1. Lacanian Psychoanalysis with Babies, Children and Adolescents: Further Notes on the Child, Edited by Carol Owens and Stephanie Farrelly Quinn 2. Perversion: a Lacanian Psychoanalytic Approach to the Subject, Stephanie S. Swales
1. Lacanian Psychoanalysis with Babies, Children and Adolescents: Further Notes on the Child Edited by Carol Owens and Stephanie Farrelly Quinn; Karnac Books Ltd, 2017, 270 pp. Review by Judith Hamilton, MD and Tara Dubrow, RP
It is a pleasure to write a book review on this very interesting, informative and inspiring book on Lacanian approaches to working with babies, children and adolescents. As the editors comment in their fine introduction, ”In the long trajectory of his teaching Lacan did not say or write very much exclusively about psychoanalytic practice with children, with “young subjects” ” (p. xxi). His early papers on the “Family Complexes” (Lacan, 1938), the “Mirror Stage” (Lacan, 1949) and most of the early seminars describe topics relevant to work with the young child: ego development, ideal ego and ego ideal, identifications, the paternal function and metaphor, need, desire, the desire of the Other and the demand of the Other and the three major clinical structures as well as phobia (Lacan, fourth seminar on the “Object Relation”, 1956-576). He discusses cases reported by other analysts, for example, Melanie Klein’s “Little Dick” (in Lacan, Seminar 1, “Freud’s Papers on Technique”, 1953-54, pp. 68-70 and 81-88) to describe the introduction in the child of language, the unconscious, the symbolic and the divided subject. In his brief “Note on the Child” (Lacan, 1969), he claimed that “the child’s symptom is found to be in a position of answering to what is symptomatic in the family structure” (p. xxiii). And in the paper “Aggressiveness in Psychoanalysis” (Lacan 1948) he seemingly predicted aspects of contemporary society that manifest in children and adolescents as well as adults coming for treatment: the degradation of the Oedipus complex and its organizing effect, the denial of castration, the diminution of the prohibiting superego and of ideals that support cultural coherence and symbolic aims, and the increased expression of the “essential aggressive ambivalence immanent in the primordial relationship to one’s fellow man” (p. xxiii).
This book consists of a collection of individual papers written in response to a request, sent to Lacanian analysts who work with children and adolescents, to contribute to this project. They were asked to describe how the work with children is “different” from work with adults, both in theory and in practice. Lacanians take for granted that the child is a subject and must be treated on a case-by-case basis, not as primarily a representative of a diagnostic or an age group, that “the singularity of their symptom and the particularity of their desire” (p. xxv) must be identified and sought. But in the case of a child, he or she is subjected to the consent of the Other, such as the parents or other “carers” of a foster-home or an institution, which introduces complications in the nature and maintenance of the frame. Using the questions raised about treatment by Lacan in his paper “Direction of the Treatment and the Principles of Its Power” (Lacan, 1957) the editors asked contributors to answer five questions:
Who analyses children today within a Lacanian psychoanalytic frame? What is the place of interpretation with children? Where do we stand (sit, or play) in the transference with the child and her or his Other(s)? How does the analyst working with children act with her or his being? How do we take the desire of a child, literally (p.xxvi).
The papers range from reports of work with individual children and adolescents, usually prefaced and interspersed with the relevant Lacanian theory; principles of working with this population; and discussions of the nature and effects on them of the environmental (family, institutional, cultural) milieux that these youngsters and youth find themselves in. The papers discuss children who range from neurotic to psychotic in character structure. The settings for treatment range from the private clinic to an office in an institution. There is a unique paper reproducing extracts from Françoise Dolto’s “Seminars on Child Psychoanalysis”. She was a psychoanalyst friend and supporter of Lacan who, because of her radio broadcasts and her highly readable books and recordings, was a household name in France in the seventies, eighties, and beyond, similar to Winnicott in England. In fact, when Winnicott interviewed her in relation to her IPA (International Psychoanalytical Association) status in 1953, along with those analysts who had split from the SPP (Société Psychanalyique de Paris), he deemed that she was “thirty years ahead of her time” and had “too much intuition and not enough method to be a training analyst…” (Roudinsesco, 1986, p. 319) (p. 33) Finally a new term, “inventions”, is introduced into the possible developments in and outcome of a treatment, a new element in a reworked structure that the subject develops as a means to cope with themselves in their situations and that needs to be recognized as such by the analyst.
