The open clinic

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By TALES AB'SÁBER*

Psychoanalysis as a theoretical ethical experience of transformation

From 2014 onwards, a broad movement took place in Brazil to take over public spaces for free, collective and social work by psychoanalysts. This socialization of psychoanalysis and the clinical and theoretical discussion of its commodified bases preceded the radical turn to the right in the country's political life, which partially criminalized the institutional left, Lula's labor party, and brought a hybrid government to power. of neoliberalism and neofascism, very Brazilian.

In any way you can see it, a movement radically opposed to all social life that carries out collective, common work with universal free access. Public psychoanalytic clinics, however, continued their work with full vitality. Its strength came from its theoretical roots and its social truth. The Clínica Aberta de Psicanálise, at Casa do Povo in São Paulo, was one of the forerunners of the movement, which today has become national, in a spiritual confrontation with the conversion of life to selfishness and the most radical social abandonment, very typical of the new right in Brazil .

Psychoanalysis was profoundly marked by the structuring fantasy, ideological real, of the psychosocial reality of the individual, his existence and his problems. Freud's discipline was originally constituted in the field of the effects of the life of the modern individual, as an idea of ​​psychology of the heroic figure of the personal individual - and of the doctor scientific hero, like so many other heroes, in the culture of the symbolic market of individuals – an existing psychological being integrated under the plural intensities of the multiple spheres of existence in modernity.

As an ideological conception that also composes it, the multiplicity of the life of modern practices was bundled and referred to the figurative idea of ​​responsibility monadic of each one, an ideological cultural superego, with narcissistic effects. This is how the field of adventure of the individual subject, the “free man” in the open market of possible destinations of the constant expansion of Capital over lives, with its social and intimate journey and its formation through the entirely modern world, was configured.

Some subjective ideological figures are known in the midst of the historical process of such psychology, and practical ideology, which was generalized: The Protestant Puritan and His Personal Ethical Loneliness radical before God and the bible, the faustian bourgeois hero who alone creates the industrial world and designs the new society, the image of the isolated social Robinson Crusoes, so criticized by Marx, as the pragmatic lord of science and technology, omnipotent, or even the figure of the genius romantic artist, or your philosopher, who, always alone, constructed or deconstructed the whole meaning of their world.

We can clearly verify this titanic figure of modern subjectivation in all nineteenth-century novelistic literature, as well as we can, with psychoanalysis, and the historical limit of the illusions of the world of the infinite expansion of progress – with its order of general destruction that presented itself in its entirety in the XNUMXth century – check its crisis, a symbolic and emotional fraying even for itself. This real flawed and incomplete dimension of the modern individual, of his historical reason and his metaphysics of the Enlightenment, which loses value for itself at the height of its own process of historical configuration, was very represented in the advanced literature of modernity, by Flaubert and Dostoyevsky, Machado de Assis and Henry James, to Kafka or Beckett.

In fact, the cutting-edge literature of the modern individual's novel configured and anticipated in everything, and in detail, the world of theory and the need for psychoanalytical work on an I that no longer resolved itself in any way in itself or by itself. . Because artists and poets knew directly what the man of science needed to access through his hard work, Freud said. That rational and autonomous modern individual, a presupposed ideological theoretical entity with subjectivizing effects, was, with its own development, questioned in its roots and psychopolitical structures, by the literature of its time, by the science of the enigma of the unconscious of psychoanalysis, as well as by significant part of contemporary philosophy. At best the individual he became a conceptual and political figure, partial and alienated in his own way, in relation to the multiple forces and many others that we come to understand that he is composed of.

In the collective work presented here, under the contemporary crisis of the reproduction of life in the order of late modernity, of the turbocharged and total capitalism of today's world - degrading life on earth, permanently questioning the space of public political organization and producer of the spectacle of the unique validity of the image and the commodity in the human world, its only subject – the device and the effects of the group’s existence, articulated in a psychoanalytical way, seem to us entities and powers for life as true and productive as the traditional individual once was modern, hero of the pages of novels of his time, and of the psychoanalyst's original social setting, bourgeois but post-bourgeois... This displacement that we propose, in the image and composition of the subject that articulates a psychoanalysis in the world, implies political displacements and unconscious fantasies of all kinds, which revive our understanding of clinical work, together with its ever-present politics in the world, hidden or revealed, and its virtualities and potentials in a critical world.

