2023-11-07 15:23:57
What is the point of being a Lacanian in an institution? What is the specificity of this orientation with patients followed in psychiatry, and more specifically with children?
It is as a clinical psychologist that I work in a day hospital in an infant and juvenile psychiatry sector which welcomes children aged 4 to 12 with psychological disorders: childhood psychosis, behavioral disorders, spectrum disorders autistic… Of course, there is no question here of conducting formalized interviews with these young patients who are unable to bear being face to face with me in a room. Even less to lay them down on a couch! However, this does not mean that there is nothing to say to them: “They can’t hear what you have to say to them as you’re taking care of them. […] But anyway, there is surely something to tell them (1) » which does not have the form of a classical interpretation. How can psychoanalysis, and more specifically that of a Lacanian orientation, guide us?
Whatever the child’s diagnosis, the difficulty of relating to others is central. Because the child’s Other, the one with whom he deals, in his head, in his body, is a tyrannical Other, who persecutes him with too much presence – for example whose voice invades him – or who leaves him fall like trash.
How to “be there”?
It is then a question, for the psychoanalyst, of not occupying the position that Jacques Lacan calls the big Other, but that of an empty place. For the psychotic child, the desire for the Other manifests itself more as a desire to enjoy him and to command him. As an adult and, moreover, a caregiver, we can quickly be tempted to want something for these children in great difficulty, and to do it for them, to know for them. For example, we may want the child to tell us what he is experiencing, to tell us what is in his head, and our quality as a “psychologist” invites us to do so. We may also want him to formulate his request, or participate in this or that workshop that seems appropriate for him. We then place ourselves in the position of wanting him to tell us, to speak to us, to participate… and in doing so, we occupy the place of an Other who wants for him, becoming an Other who commands him and whose he is at the mercy.
So how to do it? What position should you adopt? As Laurent Dupont says on the 53 bloge Days of the School of the Freudian Cause which have as their theme “Interpret, scan, punctuate, cut”, we can draw on a saying by Jacques Alain Miller: “The analyst does not think.” In his act, he erases himself, he erases his thoughts, he restrains his will to think. There remains his presence, he must be there. (3) » How then to be there, while erasing one’s thoughts, such is the paradoxical position of the psychoanalyst. One way to occupy this place is to let ourselves be taught by the child, to become his secretary or his assistant, to let ourselves be maneuvered by him, so that he trusts us and lets us enter his world. It also consists of agreeing to decomplete oneself, to let oneself be “barred” by the child without trying to confront him, even if this can give the impression that he is manipulating us or leading us around.
The children we receive often report hallucinations and/or delusional ideas. With Freud, we know that these painful and problematic phenomena are also a means that the subject puts in place to defend himself once morest an unbearable reality. The challenge is then to respect this defense, while delicately introducing small deviations, small proposals to invite the child to make himself more responsible for what he suffers from, by supporting him so that he can find his own solutions. So, when a child manages to bear witness to these phenomena, it is already a way of separating from them at a minimum, of giving up a little of this enjoyment – that is to say, this pain – by sharing it with another. and look for less expensive solutions. If he tells us how much the gaze persecutes him, we can help him find a way to protect himself from it, by offering him, for example, to go out and take refuge in a small cabin when too much gaze invades him. We can also avoid speaking directly to him, but pass an object between him and us, to alleviate this too much staring. This may also be the time to offer medication that will soothe him. But it also means identifying and supporting the unique inventions that the child has already started to put in place, because he did not wait for us to seek treatment. We can thus take an interest in our interests: dinosaurs, war, pokemon, manga… which present themselves as an obsession that we might be tempted to limit. Starting from this singular interest and agreeing to let yourself be taught by the child helps to gradually expand and build a world in which he finds his place.
Build with others
Finally, the position of the Lacanian psychoanalyst is also that which he occupies vis-à-vis other caregivers. That is to say, identify your own impasses, and invite others to do so as well. During the team meeting (weekly in our institution), it is then a matter of working together to identify the logic of what is at stake for a particular child, starting from what is at an impasse for each child. The stopping point of a caregiver with regard to a child very often refers to the singular logic of the patient’s symptom and enlightens us on a position to be constructed together.
Hélène de La Bouillerie
Psychologist
Psychoanalyst member of the School of the Freudian Cause
(1) Lacan J., “Conference in Geneva on the symptom”, The Cause of Desire, no. 95, April 2017, p. 17.
(2) The next ECF days will take place on November 18 and 19, 2023. See the event in our calendar and on www.journees.causefreudienne.org
(3) Miller J.-A., “The Lacanian orientation. The Un-tout-seul”, teaching delivered within the framework of the psychoanalysis department of the University of Paris 8, course of March 30, 2011, unpublished
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