Introduction to Psychosomatic Medicine: New concept of time. Overdetermination and multiple causalit
Rupture is the distance with the sensitive experience. Every time a new concept appears, there is a rupture. For example, Copernicus´revolution, is the moment in which Copernicus showed us that the perception from our senses is illusory.
Psychoanalysis produced there ruptures:
The center of the psychic life of the individual is no longer the conscience but the unconscious which not only over determines the conscience but also generates it.
Freud established a new level of objectivity, as the Psychoanalysis is a science of effects and not of causes. Positivist science says that if all the causes were known, we could know all the possible effects. As opposed to that, in Psychoanalysis, we take the very last effect from the unconscious work, the speech, and from there, we read all the operations and we build the determing cause: the unconscious.
Freud remarked the importance of sexuality. Sexuality to Feud is anything touched by the words: According to Freud, sexual is the trauma related to the ingress to the language. Human being ’s trauma is… to talk. Because we talk, we are going to die and we are going to rejoice. That is the disease of the human being: if we accept that we are going to rejoice and that we are going to die, there is no need to sicken from anything else.
Before the production of the unconscious, it was impossible to know anything about the unconscious reality, there was no scientific practice, it was ideological.
Freud in "Psychotherapy, treatment through the spirit" says, that after very sterile times, medicine made big process: understood the cells, the chemical mechanisms, the functions… All these findings were related to the soma of the human beings. This is why doctors were attracted to focus on the soma and abandoned the study of the psyche to the philosophers.
After the Psychoanalysis was born in 1900 with the Interpretaron of the Dreams, we can ask ourselves: what are the causes of that disorder which has affected the mood, perturbating the soma?
If every time a new concept is created, we put some distance with the sensitive experience, we could then think that with the concept of Unconscious there is a rupture in the History of Medicine. According to Freud: “Nothing occurs to the human being without an active role of his psyche”. All scientific progress happens by rupture. Sciences add up 1: rupture, does not mean to abandon the prior findings.
Psychoanalytic method, produces a new reality, something which was not there before. If we consider that the unconscious is somewhere, we could then think that the patient through free association could reach the Unconscious. However, Freud, in the Interpretation of the Dreams made it very clear that dreams have a sense AFTER the psychoanalytic interpretation. Dreams have sense and their sense is to fulfil wishes. The method in psychoanalysis, is a method of interpretation-construction, this is the only one capable to produced the unconscious. Why? Because we can not see the Unconscious, it is no where. We can only see his effects: a dream, a symptom, a joke, a slip… This is how the Unconscious “talks”. The Unconscious doesn’t pre- exit, it has to be built (by interpretation)1.
In line with this conception of production, we need to think (or rethink) some matters in traditional medicine:
In line with this conception of production, we need to think (or rethink) some matters in traditional medicine:
According to psychoanalysis, sickness is a process, there is not a prior status of health that the psychoanalysis is going to restore. The idea is to build a new health that was not there before.
The body, is also a production. Lacan in his work “ Psychoanalysis and medicine” highlights two key contributions of psychoanalysis to Medicine:
Discordance between demand and desire: Science is incapable (exactly the same as the subject he treats) of knowing what he wants.
Jouissance of the body: the body has been built up to experience jousissance. This dimenssion has not been taken into account at all by the traditional medicine. Jouissance of the body can not be mistaken with pleasure. Pleasure would be the least excitement, what makes the tension to disappear. This would mean that pleasure keeps us away from the jouissance. Because what we call “jouissance of the body”, is always related to tension, spending, effort, even feat. Doubtless there is jouissance the moment the pain begins to appear. Jouissance of the human being is the jouissance of a mortal subject and mortal does not mean that he is going to die but that he KNOWS he is going to die.
When the patient goes to see a doctor, he expects the doctor will remove him from his condition of being sick. However, with this way of thinking, we are not taking into account, that in most cases, patients are attached to the idea of keeping their disease. Between demand and desire, there is always a lack: when someone asks for something, this is not the same (and sometime it is just the opposite), as what he wants.
Many doctors can realise that the patient, beyond any appearance, does not want to heal. For traditional medicine, this is just intuition (they dont know the science nor the theory which supports it). However, Psychoanalysis as a science, has distinguished between demand and desire.
There are, for example, patients who have multiple unbearable muscular pains. After seeing many different doctors and trying several medications and treatments, all of them unsuccessful, finally one of the doctors concludes he does not want to heal. Apparently, the patient wanted to heal, and this is what he was requesting doctor after doctor, however, his desire was different from his demand. The doctor just tells the patient: “what happens is that you dont want to heal”. To his suprise, the patient gets irascible and answers back that the only thing in the world he wants is to heal. Facing a psychosomatic diagnosis, can cause the physician anxiety, because when telling the patient: ”look, there is no organic pathology, your disease is consequence of the somatisation of different psychic matters”, the patient would ask: “and what then?” and the doctor wouldn’t know the answer. Only, if we listen the patient like a subject with unconscious processes we can listen to him beyond what he says. It is not about making anybody aware. Each process, takes its own time. We can not do in one hour what we only know when it begins, each subject goes to his own pace.
