Can
we bring the psychotic out of the frame of medical care and instead
offer him a treatment center where he can become the subject of
his speech, a citzen responsible for his health? For their parts,
Freud and Lacan left us nothing on the problematics of the psychoanalytic
treatment of psychosis. Moreover, while the psychoanalysts who
came after them gave us particular information that helps us understand
psychosis, they did not give us guidelines for an effective treatment.
All of these questions have greatly concerned our research group,
which has devoted to them many meetings and a great deal of research
for many years.
Since
Gifric created the psychoanalytic treatment center for young adult
psychotics in 1982, the group has committed itself to the systematic
computerization of treatment data concerning the approximately
three hundred people who have had an admission interview. This
data spans the 28 years of the Center’s functioning, and it concerns
the principal aspects of the lives of the patients at the Center
as well as all of those invested in the patients’ treatment and
clinical progress.
This
data and the analysis of this data periodically are topics for
scientific communications and publications. Our teaching related
to this subject frequently incorporates this rich source of information.
The
Psychoanalytic Center for the Treatment of Young Adult Psychotics
In
1982 Gifric collaborated with the Psychiatric Hospital Center
for the region of Québec, the Robert-Giffard Hospital Center,
to open a psychoanalytic center for the treatment of psychosis.
This center is situated within the community and known by the
name of “388.”
Analytic
Practice with Psychotics
The
psychotics who ask to be treated at the Center know from the start
about the stakes of analysis that will be at the heart of their
treatment. Through the course of the admission interview, two
points will be clarified: 1) Are we meeting with a psychotic?,
and 2) What is he or she asking for? The identification of the
position of the subject within the structure and the identification
of the location of the elements of psychotic experience in the
discourse of the subject both will be considered separately from
the symptomatic phenomenology. Additionally, this consideration
will occur without reference to the patient’s previous files,
that is, without reference to past discourse about the patient.
From
the beginning, what is taken into account is the discourse of
the subject regarding that which he identifies as his problem.
From the beginning of treatment, the subject will be enrolled
in a program of daily activities arranged with his collaboration
in order to establish a minimal symbolic framework that makes
psychoanalytic treatment possible. Through the transference, the
spontaneous work of the psychotic and the delusion are constrained
through a new social link between the psychotic and the psychoanalyst’s
desire for savoir (knowledge from the unconscious). Progressively,
the dream that responds to the desire of the analyst will provide
the signifiers that will allow a breaking apart of the certitude
of the delusion, thus introducing the subject to a new logic:
that of the signifier.
From
there, the psychotic will work for the production of a new savoir
that contrasts with the logic of the delusion. This savoir will
come to enter into a new social link where his subjective history
will be articulated. A logic specific to the treatment of the
psychotic thus appears, and it affirms the original wager that
consisted of giving full value to the speech of the psychotic
subject.
