These clinical notes describe the main points raised by Jacques-Alain Miller of the University of Paris VIII in the first Paris/Chicago psychoanalytic workshop on the analytic cure on July 25, 1986. Miller starts by addressing common misconceptions about Lacanian theory and practice before explaining the structure, the techniques, and the forms of interpretation that constitute the analytic clinic. Miller concludes by explaining why the definition of the analytic cure is not reducible to the biological model of adaptation or the invocation of borderline categories. The most important challenge of psychoanalysis will always be to explain hysteria. Shiva Kumar Srinivasan has a Ph.D. from the University of Wales at Cardiff in English Literature and Lacanian Psychoanalysis (1996). His Ph.D. thesis was titled ‘Oedipus Redux: D. H. Lawrence in the Freudian Field.’ These clinical study notes summarize the main points raised in important psychoanalytic texts. They should be of use to students, theorists, and lay practitioners of psychoanalysis who are preparing to read or re-read the psychoanalytic literature associated mainly (though not only) with the theories of Sigmund Freud and Jacques Lacan.

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CLINICAL STUDY NOTES (October 2016)
JACQUES-ALAIN MILLER ON THE ANALYTIC CURE
Jacques-Alain Miller (1987). ‘How Psychoanalysis Cures According to Lacan,’
Newsletter of the Freudian Field, Vol. 1, No. 2, pp. 4-30, The First Paris/Chicago
Psychoanalytic Workshop, July 25, 1986.
INTRODUCTION
Each school of psychoanalysis has a different model of cure. Some critics even
wonder whether it is possible to decisively cure a patient in the analytic clinic; and
analysts are more likely to use the term the ‘end of analysis’ to indicate closure
rather than the conventional medical term ‘cure.’ It is interesting to note that many
dictionaries of psychoanalysis do not even have an entry for ‘cure.’1 What they all
have in common however is the belief that it is important for the patient to talk to
the analyst; that is why psychoanalysis has always been described as the ‘talking
cure.’2 The belief in talking however does not mean that when a patient is cured, the
analyst necessarily knows how that came about since not all patients who are willing
to talk can be cured. A theory of clinical analysis must make up its mind on whether
talking is only a necessary condition or whether it is both a necessary and a sufficient
condition to cure the patient. That is why this psychoanalytic workshop of July 25,
1986 is important. It gave Jacques-Alain Miller of the University of Paris VIII an
opportunity to explain what exactly is at stake in psychoanalysis. In order to
understand what really happens in the analytic clinic when the patient talks, it is
important to know the relationship between ‘cause and effect’ in the analytic realm;
1 Dylan Evans (1996, 1997). ‘End of Analysis,’ An Introductory Dictionary of Lacanian
Psychoanalysis (London: Routledge), pp. 53-55.
2 Colin McCabe (1981). TheTalking Cure (London: Macmillan).

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this relationship is usually described in the context of ‘psychic determinism.’3 This
model of psychic determinism in turn is derived from the approaches to physical
determinism in the medical sciences, linguistics, and sociology. In other words,
every school of analytic thought and practice has to identify its own model of
causality in the context of either medicine directly or in comparison to other forms of
analysis indirectly.4 Only then will it become possible to explain how, when, and
why psychoanalysis can cure a patient.5 This workshop is structured as an attempt
to correct a few common misconceptions about the theory and practice of Lacanian
psychoanalysis. This correction was necessitated by the fact that Lacanian theory
was not well known in America in 1986. Most American analysts were trained in ego
psychology and some in object relations theory; they were therefore not familiar
with the work of Lacan.6 Given that there are a number of important theoretical
differences between ego psychology and Lacanian psychoanalysis, Miller found it
useful to address these common misconceptions first before stating his clinical
position on what exactly constitutes the Lacanian definition of a cure.7 These clinical
notes will first list these common misconceptions along with Miller’s attempt to
correct these before setting out Miller’s own approach to the Lacanian clinic in the
last section of these clinical notes.