Since the production of the concept of unconscious in the Interpretation of the Dreams, conscience is no longer the centre of the psyche. According to this new concept of psychic apparatus, the conscience becomes another perceptual organ (like the eyes, the ears…3) and the human being is led by his unconscious. This “new conception” of the psychic apparatus will allow us to understand the psychosomatic phenomena. Why? Because Psychoanalysis is not limited to the study of the disorders. Under the law that the mechanisms are the same in healthy and sick individuals, when Psychoanalysis works each of the psychic structures (neurosis, psychosis…) it explains what each of these structures tell us about the normal functioning of the psychic apparatus. The psychosomatic structure shows that psyche and soma are inseparable. Psychosomatic patients are the living example: if we separate them, we sicken.
Under normal circumstances, exactly because we cannot separate psyche from soma, all the stimulus that the apparatus receive, need to be elaborated via psyche and via soma. What happens in the psychosomatic patients is that to them, thinking is painful so they elaborate everything via soma. It has been said that Freud did not work the psychosomatic phenomena, however, we believe he made key contributions to the study of this structure in his work about actual neurosis and “Diferencial diagnosis with transference neurosis”. In these texts he explains that “the mechanism of anxiety neurosis consists in the deviation of the somatic sexual excitement from the psyche. This results in an abnormal exploitation of that excitement”. This is exactly what happens to the psychosomatic patient: he is incapable to symbolise, to transform the somatic into psychic.
In texts prior to the Interpretation of the Dreams ("Defense neuropsycosis, Phobias and Obsessions"…) Freud worked to distinguish actual neurosis (anxiety neurosis, hypochondria and neurasthenia) from transference neurosis (hysteria, obsessive neurosis and phobia).
In Psychosis and transference neurosis (hysteria, phobia and obsessive neurosis) symptoms can be studied using the model of the work of dreams —> there is psychic mechanism: condensation and displacement. We could say, there is fulfilment of wishes (like in the dreams 4). To understand and study actual neurosis, we cannot use the model of the dreams. Why? Because these neurosis are related to a history of encounters with jouissance. There is not psychic mechanism, in the sense that everything is elaborated via soma (as if separating psyche and soma was possible).
Health and disease criteria. Disease process. Understanding “health” as a production.
First of all we need to pay attention to the concept of “working”: working gives place to something which was not there before, something new. Since Hegel, the concept of experience is no longer “what happened”, “experience”, is an experience of the language 5.
According to Psychoanalysis, everything in the human being is a construction in which the raw material is the speech of the patient. Freud sets a new level of objectivity. As opposed to the positive sciences, Psychoanalysis takes the very last effect: the dream, is the telling of the dream, reality to the subject is what he says about it: It is a reality passed through the word.
So, disease, symptom would be the apparent object, the manifest content on which we need to work. The theoretical object would be the concept of unconscious, we read the symptoms and dreams applying the theory of the unconscious which allows a psychoanalytic listening 6. The real object would be the unconscious of a specific patient. Hence, through his psychoanalytical process we can read, understand which psychical structure the patient is undertaking. What does this mean? Remember that according to Freud, dreams have a sense, but they only have a sense AFTER interpretation. It is the psychoanalytical work what gives them a sense. With neurothical symptoms and psychosomatic disease is exactly the same: according to psychoanalysis we can not establish that a a patient holds a psychosomatic structure only because he suffers from one of those diseases that traditional medicine considers to be psychosomatic (asthma, ulcer…). We can only know which is the underlying structure behind a symptom after interpretation.
According to psychoanalysis, getting sick and maintaining that sickness implies some working. Disease is the outcome, the result of certain working. This working is conditioned by their laws. In the case of the unconscious work, they would be: condensation and displacement, secondary elaboration and staging. Freud proved how in the production of a symptom or a delirium, these four operators also intervene: sicken is a process that implies certain working.
It has been observed that psyco - somatic patients, present a history of actual neurosis. When Freud talks about anxiety neurosis, he remarks that there is no psychic mechanism. That means that there is no condensation nor displacement, as in the production of the hysterical symptoms. We then need to think, which type of working leads to the psychosomatic disease.
The work required to maintain a psychosomatic structure is very costly from a pulsional economy point of view: the patient suffers from the organic disease and all the suffering that implies into his daily life. All this working is aimed to deny that he is a psychical subject, with psychical processes and pretend to reduce his body to a biological one.
New concept of time
The concept of time used in Psychoanalysis is the apres - coup, recurrence, future perfect. When Freud says that the unconscious has “no time”, he is referring to the cronológical time, to the time of the clock. There are two concepts of time: the time of the unconscious, used by the psychoanalysis, discontinuous and the Aristotelian time, real, continuos. These two concepts, do not exclude each others, the new concept of time used by Freud, does not delete the Aristotelian time, he takes it into account.
Why is so important to make this distinction? Because the concept of apres-coup, allows us to introduce key points regarding the diagnosis, prognosis and treatment and enable us to think the issue with the time in the psychosomatic structure.
