拉康与弗洛伊德的临床实践

Jacques Lacan and the Freudian Practice of
Psychoanalysis

雅克 拉康与弗洛伊德的精神分析实践
Dany Nobus
丹尼 诺布斯

Chapter 1
Diagnosis via speech and
Transference
第一章
经由言说与移情的诊断
WHY DIAGNOSIS?
为什么诊断?

Throughout his works, Lacan insisted on the differences between various
mental organizations, on the analyst’s need to recognize these differences,
and on the mandatory adoption of a differential treatment approach in
the light of the psychic economy the analyst has acknowledged in the
patient. The ‘Lacanian analyst’ has to bear in mind some basic nosological
categories and is held to diagnose patients at the earliest stage of the
clinical process, because her position within the treatment should differ
according to the psychic structure of the patient. Hence, the initial
assessment of the patient is not merely a matter of registration, due to
the fact that it has major clinical consequences.

在拉康的著作里,他坚持这些差异,在各色各样的精神病组织之间的差异,当它们探讨分析家体认这些差异的需要,与探讨义务地採用差异的治疗方法,从分析家在病人身上洞见的心灵活动的观点。“拉康派的分析家”必须将一些基本的疾病分类牢记在心,并且被认为应该诊断病人,在临床过程的最早期的阶段,因为分析家在治疗中的立场应该有所不同,依照病人的心灵的结构。因此,对于病人的最初的评估不仅是铭记的事情,由于这个事实:它具有重大的临床的结果。

Like so many other aspects of Lacan’s clinical theory, the importance
of a correct diagnosis prior to the beginning of psychoanalytic treatment
is rooted in Freud’s papers on technique. In ‘On Beginning the Treatment’
(Freud 1913c), Freud argued in favour of a trial period (Probezeit,
Erprobung, Sondierung) of one or two weeks before the start of the
treatment, for which he adduced the necessary, yet laborious diagnostic
procedure as one of the main reasons.

像拉康的临床理论的许多其他的层面,在精神分析的治疗的开始之前,正确的诊断的重要性,是以弗洛伊德探讨精神分析技术的论文作为依据。在“论治疗的开始”(弗洛伊德1913c),弗洛伊主张,他赞同在治疗开始之前,要有一段大约一到两个星期的尝试期。他举出这个必要,但是费力的诊断的程序,作为这个尝试期的其中一个主要的理由。

Until the end of his career, Freud
remained convinced that the standard method of psychoanalysis was of
no use to people suffering from paraphrenia—or some other form of
psychosis—which prompted him to demand that the analyst recognize
this contraindication during the trial period (ibid.: 124).1 Failure to do
so, or making a diagnostic mistake, would be disastrous as some patients
(neurotics wrongly diagnosed as paraphrenics) would be unjustly
excluded from treatment, whereas others (paraphrenics erroneously
qualified as neurotics) would be unjustly admitted.

一直到他从事业退休,弗洛伊德始终相信,精神分析的这个标准方法对于患精神分裂症的人们是没有用途,或是对某个其他种类的精神病。这引起他做这个要求:精神分析家应该在尝试期,就体认这个禁忌徵侯。假如精神分析家没有体认出来,或是犯了诊断的错误,那将会是个灾难。因为病人(神经症者被错误诊断成为精神分裂症者),将会不公平地被排除在治疗之外。另一方面,其他的病人(精神分裂症者被错误地被认为是神经症者的特质),将会不公平地被接纳看诊。

Compared to Freud’s dual opposition of neurosis and psychosis,
Lacan’s nosological framework is slightly more sophisticated and its
categories more mutually exclusive. Whereas Freud also designated the
psychoses as narcissistic neuroses (and the neuroses proper as
transference neuroses) (Freud 1916–17a[1915–17]:420), Lacan defined
neurosis and psychosis as fundamentally different psychic structures with
separate causalities.

跟弗洛伊德将神经症与精神病的双重对立比较起来,拉康的疾病分类架构就稍微更加精细。这个疾病分类的范畴更加将两种疾病互相排除。虽然弗洛伊德也将精神病者指明作为是自恋的神经症者(并且将神经者的本身作为是移情的神经症者),拉康则是定义神经症与精神病,作为是基本上不同的心灵的结构,具有差异的因果关系。

To the Freudian neurosis/psychosis dualism he also
added the distinct psychic structure of perversion, which Freud chiefly
addressed on a purely phenomenological level—as sadism, masochism,
exhibitionism, voyeurism, etc. Indeed, Freud never sharply discriminated
between psychosis and perversion, and his only formal distinction
between perversion and neurosis resides in his thesis that the latter is the
negative of the former, which he defended for example in ‘Three Essays
on the Theory of Sexuality’ (1905d:165). Lacan rationalized and
systematized Freud’s diagnostic categories, ultimately constructing the
triptych of neurosis, psychosis and perversion, in which each of the terms
represents a separate clinical entity.

在弗洛伊德的神经症与精神病的双重区分之上,拉康补充倒错症,作为明显的心灵的结构。弗洛伊德则是依据纯粹现象学的层面,来处理倒错症的心灵结构,作为是虐待狂,受虐狂,暴露狂,窥视狂,等等。的确,弗洛伊德从来没有明显区别精神病与倒错症的不同。他对于倒错症与神经症的唯一的正式的区别在于他的那个主要论述:神经症是倒错症的否定。他辩护这个主要论述,譬如,在“性学三论”。拉康则是将弗洛伊德的诊断的范畴合理化与系统化。他最后建构神经症,精神病,与倒错症的三个连环。在这三个连环里,每一个术语都代表分开的临床实体。

Furthermore, the clinical impact of these categories within Lacanian
analysis no longer concerns the patient’s possible entry to the treatment,
but rather the analyst’s prescribed position within the treatment and his
preferable handling of transference. Unlike Freud, Lacan did not regard
psychotics as unsuitable candidates for analysis. This does not imply
that for Lacan the Freudian dispositions remain valid under all
circumstances, but that the clinical premises of Freudian psychoanalysis
can and should be modified, without therefore losing their vigour, to
accommodate different types of patients.

而且,在拉康的精神分析里,这些范畴对于临床的影响,不再是关注于病人是否可能进入治疗。而是关注于精神分析家在治疗里被指定的立场,以及他较为有利地处理移情。不像弗洛伊德,拉康并没有将精神病视为是精神分析的不合适的对象。这并没有意味着,对于拉康,弗洛伊德的性情无论在什么情况始都是正确。而是意味著,弗洛伊德的精神分析的临床的假设能够,而且应该被修正。但是不要因此就丧失这些假设的力量,这是为了接纳不同种类的病人。

雄伯译
32hsiung@pchome.com.tw
https://springhero.wordpress.com

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