MISCONCEPTIONS ABOUT LACAN
Miller addresses common misconceptions about Lacanian theory and practice in the
context of the work done by American analysts like Heinz Kohut, Richard Chessick,
Arnold Cooper, Otto Kernberg, and others. The title of this workshop, for instance, is
3 Charles Rycroft (1968, 1995). ‘Determinism, Psychic,’ in A Critical Dictionary of
Psychoanalysis (London: Penguin Books), pp. 37-38.
4 See, for instance, Sándor Ferenczi (1927). ‘Freud’s Influence on Medicine,’ The First
Freudians, edited by Hendrik M. Ruitenbeck (New York: Jason Aronson), pp. 16-31 and Iago
Galdston (1956). ‘Freud and Romantic Medicine,’ in Frank Cioffi (1973). Freud: Modern
Judgements (London: Macmillan), pp. 103-123. See also Jacalyn Duffin, who situates
psychoanalysis within the history of psychiatry, in the History of Medicine: A Scandalously
Short Introduction (London: Macmillan, 1999), pp. 276-302.
5 An early collection of essays on this topic is available in a volume edited by Louis Paul
(1963). Psychoanalytic Clinical Interpretation (London: The Free Press of Glencoe).
6 For a feel of the clinical dimensions of psychoanalysis in America, see Janet Malcolm (1980,
1981). Psychoanalysis:The Impossible Profession (New York: Vintage Books, Random House).
7 See also Joseph H. Smith and William Kerrigan (1983). Interpreting Lacan (New Haven and
London: Yale University Press), Vol. 6, for essays on this theme from the Forum on
Psychiatry and the Humanities, The Washington School of Psychiatry.

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a reference to a book by Kohut; the misconceptions are related to Chessick’s mis-
interpretation of Lacan. These misconceptions relate to how the work of Jacques
Lacan should be situated in the context of French thought; the technique of the ‘pass’
in Lacanian practice; the role of interpretation in psychoanalysis; the theory of
aggression; and, finally, in Lacan’s relationship to surrealism. These misconceptions
may not seem that important given that Lacanian theory is to be found everywhere
nowadays; but it was, needless to say, important to calibrate Lacanian theory
precisely when it was first introduced in American psychoanalysis. I will list Miller’s
response to these misconceptions (as given above) sequentially. Miller’s first point is
that the Lacanian theory of psychoanalysis must be related to Lacanian practice. The
fact that Lacan’s name is to be found in the company of Roland Barthes, Claude-Lévi
Strauss, Michel Foucault, and Jacques Derrida in anthologies of critical theory can be
misleading because these theorists did not have to see patients. While it is acceptable
to read these theorists in conjunction with Lacan in literary studies, it is important to
remember that they were not trying to cure patients. They were more interested in
areas like literary theory, structural anthropology, the history of ideas, and the
history of philosophy, respectively. What these continental thinkers really have in
common is a strong commitment to exploring the concept of structure in the
‘sciences of Man’ within the French academy. So, while they all have a similar point
of departure within structuralist approaches to theories of subjectivity, they do not
have the same point of arrival.8 This simple distinction is usually forgotten when
Jacques Lacan’s work is taught in America because he was mainly read by theorists
of film and literature; this led to the mistaken impression that Lacan is just another
French semiologist like those listed above.9 We have to differentiate between the
uses of semiology in literary studies and in clinical medicine.10
CLINICAL TECHNIQUES IN LACAN
The second point that Miller takes up relates to the technique of the pass. It was
believed that in the Lacanian approach to training analysts, it is students who decide
who should become an analyst. Miller corrects this misconception by stating that
while students have a say in these matters, that is not tantamount to their deciding
8 For a brief account, see Donald E. Hall (2004). Subjectivity (New York and London:
Routledge), the New Critical Idiom Series, edited by John Drakakis.
9 See Slavoj Žižek (1987). ‘Why Lacan is Not a Post Structuralist,’ Newsletter of the Freudian
Field, Vol. 1, No. 2, 1987, pp. 31-39 and Slavoj Žižek (1990). ‘The Limits of the Semiotic
Approach to Psychoanalysis,’ Psychoanalysis and …edited by Richard Feldstein and Henry
Sussman (London: Routledge), pp. 89-110.
