.........James E. Gorney

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Lacan brilliantly and incisively maps for us the unfolding dialectic of Dora's treatment with Freud. On the path toward realizing and recognizing her truth, symptoms are deciphered as "symbols written in the sand of the flesh" by virtue of the analyst's dialectical acuity and his speaking from the place of the Other. This is by and large the case until Freud, in a state of counter-transferential perplexity and denial, and unwitting identification with Herr K, finally swallows the imaginary lure which has been dangled in front of him by the patient and thus joins with her in a struggle on the field of the imaginary. The patient's sudden transferential exit from the treatment can thus be understood dialectically as a stagnation engendered and abetted by Freud's sudden abandonment of being in the place of the Other and engaging at the level of an ego-to-ego struggle for recognition.

Such instances of stagnation are common, as we are all aware, in analytic practice. Indeed, there is a vast literature on "stalemate," "impasse" and "unanalyzability." As with Dora, Lacan has a great deal to offer the clinician here when he suggests that it is the failure of the analyst to maintain neutrality and access to the symbolic order which engenders, amplifies, and sustains malignant transference reactions. Lacan asserts:

"There is not progress for the subject other than through the integration which he arrives at from his position in the universal; technically through the projection of the past into a discourse in the process of becoming." This is the process which was aborted for- Dora via the analyst's counter-transferential entanglement in the imaginary, as it still is for many patients.

I would now like to cast a bit more light on how the dialectical realization of the subject can be thwarted or facilitated by the analyst. Toward this end, before returning to Dora, let me share with you the dilemma of another young female patient -- List.

List had been in treatment for three years with a young analyst in training when a serious impasse developed and the case was brought to me for supervision. The patient's main complaints since her early teenage years centered around powerful suicidal feelings and impulses. Indeed, for many years she had often ruainated on the troublesome and paradoxical thought, "I might as well kill myself since I already feel dead." Over time, her emotional and social existence had assumed the quality of the stable pattern of instability characteristic of what is now glibly called "a borderline state" -- which really means, as Andre Green has observed, a state of being which is at the borderline of an analyst's understanding and technical competence.

In her late teens, Lisi had engaged in a four-year traditional analysis with a well known Freudian analyst. After a long period in which she felt dazed and could think of nothing to say during the sessions, while the analyst confronted and berated her in regard to her "resistance," she decided to terminate suddenly and left the analyst's office feeling "spaced-out" and "dead." She then walked out onto the busy city street, and woke up the next morning in her apartment alone, having been raped, beaten and robbed -- with no memory of what had happened or with whom. The results of her analysis did not exactly inspire her with very much hope for the future or confidence in regard to the analytic process.

Nevertheless, for some inexplicable reason, she went on to become a psychotherapist herself -- although of a non-psychoanalytic orientation -- and by all reports, a reasonably competent one. The recurrent feelings of being dead persisted, however, and she entered treatment with the analyst in training. The work proceeded on a primarily supportive and superficial level for three years, with efforts directed at, in the words of the young analyst, "strengthening the patient's ego" and "building an intimate relationship." Xet, the recurrent thoughts of being dead never entirely disappeared and always seemed to be lurking just around the corner. Then Lisi began to complain of malaise; she quit her job at the clinic where she worked; her medical insurance was terminated. Over a period of three months, she claimed to be unable to pay the bill. All interpretations by the analyst in regard to resistance were to no avail. There was much anger, frustration and mutual recriminations. Increasingly, all talk focused on a struggle over the bill. There were long periods when the patient had nothing to say; there were threats of her leaving. It was at this juncture that the analyst in training consulted with me.