The book is divided into five sections. Part One consists of four pieces on the direction of the treatment with children, the “direction” referring to the “conducting” of a treatment by an analyst acknowledged to have his or her own desire. The first, subtitled “framing challenges and inventions” by Stephanie Swales is a beautifully written essay of a systematic Lacanian approach to psychoanalysis with children. She presents the frame as it is impacted by the demand (strong request that includes “need”) of the parents, of the analyst and of the child. She gives a very clear relation of Lacanian theory to suggested methods and gives a very full reference list. Hilda Fernández Alvarez, using clinical examples of young neurotic subjects, also discusses the demand – “the spatial-temporal conditions of the demand within transference, the object/subject polarity, and the conditions that open and close the unconscious with regard to the analytic work with children and adolescents” (p. 18). Françoise Dolto, in very clear language, gives advice and directives on “the position the analyst should take up around the child’s demand; the function of the practitioner in drawing out the child’s desire; the notion of the child as symptom of the parents; and how to approach the preliminary sessions.” (p. xxviii) She clearly approaches the child as a “speaking subject” and her own inventions and innovations that she put to work in the creation in 1979 of the Maison Verte, an informal setting in which parents and children could spend time in the presence of therapists. As reported to us in Toronto, at a TPS meeting, by Marie Normandin, a child therapist in Montreal, this setting was reproduced in Montreal in 1992 as La Maison Bussionnière (MB) “where children from 0 to 4 years of age are helped to communicate and socialize using the theories of Françoise Dolto”. (Normandin, Marie, 2012, La Maison Buissonnière : Early Childhood Communication and Françoise Dolto’s Theory of the Unconscious Image of the Body”) Finally, in this section, Bice Benvenuto “addresses the decline of the paternal imago and considers how in our time of the “failed patriarch”, substitutes for this symbolic function are diffused in social networks (both virtual and “real”)” (p. xxix).
Part Two deals with “Clinical Structures (Edges, Limits, Boundaries)” (p. viii). Leonardo Rodriguez, who has had a long-standing interest and expertise with anxiety neurosis in children, describes in detail the ways in which “… impressive scientific and technological advances…have had an impact upon the ways in which subjectivity is constituted…as well as our conceptions of childhood, the education of children and young people, and maternal and paternal function.” (p. 66) He considers that “the psychopathological organisations [i.e. neurotic, psychotic, perverse in Lacanian theory]…have not changed in their structure, and new types of symptoms have not appeared…” It is “true that some symptoms, syndromes, and clinical presentations have increased…” (p. 67) such as addictions, disorders of desire (eating disorders), personality disorders and disorders responsive to contemporary pharmacologic approaches such as bipolar, anxiety, depression, hyperactivity, and deficits of attention. He stresses the necessity of treating the child and the parents as subjects and that the analyst’s desire include “respect for the singularity of the individual human subject in his or her capacity as a speaking being”, within the framework of the transindividual status of the unconscious of all members of a family. Cristina Laurita considers the theoretical and technical questions at work in the treatments of children who are psychotic, Elizabeth Monahan and Marie Walshe, in the treatments of adolescents. Elizabeth presents the signifier “unravelling” as a means of her patient’s negotiating “the difficult movement from pre-Oedipal to genital stage.” (p. xxxi). Marie Walshe in a particularly fine paper presents three cases as well as discussing the case of Dora, bringing the theory into close conjunction with her observations, analysis, and what to do about them in treatment. She remarks on “the exquisite porous fluidity of the modern adolescent subject”, of the multiple transferences this results in, and “whether anxiety at the level of desire can be distinguished from anxiety at the level of the Real.” (p.108)
Part Three consists of four essays on “Symptoms and Systems”. Referencing Sabina Spielrein in the 1920’s, Michael Gerard Plastow contrasts the more traditional psychoanalytic approach of removing the patient’s symptom to that implied by Spielrein and taken up by Lacan of guiding the patient towards identifying with their symptom, making use of it to achieve jouissance in a manageable way. Kate Briggs discusses the “invention” as a key aspect of analytic work in the twenty-first century where the Real is having more pervasive and disordered affects [sic].” (p. 140, referencing Jacques-Alain Miller, 2003, 2013). In the case of a fifteen-year old girl, she shows how the girl’s silence reflects “not a reticence to engage or to speak but an anomaly regarding their place as a speaking subject.” After an impulsive suicide attempt, the girl presented as “indifferent, as if it had nothing to do with her psychic reality.” (p. 140) She had “not subjectivated her attempt.” She described cases illustrating various disorders involving the patients’ lack of integration of the Imaginary, Symbolic and Real, describing the analyst as a regulated place, an Other who relates to the patient as a subject, in which the patient can verify her evolved construction of herself. Kristen Hennessy, who works with severely abused children removed from their families by the law and placed into foster care, asks the question and describes children in whom the symptom may reflect disorders of the system of care itself. Donna Redmond explores the tendency towards debasement in the sphere of female adolescence in patients within an Irish sexual health service for adolescents.
