A Clinical Introduction to Lacanian Psychoanalysis: Theory and Technique

An outstanding facet of this book is the jacket illustration, part of a design by Annamarie McMahon. It consists essentially of a reproduction of the painting fatuously entitled The Tempest, executed around 1505 by the Venetian painter Giorgione. This painting has a long history of controversy; there are innumerable disagreements about what it means, and X-ray studies have shown that there were figures in it subsequently painted over by the artist for reasons we do not know. So, just as it is with Lacan's work, we are confronted with an ambiguous, controversial, and multilayered presentation.

Bruce Fink, professor of psychology at Duquesne University, is labeled on the dust jacket as a “practicing psychoanalyst.” In his acknowledgments section, Fink tells us that Jacques-Alain Miller is “widely recognized as the foremost interpreter of Lacan's work today—and taught me the lion's share of what I know about Lacanian psychoanalysis.” Unfortunately, Jacques-Alain Miller, Lacan's son-in-law, is an extremely controversial figure and, like Lacan, has become involved in a great many arguments about the interpretation and teaching of Lacan's system, in spite of the fact that he was the designated heir of Lacan's mantle. So what we are presented with in the book under review is Lacan as interpreted by Jacques-Alain Miller, whose teachings in turn have been interpreted by Bruce Fink—i.e., a multilayered representation of Lacan's system. Fink acknowledges that writing such a book “is a bold and perhaps foolhardy endeavor, and in attempting it I have no doubt exposed myself to criticism from all fronts” (p. 219). This is certainly true, but the purpose of this review is not simply to criticize Fink but to introduce the prospective reader to Fink's difficult book.

Actually, the book contains three books. The first 78 pages form an attempt to introduce some of Lacan's basic concepts. This is followed by three long chapters presenting Lacan's theoretical formulations of psychoses, neuroses, and perversions, as well as a valiant attempt on Fink's part to illustrate some of these concepts with clinical material. The final portion of the book, about 65 pages, consists of notes and recommended readings and should be read by anyone interested in Lacan because some of Fink's best elucidations are unfortunately buried in this section, which readers might tend to skip over.

There are two ways to teach Lacan. I have been trying to introduce Lacan to psychiatrists and psychotherapists by presenting selections and snippets from his teachings that would have immediate application to everyday clinical problems (1–3). Fink, on the other hand, attempts to introduce Lacan's entire system, at least in outline. In order to do this, he has to make many unsupported generalizations, and the reader must be tolerant because many of Lacan's pronouncements are of a “take it or leave it” quality. It is fairly well-known that although Lacan claimed to be returning to the early work of Freud, his system actually differs from Freud's in many fundamental ways; a book review is too short a forum to discuss this at length.

Lacan deliberately wrote in an obscure and at times absolutely unintelligible manner, one made infinitely more complicated, I have painfully learned, by much play on words in sophisticated French that defies translation even by professors of French. Fink attempts to be as clear as possible, and one must give him credit for making a tremendous effort to explain Lacan's ambiguous, deliberately obscure, and narcissistically esoteric prose, but at certain points he simply is unable to do so. For example, he almost immediately gets into the issue of “the analyst's desire,” which Fink tells us “is a kind of pure desiring that does not alight on any particular object, that does not show the analysand (the person engaged in analyzing himself or herself) what the analyst wants from him or her—though the analysand almost inevitably tries to read a specific desire into even the slightest intervention or interpretation” (p. 6). I must admit that I never gleaned from Fink's book an understanding of what is meant by “pure desiring,” which sounds like a kind of Platonic concept devoid of any content. I do not blame Fink for this; I think it is an example of Lacan's obscurity and ambiguity. Fink writes, “The French man or woman in the street understands nothing of Lacan's grammar, much less of his multilayered polyvalent pronouncements” (p. xii), and he argues that French therapists have to learn about Lacan's work in a sort of apprenticeship to other Lacanians. This is how Fink maintains he learned about Lacan, and there is nothing to quarrel with in that contention.

If “pure desire” simply means that the analyst should usually feel free to express a desire for patients to continue their analysis, I would have no trouble with the concept, but I disagree with Fink that “the therapist must always express a desire for patients to continue, even if he or she feels that these patients have completed their work” (p. 5). I do not agree with his criticism of an analyst who told a patient that he could do nothing further for her; on the contrary, I admire this analyst's honesty. It is sometimes necessary, when the material seems to indicate it, to firmly suggest to a patient that perhaps at some level the analyst is considering termination, and I do not think this indicates to the patient that the analyst wishes the patient would stop coming, as long as there is no unusual countertransference problem. In my view, it is an indication that the analyst appropriately places the patient's needs ahead of his or her own, including the analyst's need to keep all analytic hours filled for financial purposes.

The other major area where I disagree with Fink is on the issue of the so-called short session. As Fink correctly notes, Lacan's varying of the length of the sessions scandalized the psychoanalytic establishment, and Fink tries to defend such behavior, although he admits that in most schools of psychology and psychoanalysis “such behavior on the analyst's part would be considered a serious breach of professional ethics—abusive, unconscionable, and downright nasty” (p. 19). He even goes on to suggest that a patient who received several extremely short sessions in a row was “in a sense, asking for it” (p. 19), which reminds me of the old argument that a woman who was raped brought this on herself by “asking for it” in some fashion. Fink says, “Not openly, necessarily; not even verbally, perhaps. But he may very well have known, at some level, what he was doing; he simply could not help it” (p. 19). This is usually known as blaming the victim, and I think that any analyst who practices what Fink labels as “scansion” is simply acting out some form of countertransference or worse. The argument that “scansion” makes it impossible for the patient to fill up the session with trivia does not hold, since it is quite feasible to interpret this to the patient and try to understand the meaning of it without punishing the patient—and charging a full fee for a 5-minute session is punishment no matter how it is rationalized. It is also something that Lacan himself used, according to Roudinesco (4), whose outstanding biography of Lacan would make a good starting point toward an understanding of Lacanian psychoanalysis before reading Fink's book. Roudinesco tells us that Lacan got his hair cut and received pedicures during sessions with his patients (p. 391). Fink does not discuss this.

