Psychosis: sex, gender or symptom?
The reference to gene as real is promoted too by analysts who entrust the future of psychoanalysis to its articulation with physiology and the neuro-sciences; "the meta- psychological considerations leave the advances of the Project in the shadow ", we read in a recent article of the Journal of The American Psychoanalytical Association, " recent knowledge about the cerebral bases of the emotions at levels beyond the conscience due to the pre-frontal regulation of the affections, allows for a better understanding of the psychical structure described by the analytic meta-psychology ... and it is of uttermost importance for the future theoretical and clinical developments of psychoanalysis".
Similar voices reduce the etiology of psychosis to the gene. Let's just choose one of the countless articles on that direction issued by the official publication of the American Psychiatric Society: "the genes which are responsible for schizophrenia show very early in the fetal life, acting over other neuronal areas. The masculine - feminine differences are the result of sexual malformation in the genes which determine the schizophrenia. How do men and women differ biologically? How are masculine and feminine brains?" (Seeman, 1999).
Some authors critic the psychoanalytical hermeneutic deviation, looking for something real beyond the rhetoric which brings them to a confusion between science and psychoanalysis. John Gedo, in the same above mentioned Journal, affirms: "since he was incapable of correlating the clinical data with the neurology of his time, Freud tried to widen the field of psychoanalysis by means of a speculative meta-psychology, abandoning thus the field of science"; in a critique which can be qualified as quasi-Lacanian, he adds: "the hermeneutic is not acquainted with important data such as the occurrence of the trauma ... and promotes the theoretical fiction of analysts having an intact ego".
The opposition to the biologism takes the form of a reduction of psychoanalysis to the psychological experience. Stoller and Melanie Klein meet at one point. Stoller, by defining gender as a feeling of being part of a certain sex which goes back to the motherly world, and Melanie Klein, by referring the cause for schizophrenia to the early relation of the child with his mother, in such a way that the symbolic is reduced to a psycho-genetic product, corollary of an emotional experience of learning.
The American relativism and the economy are not absent in the debate. Hence, the International Organization for Gender Rights fights for the de-pathologization of transsexualism, trying to repeat the history of the homosexual lobby, we are in the eve of the erasure of transsexualism as a Gender Identity Disorder of the DSM. Abandoning the psychiatric theory of the gender with a biological theory would allow the medical insurance, which does not cover plastic surgery for esthetical reasons, to do it for physiological reasons. Many scientific investigations aim to change the forms of language in order to create a Fair Gender Language which would not be sexist.
The practice with psychotic patients demands the analyst to take a clear position , a firme standing in the debate. The "not to retreat in front of the psychosis" consists, nowadays more than ever, in the adoption of the symptomatic invention of the speaking being as a guide, for the etiologic theory as well as for the intervention; hence we go through the old biological dichotomy - hermeneutic which redounds in a false chemotherapy - psychotherapy opposition, ignoring the issue of jouissance.
Lacan teaches us that the real of science is not the real of psychoanalysis. The psychoanalytical real is the impossibility to write the sexual relationship and consists in the assertion that is language which marks the fate of the jouissance of the subject. Freud already taught us in the Three Essays that the election of object is not the gist of sexuality, by emphasizing the contingency of the object where it concerns the satisfaction of pulsion and establishing one first identification, previous to any object relation, in his chapter about "The identification". At the point where the theory of gender leads us to the identifications, Freud leads us to the pulsion and its destinies. Paradoxically Stoller remains attached to a biological concept of gender, by conceiving a third transsexual sex based upon the other two. The gender - sex differentiation creates merely a binary which generates the delirium that supports the anatomic side of sex as real. The Anglo-Saxon sexuation - gender confusion repeats the mistake of Freud's English translator: instinct instead of Trieb. To "mother imprinting" we must oppose freudian "fixierung" and the corporeity of the significant; to the "gender map" (mental and cerebral codification of masculinity, femininity and androgynous) we oppose the Urvedrangung. With Lacan we opt for the first contingent incidence of jouissance of the tongue in the body as the primary etiologic cause of the psychosis, as well as of the sexual position.
Nevertheless, there's no significant whatsoever in the language relating the universal law between sexes. Therefore, in Lacan the clinic of the subject is followed by the clinic of the sexuation of the speaking being, beyond the Name of the Father, which consists of locating the one by one of the solutions which the subject produces in his encounters with the radical otherness of the Other sex. The logic of the sexuation which Lacan develops starting from the 70's does not elide the issue of psychosis. Sexuation and etiology tie up in the work of the psychosis.
