From LQ 208
The Chronicle of Éric Laurent
Starts of the Clinic and the Dead-End of Neuro-Multiculturalism
The busiest forum on the current debates on the clinic has just taken place, from the 5th to the 9th of May in Philadelphia, with a well-chosen name. It was the 165th Congress of the American Psychiatry Association. The title and slogan of the Congress was: Integration. Between the General Practitioner and the hospital in a broader sense, how can psychiatric care be integrated into a system which is acquainted with the difficulties of public and private management networking, distinguished within different Health Maintenance Organisations, but not integrated within a unified health system? The system is also aware of the excessive prescription of psychotropic drugs by General Practitioners and the difficulty in integrating civilian and military psychiatry in the treatment of war veterans presenting post-traumatic syndromes.
Such a Congress represents 10,000 participants, with a profusion of everything: plenary sessions, workshops, round-tables, lectures, symposiums, guest speakers, key-note speakers, and a myriad of posters. It opened with a conversation between Aaron Beck, Emeritus Professor of Psychiatry in Pennsylvania, and Glen O. Gabbard, Professor of Psychiatry in the States of New York and Texas, on the points of convergence and divergence between cognitive and psychodynamic psychotherapies. Let it be clear: no slides, no texts, just speech, supreme luxury.
The program is 192 pages long, without counting the hundreds of poster pages. It begins with a 30 page Disclosure Index, in which the speakers who have had any action or engagement with pharmaceutical laboratories must declare them. It is also necessary that the speakers who have nothing to declare do so. The program evokes all that is said in the psychiatric field. It is very difficult to orient oneself in this democratic labyrinth, in which, nevertheless, there is a very strict pecking order. For psychoanalysis, it is easy; there is only one presentation in the program’s index, entitled: “Adolescence and childhood development reorganisation: A neuro-psychoanalytic model”. All in all, it is useful to refer to the specialised articles that appeared in the New York Times and the Washington Post in which Benedict Carey and N. C. Aizenman have resumed the main points.
In this Congress, there was a lot spoken about the consequences of the reorganisation of the clinical field, under the influence of the DSM-5 to be published in May 2013, and of the importance of this reorganisation on “integrated care”. The upcoming master is polarising the field already. The 162 member committee in charge of finalising the document has made public its strategic and highly political decision of renouncing two novelties which had made a scandal.
One of them was the new category of “attenuated psychosis risk syndrome”, which concerns identifying young people at risk of developing later on serious psychosis whilst suffering from minor hallucinations or delusional ideas. The greater risk was that they would be heavily medicated, at the price of unwanted side effects. Psychiatric classifications cannot offer themselves the luxury of admitting “ordinary psychosis” because it would be necessary to medicate them in an equally ordinary way. It also renounced to the new “Mixed Anxiety-Depressive Disorder” which opened up the way to placing the entire population under anti-depressants. We must not believe that these categories have been abandoned, because they have been proposed by the most fundamentalist sector of bio-psychiatry. They consider that pathology is probably one vast continuum in which clinical entities are nothing but unfounded rhetorical artifices, and that it would be better to distinguish degrees of intensity. These categories will then be placed in an ad hoccategory, which we have learnt about through HAS literature: “Disorders requiring further research”. Nevertheless, it is a failure of the Big pharma lobby. Allen J. Frances, President of the committee that developed the DSM-4, now at the head of the opposition movement against diagnostic extensions, is delighted about this drawing back but he underlines that there are still a certain number of categories likely to provoke adverse effects, like the “minor neuro-cognitive disorder”, or the too easily accepted “addiction”. He declares to Aizenham: “The implications go much further that anything that you have ever imagined (…) Add a new symptom and suddenly tens of millions of people who have no diagnosis up until now wake up with this one and will be bombarded by television adds proposing medical treatments… Instead of curbing the problem, the DSM-5 will open up the floodgates even more”. The fact that they are obliged to add a paragraph distinguishing sadness and the symptoms accompanying significant loss, which may resemble depression but isn’t, is hardly reassuring.
