J-J.Tyszler : The history of Melancholy - 4

Dec 4, 2012

École Pratique des Hautes Études en Psychopathologie

Paris, Fall 2012


            Today, I’ll discuss the other words around melancholy, beginning with "depression." Why can’t we just say "depression" instead of "melancholy" ? Depression is in fact the common word now in medicine. However, nowadays we encounter a significant problem that could be called "tautological clinique.” Often, what is called "depression" is what can be "healed" with anti-depressants. Of course, that’s a real problem. This confounding tautology also applies to terms like "bipolar disorders."

In the United States, diagnoses of "bipolar disorders" have multiplied by fifteen or twenty since the launch of thymoregulators. The first thymoregulator was lithium, lithium salts. As is often the case in medicine, this discovery was fortuitous. Lithium was followed by a whole gamut of medication, all derivatives of anti-epileptics. So the most incredible thing happened: once these medications were launched, the number of cases increased tenfold! You don’t need to be a genius to understand the link between the pharmaceutical industry and certain ways of recounting clinique. I have to tell you also that in France, we really resist this.

But in most countries around the world now, the so-called “bipolar disorders” lead to children being medicated – and this poses a significant ethical problem. How do we, scientists, justify giving small children such powerful medication, which they will consume for years and years? You need to know about this, read about it, including articles by American psychiatrists who are beginning to complain about the influence exerted by the pharmaceutical industry in American nosography. Although we’re not completely immune in France, we are one of the few countries that most resist this prescription frenzy.

So, why not just say "depression"? The term "depression" isn’t scandalous in and of itself. When someone has a very serious car accident, they might develop a "reactional depression" (dépression réactionnelle). And evidently, this person’s morale will be down if he or a family member has been seriously injured. There’s also the very old framework of "neurotic depressions": obsession, phobia, hysteria – the great neuroses and of course, everyone has noticed that we all experience depressive periods, periods of great depressive lassitude, the way the neurotic fights against his symptoms, etc.. And finally, we have "psychotic depressions," manic-depressive psychoses. There used to be the term "endogenous" (maladies endogènes). Unfortunately, I cannot comment at length on this one, because it would require a long digression into the pre-war German psychiatric tradition, and that would lead us astray. Inspired by philosophy, this tradition often posited mental illness vis-a-vis the order of the world itself, like the Greeks. They had wondered if illnesses like melancholy, which called upon temporality (the subject’s circularity, the subject in the cosmos), couldn’t be considered under the form of the great inclusion of the individual within the cycle of life and death. As a result, they produced a lot of interesting work using the term “endogenous.” You can hear it in the very word; the term starts sliding into the history of genes and genetics, not geneticism, though. This wasn’t a geneticist program. The notion of “endogenous” referred to the subject’s inclusion into the wider rhythms of life, the seasons, Nature, etc…German phenomenology thought about this problem. Horatius Tellenbach is a good reference for this kind of work (he was one of the last students of Heidegerrian philosophy in Germany).

Also, you can use Lacan’s categories, which are extremely powerful in clinique : Imaginary, Symbolic and Real (l’Imaginaire, le Symbolique et le Réel). In casuistry, these categories are easy to unfold. You might ask: "What is an "imaginary depression" ? You know what it is, of course. It’s a depression that touches upon the category of narcissism, what Freud calls the ideal ego (le Moi idéal), the sense of completeness (la complétude moïque). For instance, take the youngest sibling who thinks his elder brother or sister is the parents’ favorite child. This idea results in an imaginary depression. Or take the younger sister, who becomes depressed because the eldest is prettier. That’s a question of narcissism, of body image, of representation – and this issue will accompany the little girl up to her adolescence or even later. She’ll keep a depressive trace of the imaginary fight she was unable to win against her sister or mother. As a clinician, it happens sometimes: you receive a little girl as a patient whose mother is beautiful. It’s no easy thing for the little girl. And you can see right away that there’s a problem – for the girl’s situation, I mean. There’s a chiasmus between the criteria for beauty, the surrounding values, and this little girl’s experience. These questions can be difficult to treat.

Examples like this abound. So we’ll use the term “imaginary,” but this doesn’t mean it’s “futile.” Telling a patient “oh, it’s nothing, it’s imaginary” won’t do. For instance, if you tell this little girl “who cares if your sister is more beautiful,” or “don’t worry, there are many criteria for beauty”… Or when a woman meets a man, she becomes more beautiful immediately, it’s true. But these reassuring words won’t suffice for the ideal ego (moi idéal) who cannot hear dialectical messages. As an instance, the ego is not a dialectician.