Sarit or the impasses of psychotherapy
Sarit is presented in a patient presentation by her new therapist, to whom she was derived after a crisis in her previous treatment, a crisis which had been provoked by what we shall call a furor interpretandis (fury of interpretation) by the psychologist "who pushed me to separate from my parents and look for men in order to engage with them in a proper relationship". She adds: "even though it helped me to get out of my sexual abstinence, it was very threatening when she used to say that it originated in my incestuous relationship with my father". Her father used to talk to her about his own sexual intimacy; he was committed to a psychiatric hospital because of a suicide attempt aiming to one of his eyes, which sight he lost. The father used to say he was stupid and was not clever enough to study. Her mother, on the other hand, a math teacher, was very ambitious to succeed in her studies; "pillar of the family, source of security in my existence". The love life of Sarit began with a romance in high school to which she often refers as a relationship with "an ordinary guy". At University she meets a professor whom she marries. The work of the psychosis produced a unique invention: "the substitutes". Her husband is substituted by suitors or lovers, or by mythological figures of the entertainment world. Sometimes her brother, a biologist, substitutes her husband, also a biologist. Some day she will marry her brother, she says. Referring to the interpretation of the psychologist in relation to the "contents" of her deliriums and to her supposed defensive function in the proximity of her husband, Sarit affirms emphatically that saying those things should not be the therapist's role. In addition to this, there are deliriums which transform her into a famous figure whose life is being recorded on film, which gives her much pleasure and calms her anxiety. Nevertheless, the marital life goes on without any significant incidents. Sarit and her husband spend many hours together. Only when sexual tension increases, excesses appear which are dealt by her using "the substitutes". Substitutions follow each other incessantly. Sarit spends each day with a different lover and affirms she never knows which man she will find each time she returns home; "my husband comes back home every two weeks and the rest of the time he lives with another woman". Slowly, the formerly cacophonous chorus of lovers is reduced to delirious conversations with one or two simultaneous interlocutors: the substitutions start to take place only within the circle of "the clever ones", which "allows me to live a different life". The films produced about her are screened every night in front of the select public of "the clever ones". Even though there is some relation among them, she says it's forbidden for her to know anything about that relation. When the psychologist inquires about the prohibition, the first answer is perplexity. The unwise insistence receives a deserved delirious answer: "because I am an extraterrestrial". She adds: "the psychologist used to say that I felt pleasure in showing my breasts and seduce men in order to later keep them far away". She requested then to replace the psychologist with a psychiatrist "to whom I could talk about my lovers without being asked many questions". Between the night filming sessions and lovers, the life of the couple continues: "we have a great necessity to talk, my husband and I; we talk like broken records, we repeat and repeat, we don't listen to each other".
How is Sarit's love life organized? Which is her choice in the field of sexuation? Sarit imitates an hysterical subject, fact which misleads her psychologist. She shows us that the psychosis may well reject the phallus as a referent but may retain imaginary phallic identifications, wear sexual clothing; her imaginary partners allow her to remain in her marriage and act as a prosthesis in front of the abyss that the encounter with the Other sex produces because of the lack of symbolic support. The imaginary staging to which she surrenders in front of the blind look of the foreclosed father, who returns in reality, reminds us of what Miller had said in Arcachon: "after all, the stage of the mirror ... as the paternal metaphor .. is also a symptomatic device". Sarit's psychosis even attempts a rudimental binary by using a significant in order to produce a pseudo imaginary classification without turning to the father; that significant is taken from the paternal language but it suffers from the mark of the relentless maternal law; even though it exists in the common language, its use is neological and acquires the dignity of the symptomatic localization of jouissance. Let's locate Sarit's exceptional place , not divided by castration, as the one defined by the fixation to the image of The woman of "the clever ones". Wisely, she doesn't know about the relationships among them, which allows her to keep the circle not hermetically closed, avoiding thus to complete the Other , pursuer of jouissance.
Sarit shows us which position to take in the debate. Lacan already taught us (seminary III) that the outburst of a psychosis is often produced by an obstinate interpretation. If the analyst plays the role of the breach which prevents the suture of the identification in the neurosis, he will become the addressee of the attempts of restoration of identification in the psychosis.
We share then the critique to the hermeneutics, by opposing the interpretation
which tries to make sense, even in the practice with psychotic subjects,
without resorting to the supposedly anatomic real as etiology of the illness
or the sexuation; we don't strengthen our intervention with a univocal
belief in the word, as psychotherapy does, as does the psychology furnished
exclusively with the Oedipus in order to deal with the sexual position;
we don't reduce sexuation to the symbolic as a theory of the gender, we
put a stake also in the sign; the universalizing fight for sexual equality
doesn't make us neglect the singular real - nonsense inventions, which
the work of the psychosis produces, one by one, locating the auto-erotic
jouissance in a certain dimension of sexual otherness.