There is one point on which the DSM-5 committee made the decision of drastic reduction. It is on autism, where they propose to suppress “Asperger’s Syndrome” and “Pervasive Development Disorder Not Otherwise Specified”. The effects of this decision have been the subject of lively debates. A study from Yale considers that the number of autistic subjects will decrease by half, while another study presented during the Congress considers that this will not change much, as far as the current figures are concerned. As diagnosis is essential in order to access government benefits, the Director of the Centre of Childhood Studies of the Yale School of Medicine hopes that the last hypothesis is true and that the situation will remain stable, but he then wonders what is the point in touching it. However, one of the DSM-5 committees, whose declarations we have reported in another chronicle, (“Autism: Epidemic or Ordinary State of the Subject”, in LQ no. 194 of the 10th of April) was very clear on this point. It is a question of changing the definition in order to “stop the autism epidemic”. One deduces then that this will not be easy and will give rise to claims and predictable debates.
The entire Congress of psychiatry was thus subjected to the tension existing between extension and contention. On the neuroscientists’ side, liberated from clinical problems and based on the objectivation of neurobiological variations affecting autistic subjects, they voluntarily free themselves from limits. Laurent Mottron’s article published in the last issue of “Cerveau et psycho” is exemplary in this regard. “Everything that we know today about autism leads us to see in it a different brain organisation rather than an illness” and that “it is probable that the “autistic spectrum” (…) represents a large part of the population (…) A recent Korean study showed that an individual can correspond to the behavioural criteria of autism as defined by the scientific community, whilst being totally autonomous and without his peers noticing anything. This would be the case for more than 2% of the general population, on top of the 1% for whom the difference is evident. Are these individuals “autistic”? They are, if we define them by a particular behaviour; they are not, if we define them by an illness.
Here we are then at 3%, one child in thirty, which is to say, with the gender dissymmetry, about one boy in twenty. This “considerable population”, according to this perspective, must be welcomed despite its difference and have access to knowledge through their own means, in a way that optimises the performance of its members. It is only then that we will know what autism is, because for the moment “we do not know how autistics would behave if they had access, from birth, to the right information.” The autistic community is explicitly compared to the slave community of the colonial era. Cognitive studies concluded for a long time on the supremacy of western populations, when it was nothing more than exclusion from knowledge. It is not about adapting the autistic community to a lifestyle of the majority or wanting to efface their difference with artificial behavioural treatments. In the Canadian tradition of inter-community respect, Mottron proposes a neuro-communitarianism: “The demand to adapt oneself to the majority, founded upon the logic of strength in numbers, is the warfare’s logic, or electoral logic. It should not concern the neurobiological differences that exist within the human family”. It is about finding the right place for the members of this community. Mottron really does not t like psychoanalysis and never misses an opportunity to make it known, with a lack of subtlety worthy of praise. Nevertheless, the psychoanalytic objection to the community of subjects gathered under a common label should be of interest to him. What we can say about one subject of a given type is of no use for another subject. What needs to be aimed at is not the community, but the particularity. This is underlined by TEACCH practitioners, like Bernadette Rogé, Professor at Toulouse-Le Mirail University, interviewed by Mediapart, who says we must take into account the particularity of autistics: “their willingness, their motivation, their particular sensory and cognitive functioning, which demands a lot of adaptation”. Or even, in the “Denver model” where play and learning are combined in a “positive emotional interaction”, “every domain is worked upon: language, adaptation, motor functions… in a much more natural and spontaneous way”. Beyond objections in favour of singularity, neuro-communitarianism comes to a dead-end due to its vocation of extension without any limits, beginning from behavioural traits, thus sharing the same neurological malfunctioning not otherwise specified, which is no longer a symptom.
In the same issue of Cerveau et psycho, Franck Ramus, another supporter of the disappearance of the clinic in favour of neuro-scientific evaluations, dreams of another proliferation. He brings forth l’hubris from the French politician Fasquelle who seeks to legislate on the treatments of autism. He goes even further, calling for the creation of a “National Evaluation Agency of Psychotherapies” by leaning on the argument that we know so well since the Accoyer Amendment: the juridical void. “Non-pharmaceutical treatments are not subjected to any obligatory evaluation, and are put onto the market with no form of control”. He very much sees himself as being the one to watch over the prescription of any obligation, the validation of established treatment lists, updating, as if competent in the entire psychical field. A truly complicated project. We can see the contradictions into which the AFSSAPS has blundered, now the ANSM, when its domain was already well defined: that of biological studies. We learnt of the failure of the regulatory project for the title of Psychotherapist (the decree of May 7th 2012 modifying the decree of May 20th 2010 with regard to the use of the title, cf. the communique in Lacan Quotidien of 9th May). One easily imagines the dead-end in which this new Agency will be getting lost.
