The mechanism of cure in psychoanalysis

1. Purpose of the cure To go into in the theoretical problem of <the mechanisms of cure>, demands first to define the concept of cure. It is very well-known for us, that we psychoanalyst avoid using the word <cure> in our clinical practice. We don’t say that our analysands at the end of the analysis are cured. Freud himself was not in favor of considering the cure an objective of the psychoanalytic method (1909).

It has been the case however, that through different times, the question of the purpose of Psychoanalysis arises. When trying to respond to that question, I prefer to use the concepts that Wilfred Bion and Jacques Lacan, offer some time ago. For me, these two clever and creative analysts in their own way say the same thing. Wilfred Bion tells us in 1967 that the search for interior truth is essential for mental growth …<Without truth of one self, the mind does not develop, it dies from starvation>. For that reason Bion concludes that the purpose of psychoanalysis is not the symptomatic cure, neither the adaptation of the individual to its family or society. He tells us that the purpose of psychoanalysis is to help the analysand achieve what the individual really is: <to be what he is>.

Jacques Lacan in 1973 teaches us that the ethical position of the psychoanalyst relies on the ethics of <speaking-well> ( La éthique du bien – dire ). This speaking-well of the psychoanalyst, shows the road, that takes the analysand (by himself) to discover something of his interior truth. In this proposal there is no imposition, no intention of suggestion, and no demand of adaptation, done or requested from the analyst. For that reason, Lacan confirm what he had already said in 1960, that the purpose of psychoanalysis relies on helping the subject <not to give in his desire> <to insist in his desire> ( S é mina ire VII ). In this proposal we will not put on a demand for adaptation to family or society values. On the contrary, it consist in be what this subject really is. It is clear that to achieve this purpose the subject should not give in his desire. However, Lacan adds, that this type of <end of analysis> is heroic, and that <not to give in the desire> and <to be one self> bears big sacrifices that are not always within reach of the analysand.

On the other hand, Bion alerts us of false results. He tells us that <to be what we are>, requires of a special transformation of the analysand, so called <transformation in O>. This should be distinguishes from another kind of transformation. This second one, even though is useful and have certain value, it doesn’t produce the wanted effect of <to be one self>. This second kind is called <transformation in K>. This <K> refers to knowledge. That is to say, to the changes taken place by an intellectualize analysis. It means knowledge of our own infantile and oedipal history, without true change, without an emotional experience.

The transformation in <O> that refers to something unconscious beyond the repressed produces a true change, with a deep emotional experience. Many times, transformation in <O>, or <to insist in the desire> and <to be what we really are> collides with the moral values of family or society. For that reason psychoanalysis in its foundations, is amoral. There are not any morals that we should impose to the analysand. Psychoanalysis is based in its ethics, which is the ethics of the search of the interior truth.

2. Limits of cure . The variation that exists in the <mental structures> of the analysand imposes variations in our technical approaches. It is not the same thing to analyze a neurotic structure, than to analyze a psychotic structure. A neurotic structure –including the neurotic narcissistic disturbances and the borderline cases— is a structure that is founded on the mechanism of repression (Verdrangun). This structure has the resource of use of metonymy in their relationship with the Other. (Referring to the concept of the Lacanian Other). This neurotic structure can tolerate lies, uncertainty and certain ambiguities of transference. They tolerate what the analysand could or may understand as an analyst’s rejection, without taking place a mental collapse. These capacities of the neurotic structure, allow the unfolding and the operability of transference in a <typical cure>, or also called <standard cure> where the analytic neutrality, the floating attention, the silence of the analyst, and the psychoanalytic interpretation, are basic tools that the analyst has at his disposal in this type of cases.

The compensated psychotic structure or so called stabilized psychotic, without visible psychotic clinic, doesn’t tolerate anything that resembles a rejection, since it could trigger a mental collapse. They don’t have the resource of the metonymy, leaving little space to the analyst which will then be subjected to a <rigid transference>. This will forces the analyst to be very careful with what he says and what he does in session. In those cases, the main tool that the analyst has at his disposal is something that we could call pedagogic activity. That is to say, an analysis directed to the ego, teaching the analysand to survive. This type of help is sometimes life saving and offers a possibility to re-order the subject’s life. Sometimes that is all we can aspire in that type of analysis. I should say, that enough reasons exist, to be very satisfied of this analysis and their satisfactory epilogue.