A joke can give us condensed news of these modulations of life and creation proper to the groups: the psychoanalyst Marília Velano once commented on the work groups of psychoanalysts, which the analysts, collectively, form schools..., but never manage to form... a rock band! What are these limitations of the collective work of analysts and what do they imply? The Clínica Aberta de Psicanálise e Grupo Analista, formulated by me and a group of colleagues in São Paulo, Brazil, is a concrete answer to this question.

We present here some specific speeches and emotional positions expressed by patients – or users, or citizens… – during the analytical work carried out at the Clínica Aberta de Psicanálise in Casa do Povo, a cultural center with universal access, in a central neighborhood of São Paulo that combines Brazilian middle class and poverty. These speeches reveal, to start the presentation, the complex and significantly rich modality of transference, or transferences, on many levels – vertical, group, collective, personal, institutional or with the device itself, collective setting – that the work of the analyst or group therapist, the group analyst, as we came to call him, carried out in that widely accessible clinic, produces and recognizes. The names that the patients refer to are the names of some of the analysts who take turns in their care, but understanding each patient as a patient of the group of analysts and not of a specific individual analyst, since the establishment of the model of expansion and displacement of the group psychoanalysis, characteristic of this setting:

“… Marília told me something the other time that I was 'thinking…, that I was like a plane that always flew in the same lane, that never left the same way and space, although it could…”

“ what a woman Annie…, the conversation with her was important for me…”

“I met Tales last time, and he was wearing a football shirt… today when I was coming here I remembered that… I had put on a football shirt…, if that isn’t a transfer, then I don’t know what is… ”

“at first I was thinking… does this way of talking to one person at a time work? I thought I would have to say it all over again every time I spoke to a different analyst... today, since I've come here so many times, I see that it's not like that... I say what I want and I'm thinking each time, and I don't need to nothing to repeat history... it's because you work together, right, that you all find out about us, isn't that right?"

“I keep thinking, you are different…, each one is different, Miranda is Miranda, Ricardo is Ricardo, Fabrício is Fabrício, each one has their own way… each one speaks in a different way… but, you are very similar too…, they are similar…, why is that?”

“I keep thinking, I thought it would be difficult to talk to different people in each session. But it's nothing like that. Every time I come here I think, who am I going to talk to today? I don't know. And that sounds good to me. Today I think the opposite of what I thought at the beginning. Each one tells me something, sees me in a different way, has a different way of talking. This is good, this relationship with several analysts. I keep thinking that, if I always talked to the same person, always with Ricardo, or with you, maybe I would be repeating myself, maybe I would have stopped at the same things, just with that person... this way I don't repeat myself... and that it is good…"

“… I'm just telling you this dream again so that the analysts can continue their work…”

“I am coming here because I was told that here it's a place to start over... "

In each of these phrases collected from clinical life, psychoanalysis is updated and reveals its differential productivity, reviewed by the theoretical/real displacement of the original setting carried out in the work. These are just some of the transference effects of setting public clinic and the social psychoanalysis movement, in life in the city, the Clínica Aberta de Psicanálise: a job in which psychoanalysts take turns on a weekly clinical shift, considering patients as patients of the analytical group of analysts, the so-called analyst group, and not individual patients of individual analysts and they develop a collective work of elaboration and analytical “dreaming” about the patients, and the group of patients, the patient group. We are in the sphere of the polyphony of the dream, of the articulation of multiple creations of the individual unconscious with the work of the unconscious of a group (Kaës, R., 2002). All stages of the work take place according to and through the fundamental Freudian method: free association of patients articulated with fluctuating listening, with suspension of desire and memory on the part of the analysts. As well as the associative elaborative work of the analytical group of psychoanalysts on, or under, the patients, in a suitable space and time for this.