During our last seminar, I had an interesting conversation with one of you, who is a company works doctor (médecin du travail). This profession is undergoing a major expansion. These doctors encounter not so much “imaginary depressions” but what can be called “symbolic depressions,” symbolic depreciations, in fact. These conditions don’t really touch upon narcissism itself. It’s the ideal ego (moi idéal) that’s affected but the ego’s ideal (idéal du moi), meaning the ideas we all have regarding our own place at work, the beauty of our profession, etc… Normal issues, indeed. These aren’t just issues with narcissism. The efforts we make to be part of a profession, to have a career (faire carrière), as we used to say, these are issues that concern the ego’s ideal (idéal du moi). These are a person’s ideals regarding his place in society, how his children and parents see him, etc. And as a médecin du travail, you know that this symbolic depression is now common within the work world, as we know from the press, and from the high number of suicides.

There is indeed such a thing as “corporate pathology.” It’s a genuine problem. Companies now manufacture depreciation among their employees. Luckily, there are doctors who can be present, although it’s quite a challenge to work against the norms of the corporate world. And this is very frequent in our private practices. We come across many patients who come to see us not because they love psychoanalysis or psychiatry, but because they’ve stumbled across a kind of impossibility of recognition in their work. And the disappointment is so great, that it creates an effect of depreciation. It’s difficult to problematize. Indeed, when this situation occurs, it translates into sick leaves (arrêts de travail), medications, various “solutions” with the common goal of appeasement, but solutions that won’t necessarily enable a return onto the metaphorical site where the depreciation took place.

Let’s be more specific. All of you know about today’s “evaluation” issues. It’s quite a trend. Even in kindergarten, children are “evaluated,” “assessed.” The final year of kindergarten, parents receive their kids’ “evaluation.” It’s unbelievable, really. The term “competition,” for instance. It’s normal for competition to exist. Competition, phallic rivalry, war among peoples, etc…They’re all part of our human history. We’re not about to say that competition should be banished. However, when you add up the various forms of competition within the work world (immediate evaluations, the whole discourse on work flexibility, etc..), this whole mayonnaise results in creating a true work place pathology.

We’ve begun noticing a very interesting problem. This discourse regarding competition, evaluation, etc.., is in fact anonymous. Strangely, you’re no longer dealing with a boss (un chef) when you work in a company. There’s no boss per se. Or, he’s never physically there. So, on the one hand, there’s a discourse that obliges you, but on the other hand, there’s no one present with whom to struggle (personne avec qui lutter). There’s no boss.

When I was a young intern, for instance, we would argue with the hospital director (who used to be part of the military). But you could find him easily and join him around 8pm for a cup of coffee in the hospital park. There was someone with whom to argue and fight about ideas. Things were different, then. There was a way to both receive and accompany various difficulties. Nowadays, there’s no one to see or argue with. Because numbers rule. Numbers are the boss, now. There’s no point seeing someone.

This point is crucial. Culturally speaking, we’ve shifted from the paradigm of struggle (le paradigme de la lutte) to the paradigm of “gloomdom” (la sinistrose), which is an entirely different thing. It’s rare to meet someone who thinks of himself as struggling, as leading a fight, someone who still thinks in terms of the Hegelian master and slave dialectic, or even in terms of class struggle. We’ve shifted into an entirely different signifier: fatigue, weariness, pains, victimology, total “gloomdom” indeed (la sinistrose).

Some people are working on the question of “corporate pathology,” which is becoming a significant phenomenon. And I think here, under the chapter “symbolic depression,” you’ve got a good key to move forward. Don’t think these are “imaginary depressions,” otherwise you’d be telling workers that “all of this (your depression) is just narcissistic.” But these aren’t issues of narcissism; they issues relate to a person’s value. A person’s value devalues in the eyes of others, and he perceives this very clearly. He loses his value in his own eyes and, of course, in those of his family. He comes home, tells his children this or that story. It’s a question of depreciation. This is a very vast clinique, and it’s becoming increasingly serious. There’s a lot of work here.

