In his article Ecrits, Jacques Lacan discusses the interdependent relationship between the subject of a psychoanalysis as well as the psychoanalyst himself. The premise of the article is to determine what the most effective course of treatment is whenever a psychologist is treating a patient suffering from a mental or nervous system disorder .
In the introduction, the question of the expert providing the treatment keeping himself disconnected from the patient is explored. Lacan suggests that remaining impartial and maintaining a neutral perspective is crucial in ensuring that the most effective treatment. The remainder of the article sets out the principles that all psychologists must incorporate into their practice. While Lacan acknowledges the contributions of Sigmund Freud in identifying the importance of establishing a close relationship between the subject and the researcher, he identifies more with the school of thought that suggests that an emotional disconnect between patient and doctor is imperative .
The article does not suggest at all that the patient should not be provided with the required information about his disease, in terms of the possible factors that caused it, as well as the treatment options that are available. Comparing it with modern medical science principles, the notion of ‘informed consent’ is hinted at here. This implies that any and every patient has the right to be having the knowledge about his health condition from his physician, and then be allowed to decide which course of treatment or medication he/she wants to opt for. According to Lacan, this puts the psychologist in a complicated situation . This is because he is expected to remain both aloof and simply act as a source of expert and credible information, yet is expected at the same time to be engaged in the entire treatment process. An analogy of people playing a bridge is used to explain the situation. In a game of bridge, each player has a different set of cards and depending on the hand they are dealt, each one plays a card they think will earn them the most points. Similarly, each patient that a psychologist treats is unique, with an individual personality, upbringing, life experiences and health problems, and so a customized treatment plan is needed for each. Just as players in the bridge should not be influenced or pushed into playing a certain card, similarly, people should also not be manipulated to pursue a particular course of action. The decision must be based on what they think is ‘appropriate for them at that given time’ .
The issue of transference between the psychoanalyst and the patient is also explored. Traditionally, transference was considered to be the projection of a person’s intense feeling, positive or negative, usually stemming from childhood towards a parental or authority figure, onto the psychoanalyst. The concepts of ego and super-ego are also introduced at this point. People suffering from a mental illness have weak egos and super-egos and stronger Ids (basic, instinctive reactions); consequently, in order to prevent themselves from thinking or behaving in a certain way, they require a strong hand of influence to keep them guarded and away from the problem behaviors they are trying to avoid.
Lacan highlights a very crucial, and oft-ignored subject when it comes to dealing with transference issues . Many psychological theorists have argued over the years that ‘transference is not all bad’. Their rationale is that if a patent indeed transfers the emotions he/she feels towards an important figure in their lives, onto their therapist, this will help them keep control over their patient, thereby helping them more in lesser time. Lacan disagrees with this ideology of treating patients because of two factors.
Firstly, he suggests that if such transfer is allowed to continue unchecked, it concentrates too much power with the therapist and this is not healthy in the long-run. The patient then entirely depends on the psychoanalyst, not just for health and treatment advice, but in making every decision in their lives. Recent research conducted in this field would corroborate Lacan’s opinion from years ago. If people, who are already emotionally vulnerable and unstable, have too intense a relationship with one individual, this renders them incapable of forming normally regulated relationships with other people in their lives .
Secondly, Lacan also argues that the hypothesis that emotional bonding between doctor-patient is healthy and beneficial for both does not take into account the fact that the emotions being projected can also be negative. Such a situation, instead of helping the patient, will endanger not just the relationship, but also the health of the patient. This is because any advice or lifestyle recommendation that comes from a psychologist who as viewed negatively by the patient will be perceived in their subconscious as coming from an individual the patient does not trust or care for. This will, naturally, dramatically reduce the chances of the patient following the consult he/she receives or implementing the changes they should to become and stay healthy .
The argument Lacan presents is that, all power, is not and can never be ‘always good’. Therefore, some measure of monitoring and regulation is required to ensure that both the transference and the relationship remain within the control.
Lacan concludes the essay by explaining the inherent weaknesses in the process of interpretation that is used in psychoanalysis. He is of the opinion that interpretation of facts or events in any form, no matter how unbiased, will invariably influence the perceptions of the patient. An important point that he highlights is that the newer researchers are of the opinion that if interpretation is implemented according to the rules that have been decided upon, then it does not cause problems or influence the treatment procedure .
Lacan ends his argument at the same point where he started it. The principle that a strict demarcation between the patient and the psychoanalyst must be maintained for the greater good and welfare of the patient.
Works Cited
Lacan, Jacques. The Direction of the Treatment and the Principle of its Power. New York: W.W Norton & Company, 1954. Print.
