Borders? Let us cross them!

Dr. Oswaldo Ferreira Leite Netto
 

Psychoanalysis as a tool for the emancipation of people and a form of crossing borders between human groups. Institutional restrictions impede psychoanalysis’s adaptation to contemporary demands.

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Separated nations, nationalisms, social inequality. Separated men. Pandemic: social distancing. We are facing borders! Borders which harden and dehumanize; which generate strangeness into those whose role is to listen to the minorities’ desire for freedom. Those who feel shocked by the ‘new’ sexualities that become more visible and by new conjugal and family arrangements.
 
Psychoanalysis is revolution. It facilitates and enables the recovery of vitality in thinking and language. As psychoanalysts, we carry forward Freud’s courage to subvert braced medical concepts, as well as his etiologic research and his healing efforts, which can soothe discomforts and anguish. We do not help people to eliminate their anguish, but rather to manage it; we help them find more internal space in order to live with and have ownership over their desires; we help them acknowledge conflicts, ambivalences, and their own imagination by verbalizing, narrating, and being listened to.
 
In the current days, Freudism and its practice – in my experience as a psychiatric doctor – suffer, as they have done since their beginnings, with the system’s efforts to absorb, medicalize, and bureaucratize them. The psychiatric view on psychic suffering brings along advances in respect to the functioning of the organism and the human brain. However, it also carries the power that Medicine exercises over humans who look for relief, as beings who idealize salvation and who subject themselves to prescribed, imprisoning controls, as well as impositions.
 
My clinical practice as a psychoanalyst was first established, and has been developing since, at the frontier with Medicine and psychiatry, in the face of the demands I have received as a worker in the public health system – in a public hospital connected to the School of Medicine of the University of São Paulo.
 
I crossed the well delineated border of medical knowledge in order to enter into the field of psychoanalysis, with its epistemology, fundaments, and goals. I remain active in the University’s teaching hospital as a psychoanalyst: I take part in the teaching (within the medical and psychiatric training), as well as in the assistance to psychiatric patients who present psychic suffering; I supervise young doctors (psychiatrists and interns) who wish to refine their work in the psychotherapeutic field and lean towards the psychoanalytical method as a way of listening to an individual’s subjectivity. It is my privilege to encounter, in an important university, enthusiastic, intelligent, and questioning young student-doctors, and to present them with the fundaments and peculiarities of the psychoanalytical clinic. This allows many of them to confirm their own choice for Medicine as a practice, since the stupendous technological development and the impersonality of practices based on the search for efficacy and productivity disappoints vocations that I call humanistic – those connected to the essential and founding aspects of Medicine: to listen to and console people; the particularized interest in and attention to each single individual.
 
In a country like Brazil, with its huge inequalities and continental size, each region has a diverse cultural context, with very different possibilities and opportunities of development. I was admitted into a public university having come from a privileged background; I began to attend to people in need, people who were deprived of the necessary conditions for the development of their human potentialities. First trauma: to cross the border from my original world in order to reach other territories in my own city. I developed my awareness of social injustice and, hence, of politics. The consciousness of the possibility of expanding one’s horizons, of the different points of view, as well as the fundamental and irreplaceable experience of personal analysis changed my perception. The idea of a border as a limit that outlines an enclosed territory was modified: it began to appear as a possible contact with the diverse – an interface. Therefore, in the idea that has been gradually constructed through my new experiences, the border has revealed itself as a possibility of opening toward the unknown, toward otherness. Circulation, new horizons; crossings.
 
It means reclaiming to psychoanalysis a constant relationship with that which is outside: the strange, the stranger. We, psychoanalysts, are challenged at the borders! I do not see psychoanalysts and psychoanalytic institutions as the owners of their concepts; the institutions do not control their members’ possibilities of action.
 
At the frontier where I work, we are constantly challenged by psychiatrists with questions, doubts, and criticisms to our practice, since it is directed to each patient’s singularity, to the construction of autonomy, freedom, and authenticity. We go beyond psychiatry’s search for normatization, beyond a well characterized pathologization that enables a precise diagnosis, beyond treatments searched for and chosen in response to demonstrable results. In the psychotherapy service that I direct and in which we have created a psychoanalysis hub, we ensure the presence of psychoanalysts involved with the care for psychiatric patients. We offer them our listening, something that they had never considered or imagined, given their lives’ precariousness and limitations.
 
The analysts, who come to us as interns, arriving from the elitist environments of psychoanalytical institutions, are given access to a public who comes from and inhabits other territories in the very city where we live. They live away from the center, at the margins, in communities or favelas. Our interns have the opportunity to encounter, in these patients, resilience, sensitivity, and creativity, as well as free, unusual, and peculiar lifestyles in relation to the narrowness of certain values that prevail within the privileged and dominant class. Many analysts come from elitist groups who keep a distance from black and sexually diverse people.
 
Psychoanalysis can get petrified and impoverished, sometimes because of its own institutionalization. And Freud, in 1910, in his Über wilde Psychoanalyse, calls our attention to the application of psychoanalytical theories for wild interpretations… The dialog is interrupted, the border is closed, the analyst authorizes themselves to explain, on their own, stopping the interaction with the other. I also observe this same savagery as a consequence of the medical appropriation of psychoanalytical formulations without the necessary epistemological distinction – that medical grief that is essential to the psychoanalytical practice. Freud presents, in the abovementioned work, the young doctor’s rush into formulating explanations to his patient, who receives them as aggressions and gets scandalized; this pushes the patient away and favors prejudices against the analyst’s activity. Intra-institutionally, some proposals of action and some experiences can be received with the verdict: ‘This is not psychoanalysis.’ Such an attitude establishes a border and differentiates that which is within from that which is beyond that border. The regard is rigidified. 
 
