Obsessional Neurosis
Series in Clinical Structures
What follows is an essay which will be used to provide some discussion points at an upcoming summer seminar series hosted by the Denver Theory Group as well as Michael McAndrews, practicing analyst within the Lacanian Compass. Each installment of the series explores various thoughts I have regarding the clinical structures of Lacanian psychoanlaysis.
Why Diagnosis? — Clinical Structures — Psychodiagnostics vs. Medical Diagnostics
Reification, identity, ideology, etc. All this might come up for us moderns when we think about ‘diagnosis.’ Has biopolitics or poststructuralist thought taught us nothing about giving labels to people? Whether it’s Generalized Anxiety Disorder, Major Depressive Disorder, or the accursed Adjustment Disorder, all clinicians must answer to the question: Why diagnose? Is it for insurance purposes? Or because it gives us a sense of mastery over the subject? Or does it prop up our field as professional, scientific, and valid? Surely, it at the very least it distinguishes us from life coaches!
But there is a better reason to diagnosis, and we won’t find it in master’s-level training institutions or in the DSM or from insurance companies. Psychoanalysis gives us a very convincing answer of why we diagnosis and the importance of it to our actual clinical work with real patients. A useful point of comparison is psychodiagnostics versus medical diagnostics. Paul Verhaeghe (2008) gives us a few differences:[1]
(a) Psychodiagnostics cannot only be concerned with the individual’s body or mind, as subjective development/experience takes place and is formulated within a larger context.
(b) Medical diagnostics is based on the reading of ‘signs’, nodal points that, when gathered together, form an objective diagnostic impression that holds for every case, regardless of particularities; Psychodiagnostics is confronted with ‘signifiers’, endlessly shifting elements that, when added together, make the situation increasingly complex and increasingly difficult to generalize.
This difference tunes us into the utility of psychodiagnostics: it helps the clinician articulate the signifiers they are confronted with; and it helps them navigate their own position in relation to these signifiers. A medical doctor’s personhood has no effect on the existence of a tumor or the temperature reading of the body; but a hysteric will show up very differently depending on how the therapist presents and each therapist takes on the transference of a psychotic patient differently. So psychodiagnostics should help us, first and foremost, ground our clinical practice by showing us how each party (patient and therapist) is implicated in the encounters during the treatment.
The implication for psychotherapeutic technique, according to Verhaeghe (2008), is: “…a psychotherapeutic approach ought rather to be directed toward the underlying structure. Should the therapist forget this, she unwittingly collaborates in restoring the symptom’s economic gain” (17). This produces the ‘revolving door’ effect of the patient returning only months or years later to the same or a different therapist with the same complaints. Because the psychoanalytic approach to diagnosis involves an attempt to resolve economic and structural issues within the patient as well as symptomatic concerns, the hope is for a more fundamental change within the subject’s very psychic-structural economics. The goal is not the removal of a sign/symptom, but to reorient the subject in relation to his own subjectivity.[2]
Within psychoanalysis, there are numerous models and orientations within which diagnosis takes place. From object-relations to relational/modern psychoanalysis to Freudian and Lacanian (drive) approaches to the psyche, clinicians and theorists have sought to develop creative and productive ways to orient themselves with the patient in the transference and in the treatment. Interventions and positions are adopted to more adequately situate the therapist in the clinical effort. The ‘eclectic’ approach is quickly going out of fashion. It turns out that not having anchors to one’s clinical only confuses the therapist and the patient.
Since my work is more or less oriented by Freudian-Lacanian psychoanalysis and psychodynamic psychotherapy, I would like to spend some time sketching out diagnosis from this perspective. In my mind, diagnosis from this orientation has to do with how the subject has developed in their context (in relation to the Other), how they manage pleasure and displeasure, and how they negotiate desire and fantasy. These very structural issues can be roughly divided into three categories: neurosis, psychosis, and perversion. And these can be further subdivided. Within neurosis, for instance, we have obsessional and hysteric and (sometimes) phobic.
Why these differences? Following Lacan and Freud, analysts in this tradition have found in their work with patients that when we consider major developmental-psychic moments, there are a handful of products (subjective structures) that can be identified. There might be ‘more’ than the structures, and indeed there are plenty of interesting debates (e.g., whether or not melancholia is psychotic or if phobic should be considered just a flavor hysteric neurosis) that relate to this issue. But for our purposes, we will first investigate the neurotic structure: hysteria, obsession, phobia, beginning here with obsessional neurosis.
