Letter From Dr. Paola Mieli to Her Colleagues in the USA (1)

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We immediately see that psychoanalysis is included within a mental health ideology inspired by a medical discourse driven by the idea of adaptation, symptom relief, and assimilation. It refers to a conception of psychic reality defined according to the categories of “good” or “bad” functioning. In a case of “inappropriate functioning” of the mental organism, therapy aims at re-establishing a mental balance analogous to the physical balance regained after illness. Considering a symptom to be the sign of a mental “disorder” implies the belief in a “natural” or “neurophysiological order.” This reflects a return to — or the persistence of — a 19th-century medical conception that preceded the Freudian discovery of the subjective division. But Freud has shown us that the unconscious is structured and that a symptom, far from being the sign of a disorder, should be understood as the result of a specific order of things, as a compromise formation conveying a subjective truth.

According to its founder, psychoanalysis is to be distinguished from what is generally referred to as therapy. Thanks to the understanding and handling of the transference, psychoanalysis aims not at “suppressing the symptoms,” as Freud puts it, but rather to overcome the subject’s resistances, which are grounded on a specific libidinal economy (1926: p.225). As every psychoanalyst knows, the disappearance of a symptom or a behavioral “assimilation” does not in itself represent the completion of a cure; occasionally, it may happen that such occurrences actually represent resistance to the cure.

To the concept of “therapy”, psychoanalysis opposes the concept of cure, that is, the confrontation with the subject’s division and the truth of one’s unconscious desire. Such a cure involves the modification of a subject’s libidinal economy, which entails the resolution — not the suppression or alleviation — of specific symptoms or inhibitions. Analysis is a process of discovery and novelty; the logical time that organizes a subject’s structure and history gives to it a particular rhythm; it is a process that can only unfold within the articulation of the transference and its resolution. Every case is a unique case, an “exception,” that cannot be reduced to the generality of a diagnostic category. It is not by chance that Freud recommended that analysts approach each and every new patient’s analysis as if it were the first they ever handled. To the categories of “general” and “particular” inherent in the notion of norm, psychoanalysis opposes the notions of structure and singularity.