Part Four consists of two essays which comment on the function of “the father” in the psychoanalytic work with children. In her paper called, “To invent a father…” Megan Williams presents work with a 6-year old boy who enters the consulting room saying, “There is no Daddy.” (p.185) Among other things, she articulates Freud’s theory of the emergence of the subject prior to his recognition of the Oedipus complex, the role for a boy of his penis in his Oedipus dilemma, the significance of the distinction between the actual father from what she calls the personal father. Like Freud does in “The Project for a Scientific Psychology” (Freud, 1885), she theorizes with such an organic approach that the theory seems to describe actual movements in the mind. And she describes the treatment in enough detail that she can usefully present why one of her interpretations to the boy “was a mistake” with the sentence: “A solution that knots the impossible of jouissance to desire cannot be suggested to a child from an analyst-who-knows (an analyst-father) because castration means that no subject knows: if the impossible is not to be returned to him as impotence, it can only be dealt with contingently, by an invention of the unconscious.” (p. 195) In her paper, Annie Rogers, author of The Unsayable, the Hidden Language of Trauma, 2008, explores a four-year analysis of a 6-year old boy “focusing on the last teachings of Lacan through the “Father of the Name” and the ”Real unconscious”…the position of the analyst in that field, and the invitation to the child to discover a space for the Real in the work of play.” (p.199) When the child becomes able to put the Real into language, even lalangue, he becomes freed of the secret family myths that crossed three generations.
Finally, Part Five presents papers on an increasingly common chapter in Lacanian psychoanalytic texts: the effects on children and families and psychoanalytic treatments of our 21st century world. It is entitled: “New Kids: (Post-) Modern Subjects of Technologies, Global Capitalism, Neo-Liberalism, and Bio-Medicine” (p. ix). Catherine Vanier describes “psychoanalysis and neonatology”, her work with “infants prematurely born and most often resuscitated, beginning lives assisted by new technologies…and the medical team in a neo-natal resuscitation unit” (p. xxxiii). Joanna Fortune argues in “The iMirror Stage…” that “the smartphone has become a substitute for the desire of the Other”, that early childhood use of it, as is common today, amplifies and proliferates what are the already alienating aspects of the Mirror stage, disrupts ego formation, blocks the emergence of the rivalrous, jealous competitive social bond necessary to precipitate the subject’s Intrusion complex (taken from Lacan, 1938, p. 24) and “that life lived from the beginning with the presence of the smartphone lens has had a significant impact on the developing child subject (p.227). Ona Nierenberg and Eve Watson, in considering the contemporary practice of giving hormone blockers to children who experience an identification with the other sex, express concern about the rapid ascension in these neo-liberal times of stressing “equality” and “difference” to the “hegemonic status of the “discourse of ‘trans’” which is marked by the total medicalisation of transgender identification…and is utterly at odds with psychoanalysis which unpins the subject from anatomical deadlock” (p. xxxiii). Kaye Cederman, in “Left to their own devices? Child psychoanalysis and the psycho-technologies of consumer capitalism” contends that children’s unhappiness, loneliness and anxiety, as well as deriving from “familial and other social dynamics, now seem to be compounded by adverse encounters with the new technology, for example, social media and cyberbullying…” “…symptoms with a distinctive contemporary bias…are now being reclassified as diseases…such as disorders of Depression and Post-Traumatic Stress, and Neurological “information processing” Difficulties/Disorders” (p. 251). These symptoms “seem to be related to the latest configurations of western societies, most obvious in the power and persistence of the marketing technologies, or psycho-technologies of consumer capitalism” (p. 252). She relates the symptoms to a wide breadth of Lacanian analytic theory as proposed by a number of authors which then suggests a variety of techniques, based again on the two principles of Lacanian psychoanalysis that cases are to be taken one-by-one and the child is first of all a subject.
