Confidetiality Clause

A LOT OF REALITY WITHOUT CLINICAL

GUY LE GAUFEY





Whatever adjective qualifying, sometimes, to a clinic - for example, "analytical" - has to clarify first the loop every clinic has with the dimension of "reality" with what appears to be intimately linked. Previously tried to deploy the semiotic operation of the sign pattern in the clinical situation, which I shall merely summarize so now: the clinical sign was perfectly suited to the classical definition of the sign, according to which the sign is for someone. The truth is that from this definition, "something" can be understood in different ways - not to mention the 'someone' that also may be subject to various readings.

The clinical sign is specified, among other signs, to have something that always belongs to the dimension of one or another "reality" different from their own. We will see a little later, in a few details, what to think of the term of 'reality', but before investigating in this direction, we must take into account the fact that the very notion of 'reality' is opposed to the sign. Of course, one can consider a certain reality of the sign itself, but in the case of clinical, differentiate, without thinking about it, the reality of the sign and its referent. Why?

clinical scene

The clinic begins when there are intriguing signs, signs that do not provide for themselves their own meanings, and against whom are at least two characters (can be reduced to one, but in this case the two different roles come together in one person): first, the clinician, supposed to know, not so much of what each sign means exactly as it show, but warned of the deceptive nature of the sign in itself, and consequently, not left to be fooled by a book learning that gives a sign its meaning without seeking more ... your reference. Therein lies the rub.

On the other hand, is the second, which we name the student, the innocent, that you might not see the sign, or if it is, shut up without risking further, or worse still: precipitates to read like a book, then brandishing empty significance does not melt their relevance to the uniqueness of the case, but only in the generality of a nonclinical know precisely.

The difference between these two characters is important because it unfolds in the theater space of a scene the way unrepresentable lets go of the sign to its referent - and therefore play a significant locally relevant. The student plays here to sign in its opacity, its pure presence of the sign, ie a sensible configuration, in one way or another, indicates that he is representing something different, and then have to find this 'something' with what is connected. Teach there as a free valence is what he calls the sign as such. You can be the first clinician's work, pointing to the fact that such sensitive appearance can not be understood without the presence of a proper cause, or even the student who already practice, like everyone else, the general fitness of the sign and know, more or less instinctively, when a collection agent has a value of something else, or not.

The clinician, on the other hand, embodies - in the confidence that gives students in his role of relative authority, in its practical knowledge so lovely - the conviction, if not the certainty, that there is indeed something different, There IS a reference, so that the sign until now will soon release enigmatic significance enclosed in himself, that he still hidden. And all thanks to reading clinical and patient, careful and attentive. Thus, the clinical stage is offered as a drama, an adventure cathartic may stumble and fail, but also succeed in producing a meaning that comes from a very strong bond between the sign and its something since, most of the time, it is a causal link: the sign is a consequence of the existence of the referent, of something.

The clinical signs are offered as a sign because something is built right, or began to develop through a series of steps more or less complex. Fever apparent, visible, comes from the bacterial infection is not visible and the body's defense against it. Thus saith the clinician who knows all the way: the weakness of bacteria at temperatures higher 38 degrees, the immune defense system and intelligence unlikely situation, etc. Any one know, at this time bookish, there is attached to the perception of apparent side of the sign to support the link between this sign and its referent, to build an unbroken causal chain. All this seems very scientific, very safe, then, what is the difference when we say that phobia comes from the fear of castration? Or that the hysteria comes from an unfulfilled wish?.

When this loop ends proper significance to be established, the difference between the student and the clinician is destroyed locally, is reduced to nothing. All things considered all this, there is some fall the curtain on the semiotic work that had begun with the emergence of the enigmatic sign. The public is always identified strongly with this couple student / clinician for the two of them fits the mystery of the sign and its implementation, how they finally achieve their significance. Spend half blind student and the clinician knows whose eyes penetrate the opacity of the sign is almost the quintessential semiotic odyssey in itself, and that is why the good clinician is aware of Ulysses: sly, clever, thoughtful, intuitive and hard working.

