CHAPTER TEN

A Lacanian approach to clinical

diagnosis and addiction

Rik Loose

owards the end of his Civilization and its Discontents Freud

T poses a question which he feels he cannot evade. After

contemplating the similarities between the development of
civilization and the individual he wonders whether it is possible to
make the diagnosis that "under the influence of cultural urges,
some civilizations, or some epochs of civilization-possibly the
whole of mankind- have become neurotic?" (Freud, 1930:144). He
immediately points out the danger implicit in making this kind of
diagnosis by saying that "we are only dealing with analogies and
that it is dangerous, not only with men but also with concepts, to
tear them from the sphere in which they have originated and been
evolved" (Freud, 1930:144). This is a very important remark.
264 LACAN & SCIENCE

to both the area explored and the area from which the concepts hav
been borrowed. When concepts and theories are transported fro
one area of study to another, they sometimes undergo radk
changes depending on the object of study and the context they hav
been taken from. This process can lead to confusion and th
criticism that this new application is based on a misunderstandin
of their original meaning and application. This form of criticism
grounded on a particular conception of science which suggests th
concepts refer to a particular reality or to particular objects in
straightforward and unproblematic way: concepts belong speci
cally to the objects or reality studied and should not be detache
from them and deployed elsewhere. The foundation for th
conception of science is a belief that nature contains laws and a
order which exist independently of the researcher. Lacan calls th
laws and the "order of things" in nature, which supposedly ex
independently of the human subject, a "knowledge in the real
This Lacanian conception of modem science is crucial. It evokes h
remarks on the subject of science from "Science and truth". H
indicated there that modem science, which was born in the 17
century, was the precondition for the discovery of the subject
psychoanalysis (Lacan, 1966:6-7). How are we to understand thi
Knowledge which exists in nature presupposes a subject for who
this knowledge is meaningful. It also implies a subject who has
desire to know this knowledge. This subject is called the "subject
science" and it is the subject upon which psychoanalysis operate
Modem science made the decision to find certainty in the object an
concentrated its efforts exclusively there. Freud discovered, unde
lying this search for certainty, a doubting subject and set himself t
enormous task of studying the relationship between this subject an
the object. In this task he stumbled upon the problem of meanin
and language as the elements which connect the two, but which al
obscure their relationship at the same time.
Towards the end of the 19th century Freud realized th
language is an important part of the human psyche. He observ
that the psyche is structured and that using language in certa
ways can establish a change in people. Asking people to "fre
associate" he found the focus and emphasis of their speech to
forever shifting. One thing would always lead to another, nev
settling onto something specific. Freud had cliscovered displaceme
is lost when we have to tear ourselves awa
origin; it represents an original satisfaction th
can be represented initially in hallucination
words. Freud had no conceptual tools at his
these discoveries in a theory of language;
include the subject and this object. Not that th
in his life-time, he just did not know about it. I
the object, the subject and language have far re
for our understanding of science and the que
clinical work.
The relationship between the subject of sc
object of study is of an impotent nature, becau
step in scientific research leads to the further re
instance, advances in neuroscience and neurop
only seem to lead to the discoveries of ever mo
and newer forms of interactions between them
discoveries take us any further in our understa
of psychopathology'> But that is not all. The
science retreats, the more the subject of sc
forward. TItis situation is absolutely antithe
scientific objectivity. A remark by John H
Neuropharmacology at Cambridge University
illustration of this point: 3

You know you have to be convinced, you rea

convinced in science that you are right. lhls
impartial scientist assembling facts in order to
esis is absolute balderdash. Karl Popper coul
further from the truth. You have got to be co
think most scientists are deluded. [Healy, 1996:

We could conclude from this remark that, as

does not have much time for the painstaking a
of gathering data using the empirical method
research, which according to Popper, should
one's scientific work providing that this hap
continous falsification of hypotheses. The imp
266 lACAN & SCIEN CE

remark are that scientists can be convinced about the truth be

research is done and that science orily has to prove that they w
right in their conviction. Objective science, in that case, is only a ma
of what the subject of the scientist intuitively knows already.
The history of psychiatry in the 19th and 20th centuries is
history of the continuous attempt and failure to isolate
functional area of the psyche which would give a conceptual u
and clarity to the differential clinic of psychopathological clisorde
This failure causes psychiatry to revert back to the relative securit
nosological systems and classifications which are meant to gras
clinical reality. The security provided by nosology and classifica
is the illusion of control and mastery over something which
unknown or not understood and it is indeed an illusion beca
nosological names never correspond to empirical reality; in fact t
rather obscure that reality (Verhaeghe, 1994:62). The latest
perhaps best known of these classifications is the DSM system (I-
The Dmgnostic and Statistical Manual of Mental Disorders. In rela
to such diagnostic classification systems, Dany Nobus writes:
The categories of mental disorders included in the diagnostic
manuals function as prototypical examples of states of psychic
illness that can be detennined through observation and deduction.
Nevertheless, the univocal empirical recognition and delineation o
mental disorders remains a psychiatric sign, since a perfect
objectivity and a fully adequate categorical system are impossible
to realize. Current diagnostic systems for mental disorders have
many epistemological shortcomings, which are often acknowledged
by psychiatrists themselves, but they continue to be used, in many
cases because professionals are convinced that there is nothing
better available. Of course the question is what this better thing
would be: a more guaranteed objectivity through a system with
more or less differentiations, or a radically different approach?
[Nobus, 1997:53]

