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CLINICAL NOTES
Bruce Fink (1999). ‘Neurosis,’ A Clinical Introduction to Lacanian Theory: Theory and
Technique (Cambridge, MA and London, England), pp. 112-164.
Any attempt to make sense of the neuroses must start with an analysis of the
causative mechanism at work – i.e. with repression.
There are two aspects of repression that Jacques Lacan calls attention to: the actual
thought that is subject to repression and the affects that are attached to the thought.
The thought in question is something that is incompatible with the ego; the affect in
question is that which can induce anxiety in the subject.
The repressive mechanism needs a way to deal with both. Lacan clarifies that it is the
thought which is subject to repression in the technical sense of ‘primal repression.’
The affects which can induce anxiety if this thought is given expression are not
repressed.
Instead they are displaced on to another thought which is less threatening to the
subject than the original thought which had to be repressed.
As the analysis nears the actual thoughts, fantasies, or scenarios implicated in primal
repression, it will have to trace the trajectory of the thoughts separately from the
trajectory of the affects which were attached to these thoughts across the various
layers of the mind.
The trajectories of the repressed thought and the displaced affects have to not only
be traced in their entirety, but also ‘worked-through’ across various layers of the
mind. This process is what will ultimately ensure the success of the analysis.
The successful working-through of thoughts and affects however demands that the
analyst will not allow his own symptoms to be activated during the course of the
analysis.

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That is why the training analysis is important for the formation of the analyst.
Repressed thoughts are not passive; they are actively spreading out to other
thoughts in the unconscious; these new thoughts constitute the derivatives of the
repressed.
The expenditure of effort in repression is therefore not reducible to primal
repression.
Every single instance of these derivatives is also subject to repression through a
mechanism known as ‘repression proper’ or secondary repression.
The repressed thought is not only actively generating derivatives of itself; it is also
subject to the ‘upward flow’ of the unconscious.
If there is any weakening in the mechanism of repression proper or during
libidinally charged situations in life like puberty, marriage, child-birth, and so on, the
repressed will return in the form of symptoms.
These symptoms are ‘substitutes’ for the repressed thoughts and displaced affects;
they constitute, as Sigmund Freud put it, the ‘sex life of the subject.’
What this means is that for a subject who has a sex life, there will be a ‘symptomatic
dimension’ to it; for the subject who does not have or want a sex life, they will serve
as a ‘substitute’ for a sex life.
Or, to put it simply, the best way to come to terms with the psychoanalytic
contention that the ‘aetiology of the neuroses’ is to be found in the sex life of the
subject is to understand that those subjects who do not have sex also have a sex life because
they have symptoms in the place of sex.
It is therefore tempting then to use symptoms, or clusters of symptoms, (which are
known as ‘complexes’ or ‘syndromes’) as the basis for the classification of the
neuroses (and for making diagnoses as is the case in many areas of medicine
including psychiatry).

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Lacan however cautions against this model of classification and diagnosis by
pointing out that it is quite common for obsessives to have hysterical symptoms and
vice versa.
Neurotics many even have a few psychotic symptoms or an occasional bout of
hallucination.
It could be argued that dreams themselves are a form of controlled hallucination
which has been ‘domesticated’ by the subject; since, unlike the occasional
hallucination, the subject of analysis dreams every time he falls asleep.
The fact that he does not remember the dream is itself related to the function of
repression proper since the dream itself could well be a derivative of primal
repression.
There is therefore no necessary correlation between a symptom and a mental
structure (though to some extent a frequency analysis can establish probabilities or
statistical regularities at work in the production of symptoms).
Lacan prefers to diagnose on the basis of the existential question at stake in a
neurosis rather than depend on any particular symptom that is taken out of context.
This is analogous to the fact that Freud prefers to interpret a dream on the basis of a
patient’s associations on the couch rather than depend on a pre-determined lexicon
of dream symbols.
These existential questions then determine whether the patient is a hysteric or
obsessive.
If a hysteric is using obsessive symptoms or vice versa then that is only proof of yet
another instance of psychic distortion through repression, repression proper, and the
displacement of affects.
It must be remembered that in the case of obsessives, affects are displaced; but in the
case of hysterics, the affects could be subject to ‘conversion.’