Franck Ramus boasts about not being a clinician and of only being orientated by “science”, that is to say, the horizon of the statistical series of “evidence based medicine”. He is the Research Director of the CNRS (National Centre for Scientific Research) in France, and also a member of KOllectif January 7th, a support group for the Le Mur (The wall) documentary, and “a reflection group on the theme of therapeutic practices for autistic children, so that they may progress despite the resistance of many psychoanalysts”. The leader is Brigitte Axelrad, Honorary Professor of Philosophy and Psycho-Sociology, author of a book on “The Ravages of False Memories” (2011) who sustains very different theses to those by Jean-Claude Maleval1 on the causes of the “false memories” epidemic. In this collective, we also come across Yann Kindo, Professor of History and Geography, a rationalist militant whose blog, housed by Mediapart, fires away at psychoanalysis and recommends civil disobedience in order to “become a voluntary planter of GMOs”. On May 10th 2012, loyal to the recommendations of the “Manifesto for an evidence-based psychiatry and psychology” produced by KOllectif, Franck Ramus published, in another blog housed by Mediapart, an article proudly entitled: “Psychical suffering is neither evaluable nor measurable”. My eye! He reaffirms there his faith in the validity of statistical investigation to measure everything that is psychical. However, in the dossier consecrated to autism in the April 2012 issue of Sciences et avenir, he could not hide his surprise over the little impact that the KOllectif “Manifesto” had when he had wanted to have it signed as a petition in his circle. The cause of this would be simple: “According to him, a lot of young psychiatrists would consider it too risky for their career to say out loud what they think deep down about French psychoanalysis”, the S&A dossier reports. We have here two links of the chain of the subjective field. Everything that is psychical can be measured, and if something unpredictable appears, this is the result of a psychoanalytic conspiracy. The fact, the evidence, is that the “manifesto” was a flop. The rest is interpretation.
Translation: Frances Coates-Ruet
(1) Maleval, J.C. Etonnantes mystifications de la psychotherapie authoritaire. (The astonishing mystifications of authoritarian psychotherapy)
|NLS- 2011/2012 Towards Tel Aviv.
Jacques-Alain Miller – ‘Reading a Symptom’ – full text
Jacques-Alain Miller, in his speech at the NLS Congress in London, 3 April 2011, proposed and presented the title for our next Congress: ‘Reading a Symptom’. Some weeks ago I selected extracts from this text to devise the essential elements of what we classically call an ‘argument’ (NLS-Messager 24)
Today, NLS-Messager circulates Jacques-Alain Miller’s text in full, in French and in English. In fact, it is the major common reference for our work and orients the preparation of the Congress in Tel Aviv in June 2012. From September, a good number of activities (seminars, cartels, ‘Knottings’…) will take it as their basis, and some have even started already.
A printed version of the full text is now available: it is published in Mental 26, which has just come out. It will be published in English in Hurly Burly in October.
Everyone can start studying it during summer now. Enjoy the work!
A mistake in the transcription had escaped our attention until now. It is an important sentence at the end of the second section; here is the correct version: “In the field of language, psychoanalysis doubtless finds its point of departure in the function of speech, but it refers it to writing. There is a gap between speaking and writing. Psychoanalysis operates in this gap. It exploits this difference.”
Reading A Symptom Jacques-Alain Miller
It falls to me to reveal the title of the next Congress of the NLS, to justify it before you and set out a few points of reflection that will be able to serve as markers when it comes to writing up the clinical texts this title calls for.
I have chosen it based on two indications that your president, Anne Lysy, put to me. The first is that the Executive Committee of the NLS would like the next Congress to deal with ‘the symptom’, the second is that it would like the Congress to be held in Tel-Aviv.