It is very important to look at the possibility of developin

radically different approach to our understanding of psychopat
ogy and especially to addiction (as one of the manifestation
psychopathology) which, of all the mental pathologies, is argua
the one that occurs most frequently. This radically diffe
approach is a necessity, because the attempt to find certainty
the object (of clinical reality), through naming and categorizat
will only lead to a further retreat of this o
separation between subject and object. But ther
of hoping that a similar epistemological shif
psychiatry and psychopathology as took place
towards the end of the 18th century.
Positivist science, which depends on the
and classification of empirical reality, neverthe
properly constituting itself as a science, it w
transition as that which characterizes the em
clinical medicine. That means that it hope
classification of observations to the postulatio
functional dynamic of which these observation
manifestations. What the history of psychopa
oscillation between elaborate classification sy
DSM, and the attempt to isolate from this a dif
on functional unities. Up to now, this atte
differential clinic based on functional unities
itself in the domain of psychopathology.
Paul Verhaeghe has divided approaches to
the 18th and 19th century into two broad ca
1994:74-97). I will outline some aspects of
because in some respects the ideas put forwa
but untranslated Dutch text, converge with the
sketched and, more importantly, will lead to
Verhaeghe makes a distinction between what
dream of positive-science" and the "moral tre
The first is the paradigm of reductionist m
roots that go back to Democritus who postulate
be reduced to fundamental particles. The basic
by Bayle, is that every psychopathology shou
organic cause (or be based on a disorder in on
unity) and should therefore be organically trea
discovery of neuraleptica in the early 1950s gav
idea of organic causation. The logic was as
substances can have an effect on pathological
cause of this behaviour must surely be chemical
of the consequences of this scientific way of
subject is excluded. The illness is defined as a no
the patient is only its vehicle. In fact, even as a
268 LACA N & SCIEN CE

an interference in the understanding of the nature of the disease.

subject is a passive victim of an organic agent and carries
responsibility whatsoever for his or her mental problem or dise
The second paradigm, the moral paradigm, has roots in the
century before Christ when the sophist Protagoras postulated
all perceptions could be reduced to their subjective determina
and can therefore only contain an individual truth (for instance,
people seeing the same thing does not mean that they experien
in the same way). Despite this position, Protagoras does accept
certain perceptions are better than others: the perceptions of hea
people are better than those of sick people. Better perceptions
those that have better factual consequences. This leads to a para
involving the simultaneous claims that perceptions are always
jective, and that some perceptions have better "factual" (objec
consequences than others. The inevitable consequence of
paradox is that, despite the aspect of subjectivity, one depend
an authority, or a master who knows, for knowledge about
difference between good and bad perceptions. The rele
consequences of this concept were the special institutions crea
such as psychiatric asylums and hospitals which were headed
master or "chef de clinique" who would know what is good for
patient. Essentially, diagnosis and treatment within the m
paradigm come down to this: people become mentally ill as a r
of sick-making perceptions or ideas, and treatment is done in a hea
environment with the help of a masterful figure. In other wo
treatment takes place within a discourse in which there is no place fo
choices, desires and responsibilities of the subject. This paradigm is stro
reflected in today's social/psychological approach.
It is striking that both paradigms rely on external factors. In
first paradigm the subject is the victim of an organic factor an
the second paradigm the environment is responSible for
problem of the subject. Consequently, this subject is an "acciden
component in the therapeutic mechanism and the treatment t
place despite his or her responSibility.
But psychopathology has not managed to reduce itself in
stable way to the functional systems of the brain and their disord
nor has it managed to grasp clinical reality in a perfect
unequivocal language, reminiscent of the famous statement of
18th century sensualist Condillac, who said: Une science parfaite s
above all, is the constant attempt to exclu
subjectivity (of both clinician and patient) from
Psychopathology tries to find certainty in an uns
and in the process it manages to ignore the
subject and object and between subject (of the c
In terms of a scientific conception of ps
treatment of psychopathology, the aforemen
including classificatory medicine and func
medicine-have in common the fact that the su
and clinician) stands excluded in relation to th
relation to the treatment. That surely must
because is it not the subject who is happy or
pleasure or pain, who suffers or manages to av
to die and accept this or not, who will be
otherness of-and within-the Other sex, and, w
only one who knows- whether he or she is co
or not-the true nature of their relationship
feelings, thoughts, experiences and responsibili
that these thoughts, experiences and their ca
dently of us? Or can we be told precisely how
live with- these experiences by persons who
experiences themselves? What is interesting abo
that they defy both an objective and a moral a
demand an ethical response. For instance,
positively known nor is it good or bad. All w
will have to come to terms with the fact that
that that fact is beyond good or bad. The ethica
subjects to reconcile themselves with this fact
successful outcome of this process, because su
reached an external objective or ideal.