Fink correctly notes that “psychotherapy has been largely discredited in the United States, and is frequently no more than a last resortTo the American mind, the psychotherapist is often assumed to be someone who could not hack medical school, who flunked college math or science, and whose experience of human nature may be no more profound than that of talk-show hosts. Americans have no more faith in psychology or psychoanalysis than they do in astrology and palmistry (indeed, they may have less)” (p. 29). Fink does not mention that obscure writing and elitist seminars such as those offered by Lacan only add to the opprobrium in which psychotherapy is falling in the United States, along with the fact that, as he notes, “health insurance companies often consider any therapy with a prefix `psycho' in it to be worthless; and the media depict nothing but therapists who take advantage of their patients and are more deranged than their patients in the first place” (p. 27). This is tragically correct and requires vigorous action on the part of professional organizations like APA and the American Academy of Psychoanalysis, but it is very difficult to counteract the power of the huge multinational insurance and pharmaceutical corporations, which are among those who influence the media and the political process in the United States. Fink claims that the worship of psychopharmacology is not so great in France and that there is a more tolerant understanding of human problems in that country.

In discussing analytic technique, Fink recommends “providing interpretations that are enigmatic and polyvalent” (p. 46). These are the sort of Lacanian statements that one either accepts or rejects, probably on the basis of one's own personality, and there is no point to criticizing or arguing with him in a book review. There are some really interesting aspects of the Lacanian system that should cause every psychoanalyst to stop and think, however. One of my favorites is Lacan's very vague, esoteric, and continuously changing concept of “object a.” Fink says, “`Object a' can take on many different guises. It may be a certain kind of look someone gives you, the timber of someone's voice, the whiteness, feel, or smell of someone's skin, the color of someone's eyes, the attitude someone manifests when he or she speaksWhatever an individual's characteristic cause may be, it is highly specific and nothing is easily put in its place. Desire is fixated on this cause, and this cause alone” (p. 52). He also reminds us of the importance of how our parents' desire becomes a mainspring of our own; however, he then begins to focus on Lacan's adaptation of Freud's emphasis on childhood sexuality (the so-called primal scene, for example) as the cause of all neuroses. Fink points out that Lacan, like the early Freud, emphasizes the role of the father in the formation of the neuroses, the psychoses, and the perversions, and so Lacan, in my opinion, neglects the pregenital and preverbal era. Psychoanalytic thought has shifted away from this early Freudian attitude, at least in the United States, where the preoedipal period and the role of the mother are increasingly seen as fundamental in providing the soil on which neuroses grow. In this sense, Lacan does return to the early Freudian theory as he claims to do.

Lacan's approach to diagnosis also leans somewhat on Freud's early work, and it is interesting to note that the concept of a borderline personality disorder “does not constitute a genuine diagnostic category in Lacanian psychoanalysis” (p. 77). This is an example of where Lacanian psychoanalysis loses touch with reality, for, at least in the United States, borderline personality disorder is one of the most common and difficult problems that we have to face. It is interesting to learn that Lacan's 1960 reformulation of the mirror stage (p. 88), which Fink says is currently available only in French, sounds very much as if it were taken from the work of Kohut.

What Fink does not discuss is what I consider one of the most fundamental points of disagreement between Lacanian psychoanalysts and American psychoanalysts who commonly employ Freud's structural theory. The question of whether, as Lacan says, the ego is a false concept, a misconception, and an attempt to hide a self that has no essence and is nothing but chaos brings us to a philosophical debate involving postmodernism (5). At the same time, it expresses Lacan's unresolved negative transference toward his analyst Lowenstein, who was one of the founders of American ego psychology. It is unfortunate that this does not receive more attention from Fink for a U.S. audience.

The central chapters of the book, on psychoses, neuroses, and perversions, are theoretical and very difficult. The reader will have to be quite dedicated to the task of understanding Lacan to plow through his abstract concepts, but on the whole these chapters seem to me a fair attempt to make sense out of Lacan's obfuscatory seminars. I do not agree with Fink's claim that an interpretation can lead to a psychotic break. I do not believe that a psychotic break is ever precipitated by an analyst's interpretation; to me this is a form of post hoc, ergo propter hoc reasoning. If a person is going to have a psychotic break, he or she is going to have a psychotic break, but afterwards all sorts of things are customarily blamed for it on the basis of this type of reasoning. Fink promises us more discussion of Lacan's ideas about psychoses in a sequel to the present book.

Fink recognizes that nobody can write a book about Lacan without stirring up a great deal of controversy and complaint. On the whole, I think he has made a reasonable attempt to give at least a glimpse of Lacan's approach for U.S. mental health professionals. If those mental health professionals are interested in finding out about Lacan, I suggest that Fink's book might be one place to begin—after reading Roudinesco's biography (4). My own favorite introductory text to Lacan is by Lemaire (6). There are many others. Certainly, Fink's is the best book I have seen so far that makes an attempt to find some kind of clinical application of Lacan's approach that might be intelligible to U.S. readers.

Because I sincerely believe there are aspects of Lacan's teaching that are worthwhile for those interested in practicing psychoanalytic psychotherapy, I welcome the appearance of his book, and I believe Fink deserves congratulations for the effort he has made, even though it exposes him to criticism from all sides.