Many of the people who come to work with me have never heard of psychoanalysis before. They come to someone they know to be a 'mental health professional' – as many of us categorise ourselves to the general public – but they don't come specifically looking for a psychoanalysis as I did (and continue to) as part of my formation as a psychoanalyst. They come with something that is distressing them and they want to do something about it. This article is an attempt to say something about psychoanalysis and psychoanalytic treatment without going into the dense theory that underpins it. Also, an 'analysand' is the specific word used by Lacanian psychoanalysts to refer to someone in treatment, as opposed to patient or client, to signify that psychoanalysis is unlike anything else.
Psychoanalysis was invented by Sigmund Freud, a neurologist working in Vienna in the 1870's, who noticed that when he listened to his patients talk about their lives over an extended period of time their symptoms improved. Freud conjectured that distress may be expressed in disguised forms, in physical and psychical symptoms, because expressing them directly would be overwhelming. Such symptoms are dense knots of significance and Freud believed that such symptoms can be untangled through speech in the presence of someone who wants to hear about them.
Freud developed one fundamental rule within a session – that someone say everything that comes to mind just as it comes to mind, and this fundamental rule still applies today. Speaking in this way is termed 'free association'. It applies to absolutely everything – topics that disgust us, frighten us, appear trivial, we are embarrassed to speak about and things that make us angry, including the psychoanalyst. Everything must be said because psychoanalysis privileges the unconscious element of our speech – the things that seem to break through what we want to say and which we say almost despite ourselves, things that seem to come from nowhere... and yet we say them. By allowing ourselves say everything that comes to mind without censoring what we say such material will become verbalised more often and more easily. A psychoanalyst will be listening in silence for a lot of the session in order not to interrupt the flow of speech and so that the analysand is directed by their own unconscious thought and not direction from the psychoanalyst.
We are often astonished by our own unconscious desire as it fleshes itself out in our words – a desire that often causes us suffering and contradicts what we consciously reason is in our best interest. Through free association the psychoanalyst also gets to know about the very core of how we think, so that when they do speak what they say will hit their target and resonate with us.
Freud treated his analysands through 'Interpretation' and 'Construction', two technical terms that refer to specific acts of a psychoanalyst. Just as with interpretation from one language to another, a psychoanalyst makes interpretations of an analysand's words and actions to demonstrate that the same thing can be thought about in different ways – that what may have been overlooked as meaningless can carry great significance and what seemed to be full of meaning may be a diversion from something else. Each interpretation is singular, of the moment and not a final or definitive reading of the symptom. It is always made with a view to questioning how the analysand's desire operates at any given moment and to sustain an expression of the unique subjective experience of each analysand.
Psychoanalytic construction is the creation of a thought that fills in a blank in what an analysand has said in such a way that it explains the blank in a logical way. It is used when the effects of something are felt even though the thing causing the effect is not directly known or spoken of because it is so hidden in repression – like a black hole or ripples on a pond though nothing is seen hitting the water. It must be constructed in a particularly sensitive way that is based solely within the speaker's discourse and without prescriptive or suggestive input from the psychoanalyst. A construction is created to help the analysand understand their own actions.
Through interpretation and construction Freud put meaning on the thoughts and words expressed by his analysands. He believed that if you listened long enough everything could be treated and made sense of and he often used the metaphor of archaeology to explain psychoanalysis as a psychological excavation – that everything was waiting to be discovered beneath repression. His clinical and theoretical work, however, led him to impasses where this proposition could not be sustained, and he died unable to substantiate his position.
This element of psychoanalytic experience was taken up by the French psychoanalyst Jacques Lacan – an analyst and academic notorious for the complexity of his theories and the provocative way he expressed them. After decades of trying to work within Freud's paradigm Lacan came to work in a way that moved beyond the idea of there being a way to say everything. He developed an approach to psychoanalysis that sustained a space between the immediacy of our experience and the language that we might express it in – that there is a limit to the creation of meaning and a point at which language fails us because our experience is unique to us and so singular that it cannot be fully expressed in a common language shared with others.
Lacan used the example of infants who babble and speak to us – with great conviction and great variation in intonation – but in a language that they do not share with anyone else. Before acquiring a communal 'Mother' tongue they are already experiencing their first loses, first gains, first loves and figuring out how they fit into the world they inhabit. They are developing a constellation of significance and identification with those around them that compresses like sedimentary rock into who they are becoming. They are shaped by others' expectations – to eat at increasingly regulated times, to toilet train, to not strip off at whim – all mediated by a language that existed before them and which they have to tailor their thinking within if they don't want to be left in isolation. What is absolutely singular in their experience as individuals cannot be expressed in any but absolutely singular terms – which means that they cannot be expressed in a pre-existing language. Anyone who has experienced love or bereavement will know that there is a beyond of language that is no less real just because it cannot be communicated to an other.
Lacan developed his evolving practice upon a conception of the unconscious as not buried whole beneath consciousness but as vacillating between being closed and opening briefly. We repress what is deemed unacceptable for expression, even to ourselves, into an unconscious that is unique to each of us – a molten core at the centre of our sedimentary selves. A psychoanalytic session is a space where the volcanic openings of the unconscious, facilitated by free association, are listened for and amplified. This is not for the psychoanalyst's understanding but for the analysand's – because, if such an approach aims at a target beyond (or before) the common language of the analysand the effects will be so singular that they cannot even be expressed by the analysand but are experienced at a level that is incommunicable.
This approach to psychoanalysis is characterised in the session by the 'cut'. The cut is that which throws things into question – it is an act of the psychoanalyst that punctuates the thoughts and words of the analysand to provoke a question about whether or not what they have been speaking about can be thought of in another way. This sounds very similar to Freudian interpretation but here the analysand interprets.
A psychoanalytic cut may be as simple as the silence of the analyst; that what is said is not affirmed or backed up but questioned by the silence – because a psychoanalyst is always listening to everything you say a response of silence is as important as speech. This form of psychoanalysis is not centred on the production of meaning but on privileging the singularity of our experience and forestalling conformity to internalised ideals (of health, good functioning or others' expectations) that fit us poorly. It is an especially apposite treatment for psychotic subjects, whose delusions are not treated as scar tissue of a distorted reality but as the subject's way of navigating their own reality in a singular way. Here the cut involves breaking up the subject's experience of the world as monolithically whole and complete, a world from which they feel ejected and possibly persecuted, by questioning if anyone 'has it all together'. They don't, of course, but the psychotic subject doesn't have recourse to the fantasies of the neurotic in dealing with what they lack.
By my reading the essence of Lacanian psychoanalytic treatment is a space where each person can speak the truth of their unique experience to the greatest degree that language can afford them. Each analysand simultaneously fleshes out the border crossings beyond language of bodily symptoms and experiences that are so singular that a communal language cannot suffice to name them. For some, that is something to be valued.