De-stigmatizing psychoanalysis

Noemi Kohan

xnkohan@hotmail.com

Abstract: A short vignette of only eight weeks of treatment shows how certain interventions can produce rectification in a subject, whose identification with his father and the signifier “depressed” appears to stunt all possibilities of change. It also contradicts popular believe that psychoanalysis is costly because its effects could only be obtained after a long treatment.
Key words: depressed; medication; short-term therapeutic effects.

Resumen: Este caso que lleva solo ocho semanas de tratamiento muestra como ciertas intervenciones pueden producir una rectificación en un sujeto, cuya identificación con la figura paterna y el significante “depresivo” aparenta impedir toda posibilidad de cambio. También contradice la creencia popular de que el psicoanálisis es costoso porque sus resultados solo pueden lograrse a través de un largo tratamiento.
Palabras claves: depresión; medicación; efectos terapéuticos rápidos.

One wonders what gave psychoanalysis a bad name in this country.

The layman’s discontent with psychoanalysis seems to always be that it fosters dependency, that one cannot function or make decisions unless it is first laid down, so to speak, on the couch, and therefore, when is one ready or willing to get off the couch and assume the responsibility of one’s own destiny?

Today’s solution to the supposedly costly, interminable psychoanalysis is the invention of the “happy pill,” that’s how the younger generation refers to it; there is one that fits every affliction or personality .

It all seems to boil down to economics rather than an ethical responsibility to manage our lives and emotions.

Well, fortunately applied psychoanalysis can provide short term therapeutic effects and can also prove to be cost effective.

I would like to share with you a short vignette showing the process that took place just a few weeks into treatment.

A middle age man gives me a call after many frustrated attempts to find a therapist and after having a disappointing encounter with a highly recommended orthodox psychoanalyst, who he hoped, would continue prescribing the medication he had been taking for quite some time. He claimed he could not afford his fees and did not find him to be emphatic.

When he first came to my office he appeared to be quite desperate, he explained that his search for a therapist had been extensive and he wasable to find my name through a friend of a friend.

He had many years of analysis in the city where he lived before and tells me that through it he learned to understand the dynamics of his family.

He tells me he is very depressed, that is what names him. According to Romildo do Rêgo Barros, in his Seminar held in Miami this past October, the signifier “depressed” gives a particular group of people a place in society; it guarantees a place as part of a universal group , it is like saying: it is better to be “depressed” than not to be.

He has not been able to find a good job, he has recently returned from his native country, where his father had passed away a month ago very unexpectedly.
His father had been diagnosed manic-depressive, he had many economic setbacks but his grandfather always bailed him out. He remembers him sitting on a chair for countless hours looking into space. His parents had separated many years before and at some point his father had disappeared for several years without anybody knowing his whereabouts.

Upon his return from his father’s burial he felt lost, not knowing where he was going, in a city that did not feel familiar at all; two days later he got extremely ill, with no energy to get out of bed for three weeks , feeling very alone as he “had nobody to serve him a cup of tea.”

He had moved to this city a couple of years ago because he needed a change and ever since things did not go well. Actually things were not well since 2000 in the city he loved so much; around that time he had separated from a long term relationship and not long after that he also lost his job.

He said he knew he was lying to himself by suddenly deciding to move to Miami, making such a drastic change in such a short period of time without really thinking of the consequences, stating this was probably impulsive. Maybe, he said, “I had a manic episode.”

He felt that the blossoming economic situation in Miami would provide him the opportunity for a career change that was compatible with his profession which he never practiced as he emigrated immediately following his graduation.
He lived for 20 years in a very cosmopolitan city which he loves , where everything is familiar and where he adapted rapidly and well. He soon found love and he enjoyed a very active social life.

What prompted the desire for the change that brought him to this city was a progressive social isolation that started before the separation from his long –term partner, an event that took him quite by surprise as he never “thought it would happen”. He was pretty reluctant to respond to my questions in reference to this relationship claiming it is not the reason for the present depression even though later on mentioned that the relationship had slowly deteriorated but offered no further explanation and appeared quite bothered each time I interrupted him with a question.

