic alive, and to maintain our own ex-centricity before our discipline of psychoanalysis is entirely disciplined by those cultural forces whose tight embrace could love us to death.
Dr. Young received her undergraduate degree from Brown University, and her Ph.D. in clinical psychology from the University of Michigan. She currently has a psychoanalytic private practice in Farmington Hills, Ann Arbor and Northville, Michigan. Until its closure in October of 1997, she worked for ten years as a staff psychologist at the Detroit Psychiatric Institute where she taught, supervised and served as senior psychologist on the Adult Inpatient Service. Dr. Young is a consultant at the Veterans Administration Hospital in Detroit. She is the current President, Past Vice President and a founding member of the Academy for the Study of the Psychoanalytic Arts, and a Past Vice President of the MSPP. She can be contacted with e-mail at: firstname.lastname@example.org or by telephone: (248) 348-1100.