10 Readers interested in exploring these differences might want to look up the entries in
Eugen Baer (1988). Medical Semiotics (Lanham: University Press of America), Sources in
Semiotics, Vol. VII.

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who is worthy of being accorded the status of an analyst. Furthermore, Miller points
out that Lacan does not differentiate between the therapeutic and training forms of
analysis in the clinic. The technique of the pass has more to do with the patient
communicating what exactly he has learnt from his own analysis to a committee
through two of his peers. Since this mechanism is not found in most schools of
analysis outside the Freudian field, it is commonly misunderstood. This is also the
case with the Lacanian technique of punctuation in which the patient cannot
anticipate exactly how long or short an analytic session will be. This technique is
never used outside the Lacanian clinic because it is compulsory for most schools to
predefine the duration of the analytic hour for contractual purposes. Lacanians
however do not predefine the session in order to minimize resistance from patients.
If patients know exactly how long a session will last then they begin to use fillers in
the form of empty talk; this form of resistance in analysis leads invariably to the
obsessionalization of the patient. Lacan however argued that the disclosures of the
unconscious can be more effectively precipitated if the analyst used techniques like
‘variable sessions and punctuation’ rather than let the patient fall prey to empty
talk.11
INTERPRETATION IN ANALYSIS
The third point that Miller makes is that Lacanian psychoanalysis should not be
conflated with ‘hermeneutics.’ There are a number of reasons for this; the most
important being that punctuation is not the same as a traditional clinical
interpretation. Hermeneutics is often conceived to be a form of in-depth reading of
texts that is informed by philosophical concerns. The analytic model of truth is
related to uncovering forms of psychic over-determination rather than making the
case that the truth of the symptom is hidden deep inside the patient. More often than
not Lacanians point out that the meaning of the symptom is to be found on the
surface itself. But, because we have internalized the hermeneutic approach, we feel
that the truth is somewhere deep inside the patient. In other words, for Lacan,
psychoanalysis is not the same as depth psychology (which has a methodological
affinity to hermeneutics). The analyst, for Lacan, is more like an editor than a
philosopher. All he has to do is to ‘punctuate’ the discourse of the patient rather than
‘interpret’ the discourse of the patient.12 Lacan took this position for both theoretical
11 For a more detailed description of these topics, see Bruce Fink (1997, 1999). A Clinical
Introduction to Lacanian Psychoanalysis: Theory and Technique (Cambridge and London:
Harvard University Press) and Bruce Fink (2007). Fundamentals of Psychoanalytic Technique: A
Lacanian Approach for Practitioners (New York and London: W. W. Norton & Co).
12 This approach to interpretation should not be misunderstood as a lack of interest in
philosophy in Lacanian theory; the claim about punctuation is specific to Lacanian practice.
For the role played by philosophy in the development of meta-psychology, see Richard

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and practical reasons. The theoretical reason relates to the fact that the unconscious
is structured like a language; the practical reason related to the fact that
interpretations of the traditional sort have ceased to be effective.13 Analytic
interpretations were neither able to ‘surprise’ nor ‘shock’ the patient because of the
wide-spread diffusion of analytic theory into the cultural unconscious.14 It was
therefore necessary to seek recourse to a syntactical approach to analytic
interpretation rather than revel in the semantics of interpretation as used to be the
case with the pioneers of analysis. This approach was further developed by Lacanian
analysts like Serge Leclaire in Paris, but remained unknown in America until it
became available much later in English translation.15 The fourth misconception
about Lacan, according to Miller, is that the importance of the death instinct is
missing in ego psychology. Freud’s emphasis on the death instinct is related to the
fact most patients resist a cure. There are different ways of resisting the analysis. The
most common is known as the ‘negative therapeutic reaction.’16 Freud was fond of
stating that all analyses will eventually have to come to terms with the problem of
symbolic castration. The transferential affects suffered by the patient can also be an
insurmountable problem. Once a neurosis becomes deeply entrenched in the psyche,
there is a strong propensity in the patient to the compulsive repetition of the trauma.