The analyst was open and gifted -- so I encouraged him to extract himself from the struggle over resistance and counter-resistance and rather to begin listening resonantly to the patient's discourse. It shortly became clear that the word "bill" was being employed by Lisi in a supercharged manner scores of times each session. Then she began a tumultuous relationship with a young. man, not surprisingly, named Bill. Just as we began to focus in the supervision on this curious conjunction, for the first time in several months, List reported a dream:

"It was the holocaust. I was out on a date with Bill. I was in conflict -- I couldn't decide whether to stay with Bill or come to my session to be with you. I felt paralyzed and woke up thinking that maybe I should just finally do it and kill myself." The analyst, in a moment of epiphany, responded, "You're in a conflict over whether to keep struggling over a bill, or whether to speak of yourself to me. In your dream, there is a holocaust;

but what is the whole cost?"

Stunned, List reported the following story. Her mother had grown up in Germany, the daughter of a wealthy and conservative Jewish family. The mother was troubled and during her own adolescence began to see an analyst. Yet, this was accomplished in secret because her parents disapproved of such a radical enterprise. The analyst, an older woman, waived the fee, saying, "Someday when you are rich and famous, you will pay me back."

Then came the holocaust. List's mother escaped to America and then she tried to arrange for the escape of the analyst, who was also Jewish. However, the analyst was arrested by the Gestapo and disappeared forever, no doubt perishing in the carnage of one of the death camps. Lisi then paused in her narrative and said, "So my mother got married and had me -- and named me after her analyst whose name also was -- List." Then, with tears streaming down her 'face, she remarked, "That's the whole cost."

This revelation then led to many subsequent sessions in which the dialectic brought to light many facets of a long-buried family history. Lisi began to recognize and realize herself in the dialectical context of the transmission of an unpaid debt -- and the guilt engendered by it. This is what the patient had been trying to communicate in the impasse over the unpaid bill. Indeed, she said, "Being in debt sounds like being dead."

In the Antigone of Sophocles, the most malignant curse, the most horrendous imprecation of the ancient Greeks, is uttered -- "May you die and disappear in an unmarked grave." Why did the ancient Greeks consider this utterance to be so fearful? Lacan has alluded to the fact that it is only an inscribed marker, a tombstone, which insures the transmission of each of our names when we slip into the biological oblivion of death. Without our name, our personal signifier, remembered by succeeding generations, we disappear from our insertion into the symbolic chain of human experience. All we can hope to leave behind after death is a word, a name. It is the preservation of this personal signifier which insures our entry into the symbolic order.

In Lisi's treatment, the words "Bill" and "Holocaust" were signifiers functioning as nodal points or switch words. Through the therapist's resolution of countertransference struggles within the imaginary, resonant access was gained into an associative linguistic chain leading back ultimately to the discovery of an unburied corpse. This corpse, linked to the patient by a name, had been previously incapable of being signified within the dialectic of List's analytic discourse. At the same time, it had haunted her, unsymbolizable in the Real, throughout the course of her life, perpetually lived within the shadow of the unburied dead.

How, then, may this brief vignette shed some light upon the dilemma of fraud and Dora? It suggests that impasse, stalemate, or negative therapeutic reaction may all be instances of dialectical stagnation, engendered by the analyst's countertransferential elision from the place of the Other to the register of the imaginary. Freud was unable in 1898 to recognize this lapse for what it was and re-establish analytic neutrality, the place of the dead, faced with the immediacy of Dora's intense transference. When a transference/countertransference relationship becomes lived out in a two-body, ego-to-ego struggle, then therapeutic discourse becomes a two-way litany of empty words. It is at this point that impasse (as with Dora or List) is likely to occur.

However, it was the genius of Lacan to recognize that psychoanalytic impasse contains within itself the seeds of its own dialectical resolution.. Resolution can occur when the analyst becomes finally able to facilitate thf patient to speak from the place of the Other, making possible an entry out of the imaginary into the symbolic order. It is only through recognizing and disentangling himself from the imaginary identifications of his own countertransferential struggle with the patient that the analyst can permit the Other to be heard, a symbolic third dimension which can transform the frozen discourse of impasse. In the words of Lacan, "In order to free the subject's speech, we introduce him into the language of his desire, that is to say, into the primary language in which, beyond what he tells us of himself, he is already talking to us unknown to himself, and in the first place, in the symbols of the symptom."


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