In conclusion, this is a fine set of papers on these and related topics. Every one, regardless of whether it is extremely well or well written, has interesting and useful insights and illustrations of Lacanian theory and practice as it is applied in “young subjects” ranging from neonates through mid-adolescence, from neurotics through psychotics. Although I have associated certain terms with particular authors, there are many discussions throughout all the papers of the same concepts. Thus we see the theory and its application from many different angles, which surely provides each reader with at least some access to aspects of the book. I think that readers without much experience of Lacanian theory would benefit from case descriptions by some very experienced analysts; those with more Lacanian experience will be impressed and charmed with the subtleties presented in the theory and the treatments. Finally, many of the authors have written other, very worthwhile books and papers which are referenced in the extensive bibliographies.
2. Perversion: a Lacanian Psychoanalytic Approach to thSubject Stephanie S. Swales Published 2012 by the Taylor and Francis Group of Routledge, New York and East Sussex. 264 pages. Review by Judith Hamilton
The author is one of the increasing number of younger, originally English-speaking practitioners or academics, educated in North America, who were supervised in their graduate studies, in depth and in detail, by Bruce Fink. He is a leading North American translator of Lacan into English, a writer of important theoretical and clinical chapters and books, explicating and exploring the implications of Lacan’s work, and a lively, valued participant in the group of late-Lacan and now post-Lacan students. Most of these supervisees, including Swales, have had some or quite a bit of clinical experience, in a variety of settings in the United States. They write in a style that is similar to Bruce Fink and is very familiar to North Americans: clear, organized, straight-forward, with the context clearly set and almost all of the thinking steps filled in. They also tend to have the virtue of being humble in their writing, careful about defining and explaining the terms they use, provisional in their claims, clearly open to more input and enthusiastic and/or detailed in a way demonstrated by people who have come across Lacan and found him compatible with something in themselves. From an English-speaking reader’s point of view, these young writers are reader-friendly and inspiring.
Using Lacan’s distinctions among structural features to separate out the various large diagnostic groupings of neurosis, perverse and psychosis, Swales is very specific about the diagnostic and etiological distinctions between those persons who are perverse and those who do the same illegal, non-consensual acts out of a neurotic structure. Having studied the literature and treated both kinds of patients for up to a year in a forensic out-patient setting, she is also specific about the differences in the treatment approaches useful or not in each type of individual. Further, her descriptions and discussions make an important over-all contribution to the practice of psychoanalysis and psychoanalytic psychotherapy influenced by the Lacanian orientation.
Many of the characteristics of the book on which I will comment are amply illustrated by this paragraph from her introduction:
“In this book, I am privileging the later work of Lacan (1964-81) over his earlier work. This is for two main reasons. The first is that 1964 (Seminar XI) was the year that Lacan explained the two movements of the paternal metaphor, the operations of alienation and separation. These operations provide a useful framework not only for explaining the etiology of neurosis and perversion, but also for clearly differentiating between the two. Before that time, neither Freud nor Lacan had succeeded in elaborating a logically sound qualitative distinction between the two structures. The second main reason is that Lacan’s emphasis during that time period on the order of the real allowed him to arrive at more nuanced understandings of human suffering, structural positions, and the practice of psychoanalysis – understandings which take the unsayable into account. And perversion, even more so than neurosis, has to do with real order jouissance and its management.” (p. XV-XVI)
Throughout the book Swales interweaves present-day Freudian and Lacanian theories and their clinical implications, comparing and contrasting perverse from neurotic and psychotic symptoms and characters, and the contemporary professional literature and approaches to identifying and treating various kinds of sex-offenders. She emphasizes the contributions and certain advantages of the Lacanian approach. Given the detail and comprehensive nature of a book based on a doctoral dissertation as this one is, a review such as this can only touch on a very few points which the author, herself, has already written in better, much fuller language.