From this minimum approach on clinical signs in dramatic tension, we must refer to the major work of Michel Foucault, in which isolated as no one before had done what he called "the birth of the clinic." His search led him to differentiate master the ways through which drew a new clinic, which today still understand when it comes to a clinic either.

The new object of the clinic

Foucault The magnificent book - in my opinion, probably the best he wrote, because his style, his strength of conviction and the relevance of their analysis - enables us to appreciate the historical consistency that took this Reinventing the term from its early nineteenth century.

At commit itself to highlighting the role of political forces at work in the construction of the new importance of the term "clinical" before and after the French Revolution, Foucault tries not to clarify the semiotic device in this line. Is concerned, above all, by what he calls "the phenomenon of convergence between the demands of political ideology and medical technology." But throughout his work, that can not quite semiotic considerations by clarifying the role attributed to the eye clinic.

outstanding talent in this writer to give existence and consistency to be as fleeting as that of a fresh look at a medical nature. Not that the clinic was something new in itself. From Hippocrates and Galen, the sick bed had always been the privileged place of medical inquiry. But Foucault is right, or at least convince us and force us to capitulate without resistance to the idea that at the turn of the century of enlightenment, something intervened in the clinical gaze that never would have happened before.

clearly shows that the uniqueness of the clinical case never occurs naturally, by itself, despite its pretensions to do so. Informs us that the creation of the modern clinic was first in a combat medicine at the School and for the Société Royale de Médecine, a fight between a medicine of the essences of diseases, and other appearances of disease, interested in epidemics, with a more hygienist, and nearly statistical. This was a turning point for highlighting the disease, not itself but its visible appearances, and beyond their social, regional, family, etc. Only this historical episode of struggle between two drugs can well understand why the eye clinic needed a new field, a field that had nothing natural, a new concept of hospital clinical space in which the signs of the disease presented as a homogeneous field. This is a key point: the purpose of the clinical gaze is no longer found in nature, as a pure expression of its essence through the variety of appearances, but in the teaching hospital, ie a place which have been isolated some typical cases of disease. What is now in such a place where there is clinical clinical gaze, are both diseases, but sets semiological signs posed problems, and indirectly reveal the presence of this or that disease. There was here a change in value of the visible: before, the pathological signs were only direct indices of disease be considered a complex, but well outside the individual. In the hospital clinical signs fend for themselves, compose a message that the clinician must decipher sign by sign, letter by letter. Importance


description
From this first election that produced the new clinical area, improved the problem arises from a modern clinic, of course, is a technical and ethical priority of the eye, the look that highlights the signs But this is not enough as it is to teach students, so to combine the sharpness of the eyes of clinical warned the unit of language. It is only through the latter to expect a transfer of clinical knowledge. Hence the importance of 'description' key term clinical universe. Some Amard, cited by Foucault, rightly said: "L'art de décrire les faits art est le suprême en médecine, tout devant lui stick."

In seeking a language as sharp as his acute visual insight, clinical knowledge had to quickly invent a terminology rather rigid, as it was then to combine the uniqueness of what we saw with the homogeneity of the transmissible. Hence a serious conflict between the naturalism of a clinic open to a look not charged with knowledge outside the object, and nomenclature essential more or less rigid through the innocent eyes can become cultured in a word, which recognizes through the scatter of the data of all kinds, the factors relevant to establishing the correct diagnosis. This is the conflict that is embodied in the two characters in the scene described at the beginning clinical.

most interesting in the considerations of Foucault's what he called "the alphabetic structure of this disease, here are his notations in regard to the link between general medical semiology and semiotics, ie between symptom and sign. Alphabetical

This conception corresponds to a paradigm shift much larger than that studied here. Throughout the seventeenth century and the first of the eighteenth century, the model of the formation of a knowledge era and the botanical classification, ordering from the heterogeneity visible similarities perceptible, without fear of getting lost in a tree structure indefinitely. It was, at that time, the central paradigm for moving from the infinity of the apparent to the finiteness of the elements of human knowledge. Since the end of the eighteenth century, is the opposite: the grammar is presented as a model of knowledge construction, as it reveals how a language can understand the infinity of which can mean from a series finite terms - something which was later reduced to the double articulation of language. Then it was no longer in the construction of knowledge, to describe the infinite noticeable differences, but also to make the minimum battery whose terms would be in all the manifestations that we see. A glance: the endless varieties of the visible, a clinical terminology: basic bricks from which diseases are constructed, and therefore understood.

