The Subject of Lacan: A Lacanian Reader for Psychologists

12 The Treatment of Psychosis

209 1 2 The Treatment of Psychosis Willy Apollon, Danielle Bergeron, and Lucie Cantin General Problematic Willy Apollon T his title merits a few explanatory remarks. It refers to the title of our book Traiter la psychose (Treating Psychosis), published in 1990 within a very specific framework. Its aim was to publicize the results of a report on our practices at the Psychoanalytic Treatment Center for Young Psychotic Adults in Quebec, the “388,” both within Quebec and throughout North America in particular. The present paper delineates the argument running through our research and our clinical advances. The Framework Since 1982, we have been operating a Psychoanalytic Treatment Center with an average capacity of sixty psychotic patients, Translated by Tracy McNulty 32582 Chap 12 4/18/00, 9:32 AM 209 210 Willy Apollon, Danielle Bergeron, and Lucie Cantin supported by a contract with the government of Quebec that allows relative financial and administrative autonomy. The Center, situated within the city of Quebec, has administrative links with the Centre Hospitalier Robert-Giffard, and sponsors university internships for young professionals in the medical, psychiatric, psychological , and anthropological fields. The staff includes psychiatrists, who head the treatment teams, psychoanalysts affiliated with GIFRIC (The Interdisciplinary Freudian Group for Research and Clinical Interventions) who oversee individual analyses, and clinical staff members, social worker, etc. The Center is open twentyfour hours a day, 365 days a year. The client can make use of the Center’s services at any time, and can even receive help at home in an emergency. The Center has seven beds, divided between five rooms, for in-house treatment of the crisis. Each employee receives two hours of clinical psychoanalytic training and a half-hour of individual supervision per week. Our Method The theoretical framework in which the treatment takes place conditions its possibilities. In this setting, our aim is to connect the four logical facets of working that lead from the patient’s “spontaneous work”—which overdetermines the psychotic experience—to an experience under transference in which the subject encounters the desire of the analyst, there where the Other’s injunction was. This method is mandated by our clinical objective, which is to compel the psychotic to produce a savoir that can be deduced from the experience under transference. The new savoir will take the place of the delusional certainty at the base of the psychotic enterprise. Such a method is problematic within an institutional framework such as a hospital. When the individual is taken in charge by the institution and administered all kinds of treatment supposedly in accordance with his “needs,” the subject is placed in a paranoid position that condemns the transference to veer into erotomania, on the one hand, and on the other, engages the spontaneous work of psychosis in a clinical impasse leading to crises that then necessitate a biochemical, or even physical, control. The Structure of a Method of Treatment What is important about the way the method is put in place is that it allows for the possibility of a treatment founded on an ethics that supports the psychotic’s analysis. The first aim of the method is 32582 Chap 12 4/18/00, 9:32 AM 210 The Treatment of Psychosis 211 thus to establish a new ethics in the way the psychotic is approached , one that addresses him as a subject and requires a response from him: what we have designated within the theory as the “constraint.” Hence, even when a psychotic is referred by an attending psychiatrist, he cannot be accepted at the Center except on the condition of making a demand, through some minimal step. From the outset the client also knows that he will be undertaking a psychoanalytic treatment at the Center and that his analysis will be the ethical axis of his treatment. Furthermore, he knows that from the moment he is admitted at the Center, he will have to be responsible for his own affairs, and that his admission marks the end of his being taken care of by someone else. When he meets with the admission committee, only his word is taken into account. A “learned ignorance” defines the way in which he is listened to. This attention to the client’s word marks a radical departure from his prior experience, since neither his dossier, nor the comments that have been made about him in the discourse of others—attending physicians or...