We need to be precise with words in order to honor the request (la demande). I think the term “depreciation” is a good one. Yes, it’s true, you’ve lost value. And that value had been deserved. It was the value of a profession. As clinicians, you must be sensitive to this, even in the hospital setting. In the old days, and those of you who attend patient presentations know this, there used to be heads of departments (chefs de service). Even earlier, they were called the “mandarins.” They were those with power, those with whom we could actually struggle and fight. They were the great masters, who acted as heads (chefs) everywhere. They imposed the law in hospitals. But then, mandarins lost a bit of their glamour (leur superbe) and became just “heads of departments” (chefs de service). And now, they’re just called “heads of units” (chefs de pôle). Most of them are forcefully grouped under that term, “head of unit.” Like in “bipolar,” the signifier “pole” (pôle in French) doesn’t exist in terms of medical transmission. It doesn’t mean anything! I remember “pole position” from Formula 1 racing, when the Ferrari was the first one to reach the finish line. But “pole” in terms of medicine? In truth, the term refers only to an administrative and financial regrouping in which individual head physicians (médecins chefs) are forced to unite in order to be “territorial directors.” It seems like nothing, but think how strange it is for a doctor who, at the age of 60, goes from being “head of department” (chef de service) to “head of unit” (chef de pôle). This doctor didn’t go to medical school to transmit his administrative know-how! Administration is not his job! Even if this shift comes accompanied with financial reward, this creates a form of depreciation; and the financial compensation, or whatever, represents the hospital’s attempt at making up for this depreciation. There are a lot of professions like that where the very name of the profession (le nom du métier) is affected, and depreciated.

Like Lacan, I am convinced that the name of the profession is one of the “names of the father” (le nom d’un métier, c’est un des noms du père). It’s that simple. When someone has a profession, especially in professions like ours that require a form of handicraft (une forme d’artisanat), the name of his or her profession is crucial. It’s one of the names that lasts throughout our lives. Of course, some could argue and say “Who cares? Does it really matter whether we call it a pole, or a unit or whatever?” But such sifts affect the very fabric of the name itself. You’ll find a thousand forms of imaginary depreciation, symbolic depression or depreciation. Of course, we need to preserve the “real” rim of depression (le bord réel de la dépression) regarding melancholy.

Clinically, this partition works. There’s no point in banishing the term “depression,” but you must give the term some consistency and use another word to typify how you’re using “depression.” Therefore, I propose the expressions “imaginary depression,” “symbolic depression” and the “real of depression” (le réel de la dépression), what we used to call “melancholy.”

I have authorized myself to add another word (which is not yet universally recognized)… I think another zone ought to be convoked, one more social and general. So I’ve chosen the term “depressivity” (dépressivité). The word exists in the dictionary. Its use in the clinical context isn’t so common, however. Still, I considered it was necessary to add “depressivity” to the terms “depression” and “melancholy,” because it corresponds to a certain difficulty within culture, one that is related to the gaze. In my view, “depressivity” conveys the current shape of disenchantment our young people are experiencing today, the disenchanted shape of the gaze we place onto a world experienced as a world lacking in ideals.

In tonight’s edition of Le Monde, an article mentions that 23% of young people are considered precarious in France. ¼ of French youth! Do you realize how enormous that is? What kind of word do we use to describe this phenomenon? These young people aren’t “depressed.” But their gaze onto what is now a blocked horizon deserves specific terminology. I didn’t use works of modern sociology, because they weren’t available to me at the time. What came to me was the work of Imre Kertész, the Hungarian author who won Nobel in Literature in 2002. His books absolutely flopped in Hungary – and we can see why. Kertész started becoming successful in Germany. After the second world war, Germany worked a lot on its own memory. So Kertész’s international success came through Germany. In Hungary, people think he’s a fool, even today. This man was truly unlucky. First, he experienced deportation, then, Stalinism – two kinds of totalitarianism. Like others who carry a kind of question mark inside themselves, Imre Kertész writes:


“My conviction is nonetheless that the devaluation of life, the raving existential decline that is destroying our era, are due to a profound depression whose roots plunge deep into the experiences that shatter the course of history, and deep into the cathartic knowledge that springs from them.”


“Ma conviction est cependant que la dévaluation de la vie, le déclin existentiel galopant qui détruit notre époque sont dûs à une profonde dépression dont les racines plongent dans les expériences qui brisent le cours de l’histoire et dans le rejet du savoir cathartique qui en découle.”


