Clinic of the Real

We have discussed our similar views on the bio-psychic interactional view many times, and I wanted to recommend a recent book by Paul Verhaeghe – “On Being Normal and Other Disorders,” partly because it is one of the clearest statements of Lacan’s approach to differential diagnostics and treatment, and partially because it is the first text I have seen which takes an approach similar to mine – integrating a Freudian and Lacanian approach with recent developmental, neuroscientific, and psychosomatic research.

For Verhaeghe mutilation, anorexia, addiction, panic and other symptoms can be described as “actualpathological” attempts to deal with the drive where psychic processing is unable to create “psychopathology.”

If we return to Freud’s early work we can find the elaboration of actual neurosis versus psychoneurosis. Verhaeghe links this to the early transformation of the bodily drive in relation to the response of the Other and sketches out a map of how and why a more bodily response to the core anxiety-depression cycle (similar to Klein) develops when there is no imaginary and symbolic elaboration (or mentalization). In my work I have found a continuum from physiopathology to neuropathology to psychopathology that links medicine and psychoanalysis to understand the evolving human bio-neuro-psychic metabolizing immune process.

After reaching conclusions similar to Verhaeghe some years ago, I decided to undertake training and research that would allow me to work directly with the drive and create a “Clinic of the Real” which could treat neurological, immune, psychosomatic and borderline syndromes from an analytic position. Verhaeghe calls for this in his book when he describes Lacanian discourse theory and how to act from the position of the analyst in therapy (or medicine) while not yet being able to perform classical psychoanalytic methods – because in such patients psychic processing is not yet available. I try to create an environment where subjectivization or “subject amplification” is facilitated by the analytic position while working on the bodily drive with methods that do not override and suppress (pharmaceuticals) but support and detoxify (homeopathy, naturopathy, acupuncture) the deposited physical and psychic intrusions of the Other. Sometimes patients who begin here end up transforming their physical or “actual” symptoms into psychic ones and undertaking a more “pure” analysis.

In Lacan’s later work he focuses on the drive caught between bodily jouissance and the desire of the Other (mother, culture, language,etc.). The development of gender and sexual difference in the social will reenact this more primal split of being human, such that the “choice” of gender is a form of defense against primordial jouissance. The hysteric’s body and relation to the Other is “carved up” in such a way that this choice is far from clear. Paradoxically, Lacan believes this is closer to the analyst’s position than most “normal” neurotics in its lack of fixation – to the extent that analysis must often hystericize a rigid character structure to achieve a new breakthrough.

The case is very different for “borderline” or “actualpathological” conditions

What Verhaeghe calls “subject amplification” or I call subjectivization refers to the original relation between the subject which comes to be through signifiers of the Other (parents, culture). In a case in which this did not take place and bodily jouissance or anxiety remains at the level of actual physio- or neuro-pathology (since it could not be processed into psycho-pathology), one may recreate a relation in which new imaginary-symbolic signifiers are offered – not imposed – from what Lacan calls the position of the analyst.

In investigating the historical reconstruction of psychosomatic symptoms such as neurasthenia, psycheasthenia, possession, delusions, borderline syndromes, autoimmune dysfunction, addiction, panic, chronic fatigue, ADD…, I found (as the periods of elipsis indicate) no clear cut gap where so called physiological medical symptoms and psychiatric symptoms divide, so I have tried to develop an Analytic Medicine alongside “pure” analysis. The techniques used must be practiced within Lacan’s position of the analyst.

With homeopathic medicine and acupuncture we are able to contain symptoms without suppressing them and producing toxic side effects. Simultaneously we offer new signifiers for patients to process the experience of illness – what Verhaeghe calls “subject amplification.” Most important the therapeutic relationship is made from the position of the analyst – not the medical master or medical knowledge of the symptom. This leaves room for the demand for analysis to emerge through further imaginary-symbolic elaboration and the creation of new subjectivities and new social links.