The Freudian Intervention

Freud shifted emphasis from the eye to the

practice. The difference between seeing and
270 l ACAN & SCI ENCE

enormous. What you see is what you see, but when you listen you
can hear things. Things that are hiddeI1' from the eye, things that
have mearung or- when not understood-can cause distress. What
Freud heard was that mearung is not always obvious, nor the
language that produces it. Freud heard the existence of the
unconscious. This discovery of the unconscious allowed him to
generate a psychopathological clinic based on the dialectical
interaction of subjectivity and clinical structure, thus undermining
any attempt at strict differentiation and separation of subject and
object in the psychoanalytic arena. This dialectical interaction
transforms the classical psychiatric nosography and provides it
with the possibility of a theoretical unity. This is however a form of
unity that is not acceptable to the pretensions of objective and
empirical science who prefer instead the unity of the observable
object and the unity of word or concept and thing. The preference
for this kind of unity in objective and empirical science, so prevalent
also in the domain of psychiatry and psychopathology, has led to an
impasse, especially in the area of clinical diagnosis 6 The failure to
create a diagnostic system that classifies symptoms and syndromes
of mental disorders on the basis of a precisely locatable causation, a
uniform etiology and an accurate prognosis for each disorder, i.e.,
the failure to create a diagnostic system that matches up perfectly
with clinical reality, has become blatantly obvious in clinical
practice. Moving away from diagnosis and treatment, psychiatry,
to a large extent, has become a practice of patient management and
patient care. And where this transformation has not taken place
(yet), psychiatry and clinical diagnosis are largely a practice of
intuition based on personal experience. Verhaeghe writes:

Every clinician has experienced in his life a certain amount of

anxiety, depression, relationship p roblems, problems in growing
up, etc. As long as w hat he encounters in his client is situated within
the limits of his own experience, he will consider this more than
likely as "normal". However, if w hat he encounters in his client is
situated outside his quantitative field of experiences, he will
suddenly diagnose it as pathological and if it is situated outside
his qualitative field of experiences, the diagnosis will become
psychosis. [Verhaeghe, 1994:35]

There are simply no absolute criteria available that would neatly

normality and abnormality- is based on the fact
outside language that can guarantee the ab
truthfulness of these criteria. Therefore the un
category (or concept) and clinical reality (o
established. There is no a priori corresponde
orders. In psychoanalysis there is really only on
or one criterion for truth, and that is that the
subject in language entails the confrontation of
trauma of a lack. All subjects, in their own way,
with that fact. Everything the subject does, wh
outside language, is to be understood as the atte
trauma of the lack.
Considering the impasse in clinical psyc
pathology in terms of failing to develop a
diagnosis and treatment (in psychiatry treatme
dependent on making the correct diagnosis), it
to look at the possibility of applying the
psychoanalysis to the clinical area of addiction
area is it more obvious that the relationship
object can be very problematic and extremely
reason it makes sense to apply a theory that is b
ship between the subject and object and to appl
that centres around the different structures, m
that characterize this relationship. For insta
establish a differential diagnosis of perver
description and classification of sexual beha
quences and the contexts in which they occ
precisely because it ignored the clinical structu
between the subject and the (sexual) object (N
Ternrnerman, 1994:126, 127; Verhaeghe, 1994
reason why it makes sense to consider the p
psychoanalysis can make to the area of 'ad
contributions made by objective and empirical
have so far only led to unsatisfactory results th
inconsistency. A coherent diagnosis of addic
272 l ACAN & SCIENCE

description of addictive/compulsive behaviours (drug taking,

alcohol consumption), the addictive/toxic characteristics of drugs
and alcohol (and their effects on the psyche, soma and social
environment), and the course and development of the addictive
disorder / disease--has not been succesfully realized. Nor has it
been possible to establish a precise cause-and-effect relationship
between addiction and specific psychological characteristics, social
factors or medical/organic anomalies that can explain the phenom-
enon of addiction in a uniform way?
It appears that something in relation to addiction is indetermi-
nate. In other words, it is very difficult to positively define either
addiction or drugs themselves (including alcohol). Perhaps the most
commonsense definition of a drug is that it is a substance which
when incorporated produces alterations of the mind and the body.
1hls definition makes so much sense that it has no explanatory
value. Coffee, tea, tobacco, sugar, water, food, prescription drugs,
illegal drugs, can all be incorporated and may even act as drugs. A
lot of people are addicted to alcohol, but can we say that it is a
drug? Is it perhaps a poison, or a food? Particular drugs taken in
certain doses can become poisons but in other doses function as
remedies (Plato already hinted at this ambiguity of the pharrmlkon).
Does a drug become a medicine when it is made available only by
medical prescription (it seems that marijuana is now going to be
used for the medical treatment of glaucoma, whilst amphetamines
travelled the other direction by crossing over from being legal to
being illegal) and what exactly is the difference between prozac and
ecstacy besides the legal aspect? (Lenson, 1995:4). The history of
legislation of drugs shows that, in terms of function and effects of
drugs, the law is arbitrary. Despite these indeterminate and
undefinable aspects of drugs and drug-taking we definitely know
that addictions exist. The real problem is how to study them.
Empirical science relies for its assertions on statistically significant
data gathered from so-called representative samples. 1hls approach
is therefore never in a position to address the relationship between
drug (object) and addict (subject). A consequence of the empirical
method is the assumption that drugs cause uniform effects implying
that the effects are only related to the drugs and indeed have
nothing to do with the relationship between the object-drug and the
subject-user of the drug. Empirical science is forced, by its
 A LACANIAN APPROACH TO CLINI CAL DIAGNOSIS 273