It’s not so much that depression, meaning the depressed gaze onto the world, is linked to the trauma of existence or history. There have always been historical traumas. Kertész says that what spurs “depressivity,” however, is the rejection of knowledge which accompanies trauma. “We don’t want to know about this; it doesn’t interest anyone.” It’s this “cathartic rejection of knowledge” that plunges the gaze into this form of depressivity.  What is beautiful, then, is that Kertész is concerned with the loss of the signifying gaze (we encountered this with Ségla’s “loss of mental vision” (perte de vision mentale)). Kertész uses this perspective (the function of the gaze on life), and his diagnosis about culture resonates in the same way as this loss.

Kertész writes:

“The non-assimilation of experience, indeed sometimes even the impossibility of assimilation, constitutes, I believe, the twentieth century’s characteristic and incomparable experience. It’s irrational, we’re told, as if the rational and irrational were two opposite natural elements which the laws of physics have yet to explore and which, meanwhile, push men around here and there, depending on their mood. What is truly incomprehensible about the history of the twentieth century? What we experience as irrational, incomprehensible, or rather what we declare as such, resides in our inner world rather than external factors. Quite simply, we can not, we will not, nor do we dare face the brutal fact that the existential bottom which Man touched upon during our century is not merely the particular and unusual history of one or two generations, but that it constitutes a norm born from the experience that contains humanity’s general potentialities, and therefore, that being the case, our own. In other words, it is not history that is incomprehensible, it is us who no longer understand ourselves.”


“La non assimilation du vécu, voire parfois l’impossibilité de l’assimiler, constitue, je crois, le vécu caractéristique et incomparable du vingtième siècle. C’est irrationel, dit-on, comme si le rationnel et l’irrationel étaient deux éléments naturels opposés que les lois de la physique n’ont pas encore exploré, et qui, en attendant, ballotent les hommes de ci, de là, selon leur humeur. Qu’est-ce qui est réellement incompréhensible dans l’histoire du vingtième siècle? Ce que nous ressentons comme irrationel incompréhensible, ou plutôt que nous déclarons tel, réside en notre univers intérieur plutôt que dans des facteurs extérieurs. Tout simplement, nous ne pouvons, voulons, ni n’osons voir en face le fait brutal que le fond existentiel que l’homme a touché durant notre siècle n’est pas seulement l’histoire particulière et insolite d’une ou deux generations, mais constitue une norme issue de l’expérience qui contient les potentialités générales de l’humanité, et donc, dans ce cas de figure, des notres. En d’autres termes, ce n’est pas l’histoire qui est incompréhensible, c’est nous qui ne nous comprenons plus nous-mêmes.”


It’s not a question of history, then. There are many history books. The issue is that the modern subject has stopped understanding himself within this history. He doesn’t know how to read it. In the clinical context, you recall how our colleagues in child psychopathology mentioned what we mean by children who are “non readers” (enfants non lecteurs). Nowadays, we meet many children sent to us after the evaluation that takes place during the final year of kindergarten, or right after first grade. And we are told that this or that child can’t read. I want to reassure the girls, so to speak. Generally speaking, only boys are concerned. It’s a gendered clinique. Only boys can’t enter the apprenticeship of the letter (l’apprentissage de la lettre). It’s reassuring to see that there are still differential cliniques. There are “non-readers,” it’s true – and this phenomenon becomes a fairly extensive psychopathology.

            This isn’t what Kertész is saying, however. Kertész is saying that this applies to us children who have become adults, who are non-readers. We can no longer decipher our own world. So in effect, Kertész is asking “How are we positioned to read our own era?” Can we even read it? We’re not even talking about the crash of trauma caused by the preceding world wars. When I was in Brussels on Saturday, I asked a young economist if economics can help us decipher economics. His answer was “of course not.” Not one of us is able to read what we’re calling “the economic crisis.” We have no idea how to “read” it. And it’s very disarming for a whole generation (like my children, who are about 25 years old) to be told in advance that the situation isn’t legible (la situation est illisible).

We aren’t talking about a single case of melancholy or depression, but a form of depression within the culture. The word “depressivity” succeeds in expressing that idea. The word “melancholy” is too ambiguous on account of its robust clinical meaning, which we’ve been describing throughout this seminar.  This “depressive blade” (lame depressive), which you are experiencing and which touches upon economics as well the current political discourse about economics, deserves a name.

People share the general sense that there’s no overarching political discourse. The state doesn’t have a clear position vis-a-vis anything. High officials contradict each other, they fight, etc… It’s not a problem of polemics; it’s a problem of legibility. We need a word to describe all this, so I suggested “depressivity.” Kertész is one of those authors who discusses this very well.