The Obsessional-To-Be — Being Loved Too Much
For this we have to turn to etiology and human development, which Lacanians have recast as subject-formation. Joel Dor begins here as well, and tells us that the starting point for the obsessional is, “the sign of the mother’s unsatisfied desire, through which the child joins her in the particular privileged dual relationship [of the dyad]. Early on, the child perceives the signs of this dissatisfaction” (Dor, p. 113). Because of the extra attention paid to the child (for instance, extra touching or wooing when compared to other children — particularly if those other children are in the same family/home), the body of the child is overstimulated and produces a great deal of pleasure.
As Verhaeghe notes, there is often a connection (at least in modern, psychological terms) between narcissistic tendencies/personalities and obsessional neurosis owing in large part to this dyadic relationship of over-attending. Our modern lingo of “perfectionist” tendencies may also be linked to this: if the child is always doted on and sees itself as the paternal limit and arbiter of mother’s desire, it is conceivable that the subject learns that only the best will do! Those are inhuman expectations to hold for oneself.
As emphasized in Freud and later in Laplanche, the mother’s own sexuality is transferred onto the child’s own psychic and bodily life. And, while Dor notes that Freud abandoned the ‘seduction theory’ soon after adopting it, it is “nonetheless a predisposing element,” that what Freud “intuited about maternal seduction does seem to be a determinative influence when we specify its impact as consisting in her signifying to the child, early on, that her desire is incompletely satisfied” (pp. 114–115). In his early conceptualization of the etiological aspects of obsessional neurosis, Freud designated obsessive tendencies as primarily defensive: that is, as attempts to avoid punishment by reprimanding oneself as a result of this bodily pleasure.
But the child, in a mother-child dyad, is fundamentally passive, completely dependent upon the mother, and her own regulation of jouissance and desire. So the excess that is passed onto the child is experienced as aggressive, as an aggressive sexuality — hence, seduction. The child is left to bear witness to and experience passively the traces of his mother’s unsatisfied desire. This is often seen in the nostalgia of obsessionals later in life, in their fantasies of sexual passivity (e.g., of the seductive nurse or teacher, and so on).
Winnicott’s formula “there is no baby” is apt here — we cannot think of a baby and a mother as two distinct entities interacting with one another. Rather, we must think about how the two entities constitute each other intersubjectively, especially regarding the psychological development of the child. And in this relationship there is loss: a basic separation that occurs as soon as the child leaves the womb and continues progressively as the child grows up. And something is always ‘lost’ during this process. How the subject relates to this lack is very determinative in how they will be constituted as a subject, i.e., their subjective structure/clinical diagnosis. Fink describes loss as something which ‘drops out’ of the relationship following the aftermath of separation which “the obsessive refuses to recognize [as] related to the Other” (p. 118). For instance, as separation goes on, the child might ‘take the breast for himself’ while disregarding its connection to the mOther. So the child compensates for separation by annulling the existence of the Other and role it plays in his personal satisfaction. The subject learns to see itself as complete in itself, without any need of the Other. As such, obsessives have a proclivity to masturbation rather than sex to avoid confronting the fact that his enjoyment is actually tied to another. Pornography, especially, allows such procedures of isolation: the obsessive can look up specifically which type of person, or body part of a person, or role a person plays to get off without confronting their human desire.[3]
In the transition from being to having the phallus, the obsessional-subject-to-be must come up against the paternal function (his father or a representative thereof). The paternal function is found lacking, from the get-go, because of the myriad messages (signifiers) of the maternal desire which says: “He was not enough, I need you as well.” Being the passive recipient of his mother’s desire, the child never learns to articulate or orient towards his own. How, then, can he negotiate with the paternal function, the limit?
Desire, being the offspring of need, can be turned into demand if it’s left suspended: “Daddy, where do babies come from?” A desire to know one’s origin is formulated into a direct question which is then thwarted/frustrated by the response of the Other: “From storks.”
But in the obsessional-to-be, the desire which is born from need is immediately colonized by the mOther, taken into her own coordinates of (dis-)satisfaction. Hence young children who, after showing even the slightest appreciation of bodily movement, are put into two or three different sports teams and taught to play an instrument all after their school day. The tyrannical attending to any and every desire produced by insufficiently met needs in the child contribute to two structural traits in the obsessional:
“On the one hand, obsessional neurosis always bears the mark of imperious need. On the other hand, the obsessional is stricken with weakness in the expression of his demand… He therefore tries to make the other guess at and articulate what he himself desires but can never manage to ask for.” (Dor, 117)
We can expect resentment and relatively unsatisfying relationships in the obsessional, who never learned that to get satisfaction, one has to make demands for oneself. Instead, the obsessional will wait, often until a tipping point. A common manifestation of this is the person who waits until the partner makes a grave mistake to split up with them, even though he didn’t want the relationship to begin with. Or, as Zizek says in The Ticklish Subject of the deadlock of the obsessional as the subject “who organizes his entire life as the expectation of the moment when his Master will die, so that he will then finally be able to become fully alive, to ‘enjoy life’” (p. 124).