methodology, to avoid considering the possibility that toxicity and

the effect of drugs are inherent to the subject. This conception fails
because drugs are profoundly ambiguous in both their function and
their effect. They can function as poisons or as remedies.
Concerning their effect, it is a well-known fact that drugs and
alcohol can affect people differently and can affect the same person
differently at different times. In other words neither function nor
effect is uniform 8 Objective and empirical research fails in the area
of addiction because the subject (yet again) throws a spanner in the
works. Or perhaps it is better to say that the subject is not allowed to
put in its spoke. Alain Delrieu, who published a very detailed study
of more than 400 written texts on addiction published in the 19th
and 20th century to which he gave the title L'Inconsistance de fa
Toxicomanie (The Inconsistency of Addiction), concluded: "Despite the
multiplicity of scientific disciplines which are interested in this
theme, it is actually impossible to respond in a straightforward way
to two questions which obsess the adult world, 'why do so many
young people take drugs?' and 'who are those who take drugs?' "
(Delrieu, 1988:101, my translation). In other words, addiction exists,
but there is no such person as the (typical) addict. This is precisely
the point Markos Zafiropoulos refers to with his book title The
Addict does not Exist." Despite the uniform social, legal and medical
manifestation of addiction, the relationship between addiction and
the subject is neither uniform nor predictable in any way. Listening
to the discourse of addiction is perhaps a way out of the impasse.
That means listening to the speaking subject who is addicted and
that implies a listening beyond a general symptomatology. But
what can we say about some of what has been heard so far?

Civilization and its toxicomanias-rudiments for a differential

diagnosis of addiction based on the concept of "administration"
In the very last pages of Civifiwtion and its Discontents Freud
diagnoses the disorder in human civilization in a way that would
not be acceptable to psychiatry. In his observation of civilization he
has come to the conclusion that it is an irrefutable fact that man
wants happiness, but cannot have it. (Freud, 1930:145). In other
words, man is destined to suffer. Earlier on in the article he wrote:
274 LACAN & SCIENCE

But the most interesting methods of averting' suffering are those

which seek to influence our own organism. In the last analysis, all
suffering is nothing else than sensation; it only exists in so far as we
feel it, and we only feel it in consequence of certain ways in which
our organism is regulated. The crudest, but also the most effective
among these methods of influence is the chemical one-intoxica-
tion. [Freud, 1930:78J
The connection, established by Freud here, between suffering, the
regulation of our bodies and intoxication is extremely interesting
and demands further exploration. The immediate context from
which this quote is taken is crucial for an understanding of the
problem of addiction in the field of psychoanalysis. I will therefore
explore this context in some detail here. Freud indicates that
suffering threatens us from three directions: our bodies, the external
world and our relations to others (Freud, 1930:77). This last source
causes us most suffering. Isolating ourselves from others is thus one
solution to our problems. Drugs and alcohol can provide us with
pleasure, but they can also render us incapable of " receiving
unpleasurable impulses". These two effects appear to be intimately
connected with each other. Both the pleasure these " foreign
substances" can generate and the halt they can call to unpleasurable
impulses, whether they come from within or outside the organism,
are independent of the Other. Freud writes: "The service rendered
by intoxicating media in the struggle for happiness and in keeping
misery at a distance is so highly prized as a benefit that individuals
and peoples alike have given them an established place in the
economies of their libido" (Freud, 1930:78). Implied in this
statement and its wider context we already encounter the rudiments
for a possible differential diagnosis of addiction which is not based
on observation of empirical material, but is based on a certain
economy and distribution of pleasure and jouissance. The economy
and distribution of jouissance result from the constitution of the
subject in language (or the field of the Other). In an article entitled
"Libido and toxic substance", I have argued how the constitution of
the subject in language is able to represent " certain ways in which
our organism is regulated", how different forms of jouissance result
from this process, and how certain distributions of these forms can
lead to toxicity and indeed cause suffering, pain and anxiety (Loose,
1996:32-43). I will briefly outline that argument here.
jouissance, a kind of enjoyment that is different
of immediate experience and total vitality. The
Signifier causes a differentiation of jouissance. B
than that! It produces a subject, it allows this sub
turns the being of a real organism into a body
Freud's point of departure was that the constitu
subject is not a very successful process and Lac
that this failure also applies to the body. Langua
is structurally incomplete and because of that fa
only partially symbolized body in language. The
ized) parts of the body can become cause for su
sense they have a toxic effect. lo The use of drug
serve as an attempt to regulate this toxicity
important to note that the real toxicity is not situ
or drugs but in the body." The signifier also cr
subject by cutting him off from a primordia
characterizes the dual unity with the mother
oceanic feeling). This is known as symbolic ca
castration leaves the subject unsatisfied beca
something more than ordinary pleasure or jouissa
desire threatens to be realized, the subject will p
his annihilation. The realm beyond ordinary plea
the death-drive. Drugs and alcohol can functi
break with ordinary (thus limited) pleasure (or
and produce something more or indeed, occa
function as barriers against the lethal or toxi
ordinary pleasure which threatens to annihilate
latter case, the toxicity is not situated in the ch
subject. On top of this the introduction of the
speech which never reaches its full potentia!.12 F
it is inevitable that the subject not only desires
things, but will also suffer and experience anxiety
shows that in a Lacanian conception of the s
alcohol can function differently for different peop
relationship to jouissance, pleasure, anxiety, pain a
276 lACAN & SCIEN C E

