For Lacan, human subjects construct themselves through language. One of the chief goals of Lacanian clinical practice is to create a space wherein the patient can experience and release jouissance through speech without the disintegration of the his or her sense of self. The analyst will then determine where a patient lies on a diagnostic continuum—neurotic (obsessional or hysteric), perverse, or psychotic.
Psychotic patients, according to Lacanian analysis, are most greatly disconnected at the level of language, or the symbolic. The Lacanian analyst works with the disjointed speech of the psychotic to allow him or her to live within and to express, through language, the world of signifiers without significant discontinuity.
The perverse patient, on the other hand, is often drawn to a fetish object. The fetish object is a compliant one, and it allows the patient to experience jouissance without having to relive the experience of castration which was attendant upon the "Father's 'No.'" The perverse patient engages in an act of substitution, whereby a complicit object grants a sense of release—a real or simulated experience of jouissance—while allowing him or her to avoid the painful sense of separation from the Other, or the presymbolic mother.
The obsessional neurotic fears loss of control. Obsessional neurotics struggle to control and contain the upwelling of desire and the accompanying experience of jouissance. The obsessional neurotic speaks the language of mastery and order and attempts to exercise control well beyond his or her purview. The analyst is sensitive to dichotomizing tendencies in the patient's speech (order and disorder, right and wrong). According to Lacan, the patient's fantasy is that the upwelling of jouissance will alienate those around him or her and leave havoc in its wake. The analyst works with the obsessional neurotic to help the patient meet his or her needs without limiting defenses—to experience and speak desire without the fear of losing self-control.
Hysterics experience a deep and debilitating sense of lack which leads to a feeling of alienation from the Other. Once the hysteric obtains the imaginary object of the mother's desire, he or she wishes to be rid of it— sometimes almost violently. The goal of Lacanian analysis when working with hysterics is to move them beyond the dichotomy of having/not having, to help them to achieve satisfactory levels of comfort with themselves, and to find a neutral space where the sense of lack is not all-consuming.
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