Stimați colegi,

Vă invităm să participați la Cel de-al XXIV-lea Congres SNPCAR şi a 46-a Conferinţă Naţională de Neurologie-Psihiatrie a Copilului şi Adolescentului şi Profesiuni Asociate din România cu participare internaţională

25-28 septembrie 2024 – CRAIOVA, Hotel Ramada

Vă așteptăm cu drag!

Asist. Univ. Dr. Cojocaru Adriana – Președinte SNPCAR

Informații şi înregistrări: vezi primul anunț 


From anxiety to phobia and back again. A psychoanalytic perspective

Autor: Virgil Ciomoș
Distribuie pe:

SUMMARY
Building on the clinical experience characteristic of psychoanalysis, the author emphasizes the genetic link between anxiety and phobia and analyses the “topology”, specific to the last one, insisting foremost on the relations between the point (including “the vanishing point”) and the dimensional space in defining the symptomatology specific to this condition. He subsequently points out a few “methodological” considerations regarding both the orientation of the analytic treatment of the phobia cases, and the return of anxiety, as an obligatory point of passage towards a possible success in the psychoanalytic therapy of phobia.
Keywords: anxiety, phobia, symptomatology, topology, psychoanalysis
First of all, let me make a remark of philological nature (and more besides): although each author has felt free to differentiate (or not) between anxiety and anguish, however, the two terms are used equally to translate the word Angst, that is their German version which was consecrated, as it is known, by Kierkegaard, the author of the famous work Begriff der Angst. Nonetheless, those who insisted on the difference invoke, in fact, as unique criterion, only the quantity: thus, anguish would be “smaller” while anxiety, “bigger” in amount. To nuance this scale, a third affect was introduced meant to precede anguish, namely, restlessness. From this perspective, anguish would be a type of restlessness that is more intense, respectively, a less intense anxiety. In our case, we will choose the term “anguish” and not because of its mediating position between restlessness and anxiety. In this debate, what remains important is the task of analysing what all three disorders have in common and, if possible, what is essentially common to all of them. Otherwise, if anguish itself could come to the attention of the psychiatry of phenomenological inspiration and, simultaneously, to that of psychoanalysis, this is due, first of all, to Kierkegaard’s exceptional contributions, developed by Freud and by Heidegger and later by Binswanger, Tatossian, Maldiney as well as by all others psychoanalytic psychiatrists and philosophers who followed them. From the perspective of this great affiliation, the anguish is somehow “unfathomable” because, unlike other affects, it is not determinate. Even if it had one more “object”, then the latter would also remain indeterminate. As indeterminate as it even risks losing its objectival character.
A consequence which, at the limit, led Lacan to compare it with its purely negative pendant this time, l’Achose – that is, with the “non – Thing”. There comes also the proper paradox of anguish: without a de – terminate meaning, anguish is the only one which does not deceive. It simply “is” or “is not” and nothing more since the verb “to be” does not have any determinate meaning either. Saying about one thing only that “it is” means, once again, not saying anything “meaningfully”. In that, we may also find the main difficulty concerning the way how to diagnose and treat anguish.
The second philological remark concerns the fact that anguish has a character of affect. The Latin term of “affectio” of which it derives, results from a contraction of the words ad and facere. The immediate consequence of this etymology is that anguish cannot be an affect that involves only passivity; it is also an act – action, a fact that is also suggested by one of its related (if not really derived) affects, namely panic attack.
Panic is an affect whose modern name derives from the one of the ancient God Pan (the god of the noon, that is, of that moment of the day when things are no longer shaded, and no longer duplicated) and this name derives, in its turn, from the common word pan, written with lowercase letters, with the meaning of “all”, more precisely, of “everything and nothing”, actually the same meaning as in logic: dictum de omni et nullo. We could therefore say that the panic attack concerns “everything” and, consequently, “nothing”, that is de-terminate precisely because its origin – anguish itself, to return to it – is an indeterminate act, without a particular signification. However paradoxical it may seem, this is possible for the human being, namely to put into act the nothingness. In psychoanalysis, such an affect and therefore an indeterminate act done without a particular signification, represents an “analogy” to what, in the Lacanian terminology, is called “jouissance”. A sort of psychic “pulse” without a “determinate concept” as Kant would say.
Here are some important conclusions for the theme we are about to address. Firstly, all the other affects other than anguish being determinate, seem to be somehow meant to avoid, in one way or another, the jouissance, which, to say so, anguishes the subject just because it does no longer depend on the meaning and therefore not on the subject’s cognition, either. Secondly, in its quality of “pure” putting the anguish into act – the meaningless one the jouissance just as “pure” as anguish – can no longer be interpreted in the analytical cure, since the interpretation itself always presupposes a certain meaning. That is why Lacan understands to warn all therapists, irrespective of their orientation, that: “Feeling what the subject can endure from his/her anguish will put you at trial at any moment” [1].