These structures of group and social commitment are entirely traversed at all times by the first psychoanalytical method, the thread that unifies and makes work at all stages of the idea of ​​social clinic carried out here, thus articulating it to the fundamental model of the Freudian unconscious, and testing it from this other way. That is why it is about psychoanalysis, and not another modality of clinical reception. In the multiplication of individuals, for the power of the group, and for the power of the cultural and social setting that is produced, it is psychoanalysis itself in its fundamental principle that is seen multiplied. It is a clinic that, as we will see, comes from the tradition of the psychoanalytic field, is inscribed in it and reads its results according to its criteria and parameters.

The first point to be noted about a new human structure of encounter and experience, a psychoanalytic setting, operating under the regime of the Freudian method and its model of the background unconscious, is that it can give us real and concrete new news about the unconscious and their potentialities of meaning (Anzieu, D., 2000). Let's look at a well-known historical example. The analyst and pediatrician Donald Winnicott, for example, only came to recognize and think about the new psychoanalytic logic of transitional objects and phenomena after twenty-five years of work in a renewed setting, of his psychoanalysis present in the public clinic of an English pediatric hospital ( Winnicott, D., 1936, 1941), which even reached babies and their mothers.

His public psychoanalytic action did not coincide with the personal and individual analytic setting in which he himself was trained. And this displacement not only increased the power of social presence of psychoanalysis in the world, but also led to the production of clinical and theoretical problems that had not yet been perceived or thought about. The setting, the sensorial nature of the care relationship, its chosen form of space, time and presence, its place in the symbolic and cultural life of the city and the human and political configuration of the analyst, or analysts, that he implies and proposes, always it was the true source of the theoretical life of psychoanalysis. And also your destiny.

In fact, psychoanalysis emanates from its living experience, its symbolic thing which is an event, in order to be able to be thought of. And, in a second time, as a theory, psychoanalysis also returns to its settings. In origin, before all psychoanalytic theoretical data, in the first place psychoanalysis was a clinical human experience. of setting, the original ethical and empty clinical space, invented by Josef Breuer, before Freud, from where fundamental experiences emerged under the status of observation and the presence of the analyst, which allowed Freud's genius to develop radically, theoretically and clinically, of his knowledge (Breuer, J. and Freud, S., 1895), in a second time.

The Clínica Aberta de Psicanálise is a psychoanalytical setting. A setting that, in its own way of presenting itself, its political way of organizing and proposing practices in life and culture, its character of biopolitical device, as Foucault said, it articulates social and theoretical elements of the psychoanalytic discipline in a new way. This way of thinking and organizing psychoanalysis in the world is only possible today, after 120 years of continuous and accumulated historical psychoanalytic experience, because it fully relies on the presence of history in its constitution. It is a contemporary articulation of the theoretical possibilities of this history, its multiple observations and constructions of many orders of psychoanalytic experience.

This setting organizes and makes organic the following heterogeneous elements, now unified by a common social desire: public space, group subject of analysts at work, mutual creation of the workplace with patients, clinical duty with free and universal access, absence of bureaucratic overload or social control through the mediation of money, attentive listening to the communication potential of the single session, alternating analysts in the continued care of patients who wish to continue the work and therapeutic project designed by the patient, whether just one or several sessions, with understanding not neither pedagogical nor adaptive of what an analysis is. This configuration responds precisely to the potential for multiple displacement, the plurivocity of the Freudian unconscious, in Freud's own words about the formation of dreams, and to the status of the unconscious in group functioning, as observed by Rene Käes and his work group in Lyon.

The historical existence of potential moments of intense meaning in the single session, already researched with children since the psychoanalytic pediatric work of Donald Winnicott in the 1930s to 1970s (Winnicot, D., 1971), the discipline of emotional attention to the here and now, understanding central to the Kleinian tradition, which unfolds and complements the psychoanalytical method of floating listening and free association with the work of suspending desire and memory – in a de-reference excessive reference to the past and the future on the part of the analyst – (Bion, W. 1967) and the group of unconscious elaboration of the analysts on the patients, as well as on the group of the patients (Käes, 2004) , are the elements of the history of psychoanalysis which were united and synthesized in the form of production of experience with the Freudian unconscious that we call Clínica Aberta and the Grupo Analista. Thus, the clinic, as a contemporary intervention structure, is in fact a reading of the history of psychoanalysis.