In reference to the loss of his father he responded despondently that it was not what he wanted to discuss.

He complained of his misery, of his lack of attention and inability to focus, he had just had a minor traffic accident, “I am so upset that I’m not benefiting from the work we are doing, I don’t care about anything, not my physical health, not my appearance; I have had thoughts not of suicide but that I would be better off dead. The anger I feel is not benefiting me,”

I underlined that maybe not.

He continued complaining about his present job, his inability to find anything compatible with his experience and how impotent he felt for the last two years. He stated he did not have an unconscious need to close all the doors, he wants to be compensated for his efforts, “I don’t have pharaonic expectations,” followed by more laments, “my situation is uncontrollable, I lied to myself.”

I asked why he was quarreling with me as his tone was one of constant reproach .
He said “I don’t know how to re-invent myself, when I recuperated from my flu I found myself alone with my depression, without support, my father’s death left me in shock together with everything else, I am identifying myself with my father’s illness, I look in the mirror and I see him, his illness, his economic situation.”

I stated that based on what I observed “he was not his father” and ended the session.

On our next meeting he said he had been thinking about his anger and stated he had made some advances, he had contacted a job placement agency and today he had an interview that went very well. He said “ I worry needlessly.”

He told me he was very upset because he could not get in touch with a psychiatrist I referred him to and went on and on citing all the reasons why he thought this person was irresponsible as a professional to which I agreed and told him that he holds on to what is not working well so he could unload his anger. He stated “ I’m afraid that maybe I got used to being in misery and I accepted it, I know I’m waiting for someone to bail me out.” I ended the session at that point.

Jacques Alain Miller, in his closing conference at the clinical workshop of the Freudian Field in Bilbao (2), said that subjectivity is not a given, in the direction of a cure, it is a matter of producing a “subject” as the effect of a metaphor of the Name of the Father, that is, as a signification linked to the series of identifications.

On our next meeting he said he was doing better, “ I left with anguish the last time because our session was short but there is improvement, I was offered a job.

“He complained that the salary was not that great and that he had a rough week debating whether he should allow himself to engage in activities or go to places that give him pleasure, said that even though he feels liberated he is afraid to share the good news for fear it will not happen. He elaborated some more on the mistake he has made by moving to Miami .

He wondered why he is not using his time to enjoy certain things, “why do I have to wait until I’m short of time to get the motivation”?

“I would like to understand why I am not allowing myself to experience joy and pleasure , am I destined to remain alone?”

I questioned him: destined? and ended the session.

On our next meeting he claimed he was sad and got into a panic before coming to session, he still cannot get rid of the anger for having moved to this city and that how he neglects himself is damaging. He started talking about his depression, claiming it was always there but it started with a sense of inadequacy. He started talking about his father, whose only accomplishment was to have a family. “Father did not have love from his own father who considered him a failure. I loved my father but I also hated him; his ups and downs affected everybody, my relationship was a distant one, I resented him, he envied my accomplishments, the fact that I had opportunities, I traveled , went to private schools, he made it easy for me. He lived through me.”

‘I distanced myself from my family and my independence represented a challenge. I had not been raised to face sacrifices and stress. I have built walls around me that I don’t know if I can destroy. I sabotage all possibility to do or have more, I feel threatened by success and pleasure.”

With some reticence he mentioned that he spend time this past weekend with a good friend that turned into a romantic encounter but he is fearful.

These are only eight weeks of treatment. The purpose of presenting this case was to point out the two or three interventions that had the effect of moving the subject from a pure whining demand to analyzing the causes of his suffering.

¹ Barros, Romildo do Rêgo. “ Clínica de la Depresión”. Miami, Florida, October 2006.
² Miller, J.- A. Introducción a la Clínica Lacaniana. Barcelona: Ediciones ELP, 2006, p. 44.