So that is no longer perceive a disease in itself but only what I here call their "bricks", ie with minimal signs that the clinician will conclude on this or that disease. The diagnosis comes as a conclusion hypothetical, and not the indirect perception of a disease that would hide behind the signs that betray. "What is pleurisy?" Asks the great French physician Cabanis after describing the signs that characterize them. He answers: "It is the accumulation of these accidents that constitute it. The word "pleurisy" does nothing but remind them in a more abbreviated. "We then consider some of the modern clinical nominalism in the sense that what really exists, and not so much the disease, considered as the universal the Middle Ages, but the pathological signs in their own references. These Clinical signs are the alphabet that the good student must learn by heart. It's almost the reverse of the previous design in which the same signs were only a kind of drawing on a canvas visible evidence of the presence of a being as invisible as grim, fateful and fatal. Foucault writes

memorable pages to the fact that, at this turning point, a fairly religious conception of the disease, as individuated manifestation of evil, is undone in favor of a conception that is in death, anatomic pathology, the ultimate rationality of the forces opposed to life. The new clinic is to be secular, not because their clinicians would hereinafter atheists, but because the presence of evil in ancient evil, discomfort, it vanishes as evil unitary principle of each disease. Until then, each had an independent existence that could be thought of as a subject in the kingdom of evil, in obedience to his master, the evil spirit. The great model of the Incarnation, which allowed for centuries to think the connection between essence and existence, between being and its manifestations, remains a cornerstone in the old clinic in the old way of moving from the variety of signs to disease unit. Thereafter, due to the eye clinic that refocuses on reading the present pathological signs made to teach a hospital, the kingdom away from the bad with his subjects, different diseases, and draws a new link between sign and reality.

clinical reality and rationality

reality then implies that each sign, and not the disease itself. This is clearest in the appointment of Cabanis: The same sign could very well be in completely different diseases. Only the set points to one, and a single. But it needed a clear step to free the notion of essence of each disease, and enrollment in a nosography and nosology. Was the work of Broussais French physician who, in the famous question of fever, was to consider all (you knew at least a dozen), there were one, of course, but that was the way in which the tissues react when, for whatever reason, were irritated. A conception of a series of essential fevers substituting the idea of \u200b\u200bone form of reaction of the organism. In a dispute with another doctor, Broussais himself spoke of "desesencializar" the "general status of the fever" to consider only the apparent location of the sign, and from there to understand the suffering, not sick, but isolated tissue the location (and eventually, if you could, cure).

With him, it is no longer so look for signs that would conclude on this or that disease, but to locate the sign in the space of the body, because this location allows us to conceive causality (and then rationality) that requires no thought of almost metaphysical entities, as it disease appeared to Broussais offered him the nosology of the time. The later clinical sign based on its rationality in this vital location. Foucault says: L'espace

local maladie est in même temps, et immédiatement, a causal espace ..

local space of the disease is at the same time, and instantly, a causal space.

But the space needs quite an injury, at least the manifestation of the body in space allows the sign to be attributed to a direct or indirect cause. Here is the crux of the new clinic, which allowed not to rush to any essence of the disease, and for that reason, not to return so quickly to the mode of thinking before, using the new terminology of the modern clinic. Here we can guess some questions that may pose a clinical analytical, starting with problems encountered in psychiatry.