In the section on the history of the concept of perversion, she comes to the point that Foucault wrote “commenting on the current discourses,,,’that [m]odern society is perverse…in actual fact’ (1976/90), such that there are a considerable number of different things that turn people on, a kind of sexual mosaic.” (p.4) Verhaeghe (2001a) a Belgian Lacanian analyst, “called the current sexual norm the norm of informed consent, ‘meaning that everything is allowed, on condition that both partners agree…As a consequence, the field of perversion has narrowed down to sexual harassment and to paedophilia and incest, that is, to those cases where informed consent is lacking.’ In the present day, perversion, or paraphilia, as the case may be, [which in the DSM consist of Sexual Sadism, Sexual Masochism, Voyeurism, Pedophilia, Exhibitionism, Fetishism, Transvestic Fetishism, Frotteurism, and Paraphilia NOS] is therefore largely restricted to the forensic field.” (p.5)
Swales writes: “Forensic diagnoses are based on illegal behaviours, such as rape or voyeurism, and treatment is oriented toward preventing future occurrences of those behaviours.” It is in this context that Swales tells us that in most forensic settings, “therapists are trying to appeal to a patient’s sense of guilt and empathy to make a case for why his sex offense was wrong and why he should not re-offend;..” (p.12) but, she claims, while this one-size-fits-all treatment is useful for those cases whose perversion is in the context of a neurotic disorder, it is not useful for those whose perversion is in the context of a perverse personality structure as described by Lacan. These cases have important similarities to those who are diagnosable as antisocial or psychopathic personalities and form a relatively small proportion of the cases of perversion reviewed by Swales in the literature and in her practice. Interestingly, one of the very few reports of “analytic treatment with an individual who might meet Lacan’s diagnostic criteria for perversion…is by Arthur Leonoff (1997), and it is entitled ‘Destruo Ergo Sum: Towards a Psychoanalytic Understanding of Sadism’.”
There are two areas in which she makes an especially fruitful contribution to the understanding of the theory implied by Lacan’s work. The first is the division of the big Other into an earlier big Other, represented usually by the infantile mother, and a later big Other, represented by the father or more usually by a later, say toddler and beyond, mother. The second is the division into earlier and later functions, or movements, of the paternal metaphor, which leads to the clarification of at least one formulation of the terms alienation and separation (of which there are a number in the literature), the operators introduced by Lacan in Seminar XI when he heads off from the “return to Freud” into his own theoretical developments.
She clarifies certain points new to me: for example, in her description of the real, which is an important clinical concept in describing the pervert’s dynamics, she follows Fink in suggesting that ‘the real shows up as something anomalous in language, something unaccountable, unexplainable…as kinks in the symbolic order.’ (p. 24) She notes that “[Jacques-Alain] Miller (2009b) taught that Lacan conceived of a first real, R1, a real before the letter, and a second real, R2, a real after the letter”, the letter referring to language and the experience of its acquisition as it is used in the symbolic order. The first real consists of unsymbolizable experience and undergoes primary repression forming the core of the unconscious; the second real consists also of what cannot be symbolized but includes trauma-caused experience. Related to this: Whereas early Lacan described the “body” as over-written by the imaginary and then the symbolic, the later Lacan stressed: “We are all born with a certain amount of what might be called real or bodily jouissance, which is a “substance” (Lacan, 1975) similar to Freud’s libido.” The infant is “full of jouissance”, his “entire body is an erogenous zone”, from which jouissance is gradually “drained off” by development. This is a form of “castration”, to use the Lacanian terminology, such that the adult is left with achieving drive-motivated bodily jouissance only in the genitals, while the rest of his motivations are described as desire – for more desire, for substitutive satisfactions representing object a, or for love. As Swales so carefully demonstrates: the pervert, who disavows castration, is engaged in jouissance, his own and that of the big Other, while the neurotic, who has more or less accepted castration, is engaged in desire.
Swales clarifies another point in outlining the development of the pervert, to contrast this with the development of the neurotic. In introducing Lacan’s concepts of alienation and separation from Seminar XI, Swales describes a first big Other, the representative to the infant of the outer world, language and culture, which is usually the mother, and a second big Other which is sometimes the father but is often also the mother. As well she describes two consecutive functions of the paternal metaphor. Alienation of the young child’s subject/self from his image/ego in the mirror, which follows from the introduction of the symbolic or metaphoric aspect of language, is the result of the first time of the paternal metaphor. This Name-of-the-Father prohibits the child’s use of the mother as an accessible source of jouissance, instituting the social law against incest, which forces the child to incorporate and use language in his communications with his mother. Much of the earlier bodily-based experience cannot be put into words and thus forms the basis of his developing unconscious, resulting in the child’s subject/self becoming divided between conscious and unconscious.