The question was therefore one of determining what kind of stress, inflexion and impetus should be given to the theme of the symptom. I’ve weighed this up by drawing on the Course I give in Paris each week, where I examine Lacan and the practice of psychoanalysis today, this practice no longer being altogether that of Freud. Indeed, perhaps it is not at all Freud’s practice. Secondly, I weighed up the stress to be given to the theme ‘the symptom’ with regard to the place, Israel. And thus, all things considered, I have chosen the following title: Reading a Symptom.
Knowing How to Read
Those who read Lacan have no doubt recognised an echo of his remark in ‘Radiophonie’ that you will find on page 428 of the collection Autres écrits. He underlines that the Jew is ‘he who knows how to read’. This knowing how to read is what will be examined in Israel, knowing how to read in the practice of psychoanalysis.
I shall say right off the bat that knowing how to read, as I understand it, complements putting it well which has become a slogan in our circles. I would readily maintain that putting it well in psychoanalysis amounts to nothing without knowing how to read, that the putting it well proper to psychoanalysis is founded on knowing how to read. If one stays at the level of putting it well, one only gets to the half of it. Putting it well and knowing how to read are on the analyst’s side, they are his prerogative, but in the course of the analytic experience putting it well and knowing how to read transfer over to the analysand’s side. In some sense the analysand learns, unencumbered by any pedagogy, to put things well and also to read.
The art of putting it well defines the traditional discipline called rhetoric. Psychoanalysis certainly partakes of rhetoric, but doesn’t boil down to that. It seems to me that knowing how to read is what makes the difference. Psychoanalysis isn’t simply a matter oflistening, it is also a matter of reading. In the field of language, psychoanalysis doubtless finds its point of departure in the function of speech, but it refers it to writing. There is a gap between speaking and writing. Psychoanalysis operates in this gap. It exploits this difference.
I’ll add a more personal touch to my choice of title, Reading a Symptom, because this knowing how to read is something Lacan imputed to me. You can find that in the epigraph to his written version of ‘Television’, in the collection [Television/A Challenge to the Psychoanalytic Establishment], on page 1. I put some questions to him for a television broadcast and he wrote as an epigraph to the text that, with a few changes, reproduces what he said on that occasion: ‘He who interrogates me also knows how to read me.’ So Lacan pinned this knowing how to read on me, at least a knowing how to read Lacan. It is a credential he bestowed on me for the annotations with which I punctuated his talk in the margins of the text, many of which make reference to his formulas, the mathemes. So the question of knowing how to read has every reason to mean a lot to me.
After this introduction, I shall now set out the point I’ve reached in my Course this year, which has led me precisely to this business of reading, of reading a symptom. Right now, I am in the process of articulating the conceptual opposition between Being and existence. And this is one step on the way by which I mean to contrast Being and the real.
For me, it is a question of highlighting the limits of ontology, the doctrine of Being. The Greeks invented ontology. But they sensed its limits because some of them developed a discourse that explicitly concerned what lies beyond Being. We are to believe they felt the necessity of this beyond Being, because therein they placed the One. In particular, the fellow who developed the cult of the One as a beyond Being was a certain Plotinus. And he drew this, centuries down the line, from hisreading of Plato, more precisely, Plato’s Parmenides. He drew this therefore from a certain knowing how to read Plato. And upstream of Plato, there was Pythagoras, a mathematician yes, but a mathematician-mystic. Pythagoras was the one who deified the number, and especially the One. He didn’t make it an ontology, but what is technically called, after the Greek, a henology, i.e. a doctrine of the One. My thesis is that the level of Being calls upon, necessitates, a beyond of Being.
The Greeks who developed an ontology sensed the necessity of a point of support, an unshakeable foundation that Being wouldn’t give them. Being does not provide experience and thought with an unshakeable foundation precisely because there is a dialectic of Being. When you posit Being, you also posit nothingness. And when you posit that ‘Being is this’, by the same token you posit that ‘Being is not this’, therefore ‘it is that too’ by virtue of being its opposite. In sum, Being radically lacks Being, and not accidentally but essentially. Ontology always ends up in a dialectic of Being.