Before wrapping up this series of seminars by reminding you of the major divisions we’ve discussed, I want to read you a passage from the “Song of Melancholy” in Nietszche’s Thus Spoke Zarathoustra:


Bethinks thou still, bethinks thou, burning heart,

How then, thou thirstedest? –

That I should banned be

From all the trueness!

Mere fool! Mere poet!



I’ve tried show you what kind of support you may find in words. There is no other support, in fact. There’s only words, signifiers. And I’ve attempted to remind you that the message of the classics, their knowledge of melancholy comes to us through this text, this problem attributed to Aristotle, through Problem number 30. What interests the Greeks first and foremost is the interrogation that lies beneath a clinical problem. Which human question emerges? Their interest didn’t reside strictly in nosography or casuistry. We need to use casuistry, use illnesses to ask which question is posed to Man. That’s a wonderful message given to us by the classics. Don’t ever reduce a patient to the name of his illness. That’s scandalous. Even if you think this patient is x or y – which, of course, all doctors are obliged to do in some way or another. Try to make sure you avoid reducing a person to their pathology. You may say “he’s paranoid” or “he’s schizophrenic,” but in so doing, you’ve said nothing about that patient’s essential being. The Greeks had a way of thinking of mental illness as one of the great questions of human existence. So here is Aristotle’s question (Problem 30.1):


Why is it that all men of exception in philosophy, politics, poetry or in the arts, have been manifestly melancholic? And some of them to the point of being victims to the delirious bouts of black bile….?


Aristotle’s question isn’t some kind of poetico-tragic utterance. It is a real question about illness. The issue isn’t whether these “exceptional men” were in fact geniuses or not. Aristotle is simply observing that most “exceptional men” have indeed shown signs of melancholy. How doe we explain that?

If you’re still sensitive to the great questions of the Greeks, you must also not reduce those questions to simply somatic issues, for instance. Nowadays, we’re tempted to explain everything through biology, bad genetics, etc… As if cells, neurons, neuronal interconnections knew the secrets of the great human questions… Science is interesting, of course. That’s not the point. But don’t reduce the questions posed by mental illness (posées par les folies) to the strict soma.

I’ve tried to guide you to the rim of this issue with melancholy because it poses a genuine problem. There’s a real methodological issue. Freud’s discovery represents a turning point. Freud says simply that mourning is a form of knowledge (le deuil, c’est un savoir). And mourning should indeed remain a form of knowledge. In terms of human experience, sexuality is a form of knowledge also. Mourning is a form of knowledge generally afforded to women, to those women who would accompany rituals of mourning. One can find very ancient traces of this phenomenon. Freud reminds us of this fact; he reminds us that mourning is a kind of knowledge. And that, by all means, is a very good thing. Freud says: “Melancholy engages a different status, without reference or recourse to this knowledge, were it tragic.”

Freud’s position is very interesting, here. Poetry, literature, painting – they all refer to the tragic hero, the melancholy hero, as any museum goer knows. During the Middle-Ages occurs a kind of “coagulation” between the tragic hero and melancholy.

Freud disapproves of this association, however. He distinguishes between mourning (as a form of knowledge), and something else, which isn’t mourning and which problematizes the positions of subject versus object, a problem fare crueler for humans, and which has nothing to do with the tragic hero. He warns us that we cannot simply resorb melancholy into tragedy. Freud creates a radical epistemological separation here. There is such a thing as the “Freudian rift,” a period before and one after Freud.

As I mentioned last time, this rift isn’t so obvious in psychiatry or psychoanalysis. First, because it’s hard to accept. It creates certain difficulties, polemics, etc… And second, because Freud couldn’t work on this question alone. I’m always irritated when I hear people saying that great clinicians invent something “alone.” It’s a very stupid notion. That’s never occurred anywhere. Anyone who produces something of import never succeeds alone. That person has either produced with or against others. We use others as supports for or against. “Alone” means nothing; it’s an invention.

Regarding melancholy, then, Freud called upon his friend and student, Karl Abraham. Abraham’s reading, indeed his misreading of “Mania, Melancholy and Depression” puts up a smoke screen. Abraham simplified Freud’s theses. He also introduced the whole notion of stages (stades), which really caught on. As soon as this whole “stages” thing was introduced (anal, oral, genital, etc…), everybody started “understanding” Freud! The “stage” concept was very popular. Except, of course, Freud had become very hostile to these notions. And, predictably, everyone ignored Freud’s hostility and dislike. These notions simplified Freud; they created a whole new venue of inquiry that had nothing to do with him. Freud never conceived of the genital drive (la pulsion génitale) as the civilizing labor of psychoanalysis. Yet that’s how it was presented.