On the other hand, when we are confronted with a <clinic of the hole> and not with a <clinic of a neurotic conflict> or a <clinic of a neurotic trauma>, and when this <interior hole or narcissistic deficiency> of the analysand, is of such a magnitude that the transferencial bond with the analyst becomes something so fundamental for that analysand, then, we find that this analysis becomes rightfully endless. This type of analysand can re-order his system of ideals and may actualize them, producing important changes in his mental structure and improving his quality life. Also this analysand can rescue from repression his traumatic memories of childhood and to know his repressed infantile sexuality, but the <interior hole> doesn’t suffer any modification, and it requires a permanent form of some transferencial presence of the analyst’s figure (or a substitute transferencial structure, like a new subjectidol in religion or sect). Although there may be a substitute structure or an analyst change, that analysis continues to be endless.

3. Mechanisms of the cure After many considerations, I came to the conclusion that we can reduce at two the fundamental mechanisms that intervene in the analysand transformation: (a) The insight (self knowledge) and (b) Re-living (emotional experience). (a) The insight refers to the capacity of the analysand to know what he ignored of himself. That is to say, to make conscience of something that until then it was not known about himself. In the process of analysis this is achieved through the use of language. But sometimes, when the word fails, it is achieved only through an act. Here it does fit the following question: The word ( parole ) and the act of whom? The quickest and simple answer turns out to be inexact. I refer to answer: <The word and the act of the analyst>. This is and it is not certain at the same time. The analyst has one fundamental tool: <psychoanalytical interpretation>.

The analyst believes that he interprets. But, is this the case? Do allow me to ask, really who interprets? The analyst in his saying proposes an idea to the analysand. Let us suppose, the idea is inedited, is new and it points to the unconscious of the analysand. That is to say, the analyst offers an psychoanalytical interpretation. The analysand listens. I may say, the saying of the analyst had gone through (crosses) the self of the analysand under his subjectivity and has produced an effect. That effect depends on what the analysand understood originally from the analyst saying. We could say that the analysand has built his new interpretation starting from what he heard of his analyst.

Finally the interpretation that is useful is the one that the analysand has built. For that reason the question insists: Who interprets? The objective of the analyst’s intervention is to produce <an effect of signifier> through the word ( parol e ). A knot, a bond, settles down among the one that emits the word and the one that receives it. Lacan said that <knowledge> speaks alone. In his interpretation the analyst emits <a statement> ( énoncé ) that takes along a latent content that Lacan called <enunciation> ( énunciation ), which is something that surpasses the marked word. This opens the opportunity for the analysand through the <enunciation> to builds his own interpretation and fined their own sense. Regarding the act, I can say that the analyst’s word ( parole ) sometimes faints.

The word has become ineffective. The analyst’s emanated interpretation gets lost in nothingness. It happens then, that the <analyst’s act>, passes to make an entire sense for the subjectivity of the analysand and begin to have the effects of an interpretation. Here we go into forbidden territory. It is common to observe in supervisions an analyst suffering of feelings of guilt because he has carried out <an act without conscience>, that is to say a legitimate <acting out>. When examining the situation (a posteriori in supervision) we find that the analyst’s acting out, has a reason for being, and has an effect, that has been favorable in that case. (b) The second basic mechanism of <re-living> (emotional experience) refers to <the presence of affects and emotions> in the process. I dare to say that many contemporary analysts of the three geographical regions of the IPA agree on the importance of this aspect.