Finally, it will be therefore necessary to interrogate the relationships of anguish and, consequently, of jouissance with language, whose constituents – the subject’s own words, articulated in the act of subjective interpretation – have, on the contrary, “in most cases”, a certain meaning, even if not always uni- vocal. We say “in most cases” because, since antiquity, passing through Hegel and Jakobson, Lacan’s friend
– there were two great categories of words that make an exception: the personal pronouns and the verb to be – along with their punctual deictics: here and now (to which we will retur in relation to phobia) which represent precisely the terms involved in putting the anguish into act.
The consequences of the impact of anguish on the cure are just as important. Let us note that, most often, our patients do not come up with a very clear idea about their own symptom. They are, in fact, anguished either by the impossibility of saying “something meaningful” about what affects them, or by the jouissance, just as “meaningless”, which is behind any symptom, jouissance that seems to dominate them since they cannot control it. Especially when it comes to addictions. But, as is well known, to overcome this genuine “invasion” by the jouissance over the subject who is affected by it, pedagogical persuasion, alone, is not enough. All hospitals of psychiatry testify in this regard. It is another way to say that, in such cases, as well as in many others, the symptom is somehow built up in the analysis. An almost recurrent situation in the cure with adolescents, that, for the beginning, presents us with merely “states of mind” somehow “diffuse”, that is to say, indeterminate, than really articulated symptoms. Because, it is equally important to give anguish its princeps place- at least in the first part of the cure – but not only then! – especially when the subject is still in difficulty to sustain his/her own symptomatic structure and even less to expresses it through language. Otherwise, the psychological structure of adolescents is in full process of “reconfirmation” due to the emergence of their sexuality – which is plenary at this age – after the first moment in the period of childhood, that is, after “castration” in a psychoanalytic formulation. In this way, a mutuality between anguish and desire (along with its close symptom) takes shape, where desire is defined as a specific, personal way of converting the in-de-terminate object of the anguish into the i-representable object of desire, Lacan ‘s famous objet petit a.
Indeed, the period of adolescence is also the one of strengthening the subjective desire, the “ideals” – as we use to say – and, as psychoanalysis would add, the adolescent’s own fantasy. About desire we can always speak, even if it never reveals itself “as such”. In this respect, the desire represents the effect of language on jouissance. In other words, the adolescent’s wishes articulate in and through the means of the language. Just like his/her own symptoms. The hypothesis advanced by psychoanalysis was that the in-determinate “remainder” from the anguish – and hence from its senseless jouissance, the inexpressible one – resists, however, and insists, positioned in the very interior of desire – which is expressible, that is, in the form of the symptom and more specifically, the form of the symptom jouissance. That is why any prejudice to the “mask of the symptom” automatically resets the anguish in the economy of the subject.
This is not necessarily a “catastrophe”. More specifically, it is not catastrophic if the analyst has already prepared – in and through his own cure – an alternative of a particular displacement of symptom. Otherwise, a simple destabilization of the symptom may be more anguishing than the symptom itself. Practice and psychoanalytic theory teach us, however, that by integrating the function of language in the economy of the pulsion specific to the human being, anguish can be diminished or, more exactly, may be limited or condensed into the symptom area and that there is, in general, a connection between the severity of the symptom and the severity of the anguish that precedes it. In cures with adolescents, we may even support a certain “orientation”, which could be expressed, very succinctly, in the following form: how much desire is assumed, so much anguish is evacuated. It is not only a theoretical consequence but also a clinical indication, with the specification that the benefit of the cure is, moreover, in the clarification, for subject, of the ethical nature of the choice between the two alternatives.
Psychoanalysts have also noted that between the subject’s invasion by anguish and, respectively, the articulation of his/her subjective desire, there is a kind of interim period that reveals – exclusively – neither a “pure “inexpressible anguish, nor a “desire” already articulated through language. We talk here about phobia, an often disabling experience, for both the child and for the adolescent (but not only!), a kind of an almost inevitable passage, for any subject labelled as “Infantile”, with the indication that infans designates here the subject that does not speak yet. We all know that, at first and foremost approach, phobia is a disorder – be it transient or not – of the subject’s relationship to space.
