作者: Dany Nobus 丹尼·诺布斯 / 3367次阅读 时间: 2017年11月14日
来源: 雄伯译 标签: 雄伯
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Jacques Lacan and the Freudian Practice of Psychoanalysis
Dany Nobus 丹尼 诺布斯
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Chapter 1 Diagnosis via speech and Transference
第一章 经由言说与移情的诊断
WHY DIAGNOSIS? 为什么诊断?心理学空间]w9j/YAr


Throughout his works, Lacan insisted on the differences between various mental organizations, on the analyst’s need to recognize these differences, and on the mandatory adoption of a differential treatment approach in the light of the psychic economy the analyst has acknowledged in the patient. The ‘Lacanian analyst’ has to bear in mind some basic nosological categories and is held to diagnose patients at the earliest stage of the clinical process, because her position within the treatment should differ according to the psychic structure of the patient. Hence, the initial assessment of the patient is not merely a matter of registration, due to the fact that it has major clinical consequences.

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XN9|3n4_:A0在拉康的著作里,他坚持这些差异,在各色各样的精神病组织之间的差异,当它们探讨分析家体认这些差异的需要,与探讨义务地採用差异的治疗方法,从分析家在病人身上洞见的心灵活动的观点。“拉康派的分析家”必须将一些基本的疾病分类牢记在心,并且被认为应该诊断病人,在临床过程的最早期的阶段,因为分析家在治疗中的立场应该有所不同,依照病人的心灵的结构。因此,对于病人的最初的评估不仅是铭记的事情,由于这个事实:它具有重大的临床的结果。心理学空间TNf)o;r ^s]


Like so many other aspects of Lacan’s clinical theory, the importance of a correct diagnosis prior to the beginning of psychoanalytic treatment is rooted in Freud’s papers on technique. In ‘On Beginning the Treatment’ (Freud 1913c), Freud argued in favour of a trial period (Probezeit, Erprobung, Sondierung) of one or two weeks before the start of the treatment, for which he adduced the necessary, yet laborious diagnostic procedure as one of the main reasons.心理学空间)Z9xxB#|$\yk

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Until the end of his career, Freud remained convinced that the standard method of psychoanalysis was of no use to people suffering from paraphrenia—or some other form of psychosis—which prompted him to demand that the analyst recognize this contraindication during the trial period (ibid.: 124).1 Failure to do so, or making a diagnostic mistake, would be disastrous as some patients (neurotics wrongly diagnosed as paraphrenics) would be unjustly excluded from treatment, whereas others (paraphrenics erroneously qualified as neurotics) would be unjustly admitted.

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一直到他从事业退休,弗洛伊德始终相信,精神分析的这个标准方法对于患精神分裂症的人们是没有用途,或是对某个其他种类的精神病。这引起他做这个要求:精神分析家应该在尝试期,就体认这个禁忌徵侯。假如精神分析家没有体认出来,或是犯了诊断的错误,那将会是个灾难。因为病人(神经症者被错误诊断成为精神分裂症者),将会不公平地被排除在治疗之外。另一方面,其他的病人(精神分裂症者被错误地被认为是神经症者的特质),将会不公平地被接纳看诊。心理学空间f \.U8f xRP-n7`

@5y4d `U\;Ra l e0Compared to Freud’s dual opposition of neurosis and psychosis, Lacan’s nosological framework is slightly more sophisticated and its categories more mutually exclusive. Whereas Freud also designated the psychoses as narcissistic neuroses (and the neuroses proper as transference neuroses) (Freud 1916–17a[1915–17]:420), Lacan defined neurosis and psychosis as fundamentally different psychic structures with separate causalities.



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To the Freudian neurosis/psychosis dualism he also added the distinct psychic structure of perversion, which Freud chiefly addressed on a purely phenomenological level—as sadism, masochism, exhibitionism, voyeurism, etc. Indeed, Freud never sharply discriminated between psychosis and perversion, and his only formal distinction between perversion and neurosis resides in his thesis that the latter is the negative of the former, which he defended for example in ‘Three Essays on the Theory of Sexuality’ (1905d:165). Lacan rationalized and systematized Freud’s diagnostic categories, ultimately constructing the triptych of neurosis, psychosis and perversion, in which each of the terms represents a separate clinical entity.心理学空间 L!G5LRZ



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Furthermore, the clinical impact of these categories within Lacanian analysis no longer concerns the patient’s possible entry to the treatment, but rather the analyst’s prescribed position within the treatment and his preferable handling of transference. Unlike Freud, Lacan did not regard psychotics as unsuitable candidates for analysis. This does not imply that for Lacan the Freudian dispositions remain valid under all circumstances, but that the clinical premises of Freudian psychoanalysis can and should be modified, without therefore losing their vigour, to accommodate different types of patients.心理学空间C0A"wNF2VS z

Z GMN(qMZ9Z0而且,在拉康的精神分析里,这些范畴对于临床的影响,不再是关注于病人是否可能进入治疗。而是关注于精神分析家在治疗里被指定的立场,以及他较为有利地处理移情。不像弗洛伊德,拉康并没有将精神病视为是精神分析的不合适的对象。这并没有意味着,对于拉康,弗洛伊德的性情无论在什么情况始都是正确。而是意味著,弗洛伊德的精神分析的临床的假设能够,而且应该被修正。但是不要因此就丧失这些假设的力量,这是为了接纳不同种类的病人。


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