A few years ago, at the Brazilian Psychoanalysis Society of São Paulo, I took part in the creation of the Department of Community Care. We intended to offer a new possibility of institutional participation with the aim to attend to segments of the population who are under-assisted in terms of mental health, as well as to waken and encourage our members’ creativity.
 
This department has continued to expand, and it consistently offers these experiences to interested members. Experiences that still shock due to their originality and due to the threat they pose to obstinate adhesions to certain aspects held as orthodox in our practice. It is the possibility of being in a public space, offering a ‘conversation with the psychoanalyst’ in a public square, for some time, to the passerby who may be interested. One-off consultations – or a few recurrences – that enable speech and listening, allowing for the reformulation of points of view and feelings of gratitude – from both sides.
 
The current pandemic challenged us all: how to maintain certain requirements that are identified with the rigor of orthodoxy? How about the demand side? We have seen, thus, flexibilizations that some of us – not all – may had never anticipated. We know that many colleagues had been working via Skype under exceptional circumstances – for example, when the need for international travel would interfere with the presential work. Or else within bold projects that aimed to take psychoanalysis to countries where this knowledge and practice were starting to arrive.
 
This unexpected – and hopefully momentary – situation, subject to the pandemic that we expect to control, challenges us yet again. In countries like ours, there is something more chronic and which is hard to manage: social inequality. It is a great test for psychoanalysts to try and reach people absolutely in need of material resources but who still aim to construct themselves as human beings. We intend to offer tools to direct one to freedom and autonomy – a practice that includes the dynamic and conflicting unconscious.
 
Psychoanalysis’s savagery comes from a terrain very debated and questioned today: sexuality. There is an appropriation of theories in the pathologization of behaviors and manifestations now visible; the minorities, the different manifestations of sexuality, generate resistance, opposition, explanations, and wild interpretations by psychoanalysts – which is surprising, since we consider the sexual as something much larger. Even within the so-called normal sexual exchange, there can be dissatisfaction, as we verify every day in our clinic. This sends us back, thus, to the peculiarity of the human sexual life: the erotic based on imagination and fantasy.
 
‘Psychoanalytical technique’ does not mean using the current technological knowhow, quickly learnt and reproduced, as is the case with medicine and its image-based diagnosis, for example. Psychoanalysis is not about medical technique, but rather about something that cannot be learnt from books; a learning that is incompatible with the bureaucratization of trainings that provide diplomas and guarantee profit, success, and results. We must be concerned, within our training institutes, with helping our student-analysts learn not to crush their patients with ‘wild’ diagnosis.
 
I challenge us, psychoanalysts, to position against the exclusion and violence suffered by women and homosexuals. We are indeed capable of expanding our territories and crossing the borders by listening to social and psychological plurality and diversity.
 
Let us go back to the current situation of health crisis with the coronavirus pandemic. Freud, in his 1930’s  Civilization and its Discontents, refers to the original abandonment of the individual, which is reactivated by the fear of dying. Covid-19’s severity and its serious evolution, as well as its high death rates, has generated strong reactions of discouragement, primarily and above all, in the professionals involved in the care of infected patients who are in need of intensive hospital attention. In Brazil, mental health professionals have proposed initiatives to deal with these reactions. With the idea of caring for those who care, listening services via telephone and the most diverse media showed great value, reach, and effectiveness.
 
Within the medical institution with which I am affiliated, listening devices directed at professionals who work in the pandemic frontline – in infirmaries and intensive care units – have allowed individuals, via discourse, to transform the unsayable in sayable and, thus, mobilize defense mechanisms to protect themselves. Psychoanalysts have greatly adhered, away from their habitual system of consultations in private offices and leaving behind certain demands regarding the frequency and duration of sessions. It has become possible to distinguish that which is essential to the psychoanalytical listening from that which is accessory and excessively comfortable – that which can deviate and impoverish our practice and reduce its reach. Paradoxically, the pandemic is too an opportunity to cross borders, especially those generated by the socioeconomic differences that prevent many people’s access to the resources of the psychoanalytical clinic.
 
I wish to focus now on a previously mentioned issue: psychoanalysis’s strict field of knowledge and its borders with other fields.
 
Today, the need for an interdisciplinary work between psychoanalysis and other practices has become very clear. Originated by a doctor, the psychoanalytical field, both theoretically and practically, breaks up with Medicine in epistemological terms. And the psychoanalytical clinic that takes place within a mental health institution makes it evident that those two discourses do not superimpose each other. The medical objectives regarding mental health are not the same as those of psychoanalysis. But the border between those knowledges and those practices is recognized by psychiatric patients who also receive psychoanalytical attention besides medical and drug-based treatments. It is this privileged, interdisciplinary position that we, as psychoanalysts, occupy within training and mental health assistance medical institutions. This proximity forces us to revisit dogmatic and orthodox positions, which are the object of frequent criticism throughout psychoanalysis’s history: a rigidity that has indeed been established and continues to be established, weakening psychoanalysis’s creativity and innovative potential. Criticism that is directed to us and to our institutions, and which are transformed into resistances or attacks to psychoanalysis and to the concept of unconscious, instead of contributing to the deepening of our reflections and reformulations.
 
Freud himself, since Totem and Taboo, outlined psychoanalysis’s specificity in the border with sociology, anthropology, biology, and religion – thus, in contact with these fields. Bion and Lacan (Freud’s disciples) were concerned with emphasizing psychoanalysis’s need to be inserted in its historical time, integrating the scientific field.

Image credit: Alex Cerveny, ‘Joujoux e balangandãs das possibilidades’, 2016 (detail). The use of the image is authorised by the author.