Donald Winnicott in 1950 outlined the importance of working with regression during the analytic session, and he concludes that it is in the service of the analytic progress. This regression will allow and facilitate an emotional experience. Leaning back, the silence of the analyst and the interpretation of certain infantile transferencial aspects, allow and facilitate regression and intense emotional experience intra session. This aspect of regression and the emotional experience (re-living) open a possibility for transformation en <O>. In this way the analyst’s intervention stops been intellectual. The intellectualization limits the possibilities to produce a deep psychic change. The emotional experience intensifies the re-living experience. For that reason the regression in the service of the ego is welcome and very necessary to make possible certain psychic changes, inside the present psychic structure in a given case. The transferencial interpretations of <preverbal, pre-genital> aspects that we may call as belonging to the <imaginary order>, intensify the regression and the emotional experience.

These interpretations of the transferencial archaic elements, related with the imaginary (narcissistic) relationship with the other, gives a bigger value to the work of the transferencial interpretation, as oppose, to the automatic interpretation of transference, that rather produce a banalization of transference interpretation. I am one of those analysts that think that the fundamental clinical psychic structure (neurosis, psychosis and perversions) are structures which once established in early childhood, they can not be exchanged. Inside each structure, transformations and all the necessary psychic changes will allow a personal realization to happen, as well as the possibility for the subject to arrive at whatever <he really is>.

This way <a psychotic structure> based on the absence of some early psychic mechanisms, as the absence of an operative symbolic order, and its consequence of a enormous difficulty in establishing a social knot, due to the <foreclosure> ( forclu sion ) of the name of the father, (paternal function), this structure can not become a <neurotic structures > which is based in the mechanism of repression (Verdrangun), which already has the inscription of the paternal function. But, the psychotic structure, can through analysis establish a new psychic balance –call compensated or stabilized psychotic structure — and end up having some kind of inner harmony. This could be accomplished with the acquisition of a new psychotic symptom (fourth knot) that ties the three basic orders (Real, Symbolic and Imaginary –RSI). In this way, this stable psychotic structure will be able to have a functional mind and to work at a level of a (functional) social knot (unfortunately without the use of metonymy). So, the stabilized psychotic had found a useful form of living in this world. Even stabilized, functioning, and free of a disordered clinical manifestations, this structure will continue being psychotic, since it can not be otherwise. The absent early mechanism of father’s name (foreclosure) is not amendable.

4. Four additional aspects of the epilogue of the cure These are:
(a) Place of the <theory of Jouissance>
(b) <Theory of Phantom> and its significance in the analytic cure
(c) Problem of the <identification with the analyst> and
(d) Destination of those <post-analytic effects>.

(a) The theory of Jouissance in psychoanalysis constitutes a Lacanian original contribution (1960). To my knowledge this theory offers something new to the understanding of human suffering. The word used by Lacan is <Jouissance>, in Spanish we say <goce> and in English it doesn’t have a translation.

So in English the French original is used. The concept of Jouissance refers to something that is beyond the pleasure principle. An opposition between <enjoyment> ( genub ) and <pleasure> ( lust ). It is something that connotes suffering, beyond the pleasure. It is not a symptom, it is not a phantom. Each subject has his necessary mounts of Jouissance for the maintenance of his psychic balance. Also, the particular magnitude of Jouissance varies according to each subject. Why does some subjects need, for maintaining their psychic balance, a different mount of Jouissance than others? The answer of Lacan and the post-Lacanian groups to this question is not clear. For me, the necessary mounts of Jouissance for each subject has multiple causes. One of the reasons is the arbitrary mount of suffering that was present in the early infant’s life during the moment of the psyche constitution.

I consider useful to differentiate the theory of the <Freudian moral masochism>, the theory of <repetition compulsion> and the theory of <anxiety>, with this new Lacanian contribution of Jouissance. First, let us remember that the <Freudian moral masochism> also refers to a particular form of human suffering. However, in the moral masochism, the suffering obeys a command from the Freudian Superego or of the early Kleinian Superego. Moral masochism obeys a dialectical of the unconscious guilt feelings. The suffering caused by the moral masochism produces a relief of guilt feelings. During the analytic cure one of the symptoms that improves or disappears, after modifying the subject ideals, is in fact, the tendency of the subject to use some methods of punishment to alleviate the unconscious guilt (which is fictional).