Consequently, still today, the clinical information (les données cliniques) is still waiting for a kind of contextualization (une mise en perspective). And that’s why, as you read Freud and those who came after him, you will surely lose your way through all these complications. Regarding “Mania, melancholy,” remember that there are authors, the aliénistes, whose works are very solid, including “Manic-Depressive Insanity (“La folie maniaco-dépressive”) by the German Emil Kraeplin.  It’s a shame that Germans have forgotten their incredible psychiatric tradition and have given into American psychiatry.

            Kraeplin fixes the term “manic-depressive psychosis” in the sixth edition (1899) of his Treatise, completed in the eighth edition (1913). What’s amusing is that Freud’s friend, Abraham, whose lengthy contribution of 1924 on manic-depressive states doesn’t refer to Kraeplin. That’s a methodological problem, really, and it’s a problem we also have today. I was fortunate: my studies in psychiatry were exceptionally dense thanks to the masters we had, like Marcel Czermak and Charles Melman, as well as Jean Bergès for child psychiatry. Clinical psychiatry and psychoanalysis was our daily bread. But generally, many of our psychoanalyst colleagues didn’t know a thing about psychiatry. In fact, they were even proud to know nothing about it! They thought that’s what Freud’s message was, precisely because of the elements we’ve discussed. Because Freud, in several instances (including paranoia), simply doesn’t refer to psychiatry. A century later, however, this becomes an issue. That’s why I encourage you to keep one foot in each field, psychoanalysis and psychiatry. Don’t tie them together, of course; keep them separate, but close.

            In the context of his dialogue with Abraham, Freud fails to mention Kraeplin the same he ignores the great French authors (Cotard, etc…) One wonders what would have happened if Freud had been attentive to Cotard’s writings on the object in the delirium of negations, for instance, that would have been a remarkable encounter. Here Freud had been wondering about the nature of the object, of the “detritus object” (l’objet de déchet)…. Reading Cotard would have been extraordinary. It didn’t happen. So the two paths (psychiatry and psychoanalysis) kept criss-crossing over time, and here we are, a century later, living with this “near miss” (ce faux croisement). But we must accept to keep them both side by side, if not knotted, at least mutually irrigated.

            Like all disciplines, psychoanalysis has its cream pies, slogans and mistakes. And so, we’ve been encumbered by one sentence that Freud never clarified: “The object’s shadow has descended upon the Ego” (“L’ombre de l’objet est tombée sur le Moi”). That’s how Freud defines melancholy. Nobody has any idea what Freud means by that, but people love it as a slogan. That sentence is everywhere, just open a any journal, and you’ll find it with a thousand different translations and interpretations.

But this problem highlights the long peregrination of this difficulty that is naming, separating the object in psychoanalysis. What do I call an “object” in psychoanalysis? We’ll have to wait a long time, even with Lacan, for this notion to be clarified.

Let us be clear. I love reading Karl Abraham, as well the Freud/Abraham correspondence. It would be ridiculous to criticize them, one century later. Still, we must appreciate the position of the problem such as it presented itself. For instance, Abraham writes:


“It is now easy for us to circumscribe the task of an ideal therapy of melancholy. It would consist in lifting the libido’s regressive movements, and in laboring for its progression in the direction of a completed love for the object and genital organization.


Il nous est maintenant facile de circonscrire la tâche d’une thérapeutique idéale de la mélancolie. Elle consisterait à lever les mouvements régressifs de la libido, et à oeuvrer à sa progression dans le sens de l’amour objectal achevé et de l’organisation génitale.


Abraham’s idea is dead simple. He caricatures Freud and says: “All that’s necessary is to go through every stage of the foundation of drives (la mise en place du pulsionnel) (oral, anal, genital, etc..) If I do this in the cure of my melancholy patient, theoretically at least, I heal him.” Evidently, this never worked. But this should help you see what kind of problems arise when the original situation for the transmission of Freud is already off kilter. If a psychoanalyst today claimed he could cure melancholy patients, his colleagues would immediately assume he’d lost his marbles!

            The point is this: the original set up (la mise en place) using Freudian terminology, knowing that Freud had really disengaged from psychiatry, results in this kind of idealism which may have created some resistance in the transmission of Freud within the culture of psychoanalysis.