Injury or no injury

At its very birth, this psychiatric clinic is divided between those who seek tirelessly injury-and succeed when they find, as in general paralysis, "and those who do not even think to look for, as the psychiatrist Leuret Francois and his" moral treatment "in the first part of the nineteenth century. Now it is the same, but the injury has been reduced at a precise point of neuro-biological function, if needed x amount of a particular neurotransmitters, it plays no role assigned problem before the injury because he always this is the location of a tissue. Chemotherapy may be presented as a continuation of a serious clinical, in the thread of the great clinical invented at the beginning of the nineteenth century, because their success demonstrate the presence of a causal physics, chemistry, and then space and body. But this ideal doctor could not cover the whole psychiatric field unstable, hence the temptation to build a new type of clinic, no longer support both the injury and the type of operation of the sign, but in the production of a sign of another nature, much more discursive. Large clinical psychiatrists late nineteenth century and the beginning of XX (Legrand du Saule, sérieux et Capgras, De Clérambault, etc.) Ventured into a mode of description that ambition to rival the modern clinic. I have no enough time to detail their efforts, then maybe I am writing directly to Freud that aggravated the issue, to almost completely cut, the last remaining link to sign the new intelligence provided by the new clinic.

is known well enough that the gap between Charcot and Freud came on the question of injury, but there is so many people that can measure well the importance of the loss of Freud in the field of clinical rationality when it was decided to abandon his "neurotic", ie not only the idea of \u200b\u200ba causal lesion, but also sexual trauma in the pathogenesis of hysteria. In this case, the notion of tissue could be replaced by, say, historic fabric: the theory of degeneration, for example, he did without much trouble by psychiatrists who practiced it, considering that the history of generations was able to explain the presence of clinical symptoms. But the assumption lesion remained critical for them, no one is allowed to deny it, just postpone it a bit. Freud, without much hesitation, abandoned, not without problem for him, and especially for the cohort of students in which not all well understood the consequences of such a waiver. Freud

things to extremes to doubt that the analysis is decisively supported the notion of causality. In his lecture XXVII, question their assumptions auditors if you know what they called a "causal therapy." His description corresponds very closely to that of a medical clinic in the best sense of the word. But once that precise analysis can not be understood well, mainly because of this strange phenomenon, crucial in the treatment, we must mention: the transfer.

Why such detail? Because their eyes would have been a fatal error to conceive of repetition linked to the transfer as proof that the same thing had happened earlier. A transfer to the father on "medical person," writes Freud, is not proof that "the patient had previously suffered from such a libidinal tie unconscious with his father. " Disposes here the opportunity to think quietly in a kind of "clinical history" which, however, and apparently constitute the only source of analytical clinic.

What side of the sign then? We interviewed the new clinic had given a very precise understanding of the referents of the signs that she was interested, through its concern about the location. The fact that the new clinic seeking full belonged to the reality that the new scientific discourse was measured. We recall that the third section of the first book on the science of logic, Hegel, is entitled "Measure theory", and runs on more than sixty pages. This passion for it implies a conception of the sign you belong to a full clinical sign. Not that, from time to time, this sign take a qualitative shift, but the referent of this sign is still some space, which, under some conditions could be measured.

two clinics, two signs

find here one of the oldest distinctions in the nature of the sign: skeptics believed to be at least differentiate the signs 'memorial' and signs 'indicative'. Sextus Empiricus now I quote:

is said that a sign is "Memorial" has been clearly observed when associated with the thing signified by the time it is obvious, and leads us, when the latter is no longer evident, remember that first partnership, even if meaning the object is no longer presented an evident today.

A sign is called "indication", not when it is clearly associated with the thing signified, but when it designates, by its very nature and constitution, that of which is the sign, such movements body are the soul signs.