Lacan knew this well enough to define the Being of the subject of the unconscious as a want-of-Being. In doing so he was exploiting the dialectical resources of ontology. Translating the French expression manque-à-être as ‘want-of-Being’ adds something that is altogether precious: the notion of desire. Want is not only the fact of lacking, in want there is desire, there is will and precisely the desire to bring into Being that which is not. Desiremediates between Being and nothingness. We meet this desire again in psychoanalysis at the level of the analyst’s desire which animates the analytic operation in so far as this desire aims to bring the unconscious into being, to make what is repressed appear, as Freud used to say. Clearly, what is repressed is a want-to-be par excellence. What is repressed has no actual Being, it is not a word that is effectively spoken. What is repressed is a virtual Being in a potential state, regardless of whether it will come to appear or not.
The operation that leads the unconscious to Being is no operation of the Holy Ghost, it is an operation of language.This is the operation that psychoanalysis implements. Language has the function of bringing what doesn’t exist into Being. This is precisely what must have been spotted by the logicians. That language should be capable of bestowingBeing upon that which doesn’t exist filled them with despair, and so they tried to normalise its use, hoping that their artificial language would not name that which doesn’t exist. Language is a creator, and in particular it creates Being. In sum, the Being that philosophers have been talking about from the start is only ever a Being of language. That is ontology’s secret. So, that gives rise to a certain sense of giddiness.
A Discourse That Would Be of the Real (qui serait du réel)
For the philosophers themselves, this gives rise to a certain sense of giddiness. This is the giddiness of dialectic, because Being is opposed to appearance, but Being is likewise nothing but appearance, a certain modality of appearance. Thus, it is this fragility, intrinsic to Being, that justifies the invention of a term that unites being and appearing: the term ‘semblance’. Semblance is a word we use in psychoanalysis to try to bring out what is inseparably both Being and appearance. I once tried to translate the French semblant into English with the expression ‘make believe’. Indeed, if one believes in it, there is no difference between appearing and being. It is a matter of belief.
So, my thesis, which is a thesis on philosophy starting off from the analytic experience, is that the Greeks, precisely because they were eminently grappling with this sense of giddiness, sought out a beyond of Being, a beyond of semblance. What we call the real is a beyond semblance, a beyond which is problematic. Is there a beyond of semblance? The real would be, as it were, a Being, but one that would not be a Being of language, one that would be untouched by the equivocations of language, one that would be indifferent to make-believe.
Where did the Greeks find this real? They found it in mathematics and elsewhere. Since then, mathematics has continued to find it there just as philosophy has. Mathematicians readily call themselves Platonic, in the sense that they don’t think they are creating their object in the slightest, but rather spelling out a real that is already there. And that fires the imagination. At any rate, it fired Lacan’s.
Lacan once gave a Seminar under the title D’un discours qui ne serait pas du semblant. This wording has remained mysterious, even now that the Seminar has been published  , because this title presents itself in both the conditional and the negative. But in this form, it evokes a discourse qui serait du réel. That is what it means. Lacan showed reserve in not putting it in the form I’m exposing, he only put it in a conditional and negative form. D’un discours qui serait du réel, on a discourse that would find its point of departure based on the real, as does mathematics.
Lacan’s dream was to put psychoanalysis on the same level as mathematics. In this respect, it ought to be said that only in mathematics does the real not vary – albeit that, on the fringes, it does still vary none the less. In mathematical physics, which incorporates and is supported by mathematics, the notion of the real is utterly slippery because it inherits the old idea of nature. With quantum mechanics and the research onBeing beyond the atom, one can say that the real in physics has become uncertain. Physics has seen much fiercer debates between physicists than we’ve ever seen in psychoanalysis. What is real for one is mere semblance for another. They each make propaganda for their notion of the real, because from a certain point on, the observation itself is put under scrutiny. From that point on, the complex that is made up of the observer and his instruments of observation is seen to interfere, and then the real becomes relative to thesubject, i.e. it ceases to be absolute. One can say that the subject thereby screens off the real. This is not the case in mathematics.
How and with what instrument does one reach the real in mathematics? Without doubt, it is reached with language, but a language that doesn’t screen off the real, a language that is real. It is a language reduced to its materiality, a language reduced to its signifying materiality, a language reduced to the letter. In the letter, unlike homophony, it is not Being that you find, it is the real.
Flashes of the Unconscious and Desire of the Analyst
I propose to examine psychoanalysis starting off from these premises.