In other words, the neurotic subject cannot function within the safe confines of the
pleasure principle. These were some of the reasons that Freud posited the existence
Boothby (2001). Freud as Philosopher:Metapsychology after Lacan (New York: Routledge). The
main texts of metapsychology can be found in Sigmund Freud (1991). On Metapsychology:
The Theory of Psychoanalysis, translated by James Strachey, edited by Angela Richards, Vol. 11
(London: Penguin Books), The Penguin Freud Library.
13 The preoccupation with language as a model for structuring the unconscious has
percolated into mainstream analytic theory in America. See, for instance, S. Montana Katz
(2013). Metaphors and Fields: Common Ground, Common Language, and the Future of
Psychoanalysis (New York and London: Routledge), Psychoanalytic Inquiry Book Series,
edited by Joseph D. Lichtenberg.
14 For an analysis of the concept of ‘shock’ in theories of mental health, see Tim Armstrong
(2000). ‘Two Types of Shock in Modernity,’ Critical Quarterly, Vol. 42, No. 1, pp. 60- 73.
15 See Serge Leclaire’s theory of analytic interpretation in Serge Leclaire (1968, 1998).
Psychoanalyzing: On the Order of the Unconscious and the Practice of the Letter, translated by
Peggy Kamuf, edited by Werner Hamacher and David E. Wellbury (Stanford: Stanford
University Press). See also Bruce Fink (2004). Lacan to the Letter: Reading Écrits Closely
(Minneapolis and London: University of Minnesota Press) for the Lacanian approach to the
letter in theories of reading and analytic interpretation.
16 See Jean Laplanche and Jean-Bertrand Pontalis (1973, 1988). ‘Negative Therapeutic
Reaction,’ The Language of Psychoanalysis, translated by Donald Nicholson Smith,
introduction by Daniel Lagache (London: Karnac Books), pp. 263-265.

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of the death instinct; it constitutes the realm of jouissance rather than plaisir. So,
instead of seeking pleasure in a straight forward way, the neurotic subject wrestles
with ‘the pain in pleasure and the pleasure in pain.’ Every symptom will ultimately
become a source of jouissance once the patient is conditioned to its existence.17 The
emergence of the death instinct in analysis then forces us to rethink the Freudian
theory of aggression within a Lacanian model of aggressivity. The former is not
reducible to a biological instinct like ethologists think it to be. It is implicated within
a form of existential irritability that is mediated by the order of the imaginary.18
THE DEATH INSTINCT
The last of these common misconceptions is that because Lacan was interested in
Salvador Dali and the surrealists, it is not possible to do clinical research in Lacanian
analysis. Miller puts in a lot of effort to refute this misconception; he lists Lacan’s
clinical achievements at St. Anne and St. Catherine hospitals in Paris; and gives an
account of how he went about editing Lacan’s public seminars in psychoanalysis.19
Miller notes that Lacan had more patients than any other analyst of his generation
and a vast number of French analysts were themselves in analysis with him. This
was not only because Lacan used shorter sessions, but also because he was the most
influential analyst of his and subsequent generations. It is also important to
remember that Lacan had medical training and began his analytic work in close
association with French psychiatrists like Henry Ey. It is also not commonly
understood that despite his antipathy to ego psychology, Lacan was himself in
analysis with Rudolf Lowenstein and was a contemporary of Heinz Hartmann in
Paris. Lowenstein and Hartmann (along with Ernst Kris) were the main founders of
ego psychology in America. So Lacan is not a stranger to ego psychology, or
unacquainted with developments in this area, by any means. Lacan’s main reason
for theoretical disagreements with ego psychology was related to the concept of
‘adaptation’ (which he felt was closer to evolutionary biology rather than
psychoanalysis). This is because the Lacanians believe that the existence of the
unconscious makes it impossible for the subject to be fully adapted in the way that
17 See Dylan Evans (1996,1997). ‘Jouissance,’ and ‘Symptom’ in An Introductory Dictionary of
Lacanian Psychoanalysis (London: Routledge), pp. 91-92 and pp. 203-204.