In addition, from another perspective, the radicalization of the social political link of analytical practices and their production of socially oriented symbolic systems is also at stake, in order to conceive the reproduction of the symbolic reality of the liberal market as a contingency and not as a real structure of psychoanalysis. The clinic is a political, psychoanalytical act, of radically common interest, where new practices of existence and de-alienation of the idea and place of work, for patients and analysts, must come about. Group, collective and social psychoanalysis, at the root of the possibility of universal access as a desire, and therefore without the socially unequal, politically controlled regulation of money (Brown, W., 2015).

New circulation practices and occupation of life, in the city, are part of the new clinical work. The value of work and the distribution of values ​​are accentuated by the socializing democratizing vertex, the desire for free work, and not by the interested and reproductive mediation of the order of exclusions regulated by the market form, the general mediation of accumulation in a class society. From this point of view, the perspective of work at Cínica Aberta articulates psychoanalysis and some virtuality of post-capitalist life. It is our wish. The clinic operates simultaneously as care and politics, as work for transformation and work for criticism. And patients know this, they share this political desire since working with the unconscious with analysts. Everyone works for themselves and for an undetermined beyond.

We can then observe the production of patients about this offer, and about themselves. Multiple times, appointments and analysis rhythms; suspension of the teleological character of the analytic experience; dismantling their territorialized social commitments; imagined community of patients who share care about the Open Clinic with the analysts themselves; expressed gratitude and political gratitude; loving transference with the group of psychoanalysts and with the public space that receives the work and subjective effects, of a collective, plural and democratizing nature. These meanings are expressed in the short phrases collected above.

In addition to providing an experience of the unconscious, which is central to it, Clínica Aberta is an experience of subjectivation, of open political effects, through the psychoanalysis that sustains it in all its points. The patients' interest in their organization and the analysts' investment in the analysts' group itself reveals work with a psychic background, of a dialectical nature, in which thinking in relation to and about the form of the other - here a produced social form, the group analyst – grounds, through strata of the movement of thought itself, a background identification, fundamentally political.

The patients' work on the meaning of that experience, new for them, still inaugural in their lives and in the social life of the city, also leads to the establishment of themselves from the experience in relation to another, in a work that is strongly inscribed as a yourself. Patients feel that they are co-authors of the psychoanalysis that receives them, and of the political device they have chosen, through transference at work. Moreover, this is a self-creating dimension of psychoanalysis, the method and the setting that – from Berta Papenheim's original observations about her needs for psychic movement to her medical analyst Josef Breuer, who heard them, in the number one historical experience of psychoanalysis – should never have been abandoned by listening and psychoanalytic technique (Ab´Sáber, T., .2015).

Another important point is the idea of ​​celebration and gratitude that permeates the entire work. The moment of a group narcissism is well known, which erotically highlights the collective from the rest of humanity, which is part of the movements established by a psychoanalysis of groups. Or by identity, cultural, political and religious groups... However, there is an excess of eroticism in this process that we can call true and structural: the existence of an object of civilization, a personal analysis, free from the mechanisms of control and access, restriction and constraint, typical of norms, barred from thinking, of the sale of services in the liberal labor market. Free psychoanalysis of psychoanalysis organized as a commodity (Le Flore, R., 2016).

In classic terms of psychoanalytic economic thought, we can say that the energy and control not spent on the hard liberal contract in the services market, which links psychic possibilities in a predetermined way, in a real ideological blind spot of the method, unthought, are forces that become free in the public modality of setting. By dispensing with the work of the liberal economic contract, its hidden imbalance and legitimized injustice, space for experience is freed up for investment in the analytical work itself, and also for the erotic and symbolic overflow of the encounter with a good object, which, as a franchisee, becomes created by the patient himself. Ethically, we speak of a gesture of loving offer and human interest that effectively goes beyond the reason of the commodity, and the underlying logic of the market meeting, which is a field of encounter, research and celebration, political spaces for the generation of meanings of another order.