Where is the real in psychoanalysis? This is a pressing question to the extent that a psychoanalyst cannot help feeling the giddiness of Being when, in his practice, he is inundated with creations and creatures of speech.
Where is the real in all that? Is the unconscious real? No it’s not! And that is the easiest answer to give. The unconscious is a hypothesis. This remains a fundamental perspective, even if we are to stretch it out, or make it vary. Remember that for Freud the unconscious is the result of a deduction. Lacan conveyed this as closely as possible byhighlighting that the subject of the unconscious is a supposed subject, i.e. a hypothetical subject. Therefore it is not a real.
One may even pose the question as to whether it is a Being. You know that Lacan preferred to say that it is a ‘desire to be’ rather than a Being. The unconscious has no more Being than the subject itself. What Lacan writes with a barred S is something that has no Being, whose only Being is lack, and which must come into being. And we know this well, we need only draw the right conclusions from it. We know very well that the unconscious in psychoanalysis is submitted to an ought to be. It is submitted to an imperative which, as analysts, we represent.
It is in this sense that Lacan said that the status of the unconscious is ethical. If the status of the unconscious is ethical, then it is not of the order of the real. That’s what that means. The status of the real is not ethical. In its manifestations, the real is more unethical, it doesn’t do as we please. Saying that the status of the unconscious is ethical is precisely the same thing as saying that it is relative to desire, and first and foremost the analyst’s desire which tries to inspire the analysand to take up this desire.
At what point in the practice of psychoanalysis is it necessary for one to deduce the unconscious? Simply, for example, when one sees old, long-forgotten memories coming back in the analysand’s words. We have to surmise that, in the intervening period, these memories resided somewhere, in a certain locus of Being, a locus that remained unknown, inaccessible to cognition, and which is said to be ignorant of time.
To undermine still further the ontological status of the unconscious, let’s take what Lacan called the formations of the unconscious, and which highlight precisely the fleeting status of Being. Dreams vanish. They are beings with no consistency, of which often we get only snippets in analysis. Slips of the tongue, bungled actions, and witticisms are instantaneous beings that appear in a flash. They are given a sense of truth in psychoanalysis, but one that promptly slips away.
Confronting the Symptomatic Leftovers
So, among these formations of the unconscious there are symptoms. Why else include symptoms among the formations of the unconscious, if not for the fact that the Freudian symptom is truth? It is given a sense of truth, and it is interpreted. But it is distinct from all the other formations of the unconscious by virtue of its permanence. It has a different modality of Being.
For there to be a symptom in the Freudian sense, no doubt there has to be some meaning involved. It has to be open tointerpretation. This is precisely what leads Freud to distinguish between symptoms and inhibitions. Inhibition is purely and simply the limitation of a function. In and of itself, an inhibition has no sense of truth.
For there to be a symptom, the phenomenon also has to last. For example, a dream undergoes a change of status when it becomes a recurring dream. When the dream is repetitive, a trauma is implicated. The bungled action, when it is repeated, becomes symptomatic, it can even pervade all the subject’s behaviour. That is when it is given the status of a symptom. In this sense, the symptom is themost real thing that psychoanalysis gives us.
It is with regard to the symptom that we meet the burning question as to the correlation, the conjunction between the true and the real. In this sense, the symptom is Janus-like, two-faced, with a face of truth and a face of the real. What Freud discovered, and which was sensational at the time, was that a symptom can be interpreted like a dream, that it can be interpreted in accordance with a desire, and that it is a truth-effect. But, as you know, there is a second phase to this discovery: the symptom’s persistence after interpretation. Freud uncovered this as a paradox. It is indeed a paradox if the symptom is purely and simply a Being of language. When you have to do with Beings of language in analysis, you interpret them, i.e. you reduce them. You bring them back to nothing, to nothingness. The paradox here is the paradox of the leftover. There is an x that remains beyond Freudian interpretation.
Freud approached this in different ways. He brought in the negative therapeutic reaction, the death drive, and widened the perspective to the point of saying that the end of analysis as such still allowed what he called ‘symptomatic leftovers’ to remain.  Today, our practice has extended far beyond the point Freud indicated, the point at which analysis ended for Freud. Indeed, it was an end point that Freud described as always entailing a leftover, and thus the analysis would still have to be begun again after a short while, at least for analysts. A short pause, and then off again. It was a ‘stop and go’ rhythm, as we say in French now. But that’s not what our practice is.