18 See Jean Laplanche and Jean-Bertrand Pontalis (1973, 1988).‘Death Instincts,’ The Language
of Psychoanalysis, translated by Donald Nicholson Smith, introduction by Daniel Lagache
(London: Karnac Books), pp. 97-103. See also Jacques Lacan (1948, 1992). ‘Aggressivity in
Psychoanalysis,’ in Écrits: A Selection, translated by Alan Strachey (London:
Tavistock/Routledge), pp. 8-29.
19 See also Elisabeth Roudinesco (1993, 1997). ‘History of the Seminar,’ Jacques Lacan,
translated by Barbara Bray (Cambridge: Polity Press), pp. 413-427.

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animals, who have found their niche in the biological environment, can be. Unlike
animals, human beings are subject to desire; and they yearn to be ‘elsewhere.’
Lacanian analysis then is not reducible to either ego psychology or object relations
theory. It is difficult to incorporate Lacan into mainstream analysis by merely taking
an eclectic approach to the array of concepts and techniques in Lacan since he is not
just another theorist or clinician; his ‘return to Freud’ has a paradigmatic
significance.20 Lacan, as a clinician, was fully aware of the ideological implications of
taking simplistic approaches to analytic theory and practice; that is why he went
against the grain and located the unconscious along the lines of language, ethics, and
the unrealized.21 In other words, the Lacanian commitment to the death instinct in
analytic theory is at odds with the biological problem of adaptation. Any theory of
natural selection in evolutionary biology, informed by Lacanian analysis, must try to
reconcile the conflict between the desire to live (‘the survival of the fittest’) with the
subject’s desire to die, as Freud put it, in its own fashion.22 The crucial question then
is this: What is the point at which the subject prefers to die rather than survive? This then is
the exact moment when the death instinct is activated in the subject. Resistance to
therapeutic progress in analysis is the main source of clinical evidence that the death
instinct exists, or gets activated, through the ‘negative therapeutic reaction’ in
psychoanalysis.23 These then are the common misconceptions about Lacan that
Miller seeks to refute before setting forth the Lacanian approach to the analytic cure.
20 See, for instance, Richard Feldstein et al (1996). Reading Seminars I and II: Lacan’s Return to
Freud (Albany: SUNY Press), The Paris Seminars in English.
21 In other words, there are at least three different approaches or models of the unconscious
in Lacan. The linguistic model can be found in Jacques Lacan (1965, 1968). The Language of the
Self, translated by Anthony Wilden (Baltimore: The Johns Hopkins University Press); the
ethical model of the unconscious that is articulated in the context of desire, death, and the
Day of Last Judgement is available in Jacques Lacan (1986,1992). The Ethics of Psychoanalysis
1959-1960: The Seminar of Jacques Lacan, Book VII, translated by Dennis Porter, edited by
Jacques-Alain Miller (London: Tavistock/Routledge); and the pre-ontological model of gaps
in the context of the unrealized in the subject’s life occurs in Jacques Lacan (1973, 1979). The
Four Fundamental Concepts of Psychoanalysis, translated by Alan Sheridan, edited by Jacques-
Alain Miller (London: Penguin Books).
22 For the theory of natural selection, see the fourth chapter of Charles Darwin (1859, 1999).
‘Natural Selection,’ The Origin of Species (New York: Bantam Books), pp. 68-110.