It is necessary to distinguish this masochistic suffering from the suffering taken place produced by Jouissance. This Jouissance is not a symptom and it will not disappear. In second place, I have sometimes observed the tendency of some patients to repeat certain behaviors that originate suffering, it constitutes his way to guarantee the <necessary mount of Jouissance> to maintain its psychic balance. To explain this repetition of particular behaviors, by means of the theory of the <repetition compulsion> to my understanding is a conceptual error. The repetition compulsion concept is related with the death drive and with the theory of the Automathon (Lacan, 1964). In third place, it is necessary to distinguish the presence of anxiety in the subject, from the presence of Jouissance. Anxiety (bound or floating), can be seen as a symptom. It is a nuisance and a form of suffering, product of a psychic conflict. Anxiety from this phenomenic point of view is perceived as different to the suffering taken place by Jouissance. The necessary mounts of Jouissance that each subject needs to maintain his mental balance depend on his infantile history. It is something embedded in his psychic structure and therefore part of the same structure. It is not a symptom, it is not a phantom. It is not something that can be removed. It is something authentic of each subject, and each one has to learn how to live with it.

(b) The theory of <sexual phantom> ( La logiq ue du fantasme, 1967 ) has its importance for the way in which the analyst will understand and will work the sexual and erotic life of the analysand. A hundred years ago, in the beginnings of psychoanalysis, the acceptance of several variations in different sexual life models was not an easy thing.

At that time, to distinguish normal from pathological sexual behavior, created some serious discrepancies and problems. Today in spite of all the progresses of science and culture, inside psychoanalytic circles, and in relation to the sexual life values, we found some abundance in moralistic attitudes, instead of scientific values. When we participate in some clinical presentations, we encounter some resistances in some colleagues to accept the legitimate variations of sexual life. They hurry to qualify as pathological certain sexual behaviors that may fall inside the concept of <sexual phantom>. The concept of the <phantom> ( fantasme ) was introduced in psychoanalytical theory by Jacques Lacan in 1967 (seminar XIV). It corresponds approximately to a <sexual fantasy> with images and with a mini script, created by the subject in early childhood. Lacan said that the phantom is always sexual and also always perverse (because it points to veil the subject’s castration). Frequently he called it <the treasure of sexuality>. Each subject builds during his early childhood his own sexual phantom and because of it perverse nature (impeachable), many time it is repressed in the beginning of analysis.

During analysis, when modifying the ideals and censorship of the subject, the phantom becomes an active part of their sexual life. If the analyst considers pathological these perverse sexual fantasies, then he will treat them as a neurotic symptom, and will try to interpret them with the hope that this sexual phantom will disappear. If the analyst, on the contrary, considers that this perverse sexual fantasy is a <treasure of sexuality>, then it won’t treat it as a symptom and it doesn’t require of any interpretation. The analysand learns about their phantom and how to enjoy it. As you see this are very different ways of treating this aspect of the subject sexual life. According to the analyst’s theory, the sexual phantom will be approached in a different way with different consequences. (c) The problem of the identification with the analyst in the cure. (a) Is the <identification with the analyst> a healing factor in the process? (b) Can we distinguish <identification with the analyst> with <identification with the analytic function>? The thesis of the identification with <the analytic function> considers that this identification <with the function> facilitates the insight capacity of the analysand. I coincide with this idea and I am of the opinion that it is unavoidable during the analytic cure that the analysand identified with diverse signifiers from the analyst. Let us don’t forget that the patient becomes an analysand when he discovers that he wants to know more about himself.