Our practice extends beyond the point at which Freud considered there to be ends of analysis, even if the analysis had to be resumed. Our practice goes beyond the point Freud considered to be the end of analysis. In our practice, we see the subject confronting the symptomatic leftovers. Of course, one passes through the moment of deciphering the truth of the symptom, but one gets to the symptomatic remainders and refrains from saying ‘stop’. The analyst doesn’t say ‘stop’ and nor does the analysand. During this period, the analysis consists in the subject’s direct confrontation with what Freud called symptomatic leftovers, and to which wegive an altogether different status. Under the name of symptomatic leftovers, Freud came up against the real of the symptom. He came up against that which in the symptom falls wide of meaning.
The Jouissance of the Speaking Being (l’être parlant)
Back in the second section of ‘Inhibitions, Symptoms and Anxiety’, Freud was already characterising the symptom on the basis of what he called drive satisfaction, ‘as a sign of, and a substitute for [Anzeichen und Ersatz], a drive satisfaction which has remained in abeyance.’ In the third section, he explains this with reference to obsessional neurosis and paranoia, noting that the symptom presents itself first of all as a ‘foreign body’  with regard to the ego, then endeavours to become part of the ego, i.e. it tends to be incorporated into it. Freud saw the symptom as a ‘consequence of the process of repression.’  These two sections, along with the article as a whole, clearly need to be worked on with an eye to the next Congress.
I should like to underline the following: is the jouissance in question here primary?
In one sense, yes, it is. One can say that jouissance is proper to the body as such, that it is a phenomenon of the body. In this sense, a body is what enjoys, but reflexively. A body is what enjoys itself, it is what Freud called autoeroticism, though this is true for any living body. One can say that the status of the living body is to enjoy itself.
[However, in another sense], what singles out the body of the speaking being is the fact that his jouissance feels the impact of speech. Indeed, a symptom vouches for the fact that there has been an event that has marked his jouissance in the Freudian sense of Anzeichen, which introduces an Ersatz, a jouissance there ought not to be, a jouissance that troubles the jouissance there ought to be, i.e. jouissance of its nature as a body. Therefore, in this latter sense, no, the jouissance in question in the symptom is not primary. It is produced by thesignifier.
It is precisely this impact of thesignifier that makes the symptom an event, and not simply a phenomenon. Thejouissance of the symptom vouches for the fact that there has been an event, a body-event, after which ‘natural jouissance’, which can be imagined as the natural jouissance of the living body, is troubled and deviated. This jouissance is not primary, but it is primary with regard to the meaning the subject gives it, and gives it through his symptom in as much as it can be interpreted.
To grasp this better, one may turn to the contrast between metaphor and metonymy. There is a metaphor of the body’s jouissance, and this metaphor makes for an event, the event that Freud calls fixation. This presupposes the action of the signifier, as does any metaphor, but a signifier that operates outside meaning. And after the metaphor of jouissance, there is the metonymy of jouissance, i.e. its dialectic. This is when it is endowed with signification. Freud speaks about this in ‘Inhibition, Symptoms and Anxiety’. He speaks of die symbolische Bedeutung, the symbolic signification  that strikes a certain number of objects.
From Listening for Meaning to Reading the Meaningless
One can say that this has repercussions in analytic theory. For a long time in analytic theory, a little story was told about jouissance, a little story in which the primordial jouissance was to be found in the relationship with the mother, in which the impact of castration was the father’s doing, and in which drive jouissance found Ersatz objects that plugged up castration. This is a very solidly built apparatus which follows the contours of the analytic operation. But all the same – I’m going to draw the line a little darker – this is a mythical superstructure by means of which we did indeed manage for a while to remove symptoms by interpreting them within the framework of this superstructure, but by interpreting the symptom in the framework of this superstructure, i.e. by prolonging what I’ve called the metonymy of jouissance, we made the symptom swell up, i.e. we fed it with meaning. This is where my reading a symptom comes in.