Obsessional Speech — Obsessional Transference
Speech and transference come to the fore in Lacan’s work on clinical diagnostics. Already in the 30s and 40s he was formulating a revisiting of Freud in order to salvage language for the analytic setting. In the 50s, this aspect of the clinical structures becomes essential in reading Lacan — and also of the reading of analytic patients.
Speech is one of the tools that the analyst can use to make meaningful distinctions among patients in order to inform their own listening. As a point of comparison, the psychotic will “talk freely and fluently without really speaking” (Nobus, 32), whereas the neurotic will always say too much. Particularly among obsessionals, the speech is always reigned in, cautiously mediated. Free association, for this reason, is especially difficult for the obsessional. Therefore the analyst must pay close attention to what is not said, and to interrupt the obsessional’s discourse when the unconscious (that terrible, internal Other) appears on the surface.
Keeping close to Freud here, Lacan believed that neurotic symptoms are communications, an attempt to say something which had been dissociated, disavowed, repressed, or otherwise lost throughout life. The subject does not understand this foreign communication, however — it is radically alien to him. It is thus the task of the analysand and of the analyst to uncover the foreign meanings of the neurotic’s symptoms. Lacan understood this project to be basically the unraveling of the metaphors in the unconscious of the patient. What are the associations/connections that are made within which the symptom makes sense?
In terms of transference, the therapist might expect the obsessional patient to constantly try to bend to the will of analyst’s personhood without actually making any changes for themselves. Dany Nobus points out that the obsessional will be extraordinarily flexible with time and fees, only to realize that the agreement is not sustainable for them. They might show up to sessions always on time and present, and will “freely” associate to satisfy the desire of the Other, but will actually avoid talking about what really matters to them.
Another transferential element common in the obsessional analysand is how they treat the analyst as subject-supposed-to-know. Instead of coming in only for the presenting concern (e.g., depression), the obsessional might present to the office under the impression that this will be an intellectual and self-reflective adventure. Doing this will destroy the actual radicality of the treatment and personality of the therapist. Otherwise, the obsessional will constantly doubt the efficacy of treatment and the adequacy of the analyst’s skill, technique, or even training.
Jouissance Without the Other — Impossible Desire — Neutralizing the Other
Already in Totem and Taboo, Freud finds a connection between incest prohibitions and obsessional structures. Because the obsessional-to-be is ‘too close’ to the mOther, the subject will always wrestle with omnipresent guilt, particularly if the paternal function is nearby. The subject sets himself up in relation to the father in a competitive struggle to maintain the position of the phallus — that is, to reserve full rights to the source of enjoyment. Because the obsessional always feels threatened by symbolic castration, he must always struggle with loss, and how to minimize it: “The obsessional is completely unable to tolerate loss” (Dor, 119). He reserves the right to be the object of the mOther’s desire. This is something that Bruce Fink somewhat glosses over in his account of the obsessional etiology. The emphasis in Fink is having the object of his own desire within the mOther, while Dor emphasizes that the obsessional’s separation anxiety (for this is what it amounts to!) is concerned with his existence-as-phallus.
But despite the ongoing competition with the father, the obsessional needs the paternal function to remain as Master: for to do otherwise would collapse the triadic relationship (the only hope for the obsessional to continue any kind of desire of his own) into narcissistic dyad, in which the obsessional’s desire might be smothered by the mOther. To keep on desiring, the goal of all neurotics, the obsessional must keep his desire impossible.
The obsessional wants jouissance without lack, for he is unable to tolerate castration. But without limits, jouissance swallows. So the fantasy of the obsessional is a delicate: achieve, but not too much! Hence the tendency to go from project to project, from partner to partner, ‘mastering’ one object and then moving on to the next in a metonymy of desiring. In terms of desire, the obsessionals wants the Other to be fully satisfied in her desire, and thus leave him alone to his own devices: “If I can finally satisfy my husband,” e.g., “He will leave me alone.” This is tied to the obsessional subject-formation discussed above: “obsessionals decry the Other’s desire as always being too much” (Nobus, 32).