The clinic organized to be offered as a new gift economy, due to the fundamental political and erotic desire of its workers, enhances the transitional aspect that exists in all psychoanalysis and in all human development: it is a dreamed object of experience, which is there to be lived. , in the city made common for a day. Patients encounter what, more radically than other social settings, they feel they are also creating. Hence the eroticism, the civilizing joy, the effect of gratitude, a type of love bond, unknown in other analytical circuits, that this way of giving the world an experience of the Freudian unconscious produces.

Finally, for the time being, we have an important indication from the patients regarding the theory of the unconscious and the counterintuitive transference object relationship at play: that with the progress of the analytical work at Clínica Aberta, they feel a reversal in their original imaginary system , linked to culture and not to experience itself, about what psychoanalysis is and how it works. As stated by themselves, they may come to feel that encounters with multiple analysts throughout sessions allow for more movement and more freedom than would happen if they were being listened to by a single analyst. The loving bond and the guaranteed support of a qualified work with the unconscious dissolves the ideology of “the psychoanalyst, his couch and his cost”, reinaugurating the first potential of open clinical experience, both for patient and analyst.

The resistance to psychic work and the limits of the creative potential is referred, from this perspective, to the form of traditional work, inverting the norm known from the expansion of the device. Quite contrary to what is supposed by psychoanalytical and cultural common sense. Psychoanalysis is a theoretical ethical experience of transformation, which moves historical settings imagined for it to exist, and not something fixed to a specific form of setting. In fact, in this intuition of his critique of psychoanalysis, the patients seem to refer to the multiple intermediary nodes, the multiplication of associative chains in the space of dream formation, which articulate, in their multiplicity, are always much more than one, the work of connection and disconnection of displacement and condensation of the psyche. As Didier Anzieu once said, the group is like a dream.

Contrary to the fantasy of the solid integrity of the individual object as a transfer promoter, the classic single and non-transferable analyst, the existential chain of multiple listening analysts could function as something of the multiplicity of psychic knots that organize and reorganize the network of a dream, from the Freudian understanding of what a dream is, increasing, in a social and collective principle, the capacity and productivity of psychic mobility, essential to any nature of transformation.

*Tales Ab´Sáber is a psychoanalyst, member of the Department of Psychoanalysis at Instituto Sedes Sapientiae and professor of Philosophy at Unifesp. Author, among other books by Dreaming restored, forms of dreaming in Bion, Winnicott and Freud (Publisher 34).

Text presented at the meeting “Psychoanalysis for the people”, at the Freud Museum in London.

References


Ab'Saber, T. Cultural self, subject of the unconscious and history, electronic book, São Paulo: e-galaxia, 2016.

Anzieu, D. “Becoming a psychoanalyst today” (2000), psychoanalyze, Aparecida, SP: Ideas and Letters, 2004.

Bion, W. “Notes on Desire and Memory” (1967), Melanie Klien today, vol.2, Rio de Janeiro: Imago, 1990.

Brown, W. The village without attributes, Barcelona: Malpaso, 2016.

Breuer, J. Freud, S. Studies on Hysteria (1895) Sigmund Freud, Complete Works Volume 2, São Paulo: Companhia das Letras, 2017.

Käes, R. The polyphony of dreams (2002), Aparecida, SP: Ideas and Letters, 2006.

LeFlore, R. The American Gift Economy, electronic book, Amazon, 2016.

Winnicott, D. “Appetite and Emotional Disturbance” (1936), From pediatrics to psychoanalysis, Rio de Janeiro: Francisco Alves, 1988.

Winnicott, D. “The observation of babies in an established situation” (1941), From pediatrics to psychoanalysis, Rio de Janeiro: Francisco Alves, 1988.

Winnicott, D. Therapeutic consultations in child psychiatry (1971), Rio de Janeiro: Imago, 1984.

 

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