            Freud was very attentive to Karl Abraham’s arguments, particularly to a certain number of what he called “ubiquitous” arguments, meaning arguments that “work” with anything. I’m always amazed to realize that in each article published in psychoanalysis, you can find the terms “phallus,” or “noms du père”… It’s a problem, indeed. There’s a kind of “ubiquitous slogan” approach. One gets the sense that one single word works in every situation – which is a problem.

            Abraham used the term “sadism” a lot. We talked about the superego last time, and about the death drive. Freud refuses this. For him, the question whether there is or isn’t sadism in one form or another. But he refuses to consider sadism as the univocal source of melancholy. This is all the more interesting when, in fact, Abraham says “I cannot distinguish between obsessional neurosis and melancholy,” since there’s sadism in both. Freud responds, “That’s your fault, because you’re using too weak a word to describe the whole thing. You have to phrase things differently.”

            Consequently, Freud, in his own way, will look for a special status and ends up selecting the rather weak category of “narcissistic neuroses,” with the conflict between the ego and superego. Nowadays, we can admit that this conflict doesn’t suffice either to help us. It’s an interesting key, but it’s not helpful. It’s too vast.

            Earlier, I discussed the ego’s ideal (idéal du moi) concerning depression.  Well, when you read Freud carefully, you realize that even after 30 years, Freud struggles to separate the superego and the ego’s ideal (idéal du moi). He uses words to separate two instances, yet struggles to define these instances. So it’s likely that the superego engaged in melancholy isn’t superimposable onto the superego as the ordinary companion of the ego’s ideal (idéal du moi) in neurosis, for instance. It’s not the same. If hatred and debasement (la néantisation) can deploy without resistance, it is because we are, from a clinical standpoint, in a different zone, the one in which the “death drive” seems to reign in a curious, almost unknotted manner. Freud proposes the term “death drive” rather late. This expression will cause as many issues as the elaboration of the Real (le Réel) did with Lacan, the same type of renunciation and the similar wish among many psychoanalysts to bring everything back to infamous “reality” (la fameuse réalité).

            This is where we stand currently. That’s why I suggested you do that work at the end of this seminar. Because what we could call “the slow dismantling of psychiatric nosography” (“le lent démentèlement de la nosographie psychiatrique”) didn’t spare Kraeplin’s manic-depressive insanity. Today, you use “depression.” but sometimes also “mood disorders” – without any connection to the Greek concept of humor (uttered, therefore, without any sense of culture), or specter-like terms, like “bipolar” or “unipolar.” Gradually, before our very eyes, these entities are losing their homogeneity and specificity on account of the considerable extension of these terms in common usage. France is the champion of anti-depressants, as you know – in all of Europe. And this fact doesn’t seem to worry anybody, perhaps because that’s what keeping the industry alive. It creates jobs, as always… Still, it’s astonishing. Despite the fact that the Germans and British are more Americanized than we are, their statistics for anti-depressant use are significantly lower. And no one really understands why. So, we’re facing a rather disconcerting use of these terms (mood, depression, bipolarity), and this should alarm you. Or rather, not “alarm” you, but you should definitely remain vigilant even to your own use of such concepts, because entire populations can fit into these terms if you’re not careful.

            The separation between mourning and melancholy is dissolving. The difference wasn’t obvious for Freud, but at least he named it. For Freud, this separation was incomplete. But the title itself, “Mourning and Melancholia,” pointed to the separation itself by naming both rims. Freud is warning us: mourning is a form of knowledge; melancholy is a different thing. Even if at the end of his work, we remain unsatisfied in a way, we’re not entirely convinced. But the idea remains, and the question remains open.

            Today, I’m stunned that people in mourning are being prescribed anti-depressants. It’s unbelievable! A patient in mourning comes to see you, and they’ve already been prescribed anti-depressants and anxiety medication! So as a clinician, you ask: “Couldn’t this wait?... Couldn’t you wait for your sorrow to pass..?” Because there are other words than “mourning.” “Sorrow,” “sadness”… Evidently, if you lose someone you love, life isn’t going to be fun for a while. But to go so far as calling that period a “depression”…?! You see the corrosive effect of this clinique both on our solid psychiatric tradition and in the epistemological rift introduced by Freud – all this forming a kind of continuum, a specter of the so-called depressive illness.