If the child cannot accept this Name-of-the-Father, he will be psychotic in structure and there will be no distinction between his conscious and unconscious. If the role of the actual father is severely eroded by either his own or the mother’s actions, the child disavows the significance of the paternal metaphor, experiences the law as ineffectual or fraudulent, and will be perverse in structure. Although he does enter the symbolic and develop a divided subject, he goes on unconsciously experiencing the jouissance of unimpeded bodily access to the mother. Another way of putting this is that he sees himself as the object a of the big Other, himself as the object-substitute, the male perpetrator, to be used to give the mother-substitute, the female victim, the painfully intense experience of jouissance in the form of shock or terror. In milder instances, he plays the lothario, rationalizing his activity as “helping” an “inexperienced or innocent” woman who belongs to someone else achieve sexual satisfaction. In brutal or illegal instances he can be seen to be unconsciously trying to provoke a limiting, controlling response from the paternal big Other, for example, the police, that was not available in his early childhood.
The second time of the paternal metaphor, which has also failed in the person who becomes perverse, occurs in the process of separation. This is described as the prohibition of the mother’s use of the child as her source of jouissance. In her bodily and emotional care of the infant, mother achieves obvious jouissance, sometimes to the point of exhaustion. However, eventually her other interests erode this intense relation of demand. These interests must, by the second big Other, which may be herself or the father, be put into words, such that they are gradually experienced by the child as his not being the target of the jouissance demanding of the big Other/mother but the restrained satisfying object of her desire. The child is thus spared the “crocodile jaws” of the mother and is freer to develop his own subjectivity and language-based desires. The pervert, who has often experienced an over-investment of his mother in his material penis and her diminishment of his father’s value to her, becomes aware of himself as mother’s preferred object, that is, the source of his mother’s (the big Other’s) jouissance, the metonymic repetition of which becomes his mission in life. He is typically described as having an extremely ambivalent relation with his mother, while ignoring or demeaning his father, as he continues throughout life to negotiate being the unconscious mother’s source of jouissance, at the same time as not being overwhelmed by his anxiety of absorption by her.
Swales very carefully and clearly describes these processes also using the concept of the phallus and castration, showing that the pervert disavows the experience of castration, does not experience the negativization of the imaginary phallus, and identifies himself with the phallus of the mother, the one he believes she either has or wants. By contrast, the neurotic successfully traverses the first and second times of the paternal metaphor, experiences “castration”, and gives up identifying with or being the phallus for/of the mother. The neurotic identifies with the symbolic phallus, which cannot be negativized and gives him access to the advantages and responsibilities of culture. This readies him for the process of sexuation in which he faces that he is either “without having the phallus” and is female, or is “not without having the phallus” and is male.
Swales discusses many other concepts throughout this section – the ego ideal, the fundamental fantasy of the pervert, contrasting it with that of the hysteric, the disavowal of reality similar to that seen in the obsessional, the role of the object a. Throughout, she reminds us that although these processes seem to be developmental steps, they are actually also occurring throughout the individual’s life, over and over. We all know of people who have not agreed to identify with the more subdued world of desire and the law but rather enjoy the jouissance of self-righteousness, indignant rage or accusing the other of denied wishes or attitudes. The pervert takes it as his mission to stimulate these states of jouissance in the other, be it friend, partner or therapist while at the same time unconsciously trying to make the limiting big Other exist as whole and effective, giving the appearance to the observer of wanting to be stopped or caught.
In her description of a case of fetishism written up by Bruce Fink (p.72-4), Swales points out that the patient’s parents were unable to provide him a name for the female genital, leaving him concluding that females have babies because they have a bigger “butt” and only with a description of the difference obtained from little friends that the male has one thumb while the female has two. These beliefs resulted in his confusion between the sexes and his own gender-based identity. They combined with his mother’s discovery, when the patient was 5, that his father had not actually divorced one of his earlier wives before marrying the patient’s mother, thus increasing the mother’s derision of the father and reducing the symbolic value of the boy’s last name. Then, when he was in adolescence and his mother found him one day masturbating, she came in and put her hand on his erect penis and then walked out of the room. These all contributed to his having a perverse personality structure, potency difficulties and a boot fetish. These 3 pages are an example of the clarity and detail with which Swales is able to present this and other cases that provide such an instructive look into this world that many of us have seen little of.