No wonder the final example, which indicates, in this case, the new clinic was based on the sign "memorial", as advised by skeptics who signs "indicating" not warranted to be regarded as true signs. But it is also clear that the Freudian clinical settled largely in the realm of this sign "indication", as the reality that referred the most signs that Freud was interested, he had never seen anyone . Her "psychic reality" as necessary as it was, put him in a semiotic field in which they lost the ability to use the techniques of the new clinic. Could one

found another clinic? We are, today still, to this same question and the best we can do is to remember this data so well known "birth" of the clinic. It is remarkable that Freud did not hide the difficulty, and fully recognized as well known in the first paragraph entitled "Epicrisis" in the case of Elizabeth von R ... in the Studies on hysteria. Write:

I have not always been a psychotherapist, but I've raised, like other neuropathologists, and electroprognosis local diagnosis, so I find myself unique medical records for me writing novels read as a brief and of them is absent, as it were, the stamp of seriousness pattern takes the scientific. So I have to comfort me by saying that the responsibility for that result is the nature of the subject, rather than any preference of mine, is that local diagnosis and electrical reactions do not fulfill major role in the study of hysteria, while exposure depth of mental processes as we are accustomed to receiving the poet lets me, upon the application of a few psychological formulas, to obtain some sort of insight on the progress of hysteria.

This is usually read as something quite romantic, without either the release semiotic measure here is on work. The invention further the "witch", ie of metapsychology, aggravate the situation to the extent that "reality" of their bodies are fully included in the logic of signs "indicating" and also undermines the basis of clinical whose birth has been so well described by Foucault.

foot lacks analytical clinic

Our description is complicated enough, and to progress in our explanation of what a clinical analytics, we have to go back on the clinical scenario as initially presented it. At the time he split the referent of the sign, from the near presence of the 'memorial' to the near absence of the "indication" as in "short novels" of Freud, also the student vanishes: there is no one there to see the sign in itself, with full innocence. To display the sign that it is required to be set: the analyst, the narrator, the patient, no matter their title, but starting the famous triangle: clinical / student / sign missing, hereafter, foot. The sign, as enigmatic in its meaning as obvious in his presence in the medical clinic, has disappeared as such, afterward, to teach, will be built.

Earlier, at the time of the clinical study Foucault, regarding upcoming nature was revealed in the fact that the sign gave himself generously to any watchful eyes, ready and willing to learn. However, it reveals our new scenario, a feature that was quite hidden in our first considerations regarding the clinical stage: the student was, in principle, anybody. The clinician, but the student himself, because he was only this point of blindness and progressive learning that made him switch from opaque to sign sign compliment. In that, is the brother of the observer is necessary in all experimental science: the observer is any or not. On the contrary, "the situation analytical, as Freud writes, right here in the main, not supported by any third party. Apparently, this sentence is not just isolate the couple analyst / patient. But this also implies that you can not enter covertly the third, this observer status so important in the scientific point of view, because their presence determines the ability to repeat the experience. We have here with the analytical treatment, an experience that can not be repeated, which does not allow a third party, and then not give us a sign of the same nature as the scientific expertise, or clinic. This is commonly forgotten, and we tend to receive the analytical clinical sign as a sign "Memorial" it is always, without doubt, a sign "indicating" fully built by that aims to teach.

This is one of the reasons identified by Lacan in his seminar RSI, psychic reality and religion: both are achieved by signs "display." And as indispensable as these signs in the semiotic order, do not allow a clinic in the sense that Foucault deployed, but despite their many analysts who talk about "Freudian Clinic" and "Clinical Lacanian" without blinking, whereas hanging an adjective and a noun around over there is not merely a question grammar.

Do we have to grieve for those conditions as critical as regards the level of reality relevant to a clinical sign that, despite my previous ironies, would be analytical? No, they are even more serious than they seem, and precisely in this excess, we find our fate to the extent that we can play the point where it no longer needs to keep running after any reality.

It is needed now is to abandon the historical reality as well as psychological, since the latter brings with it the opposition normal / pathological basis of all psychopathology. So that vanish many things at once: the student (the observer), the enigmatic sign and its referent perspective, but also the couple regulations / pathology that was quietly at the beginning of the election of clinical sign. We are now in a sea of \u200b\u200bwords without even a guide to know where to find what significance would close properly.