23 See Sigmund Freud (1920, 1991). ‘Beyond the Pleasure Principle,’ On Metapsychology: The
Theory of Psychoanalysis, translated by James Strachey, edited by Angela Richards, Vol. 11
(London: Penguin Books), The Penguin Freud Library, especially, pp. 308-309, where the
death instinct is related to the desire of the subject to return to an inorganic form. The
relationship between illness, death, and desire in Darwin’s psyche is worth exploring from
the point of view of the Freudian death instinct. Darwin wasn’t particularly good at
adaptation himself given the resistance to the theory of evolution in Victorian society. See

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THE SELF-OBJECT IN KOHUT
Miller then goes on to examine what analysts like Kohut mean by a cure before
setting out his own approach. Since readers may not be familiar with Kohut’s theory
of the self, it is important to contrast it with the structure of the ego. The main
difference is that ego psychology conceives of the ego as an ‘autonomous’ entity that
is not affected by the environment in which it functions. The focus in ego psychology
is on the internal conflicts suffered by the subject within the psyche. The agents of
this conflict include the id, the ego, and the super-ego. The concept of self in Kohut is
a form of agency that is related to the environment; it does not exist on its own but in
relation to the objects, events, and other selves in the external world. The main cause
of mental illness, according to Kohut, is that neurotics and psychotics lack a ‘good
self-object.’ In order to cure the patient, argues Kohut, the analyst must offer himself
as the good self-object that is missing in the patient’s life. If the analyst succeeds in
making himself available then the patient will be able to work through his castration
anxiety; if not, the analysis will not be able to cure the patient. What does the patient
really want? What he wants is a self-object that will smile since this is what he had
difficulty in eliciting from a parental figure. The Kohutian analyst tries to position
himself in precisely this locus. So what is at stake is not interpretation in the quest
for an impersonal kind of truth of the neurosis; instead the analyst must focus on
‘empathy and responsiveness’ to the patient. Miller however points out that these
aspects of analysis do not have to be in conflict; they can be integrated in a clinical
situation. In any case, all that analysts have to work with is what the patient is
willing to say from the couch without prescribing any medication that will alter the
patient’s consciousness. Sooner or later the analyst will encounter patients who are
known as ‘mute hysterics.’ They won’t say anything during their analytic sessions;
this is a hysterical ruse to get the analyst to do all the hard work in the analysis.
These cases make for a more interesting practice, Miller argues, than routine cases of
obsessional neurosis.
CONCLUSION
What is really at stake in analysis then is the creation of an ‘interpreting atmosphere’
in which the patient is willing to speak. The patient’s stance is that he does not know
why he is saying what he is saying. The presence of the analyst in the locus of the
‘subject presumed to know’ is to guarantee that there is a good reason or ‘cause’ for
what is being said by the patient. The patient’s quest for a self-object that smiles is a
lot more problematic than appears to be the case in Kohut because, for Miller, the
his own account of the reception history of his books in Charles Darwin (1887, 1903, 2002).
Autobiographies (London: Penguin Books), passim.

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smile is not just a smile; it is to be conceived instead as a signifier. The function of the
signifier is ‘to represent the subject for another signifier’ (within the chain of
signification). That means the self-object is only a partial object. The analyst is not in
the locus of the individual subject but in the locus of the symbolic Other. That is why
the meaning of a symptom or a body part is not obvious. The meaning will have to
be painstakingly constructed in the course of the analysis on the basis of the patient’s
associations. Even the meaning of a bodily deformity is not reducible to anatomical
or biological facts; it depends on what the patient’s neurosis wants to do with it. The
flight into illness, or into forms of disability, can be the nucleus around which the
patient constructs his neurosis. Eventually, the patient will learn to derive some
advantage from what starts as a disadvantage. That is why the fantasies that coagulate
around the symptom will tell the analyst a lot more about the neurosis than the
symptom itself. The main task of free association is to uncover these fantasies and
work them through in the clinic. The patient may not be conscious of these fantasies
until he has expressed them. That is also why the encounter with the unconscious,
for Miller, is akin to the Freudian uncanny. It is more likely to be unnerving and not
like the smiling Kohutian self-object that the patient expects it to be. The existence of
the unconscious is then that which renders the subject existentially dis-adaptive to his
immediate environment. That is also why the biological model of adaptation is not an
adequate explanation of the human predicament. As Miller puts it, ‘what is so clear
in Freud, what he maintained to the end, is the Otherness of the unconscious: that
you cannot feel at home in the unconscious.’ Once the analytic process has taken
account of the uncanny element of the unconscious, interpretation becomes an
encounter with Otherness rather than an explanation for the subject’s behaviour as
such; it takes on the element of an existential surprise.
Miller concludes with an invocation of the existential questions on life, death, and
sexual identity that animate hysteria and obsessional neurosis. The question of
whether analysis can cure then will turn on the position that it takes on hysteria;
invoking borderline categories and obsessionalizing patients in analysis are ways of
avoiding precisely this challenge.
SHIVA KUMAR SRINIVASAN