undoubtedly the case that this has consequences for treatment, a

the effect of alcohol and drugs will be (at least to some degre
determined by the way they function for the subject.
Another important aspect of addiction, which Freud makes qui
explicit in Civilization and its Discontents, is his insistence on the fa
that addiction is a social symptom. He writes:

We owe to such media not merely the immediate yield of pleasure,

but also a greatly desired degree of independence from the external
world . For one knows that, with the help of this "drowner of cares"
one can at any time withdraw from the pressures of reality and find
refuge in a world of one's own with better conditions of sensibility.
As is well known, it is precisely this property of intoxicants which
also determines their danger and their injuriousness. [Freud, 1930:78]

Addiction as a social symptom creates a specific social bond an

forms a particular structure. All three clirtical structures of th
subject in psychoanalysis form social bonds and are relational
nature; they orient the subject in relation to the Other. These thre
positions in language represent three different ways in whic
subjects can manage with-or orientate themselves to- the origin
structural trauma or lack. If it is permissible to define the clirtic
structures (and addiction) with only a few words based not on th
results of psychological measurement, but on a structural concep
tion of the relationship between the subject and Other, then we ca
say the following:

Neurosis addresses the Other with a question. That means th

the subject has unconsciously accepted symbolic castration an
its consequence; it takes responsibility for the lack, it renounce
primordial real jouissance, puts up with ordinary pleasure an
with the inevitable guilt and anxiety.
Perversion dresses the Other with an object. That means that th
subject sometimes acknowledges the lack and at other time
refuses this. The mother is not lacking and in order to disavo
this fact (and ultimately symbolic castration), the subje
replaces the lack with an object. Primordial real jouissance
given up, but a particular jouissance related to a specific obje
comes in its place. Anxiety and guilt are often hidden an
therefore less obvious in this structure.
 and hallucinations. Arudety and guilt are
structure.
Addiction is an independence of the Other
\, relationship between the subject and the O
addiction is something else (and somew
castration and lack can be accepted, disav
the subject; addiction seeks administratio
are hidden at times, but paradoxically ma
(hidden) presence.

Administration refers to an important conce

value and clinical application are not imm
neurosis is based on the mechanism of repre
disavowal and psychosis on foreclosure, th
addiction on the mechanism of administration, o
considered to function at a different level than
Administration is not a mechanism that functio
subject; it functions at the level of the (social
does not imply that it exists without a relatio
The mechanism of administration does not de
subject is constituted in the field of the Other. I
the symptom functions in relation to the Other
that is dependent on the position of the subject
When I propose that addiction maintains an
Other, I imply that it is an attempt to adm
independently of the Other. Jouissance here ref
pleasure that makes life coherent (Freud's
pleasure principle) and to pleasure that is n
normal limitations of human culture or soci
coherent life (Freud's beyond of the pleas
dynamic tension between these two human te
of the failure of the pleasure principle and is fu
nature. It was already an object of serious c
Stoics and Epicurians (the two opposing schoo
278 LACAN & SCIENCE