I do not thank me here as a poet, and praise the joys of inner silence, or the pure presence of things of this world of ours, as he did so well in his Hugo von Hofmannsthal's Lord Chandos letter, I would much rather me echo primeidad notion coined by Charles Sanders Peirce, a concept that I discussed at length during the last seminar I taught here last year. It is consider this a sign next to the one usually quick to overlook: the sign unrelated to anything or anyone. Or in relation to who produces it as enigmatic sign, nor in relation to the listener in complete innocence, and in relation to what was given him by his meaning. This is the sign outside their reference and add any dimension of dialogue, as Peirce at its base: a pure "Would Be" something on hold, who brings his own music, as if almost completely absorbed. This concept defies primeidad reason and raised the need to be something that has no relation to anything: that is, something apparent and perfectly understandable.

This requirement, there is no fad but a poet. Rather arises as a condition of internal balance impregnable sign as a basic tripartite: to achieve any triplicity, we must rely on a "one" to be sustained by itself, without seeking more protection - another example of the same necessity is Lacan does otherwise, with unary trait. It could be shown here the relevance of this primeidad semiotics as Peirce conceived it, but what about its relevance in soil analytical looking for the clinic?





The subject

occur rupture between signs and their referents is developed following two different levels. One led to the discovery of the incompleteness of the symbolic through the efforts of David Hilbert and Kurt Gödel. This break allowed us to study the consistency of a system of signs, without bringing in any property of their referents. This was the case of arithmetic, from Frege and Russell, and his discovery of the famous paradoxes, without struggling to establish its own consistency, because he always mixed the property of their scriptures with names, including the terrible and infinite that generated, each one well-known paradoxes. In 1931, Gödel finally demonstrated that, despite its central position of mathematics, arithmetic could not prove its own completeness. That was not in any way, a weakness of his, but a key point in its operation.

But of more interest to us, to conclude, on the other hand, they give a damn about the mathematicians. Here there is a sense construct, or to enclose any significance, but arranged so that one can keep waiting, suffering that is precisely the meaning is not given, is not, and even sometimes stubbornly refuses for a long long time. I think, for example, in some analysis of dreams that end up bringing totally enigmatic signs that can not be reduced to any significance, precisely what Lacan called "the letters on hold (in souffrance) in the transfer." If, as is sometimes said, a clinic 'transfer', it must take into account, to wit, the peculiar tension that characterizes the analyst, at least as much as their theoretical knowledge, practical and anything else that analysis came from "teaching." It is not just ignorance on their part, or patience, or "listening quality": all these words refer to faltas y virtudes personales y yoicas. Se trata más bien de una postura semiótica en la cual el signo encuentra su condición inaugural, aquella que destacó Peirce con tanta audacia gracias a su «primeidad», es decir también: el mero valor de llamada del signo –y me gusta en esta ocasión poder referirme al castellano que alberga aquí algo de la «llama» en la «llamada». Lo que da su llama al signo se ahoga y se muere en la significación –sin la cual no obstante no podríamos hacer nada.

Más arriba del cierre de la significación, a partir de la cual se puede desplegar todo lo psicopatológico si se quiere, existe este punto de acogida del signo que sobrepasa cualquier clinic as it is presented as a kind of celebration of the symbolic dimension through which its existence is the subject of the word. The analyst, in his capacity not to reduce everything that is said to meanings, keeping waiting for a meaning that does not reach its end, leaving no escape, just this vague vague to be interpreted the other sign, this one is always to come, "the analyst is placed firmly on the symbolic stream bed.

By respecting thus vagueness which characterizes the very end of each meaning, the analyst offers the patient promptly to the hostel in which all reality is suspended: its history and that of their fantasies, their traumas as his enjoyment. In this thriller, obviously, you can not say much. But when empty foul when the clinic is to build analytical and taught in the form of psychopathology, everyone knows, in the act, which has lost this lack of reality that gives its name, its mood, order and disorder symbolic.

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