The second Clinical Study Days, sponsored by the World Association of Psychoanalysis in the United States, took place on January 13, 2007 in Miami. The title for the day was “Psychic suffering and the treatment challenges in the postmodern world.” Marie-Hélène Brousse began the day with a very interesting and informative lecture entitled “The treatment challenges of today.” She took up the question, “what is post-modern?” and discussed how the master discourse today responds to and is organized by scientific discourse, and how science has changed our objects and the way we live our lives. She focused on and gave examples of how our current time gives less power to the symbolic and more power to the real; we see manifestations of this in the culture and in the clinical field. With this cultural shift, we encounter changes regarding the limits of jouissance. Brousse discussed how our time is marked by limits set not by prohibition, but rather by what is possible or impossible. Our particular cultural milieu is also marked by burgeoning possibilities. Rather than one Name-of-the-Father we are dealing with “the Multiples,” as described by Jacques-Alain Miller. Brousse discussed the effects of there always being another possibility. She took up these changes and how they manifest in people’s suffering and the current state of treatment. Finally, within this context, she spoke on the role that psychoanalysis can play regarding the cure. 

This lecture was followed by five case presentations. Each case was followed by a response from both an invited guest and the guest speaker, Marie-Hélène Brousse, as well as questions and comments from the audience. Alicia Hadida Hassan presented a case from her clinical practice with children. An eight-year-old girl was brought to Hassan because she was “causing trouble at school” and was involved in various incidents including vandalism and violence. Hassan went further than to offer social skills to the girl, which was requested, and rather worked with the little girl’s position within the family and her fantasy of being the only one for her father, as well as the signifiers of being “alone” and “only one.” Indeed, certain signifiers came to the forefront of the treatment. By listening to the child, especially to the elaborate stories that she told, Hassan helped the child find a place of her own, a niche for herself, especially at school. We saw that the treatment helped her shift her subjective position. The response by Heloisa Caldas illuminated what was both unique about the case regarding the specific signifiers and emphasized the psychoanalytic methodology of the case. Broussse highlighted the work of the child’s stories to invent a useful individual myth for the child, and how this is a useful technique when working with children; it particularly allowed a structure to appear and be reorganized.

The next case, “Queen of Petra: a girl without a name” was presented by Dinorah Otero. This was a case of four years of treatment with an autistic child, who was also referred by her school for disruptive behavior. Otero discussed the role of the child’s name and how the lack of a name upon birth represented a lack of a symbolic place for the child within the family. Otero also discussed how she worked with the gaze and the voice in a particular way given the child’s autistic diagnosis. Drawings also played an important role in the case. The case focused on the child’s telling a story through pictures and how this telling made up a construction in analysis. The case portrayed stunning therapeutic effects and showed a big shift in the child’s relation to Otero; the child was able to speak with, indeed confide in, and to gaze at Otero by the end of treatment. Carmen Navarro’s response to the case illuminated the way in which Otero was working in the clinic of the real. She also discussed how Otero managed to create much needed social ties with her patient and how new signifiers emerged via the work. Brousse’s response highlighted Otero’s work with the object, and the shift in the subject from autism to paranoia, and how the patient built a symptom via the treatment.

Yael Baldwin presented “It’s a family affair: A case of bulimia nervosa,” which documented how Baldwin worked analytically within an eating disorders treatment team setting with a college aged woman suffering from bulimia. Baldwin described how the treatment worked at the level of the signifier, and how via speech the patient was able to connect her symptom to her family history, to repetition, and to various identifications with family members. The case also highlighted how the symptom was also linked to the patient’s relationship to knowledge. The case discussed how one can work at the level of speech and desire even when the setting tends toward working at the level of demand. Pam Jesperson responded by questioning and discussing the role of jouissance and the drives in the case. She also highlighted the ways in which the treatment repositioned the subject from the role of victim into a stance of responsibility. Brousse’s response brought up a lively discussion about the differences between Dialectical Behavioral Therapy and CBT models and psychoanalysis, especially the role of the Other in relation to the subject. She also highlighted how the treatment allowed the young woman to build the bulimia as a subjective symptom, an analytic symptom as it related to truth and history, that could then be worked through. 
Noemi Kohan’s case “De-stigmatizing psychoanalysis” looked at the demand for medications that provide quick solutions versus the demand for psychoanalysis, and offered a look at the therapeutic effects of a psychoanalytic treatment that lasted eight weeks. The patient discussed his depression and how it related to a career he disliked, the loss of his father, a failing relationship, his lack of a sense of place due to moving, and his progressive social isolation. Kohan showed how via some analytic interpretations that illuminated repetitions in the patient’s life, the patient, in eight weeks, moved from a position of wining demand to a different stance. Mirta Liliana Tedesco’s response to the case highlighted how Kohan’s position as the analyst and her interventions helped the patient move from the imaginary realm to the symbolic realm, and then created differences within the symbolic. Tedesco helped analyze each cut of the session and its effects. Brousse commented on how Kohan woke her patient up and how the use of scansion disturbed his defenses. An interesting discussion ensued that related to the patient’s diagnosis. Was this a case of an ordinary psychosis? What about the Lacanian orientation would allow us to call this an ordinary psychosis as opposed to, for example, an obsessive neurosis? This brought up the topic of the relationship to knowledge and the unconscious as it relates to structure. The final case, “Johnny and why is the devil chasing me?” was presented by Tracy Favre. The treatment was with a middle-aged schizophrenic male in a continuing day treatment program who suffered from devil delusions. Favre described how the major and important questions that emerged from the case were why Johnny demanded treatment as he did, what he needed from treatment, and how she was to work with him in a useful way without him feeling like she was persecuting him, as he often felt others were. Favre discussed how for her, the treatment was a learning process in working with psychosis. In her response to the details of the case, Karina Tenenbaum picked up on how Favre managed not to become the Other that would be a threat to the patient. Tenenbaum also discussed the role of an invading jouissance in psychosis and in the case. Brousse responded by picking up on the patient’s transference and how he was asking Favre to give some order to the chaos of the real in which he lived. Brousse focused on the patient’s demand for knowledge concerning his history and saw this as a positive sign and direction for the treatment. Favre and Brousse spoke about what it means for a patient to construct a personal history with the analyst.

In all of the cases the question of diagnosis arose and was discussed, as was the direction of the treatment and what was specifically Lacanian about each treatment was highlighted. Theory was wedded to the concrete reality of cases. 

To conclude the successful day, Thomas Svolos announced that the third Clinical Study Days will be held in the winter of 2008 in Omaha, Nebraska and the topic will be on the object of psychoanalysis, that is the object relating to object a, to the goal or aim of psychoanalysis, and to what psychoanalysis objects to, that is, the subversive side of psychoanalysis. The first two events have been illuminating, and I encourage all to attend the third.