The analysand develops introspection rather than requesting answers from his analyst. It is when the analysand opens up to the possibility of discovering unconscious contents. In the beginning this knowledge is put on in the analyst’s place. For that reason the patient initially search and chooses that particular analyst, where in transference deposits wisdom. This place is called by Lacan <subject-suppose-toknow –SSK>, ( sujet – suppose – savoir — SSS ). This SSS is an unavoidable phenomenon of the imaginary order (we may call it narcissistic). At the theoretical end of the analysis, the wise (phallic) analyst falls totally and the analyst appears in transference like castrated, stops to be a phallic figure. Wilfred Bion said that the analyst’s destination, at the end of the analysis, is to become devalued and useless. The analysand accepts his analyst castration and his own castration (incompleteness). In this topic of the analytic end, Bion and Lacan coincide in their proposals. None considers that the analytic end occurred when the analysand finally identified with the idealized analyst. On the contrary it will point towards a beginning of analysis.

Despite all this, during the analytic cure, the analysand will identify with certain signifiers coming from the analyst. For example with signifiers coming from his analyst’s ideals, that the analysand had deciphers through and from the analyst’s interpretations. This will produce certain changes in the operation of the Superego of the analysand. These changes in the Superego will open the road to acquire or to increase the insight capacity of the analysand. This phenomenon that I have just described would be very near the idea proposed by Kleinian analysts referring to the identification with <the analytic function>. Something very different happens with the mechanism of <identification with the analyst>, in which otherness is lost, as well as, the discrimination capacity and the asymmetric relationship with the other. The identification with the analyst, as a mechanism of cure, is fragile and without sustentation. It is called transferencial cure. However the effect of this <transferencial cure> is surprising and dramatic, similar to those taken place with the phenomenon of hypnosis.

But I repeat they are not sustained in time, because they are artificial and they don’t correspond to a discovery of inner truth and some interior change. Lacan outlines that the analyst and the analysand establishes a <asymmetric> relationship that give way to the possibility of an analytic act. This doesn’t mean that during the cure other properly non analytic moments exist (symmetrical). This happens during the pedagogic moments or the support moments, so called (orthopedic). (d) The <post-analytic effects> in the cure will be considered important or irrelevant according to the analyst’s theory. The concept of those <post-analytic effects> gets complicated when the discussion of the difference between an <interrupted analysis> and a <terminated analysis> opens up. This forces us to specify the theoretical concept of <end of analysis>. Regarding the concept of termination of analysis, we all know that it is not possible to be guided by the simple symptomatic cure. Or he capacity for work and joy as Freud said. Shortly, today, structural theory outlines that the <theoretical end of analysis> happens, when the subject accepts <to be what he is>, has gone across his <sexual phantom> and has accepted his <limitation and incompleteness>.

The post-analytic effects are related with the destination of transference. In transference, at the theoretical end of the analysis, the analyst stops occupying the place of the <subject-suppose-to-know> -SSK, and appears in transference as a limited and incomplete subject. We say that <at the end of analysis the analysand has accepted his castration> symbolic and imaginary. He also identifies with his own < sin t h om e > (1976). This means that the subject accepts (without conflict or guilt feelings) the indelible marks of childhood that have passed to the formation of character. This is possible, when in the course of the analysis the subject has modified his ideals system. These theoretical concepts of the end of analysis settle with the variations of the case by case rule, as a post-analytic effect.

FREUD, S. (1909):
Letter of January 25 of 1909 to CG Jung. OC-BN 3a. Edición. Tomo 1. Madrid BION, W. (1967):
Attention and interpretation Editorial Paidos. Buenos Aires. 1974 LACAN, J. (1960):
The Ethics of Psychoanalysis. The Seminar, book VII, London, Routledge, 1960. LACAN, J. (1964):
Tyche and Automathon. In: Four fundamental concepts of psychoanalysis. The Seminar, book XI. London, Routhledge, 1971 LACAN, J. (1967):
Logic of the Phantom. Le seminaire, Livre XIV. Mimeograph copie. Unpublished LACAN, J. (1973):
L’Étourdit Scilicet, No. 4 (pp. 5-52) 1973 LACAN, J. (1976): Le Sinthome Le seminaire, Livre XXIII.
Mimeograpf copie. Unpublished WINNICOTT, D. (1955):
Psychological and Clinical Aspects of Regression Within the Psycho-Analytical Sep-Up. Int. Psycho-anal J. 36:16-26