Reading a symptom runs counter to this. It consists in severing the symptom from meaning. Moreover, this is why Lacan replaced Freud’s interpretative apparatus – which Lacan formalised and clarified with the Oedipal ternary – with a ternary that doesn’t produce meaning: the ternary of the real, the symbolic and the imaginary. But in shifting interpretation from the Oedipal setting to the Borromean framework, the very functioning of interpretation changes and switches from listening for meaning to reading the meaningless.
When we say that psychoanalysis is a matter of listening, faut s’entendre!  In fact, what we listen for is always meaning. And meaning calls for more meaning. All the different psychotherapies stick at this level. They always wind up with thepatient having to listen to the therapist. For us, on the contrary, it is amatter of exploring what psychoanalysis is and what it can do at the level of reading strictly speaking, when one distances oneself from semantics. Here I would refer you to the precious indications on reading that can be found in Lacan’s text ‘L’Étourdit’, which you will find on page 491 and thereafter,  on the three knotting points of homophony, grammar and logic.
Targeting the Clinamen of Jouissance
Reading, knowing how to read, consists in putting distance between speech and the meaning it carries, based on writing as outside-meaning, as Anzeichen, as letter, based on its materiality. Whilst speech is always spiritual, as it were, and the interpretation that stays purely at the level of speech only swells up meaning, the discipline of reading targets the materiality of writing, i.e. the letter in so far as it produces the event of jouissance that is decisive for the formation of symptoms. Knowing how to read targets this initial shock, which stands as something like a clinamen of jouissance – clinamen is a term from the philosophy of the Stoics.
For Freud, since he started off from meaning, this presented itself as a leftover, but in fact this leftover is what lies at the very origin of the subject. It is, in a way, the original event and, at the same time, a permanent event, one that is ceaselessly reiterated.
This is laid bare in addiction, in the ‘one more drink’ we heard about earlier. Addiction lies at the root of the symptom which is made from the reiteration of the same One. It is the same, in the sense that it can’t be added up. One never gets to: ‘I’ve had three drinks so that’s enough now’. One always downs the same drink, once more.
It was in this sense that Lacan said the symptom is an et cetera, the return of the same event. One can do many things with the reiteration of the same.Indeed, one can say that in this sense the symptom is a fractal object, because fractal objects show that the reiteration of the same through successive applications gives you the most extravagant forms and even, it has been said, the most complex ones that mathematics can offer.
Interpretation as knowing how to read aims at reducing the symptom to its initial formula, i.e. the material encounter between a signifier and the body, the pure shock of language on the body. So, admittedly, to treat the symptom you have to pass through the shifting dialectic of desire, but you also have to rid yourself of the mirages of truth that this deciphering brings you and aim beyond, at the fixity of jouissance and the opacity of the real.
If I wanted to make this real speak, I would impute to it what the God of Israel says out of the midst of the burning bush, before issuing the commandments that clothe His real: I AM THAT I AM.
This text is translated from a transcription of the ‘Presentation of the Theme for the Tenth Congress of the NLS’, delivered by Jacques-Alain Miller in French at the NLS Congress in London, 3 April 2011. The French text was established by Dominique Holvoet.
Translated from the French by Adrian Price
1- Lacan, J., Le Séminaire, Livre XVIII, D’un discours qui ne serait pas du semblant, Seuil, Paris, 2007. 2- Freud, S., ‘Analysis Terminable and Interminable’ in Wild Analysis, transl. by A. Bance, Penguin, 2002, p. 184 [where the translation gives: ‘vestigial phenomena’]. 3- Freud, S., ‘Inhibitions, Symptoms and Anxiety’ trans. by J. Strachey [translation modified] in The Standard Edition of the Complete Psychological Works…, Vol. XX, Hogarth Press, London, 1959, p. 91. 4- Ibid., p. 97 & 98. 5- Ibid., p. 98-9. 6- Ibid., p. 91. 7- Ibid., p. 90 [Where it is translated simply as ‘significance’]. 8- [TN, entendre in French is both ‘to understand/agree’ and ‘to hear’. Faut s’entendre is thus ‘we gotta come to some agreement’ and ‘we gotta hear each other’.] 9- In Lacan, J., Autres écrits, Seuil, Paris, 2001.