To maintain control over jouissance without indulging in it is the core of the ambivalence of the obsessional libidinal economy. A common symptom of the obsessional is isolation: the separation of affect from thought. By doing this, the obsessional can exert control over his or her emotional life with the “aim of this operation [being] to split off the affects of a representation linked to certain repressed contents” (Dor, 122). This splitting can then be further regulated by ritual and turned into habit, allowing the subject to maintain self-control even during internally or externally heightened scenarios. This is great for firefighters — but terrible for analysands, who practice a blatant disregard for the rule of free association. Humor and undoing are other great ways to ward off the original affect tied to a signifier.
Why can’t the obsessional fully partake in his jouissance? Because, as we said, the obsessional subject’s desire is overwritten and burdened with the mOther’s desire: to get close to satisfaction, then, means to get close to her satisfaction — and this would eradicate the subject: “Desire is impossible in obsession, because the closer the obsessive gets to realizing his desire (say, to have sex with someone), the more the Other begins to take precedence over him, eclipsing him as subject” (Fink, p. 124). Fink then goes on to note that falling in love with people who are long-distance or who are emotionally/physically inaccessible is a common strategy of an obsessional who is trying to keep his love objects at arm’s length. The obsessional subject, we might say, recognizes the Law of the Father (you cannot have your mother), but only to an extent. It is internalized, but the subject does ‘keep’ some of her jouissance for himself. So the subject ends up being in a position where he will maintain his desire without fulfilling it: he finds himself at an impasse. As soon as he gets to a point where he can have ‘his’ object of satisfaction, it becomes unappealing to him, or he leaves it there. Incessant chasing of goals or projects is a commonplace among obsessionals. They might think: “First, I need this promotion, and then I can settle in,” but once the promotion is achieved, it becomes, “Okay this position actually isn’t that great. It’s actually a horizontal move that I need to make,” and so on and so forth. The metonymy (movement along a chain of signifiers/ideas/moments) of desire takes this form of the obsessional: always pushing back satisfaction with each move towards it.
The all-consuming love of the mOther and the obsessional’s place within the triadic constellation of childhood relations sets up the fundamental fantasy of non-splitness, of completeness of the subject itself. “It is not me that is lacking, it is you!” This fantasy keeps the ‘object’ of the mOther for oneself without having to share it with anyone. On Why Theory podcast, Ryan and Todd provided the great example of going to a movie theater vs viewing a movie on a phone screen or TV at home. In the latter, you get the enjoyment of the movie without the intrusion of the Other (coughs, phones going on, getting your seat kicked, etc.). But at the movie, you get the enjoyment of the Other in the form of their literal presence. And this presence is always going to intrude upon your own enjoyment of the experience. Another apt example is transportation in most American cities vs European/some American cities. In places like Houston, Denver, and other major cities in America, we get around by car. By isolating ourselves in our little insular capsules, we can move at incredible speeds, stop wherever want, sing out loud, or even watch a movie on a road trip. On the train, e.g. in NYC, we are constantly bombarded with the Other and its limitations on our enjoyment.
By neutralizing the desire of the Other and rejecting its impact on its own subjective formation, the obsessional therefore mush destroy his own desire: for to desire means there is lack, and this lack is from the intervention of the Other. But in extinguishing the desire of himself and of the Other, he will likely doubt his own existence — hence the famous formula of the obsessional: “Am I dead or alive?”
References
Bruce Fink, Clinical Introduction to Lacanian Psychoanalysis. (1999)
Dany Nobus, Jacques Lacan and the Freudian Practice of Psychoanalysis. (2000)
Joel Dor, Clinical Lacan. (2013)
Paul Verhaeghe, On Being Normal and Other Disorders. (2008)
Notes
[1] Admittedly, Verhaeghe’s treatment of medical diagnostics is a bit medieval. More contemporary approaches to medical diagnosis are taking into account larger issues like sociopolitical effects on health such as pollution and the impact of the patient’s trust of the physician. Nonetheless, this model serves as an interesting comparison ‘in spirit’ to diagnostic procedures found in psychological treatment.
[2] But this does not mean that only people who are passively interested in themselves in some philosophic sense should come to analysis. On the contrary, the mechanism of psychoanalysis is suffering; out of this pressure is the treatment born and through which it moves. Thankfully, psychoanalysis has been shown (see work done by Jonathan Shedler) to resolve symptoms at the same ‘rate’ as other therapeutic interventions. So the work of analysis is aimed at the structure, but resolves the symptoms along the way.
[3] Not sure where to put this paragraph on separation and compensation.