in ancient Greece) and it lies at the heart of (the human problem of

addiction. The term administration is ased in three ways: (1) to
govern or regulate; (2) to manage as a substitute; and (3) to dispense o
supply.
Addiction can be related to the three clinical structures o
psychosis, neurosis and perversion. But it can also be related to
Freud's (often forgotten) clinical category of the actual neuroses
and that would make addiction a clinical entity which is separat
from the clinical structures and their symptoms. This clinica
category of the actual neuroses can also play an important role in
the development of a differential diagnosis of addiction 13 Th
chemical processing of actual neurosis is a fourth form of addiction
and it is a form of addiction that has its own relationship modality
vis-d-vis the Other. This relationship modality is characterized by
the independent adminstration of jouissance which functions as th
governing or regulation of an unbearable real; a real that threatens to
annihilate the subject in actual neurosis.14
In psychosis, the foreclosure of language (or the rejection o
symbolic castration) results in a position of the subject as an objec
or "Thing" for or in the Other. The lack, which is produced by th
constitution of the subject in language, is not produced for th
psychotic subject, precisely because he or she is foreclosed from
language. This psychotic subject will be confronted with a massiv
presence of the real; an unbearable "too much" of something. Th
defensive reaction of the subject against this massive immediat
presence of real jouissance, can take the form of a "suppletion
symptom" or what Lacan calls a "sinthOme" in Seminar XXIl
(Lacan, 1977:lecture of 18-11-1975). The other solution available to
the psychotic subject is to develop a delusion against th
massiveness of the real. A delusion is constructed on the basis o
language; it is a signifying system. But language function
differently for the psychotic subject than for the neurotic (o
perverse) subject. For the latter, language contains a structural lack
which makes the signifiers continually shift as the subject tries to
find certainty about a truth that always seems to escape. For th
psychotic, language (which is the material for the delusiona
system) has to be complete in order to form a defense against th
real. Language functions as a protective wall which is meant to b
impenetrable. That is why psychotics "know for sure". It is
or delusional system available, the psychotic
body will be completely at the mercy of t
overwhelmed or invaded by jouissance. This
(catatonic) form of psychosis. Here we find th
psychosis and addiction. In the event of the sig
function as a protection against the invasion o
always has recourse to the route of the body v
Addiction here is a form of management (of jou
with drugs and alcohol as forms of self med
encounter some of the chronic addictions.
In neurosis and perversion the mechanis
disavowal result in a fundamental dissatisfact
the pleasure principle. What lies beyond this
always "too much" and yet the absence of
"never enough", a plus-de-jouir (more-to-be-e
situate one of the few (maybe the only) refere
addiction: "everything which permits the esca
(to the phallus) is clearly very welcome, that
success of drugs, for instance; there is no othe
than this one: it is what permits to break the
Willie" (Lacan, 1976:263-270, my translation)
that addiction is an attempt to break away f
and an attempt to turn the pleasure princ
operation through the refusa l of symbolic c
form of the subject dispensing with the fa
principle by supplying himself with an addi
drug or alcohol here functions as an "objec
which allows the subject to avoid the always p
with the desire of the Other and sustains in h
is able to attain the lost "object-<:ause-of-desir
access to jouissance for the subject, enabling h
detour via the Other because it can be adm
therefore essentially oral in nature and dro
structured "formations of the unconscious"
280 LA CAN & SCIENCE

Despite the attempt of neurotic (and perverse) addicts to b

away from phallic jouissance in an act that takes place independ
of the Other, it is undoubtedly the case that this act is, at the
time, an appeal to the Other as it was the encounter betwee
subject and the Other that produced the dissatisfaction of haVi
put up with limited pleasure and desire. In other words, the a
neurotic and perverse addicts is an appeal to the Other in the
of a complaint. The discourse or speech of addicts is fu
complaints. A complaint is a question, a demand directed a
Other. It is a demand to be relieved of suffering; a demand for
a demand for a solution to the problem of desire. The complai
an expression of pain and suffering also contains an accusatio
an attribution of the cause of this pain and suffering to an ext
source. TItis external source is the Other. The human dilemm
that the Other is indeed the cause of the subject's suffering, bu
subject will always have to take responsibility for dealing and l
with this fact. Addiction, based on neurotic or perverse struct
attempts to avoid this problematic and fundamental hu
dilemma, by repeating this dilemma at a different level and
way which is utterly destructive. On the one hand addi
functions independently of the Other for the subject, whilst o
other hand the subject is dependent on the act of repetitive
taking. In terms of treatment, this act should be interpreted a
appeal for help and as an analysable symptom. The problem is
the independent function (vis-ii-vis the Other) of addiction cr
complications for the transference. Addicted subjects will ten
escape the encounter with the desire of the Other (which
therapeutic or analytic relationship provokes), by taking dru
alcohol in order to avoid the anxieties and uncertainties tha
inherent to the therapeutic process.
It is without doubt the case that these different form
addiction have implications for the direction of treatment. Th
the reason why a diagnosis of addiction which includes the su
is of crucial importance for intervention in the field of addiction
essential to know what we are dealing with and to that effec
need theory to guide a clinic that includes addiction. TItis is a
which allows the subject to find or create a different orient
towards jouissance and the real via the object and signifier o
transference. The only problem is that the real of psychoana
 such a thing as evidence an
at some of the facts of huma
observed. At times people a
doubt about that and this is
the very end of Civilization

Men have gained control o

that with their help they w
addiction
one another to the last m
large part of their current
of anxiety. [Freud, 1930:14
IieTFl[et"d as an
,l)rClblem is that We stated before that man
This is a fact observed by
obviously ample evidence
fact is theoretical. The reas
theoretically is that the ex
explain this fact. Freud's
irreducible real element in
pain and suffering. This rea
stake in science. This rea
science (statistics do not he
by giving the observed dat
the real of modern scien
nological products). The re
kind of knowledge or else
object in the real. But neithe
of the human subject whi
282 LACAN & SCIENCE