            What’s strange is that I’ve never said “depressive illness,” for instance. We never used to use that term. We would say “depressive state,” which implied that you were going to treat someone for a certain period. I hardly prescribe medication anymore. But when my activity was more intensely psychiatric rather than psychoanalytic, like all my colleagues, I prescribed medication for depressive states for about three months; and if the depression was rather robust, perhaps three additional months. But we never prescribed medication for more than six months! That was unheard of!

            Then one day, someone said: “No, you’re all mistaken. These aren’t depression “states.” Depression is an “illness,” like diabetes. So why stop the treatment? If someone has a depressive “illness,” there’s no end in sight! As clinicians, you see patients who come to you with already 5, 6 or 7 years of medication! Seven years of continuous medication – continuous because, of course, they’re “ill.” See how signifiers work, how interesting these shifts are? All you’ve done here is withdraw the word “state” (so a “moment,” with a beginning and an end) and replace it with “illness.” And if it’s an “illness,” I can never know when it might stop, begin again, etc.. so I just keep on prescribing. That’s an incredible revolution in terms of practice. We can’t even say it’s a theoretical revolution, since there’s no theory behind any of this. But what a change in people’s lives! Including in the lives of children…

            So, getting back to manic-depressive psychosis… The field of psychology is subject orientated (clinique du sujet). Stated differently, this means that we generally situate our action in the field of humanism. We aren’t treating this or that illness; we’re treating this or that particular and singular individual, a particular and singular subjectivity. That’s what interests us – singular encounters. We’re not interested in words like “schizophrenia”… We’re interested in this person, who is also a schizophrenic, and that person, etc… Between two schizophrenics lies an entire universe. Every single one is different. We try to insure that psychopathology remains a clinique of subjects (clinique du sujet). However, it’s not that easy to catch a subject! Our only means is to use empathy or “viscous” feelings (les bons sentiments) – except if you undertake this long and difficult labor of trying to see the choice of objects (les déterminations objectales). That’s what the aliénistes tried to do, and that’s what Freud did. He asked:

Which object guides this particular subject?

Which cause pulls him or her forward?

What moves a dream, a symptom, a neurosis, a phobia, a perversion, etc…? What is it? You can see these questions in the slow and wondrous work of the classical aliénistes (you heard the beauty of Cotard’s description of the patient becoming the object itself). We could conduct the same kind of work with mental automatism (l’automatisme mental) and hallucinations. What kind of object is the voice? It’s an incredible clinical experience, when the voice talks about the subject in the place and in the name of the subject! One can ask, of course, what kind of object this is? Throughout the history of psychiatry, you’ll find what I call this slow work (ce lent travail), up until, say, Henri Ey who wrote some fantastic treatises, like the Traîté des Hallucinations. Afterwards, Freud and those who continued his work took these questions very seriously but they used different semantic categories, reflected in the three questions I just asked about the relationship between subject and object.

With “manic depressive psychosis,” the risk is the disappearance of the fantastic effort to elaborate within the psychoanalytic field of this “clinique of objects,” which is the only guarantee of a place for what psychoanalysis and humanist psychiatry calls “a subject.” Otherwise, you won’t know how to “do” a clinique of the subject.


 I don’t want you to leave depressed from this seminar.

My goal wasn’t to sadden you. There’s no resignation in our professional field, you know, no reason to give up. We make fun of Americans, but every ten years, they renew themselves, with follow-up studies, epidemiological studies, etc…Our American colleagues are telling us that the situation over there has gone too far. The status of what we call “psychiatry” today is being questioned. It’s very important that even a small school like ours continue to exist, and to ask questions of the highest orders, to work with words also. I’ll give you an example.

Recently, I was with some colleagues in psychiatry, and I asked them questions about the nomenclature. Because, of course, you do remember that it is people, psychiatrists, who write manuals like the DSM… It’s not done by computers, yet. So I asked: “Why did you withdraw terms like “mania” and “melancholy? Why was it so urgent to delete these terms..?” One of them replied: “You know…You like these concepts and words, but they’re all antiques now… Who cares? What’s the problem?” So I responded: “That’s very interesting. You, psychiatrists of my generation, you tell me these terms are obsolete “antiques”… But when someone organizes an exhibit in Paris on melancholy, the success is without precedent. People come in herds to visit this show, they bring their families. Everyone has come to think about melancholy… There were dozens of press articles; people were fascinated. What a paradox! In the very field that is ours, colleagues says “this won’t interest anyone,” but in the open, cultural field, it’s very clear that people are vividly interested.

Melancholy may bore some psychiatrists, but not regular people.