The contribution of psychoanalysis to the clinic of this condition resides not only in the original way of integrating it between anguish and desire (a desire that, again, emerges for both the child and the adolescent as an already sexed desire, that is, incarnate) but especially in the (essential) role that one and the same anguish has both before as well as after the phobic experience. It is an almost insurmountable challenge, it would seem, since phobias have a seemingly determined character – the phobia of public spaces, for example, or, on the contrary, of those enclosed ones, of height, depth, but also of dogs, spiders, bees, etc. – while anguish is, as we have seen, indeterminate: it comes from everywhere and from nowhere. The solution to this difficulty is already suggested by language analytics, more precisely, of the different parts of speech. Indeed, as we have seen, there are words that have a definite meaning, but there are also meaningless words, that Jakobson calls shifters. In short, though The Origin Human Language is inaccessible in the language itself – for Lacan, as for Wittgenstein, there is no meta-logic, it can be expressed in human language in the form of in- determinate words, such as, we may recall, the personal pronouns or the verb to be. Consequently, there is, a “trace” of the Origin of Language in the very language itself. Or metaphorically speaking: the “gate” of the invisible must be visible. The same is true of space. The Origin of Space is unapproachable in the space itself, which, in a scientific register, means that the original singularity from which our universe originates is beyond the physical limits set by Plank through the minimum quantum of action, but there are, however, some traces of this singularity originating in and through the “black holes” that mark the discontinuity of our physical space.
Over the millennia, human civilization has created all sorts of spatial symbols analogous to these “Black holes” capable of suggesting the spatial “traces” of … non-space: the public space of a village, to resume an example above, is in determinate just because it is not inhabited. But agora – where agoraphobia comes from – is just the expansion of the umbilical point – without dimension – of a locality, a dilation that produces a centre that is devoid of any determined dwelling, a non-place of all inhabitants, but of none of them, in part. Such non-places without dimension, analogous by excellence to the Origin, are also the implosion point of a closed space – where we get claustrophobia, the point of escape of the perspective lines – where we get the phobia toward long hallways (a point of escape which phobic individuals literally run away from), etc. All these may constitute occasions of phobia just because they are analogous to the indeterminate anguish.
There are also other analogues, that are “determinate” this time – at least in part – a kind of points (but also of holes) of condensation of the original anguish, that may further be inhabited by any determined creatures: dogs, spiders or bees. Obviously, the problem is not generated by these beings that are taken from our everyday reality but by something that the subject him/herself invests in and through them, that is, their analogous quality and, as such and partially, determinant in relation to anguish. Consequently, phobia is a kind of defence by “condensing” and then displacing the primordial anxiety (towards a certain significant representation: be it a phobogenic animal). Therefore, it is a healing attempt since, for now on, the subject will be able to avoid the phobogenic spaces without getting rid of their fear, however.
We will conclude with some theoretical and practical suggestions resulting from these too short and modest preliminary developments. By its totally indeterminate character, anguish can be considered a kind of original affect of the human being. This peculiarity or rather, this lack of peculiarity renders it unsuitable for a strictly limited approach to common knowledge, because, as we know from old Aristotle, any knowledge targets a certain generality, which is determined.
In short, the limits of any serious cognition reveal – in physics (see Heisenberg) as well as in meta- physics (see Gödel) – the aspect of indeterminate. Or, just this indetermination of the original anguish is masked in phobia because it is not the occupants – more or less aleatory and, therefore, ephemeral – of the “black holes” of the symptom that are the real cause of phobia, but what the subjects themselves are thinking: an anguish that breaks through the appearance the continuity of our psychic space, namely, in and through its points of rupture. Once again, it is not the long visible hallways that cause the phobia, but the escape point created by their own perspective. An invisible point, of course, but from which one can, however, run away! The proof of this is in the phobics themselves. This being the situation, the simple deconditioning of the subject from such “occupants” of the “Black holes” may eventually work only in case of accidental phobic conditionings, and not of structural ones. For, in the latter case, the structural one, de-conditioning can lead at most to a symptom shift, i.e. to another phobia object.
The same situation happens in addictions: the subject gives up alcohol only to choose, for example, the drug. That is why the clinic of phobias cannot be separated from that of the anguish. Hence an unexpected therapeutic difficulty: since the treatment of phobia reverts to that of the anguish, it may well be that our patients prefer, however, the phobia instead of the anguish. Because phobia is much easier to manage, that is, through simple avoidance. “You’ve taken my phobia away and I ‘ve relapsed into my anguish,” could a phobic reproach us. Out of the frying pan, into the fire, as the saying goes! Therefore, the analyst needs to make sure that, in the meantime, he could lead the analysand for a sufficiently long period of time on the path of assuming his/her own desire, since this path alone may give an articulation as acceptable as possible to the subject’s anguish.
The conclusion: We treat the phobia stimulating and encouraging the desire. In other words, the invasion of the subject by anguish and the refuge
– that is, the flight- into phobia, have one and the same cause: the subject’s inability or sometimes cowardice of assuming his/her own desire. Which does not mean that desire itself cannot anguish… But about that, on another occasion.

BIBLIOGRAPHY
1. Seminar X, L ‘Angoisse, Seuil, Paris, 2004, p. 13.