civilization. Lacan says: "It is clear that th~ knowledge imputed

something in the real, whether one calls that God or something els
has in no way anything to do with the knowledge wruch articulat
itself especially from litis, that there is a being who speaks" (Laca
1998:21, my translation) . Knowledge imputed to the real in scien
is not the knowledge related to the real of the unconscious of th
subject. The real of the unconscious has a relationsrup to meanin
because it wants to find an expression of an inexpressible jouissanc
This distinction between the real of science and the real of psych
analysis is essential and-paraphrasing Eric Laurent-it is extreme
important to convince science of the fact that there is another for
of real than the one of science (Laurent, 1998:42). This is the fact th
man has to be tom from rus place of origin wruch causes
differentiation in- and problematic distribution of-jouissance
the subject. Civilization is an attempt to regulate litis distribution;
is in that sense "a mode of jouissance, and even a common mode
jouissance, a systematical distribution of the ways and means
jouir" (Miller, 1998:25). There is no doubt about the fact that th
products and gadgets of modem science are very effective ways
producing, regulating and distributing jouissance.
Freud's theoretical explanation for man's incapacity to be happ
is that man is caught between an egoistic urge for happiness and
cultural urge for unity in human kind. Man is unhappy because th
latter urge has pushed the former into the background (Freu
1930:142,143). These two opposing urges represent the individu
and cultural super-ego (pp. 141,142). Freud's diagnosis that mankin
has become neurotic was based (as we stated in the introduction
litis chapter) on the influence of the cultural urges. In other word
man's neurosis and lack of happiness are based on the dominance
the cultural super-ego over the individual super-ego. Freud's cultur
super-ego is one that forbids, restricts, sets ideals, provides rules an
so on. It causes unhappiness because the demands of the cultur
Other force the subject to renounce its claim for individual happines
This does not seem to tally with today's preoccupation wi
happiness, enjoyment, (extreme) pleasure, individual lifestyles an
success. J.-A. Miller writes:

Can we speak today of a major neurosis of our times? If one was

able to do it, one could say that its principal determinant is the
Has the cultural super-ego (which Freud d
cause of our wlhappiness) been replaced by
perhaps that puts more emphasis (or even p
dual super-ego thereby demanding more hap
This would be a super-ego closer to the sp
Miller argues that the Lacanian super-ego
enjoy is the super-ego of our times. (Miller, 1
super-ego has taken place, this change shou
the development of modem science. Subject
more subjected than ever to gadgets and non-
enjoyment. An increasingly significant aspect
to do with the accumulation, control and d
objects. These objects are objects in the real. L
access to an aspect of the real via gadgets and
gadgets to the real because we do not const
enormous scientific apparatus which in itself
these gadgets. (Lacan, 1998b:12). Once initiate
can produce objects in the real in an auto
accidental fashion, that is to say, in a way th
desire of the subject. This has an important
remarked on by Marc Strauss when he claim
of the subject in science leads to the object r
outside signification of desire, but not wi
(Strauss, 1994:29).
In the 1950s such objects of jouissance valu
or less accidentally. These are the psychoph
scientific means to jouissance and the regula
psychopharmaca are extremely effective and
psychopharmaca supports the subject in te
about the Other which allows him to avo
unconscious choices and responsiblities. T
happiness by the Other of civilization. The su
to believe in the fulfilment of the promise o
feels tha t science owes him this happiness. The psychop
cologist Peter Waldmeier put it as follows:

So death or illness had another value for people a hundred yea

more back from now and they accepted illness and they acce
death. Whereas when the treatments became available, some h
were raised and people expected more and more from medicine
drugs. So in one way or another, people expected that wha
happens to them someone can help them and they can be ter
disappointed if they learn that in some cases this is not possib
think this is something new. The roots are probably in the availab
of treatments and the raising of hope. [Healy, 1996:571>-579]

The distinction between the real of science and the

psychoanalysis does not imply that one is without conse
for the other; it does not imply that there is no relationship b
these two forms of real. The scientific prod uction of ob
jouissance in the real can have a real effect on people. Th
become overwhelmed by this jouissance and they might
create different ways of responding to it. Esthela Solano
very interesting remark in relation to this. She said that
intervention is an intervention which forces the real of the sy
to respond differently and when one forces the real
symptom to respond differently, that is never witho
sequences (Solano, 1998:51- 52). In order to illustrate this
would like to conclude with two more quotes from David
book of interviews with famous and outstanding psychop
cologists. These quotes sum up concisely the arguments I h
forward in this chapter.

Pichot: Panic disorder was created in its present sense by Do

Klein on the basis of differential responses to drug therapy. H
written down in detail how he came to the idea that there were
distinct disorders in the anxiety neuroses, one of them, the a
episode he named panic, reacting to the antidepressant the
while the other component, basic permanent anxiety, did not.
true that the importance of a new disorder was later increase
world-wide trials of drugs, the result of which tended to influ
key people. At the beginning, many French psychiatrists consid
it as an Wlcommon disorder. But of course one finds a conditi
one searches for it. [Healy, 1996:12]
 demonstrable experimentally. [po591]

So how do we respond to the neurosis of our t

not fuel (psychopharmaca), to jouissance.
demanding" cultural super-ego has forced the
to respond differently, perhaps we can conc
symptoms of the neurosis of our times tend to
of addiction and toxicomania. That makes th
giving voice to jouissance even more pertinen