In later chapters, she later gives a similarly clear extensive case history and analysis of two men whom she treated in individual and in the first case, group psychotherapy, who satisfied many of these features: Ray, “a case of (perverse) exhibitionism” (p. 183-218), a man on probation who had exposed his genitals to women [and minors] on thousands of occasions, and was incarcerated in state prison on two occasions…”; and a contrasting “case of obsessive neurosis and pedophilic sexual interest” (p. 219-230), a mid-30’s-year old man with a PhD…who had recently finished serving a year in prison for possession of about 75 images of child pornography.” The first man had a perverse character structure and typified the importance of the presence of the gaze of the big Other in its various manifestations in his formation and practices. His treatment having been mandated, the patient “complained of depression and anxiety and also wanted to work on improving relations with his girlfriend,” only later becoming interested in working on his problems with exhibitionism. The second man, by contrast, like other neurotics, “tried to avoid the gaze of the Other when acting upon their perverse traits” because it evoked feelings of shame and guilt. Also mandated to have treatment, this man “himself wanted to pursue psychotherapeutic treatment. [His] initial complaints included symptoms of anxiety, insomnia, and feelings of inadequacy and guilt. Furthermore, [he] wanted to question his sexuality due to his interest in underage girls.”
Swales’s final chapter presents her recommendations from her experiences of the principles of treatment necessary to effectively treat someone with a perverse character structure. Because the pervert is dealing in jouissance, he does not come to psychotherapy feeling he lacks anything. Hence he does not readily form a transference to the aspect of the therapist described by the term Subject-supposed-to-know (about the unconscious, including that of the patient, and the patient’s unmet desire). In practice, the pervert goes to some lengths to evoke jouissance in the therapist, in the forms of, for example, anxiety, laughter, annoyance, frustration, horror, self-satisfaction, and surprise. If it doesn’t work the first time, he tries again. He may try overtly to turn the therapist into someone who will act as an authority stepping into his life to prevent his perverse acts to whom then he can lie or out-manoeuvre until he gets caught. If the therapist falls into these roles, the relation between the two takes place in the imaginary register of experience, in which both parties are experienced as equivalent and achieve their goals with the other by some personally compelling means such as manipulation or intimidation.
So the first step in working with the pervert is to bring him to the point of experiencing himself as lacking something that can be related to desire and the symbolic aspects of life, something that requires his own effort to search himself for clues of disavowed experience, history and motivation and their unconscious and therefore insisting and repeating origins. Group work can be an important initial or corollary treatment, since the group leader may be accepted by the pervert as a big Other that legitimately represents authority, and the group members can more effectively challenge episodes of disavowal than can an individual therapist. Similarly, cognitive behavioural techniques can be developed to give him methods by which to avoid repeating his acts. But individual, and especially Lacanian oriented, psychoanalytic psychotherapy, adds the important component of attention to the patient’s own desire, the area of lack, as distinct from his usual situation of his desire being swamped by searches for new experiences of jouissance, and more subtly, his desire being shaped by the desire of the big Other. This may be aided by identifying and supporting his more honourable identifications and ideals, even jouissance-yielding versions of these that remain legal and socially beneficial. And it may be possible eventually to achieve some recognition in him of the deeper significance to his development of failures in his parents’ attitudes and behaviours, and of the consequent effects in him of his own grandiosity and disavowal of the values of societal norms. However, in most cases this would be only momentary and not very influential. It is recognized that although the pervert may be able to limit themselves as long as they are in treatment, the advances tend to recede when they are no longer bolstered by this active attention to their own desires, conscious or unconscious. And according to Lacan’s theory itself, the basic character structures do not change over a life-time, although how they are managed can be. So the prognosis for those with a perverse character must remain guarded.
This is a wonderfully written book, making available to those of us who rarely see such cases intimate views of the origins, characteristics and potential treatments of people with serious, illegal behaviours. The theoretical parts are perhaps too detailed for the more casual professional reader, but marvelous for anyone trying to understand and teach Lacanian theory in what I think of as the North American, English-based interpretation, elucidation and style. And the clinical parts make fascinating reading, interweaving theory and practice very skillfully such that they would be useful for any clinician working with any type of patients.