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What a place is there for psychoanalysis in contemporary suffering?

Writer's picture: Grupo Tyche  Grupo de Psicanálise Grupo Tyche Grupo de Psicanálise



By Lina Petraglia.


(Speech given at the conference on 26 September 2024: The effectiveness of psychoanalysis today. Amsterdam, the Netherlands.)


Hi everyone! It is a pleasure to be here with you today.


First of all, I would like to thank you for taking the time to come, especially our guest Luiz Izcovich, who came from Paris to share his thoughts and experience regarding the effects of psychoanalysis with us here in Amsterdam. 


My name is Lina Petraglia, I am Brazilian. I have bachelor´s degree in psychology. I have started taking an interest in psychoanalysis and more specifically, Lacan in my uni years. In Brazil, psychoanalysis is actually a very popular area of studies. A lot of people go to psychoanalysis, I mean, as patients, and a lot of people are interested in becoming psychoanalysts. Psychoanalysis is taught in the university during the psychology´s bachelor and quite a few professors in the universities are psychoanalysts. It was not hard to find a school to continue studying and exchanging with other psychoanalysts. When I started working in a public psychiatric hospital, the service was led by a psychoanalyst and most of my co-workers, might they be the psychiatrists, social workers or psychologists were aligned with the psychoanalytical clinic.


So imagine my surprise when I move to the Netherlands 7 years ago and discover not only Psychoanalysis in not popular here, but more than that, Lacan is even less. To be fair, a friend, who went to university with me and casually moved to Amsterdam a bit before me, had told me this was the case, but honestly, I thought she was exaggerating. Turns out she wasn´t, or, looking at the amount of people who are here today, we might have looked in the wrong places. 


Despite the marginal presence of psychoanalysis in the public debate here today, this was not always the case. Actually, already in 1914, an important psychiatrist named Gerbrandus Jelgersma gave a speech embracing psychoanalytical ideas, which gave Freud a boost of enthusiasm regarding the acceptance of his thoughts by the international medical community. In 1920, there was big congress in the Hague and things seemed to be flowing in a direction where psychoanalysis was being welcomed by many.


When 2nd  world War came, psychoanalysis took a hit. Apparently, an important group of analysts were antisemites and did not welcome Jewish colleagues during this time of horror. This has caused an important split in the group and weakened the psychoanalytical movement even after the war.


Nevertheless, surprisingly, in the 60´s, psychoanalysis was so popular here, that it was completely covered by the health insurance. According to some sources, in the 70´s, a big part of the psychiatry and psychology professors in the Netherlands were psychoanalysts.

The other day, I read an article attributing today´s lack on interest in psychoanalysis to the fact that Psychoanalytic societies kept themselves restricted to psychiatrists and psychologists, and that this happened because, as the government paid for the treatments, they regulated who could practice it. Because of this policy, psychoanalysis would never have entered the public debate.


Nowadays, it´s not the case anymore that psychoanalysis are paid by the health insurance, these have opted to only subsidize therapeutic approaches that can provide a prescription detailing how many sessions will be needed to achieve this and this result. 


It is frequent in our practice, that we receive patients that had been in therapy prescribed by their GPs for the number of sessions they said would be needed and find it hard to understand how this is supposed to be enough.


And now, it even happens, that psychologists that we know, who work with health insurance send us patients for whom they believe a psychoanalytical treatment is necessary.

Having noticed this happening more and more, is the reason we have decided to invite you here today. Psychoanalysis is stigmatized, people imagine it is difficult for the patient, that it must be long, it has to be expensive, that it involves a lot of suffering and talking about things they would rather forget.


Well, a psychoanalysis does not have to be that. It does involves talking, that´s for sure, but it´s less about the things you say, the traumatic stories you tell about your past, your childhood, and it´s more about were you place yourself in them. It´s not about reading what is beneath the words you are saying, to discover an occult meaning to the words.


 A psychoanalyst has to listen, to read the structure of the patient´s discourse, to find the subject of unconscious, to find the words, the signifiers that he is alienated to, to point out where the unconscious desire lays.


Psychoanalysis is difficult for the analyst, because it requires going against what is seen as common sense, it requires being able to leave your moral judgements aside.


When someone comes to analysis with a complaint, for instance, about their job, we are tempted to help them get rid of the job that provides this toxic environment he is complaining about. Or we could have the urge to help a teenager, who procrastinates delivering his school work, by developing a schedule he will than follow (or not). 


People come to us, usually because they got stuck on something in their lives. Everyone creates narratives about their lives. It is important that the analyst listens and welcomes these narratives, but the intervention must be at another level. Lacan adverts us against quickly understanding what someone comes to tell. Understanding is rational, it creates an imaginary effect that leaves out the subject of the unconscious. So, if we hear and comprehend these narratives, we are at risk of getting stuck at the same points the patient comes to complain about. We might think it´s better to help them leave the job, or get the divorce, or just take the ADHD medication. 


Our job is not to imagine we know what is going on in the patient´s life and advise them on how to get rid of their problems. The analyst must differentiate between a rational demand and the unconscious desire. They have to explore the signifiers that the patient has brought, among them the burnout, procrastination etc. The analyst has to find the signifiers this subject is alienated to. In interpreting their ideals, in pointing out the way they deal with what bothers them – in other words, in asking them what their subjective implication is the suffering that they are complaining about, like Freud did with Dora, - we see a spin in the structure of the discourse. 


A psychoanalysis does not attack a symptom, assuming that a burnout has to be dealt with, in a number of sessions with a certain protocol. Symptoms are singular unconscious formations, and, in this sense, there is no burnout like the other.


Analysis is the rare opportunity to be heard in what you say. It's a punctuation mark for a patient saying: “How interesting, your boss asks you to do something you think you should not do, - you do it - and just wish he wouldn´t have asked. This sounds important! We can think about this more.” 


This has effects. This person is going to leave, they might come back saying: “I do this in my marriage, I do this with my parents.” And we're going to ask about these situations and keep going along these lines, locating the subject, the ideals, the unconscious desire. 


A different kind of therapeutic approach focused on effective results might advise them to get out of their comfort zone, do something different, follow these specific steps to achieve this result. That's not listening to the unconscious subject. That's proposing things. This may have an effect, the person may even leave work, but what effect did it have, subjectively speaking? 

The other day, someone came to me saying they were exhausted by there former therapy, that they left because they got overwhelmed by doing everything the therapist told them to do. 


Analysis, for Lacan, is what you expect from a psychoanalyst. The analyst sustains the dispositive of the treatment by receiving the discourse of the patient and provides the space for the unconscious experience to exist.   


And it´s because we believe this subjective work involves talking about its effects publicly, that we are here with you today.


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