Notes

1. In 1916 Saussure's Course in General Linguistic

book he makes a distinction in language betw
and a layer of signifieds. Neither layer is stat
particular direction. The implication is simple:
signifiers and signifieds, or words and their m
word or concept refers naturally to a particu
Arbitrary means that the relationships between
have been agreed by convention. Saussm
characterizes signifiers is their difference fro
meaning can only be generated contextually
context of other signifiers on the basis of this d
moving material and it is set in motion by a la
functioning of language itself, i.e., the lack of u
2. Pierre Pichot, a professor in psychia try, fo
Association for European Psychiatry and a
psychopharmacology, said the following in a
done by neuroscientists is extremely impressi
but until now very little comes out of it in
concrete clinical applications" (Healy, 1996:17)
3. Although we must acknowledge immediately
this remark might have been entirely different f
4. Hughes also says that he recognizes that "there
286 LACAN & SCIENCE

do pose the questions and go about it in a logical way." Howeve

does not consider himself to be one of those. He knows that delu
are dangerous, but a good scientist should be able to recognize
(Healy, 1996:545).
5. See Foucault (1973) passim.
6. The preference for this kind of unity in psychiatry (and psychopha
cology) was expressed very well by Tom Ban, Professor of Psychia
Vanderbilt University, when he said: "The only reason to have con
is to be able to commW1icate, and if we have problems using a co
in comnltmicating, we might just as well throw out such a concept.
if the dismissed concept leaves a void one should replace it with
which corresponds more with the real world (Healy, 1996:595).
7. As an illustration of the failure to establish a coherent diagnosis a
willorm explanation for addiction the reader is referred to an exc
and detailed summary of the psychiatric classifications of addicti
Ylary McMurran (1994:19-21).
8. Freud was already aware of this lack of uniformity with the
cocaine in 1887. In "Craving for and fear of coca ine" he connect
irregularity of the cocaine effect to individual variations (Byck,
175).
9. The original title in French is: Le Toxicomane n'existe pas (Zafiropo
1988:1-106).
10. In Seminar XX, Lacan calls the jOllissance related to this real aspect
body, the jouissance of the body or the jouissance of the Other (L
1998a:4). He calls ordinary (sexual) pleasure or jOllissance: p
jOllissance (Ibid. 8).
11. A psychoanalytic conception of toxicity does not necessarily con
toxicity to be inherent to drugs or alcohol, but can indicate any
that is detrimental to the subject. Toxicity, in this view, is therefo
inevitable aspect of human existence. It is nevertheless something
which the subject has to distance himself as much as possible. To
in psychoanalysis includes the real (of the body), the realm of the d
drive beyond the pleasure~principle, but also, for instance, sugge
words spoken in a hypnotic relationship. See also in this respect S
Le Poulichet's excellent book Toxicomanies et Psychanalyse (1987:7-
12. This full potential is the ideal of communication which is the abil
say it all so that nothing needs to be said anymore.
13. From 1892 onwards Freud begins to develop a structural psychopa
ogy. On the one hand he establishes the psychoneuroses (initial
called these the neuropsychoses of defence) and on the other han
develops the category of the actual neuroses. The actual neurose
characterized by an anxiety against which the subject cannot d
 successful defence system against anxiety.
relative because psychoneurotics of course als
fact, to be anxious is even their hallmark. Ther
in quality: psychoneurotic anxiety is more c
whelming. Psychoneurotic anxiety is contained
or symbolic processing of an original trauma
The cause of anxiety is the same for the a
difference is that a symbolization or psychic p
trauma never took place. Actual neurosis is
neurotic development in the subject. The actua
reaction to the direct confrontation with th
processing is lacking in essential points. Th
continous processing of this traumatic re
symptoms (i.e., symbolically structured format
the drug The psychoneuroses are an attempt to cure the
connects the actua l neuroses lack this type of cure becau
(Byck, 1974: symptom. One way out of the actual neurotic
the organism with drugs and alcohol. This solu
the body, which manages to avoid the encount
proof. Any solution that is able to avoid th
lid IlSp..:t of the guaranteed fool-proof. The problem is that the s
(Lacan, heavy price. In order to maintain the solu
phallic addiction, because it is a solution without the p
chemical intoxication is not a symptom that c
consider therefore not be resolved. Some chronic addic
actual neurosis. Addiction can be found in all
and therefore addiction will acquire a function
~"'thting from in each of these structures.
Toxicity 14. The real toxicity in addiction, when consider
entity (by being related to actual neurosis), is n
alcohol itself, but concerns that jouissance of the
devour the subject when the phallic or sexual
is unable to contain it. In "Libido and toxic su
this case, addiction takes the fonn of a kind of "
or regulates, in a homeostatic movement, the
jouissance of the Other (Loose, 1996:40-42). A
(inibiallv he mechanism, replaces the function of the sign
hand he barrier against an anxiety which results from t
which overwhelms the subject when somethin
psychically processed or symbolized. This for
288 lACAN & SCIENCE

actual neurosis. Addiction as a separate clinical entity is not a matte

"not-having-enough", but a matter of trying to get rid of a " too-mu

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