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These then are instances of conversion hysteria where the ‘strangulated affect’ leads
to the generation of symptoms even though there is no physiological cause that can
be clearly identified as the main causative mechanism at work.
Whether affects are really strangulated or whether the unconscious takes advantage
of an illness to represent a number of meanings is a question that has haunted both
the classical and psychoanalytic theories of hysteria.
Freud, for instance, reminds us in his studies on hysteria that once the unconscious
has got its grip on a particular symptom, it will re-use the symptom.
The meaning embodied in the symptom however will vary depending on the context
in which the patient presents the symptom to the analyst.
Conversion, as opposed to obsessive displacement, is a much more difficult question
to ask and answer.
But it is nonetheless a question of great theoretical importance because it is the exact
point of interaction between the psychic and the somatic that haunts the Cartesian subject.
The only thing that is uncertain is which of these two categories must be given the
greater role in terms of serving as the main cause of the neurosis.
Lacan uses the term ‘subject positions’ in his theory of the subject (in the context of
his existential questions) rather than generate a myriad host of disorders based on
the clustering of symptoms as is the case in the Diagnostic and Statistical Manual.
This not only simplifies the classificatory and diagnostic schema at a stroke, but
takes forward the psychoanalytic precept that it is the patient and not the symptoms
that are being treated.

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Attacking symptoms directly will only lead to the displacement of affects to new or
previously active symptoms; it will defeat the whole purpose of analysis which is to
replace infantile repressions with mature forms of therapeutic condemnation.
That is why it is important to not only identify the existential questions at stake in
the neuroses but also the fundamental fantasies at play therein.
The subjective stance of the neurotic subject can then be referred to in terms of the
various Lacanian schemas to situate how the hysteric and the obsessive relate
themselves to both the ‘desire of the Other’ and the ‘jouissance of the Other.’
The analytic approach however – at least in its Lacanian orientation – is to intervene
of the basis of the primacy of hysteria as the constitutive model of the Lacanian
subject.
All analyses of neurotics in the Lacanian clinic will start and proceed by necessarily
posing the question of hysteria for the ‘speaking subject.’
That is because, according to Lacan, the speaking subject is hysterical as such.
The main difficulty with obsessives then is that they resist this model of the speaking
subject where; as Lacan points out, desire in the structural sense is always ‘desire of
the Other.’
The obsessive has difficulty with this definition since he is stuck between the ‘desire
of the subject’ and the ‘desire of the Other.’
The obsessive might be well intentioned, but he is not able to subjectify the desire that
he experiences adequately to live without symptoms since he finds his sense of being
when he ‘thinks’ - rather than like the hysteric when he ‘speaks.’
And so, as Bruce Fink points out, the desire of the hysteric remains ‘unsatisfied’ and
the desire of the obsessive is ‘impossible’ to attain.
This is one of the greatest findings in the history of psychoanalysis.

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It is not possible to understand any of the cases that Freud wrote on hysteria and
obsessional neurosis without coming to terms with this crucial distinction on the
nature of desire and on whether or not it can be full-filled in the life of the patient.
Freud encounters this truth about desire in his interpretation of dreams and in the
comparisons that he makes between the dreams of children and adults though there
his terminology is different.
Freud invokes mainly the notion of wish full-fillment in his study of dreams, but the
moment we realize pace Lacan that what Freud is really talking about is desire we
can relate their theoretical and clinical approaches more effectively.
Lacan’s approach then is to hystericize the obsessive patient using a number of
techniques including the variable session, punctuation, scanding, and so on in order
to precipitate the disclosures of the unconscious.
This is just another way of saying that all neurotics – especially obsessives – must be
open to ‘the discourse of Other’ if the analysis is to proceed; hence the preoccupation
with hysteria in the Lacanian clinic and the theory of the neuroses.
Readers who found these clinical notes useful might want to read the brief case
studies and the analysis of phobia that Bruce Fink has included in his book on the
Lacanian clinic as well.
SHIVA KUMAR SRINIVASAN