According to psychoanalysis, the subject is not out of the time. As opposed to the concept of the Aristotelian time, in which the the only thing the subject can do with time is to count it, measure it. It is a time which comes from the past, goes through present and leads to the future.
In the time of the unconscious, determination does not come from the past, it comes from the future: the time of the unconscious includes the death drive. What does this mean? It means that what matters are the next sentences, the next steps (not the sentences already said).
Philosophy and thinkings prior to the Interpretation of the Dreams, have missed that there is a limit to human existence. The limit of our existence is in the future: it is from the future that repetition is triggered 7.
Several authors have set the incapacity of the psychosomatic patients to think the future, why? Because projects, life, illusions… are in the future, but death is also there. Psychosomatic patients tend to have a lot of ambition and very little working capacity: thinking the future is not phantasizing about it but to build it little by little. We need to distinguish between thought and phantasy. Thought in the sense of specific thought, for example: to become a doctor I will need to go to university, money to pay for the university tuition… To be able to do something, we need to be able to think about it, to talk about it. For the psychosomatic patients thinking is painful. They can’t think.
Thinking the diagnosis with this new concept of time, introduces a key difference from medicine: In medicine, diagnosis precedes treatment, in order to treat, first, they need to make a diagnosis. In psychoanalysis, diagnosis does not come from the symptoms that the patient tells in his session, diagnosis emerges in the same process of treatment. No matter what the diagnosis is, treatment is the same: psychoanalysis 8.
Tradicional medicine, considers that the subject going to consultation is a sick individual. On the contrary, to psychoanalysis it is all about the production of a psychical subject (sick or not sick). Psychoanalysis, does not consider the diagnosis as something definitive, immovible. It is not trying to grant a being to the subject, as the doctors would say after a process of diagnosis: “You are diabetic”.
Psychic structures ( neurosis, psychosis, perversion, psychosomatic…) are positions in the language, built up in the session, they do not preexist.
Characteristics of the object of knowledge (the unconscious) impose that the method is interpretation - construction and hence the time is the apres-coup. Unconscious does not preexist, we can’t look for it anywhere, it is produced in the session. Unconscious wish is a interpretation, only afterwards, we will know. Facts are only facts after they have been interpreted.
The process of sicken is read from the end. From the last outcome, the disease, we read the underlying psychic structure behind it.
Diagnosis in traditional medicine have big impact in patients: example, lets say that 80% of the gastric ulcers relapse the first year, however, the patient is told he has a chronic disease which happens in outbreaks. Medical diagnosis are a foretell of the future. In this sense, to tradicional medicine, future is preset, in psychoanalysis, it is to be built. A psychoanalyst is not going to come up with a diagnosis and hence a severe, mild or chronic prognosis according to the symptoms the patient talks about. To psychoanalysis, these symptoms are just hints (which led the doctor to diagnose certain disease), nothing more than manifest content (which needs to be interpreted).
In traditional medicine, one of the most difficult times comes when the doctor communicates the diagnosis to the patient (and the appropriate treatment). Howerver, in psychoanalysis, diagnosis is taken into account in the psychoanalytic listening but not to be told to the patient.
The new theoretical approach to the concept of time allows to transform the prognosis of certain diseases that tradicional medicine considers chronic and hence with no chance to cure such as: asthma, ulcer, Crohn´s disease, rheumatoid arthritis… The treatment of a disease depends on the scientific approach we undertake: depending on which theory we are subject to, different realities will be produced for that specific patient. In psychoanalysis, only after we know and when we know, it is no longer that, because once the patient undertakes psychoanalysis, he transforms himself.
Overdetermination and causality
We say that “an effect is over determined when it is the result of a complex structure , in which articulation a concept holds invariable relations with the other concepts and give the field it opens up, its name”, for example: the theory of the unconscious. In this case the over determined effect will be the one produced by a structure complexely enhanced in the concept we call Unconscious.
According to psychoanalysis, what overdetermines is the unconscious working. And what multiple determines is the pre conscious working. What does this mean? It means that multiple determination is everything that the patient comes up with, however, we need to know that multiple determination is overdetermined.
In the unconscious working, as Freud explained in the Interpretation of the Dreams, the operators are metaphor and metonymy, condensation and displacement, operations of the language. In any action, over determination is unconscious. That is why after Freud discovered the concept of Unconscious, we no longer say " I think therefore I am" (Descartes) but: “ I think where I am not”. Why this subversion of the Cartesian cogito? Because what we thought it was our conscious thinking is in fact a product-effect of the unconscious working.
We read over determination in a construction process 8. We need to be careful here: construction is not the real history of the patient, it is not to tell the patient how he lived but how he desired.
Overdetermination generates a new concept of time, and that new concept of time opens the possibility to cure because if we believe that the past generates and determines the present, there will be no chance to cure.
Over determination does not determine desire for a specific object, it over determines the unconscious wish: sexual childish repressed wish to which we need to renounce. All the drama of the human being is about that, renouncing to the incestuous desires, we need to choose between being determined by the symbolic pacts which allow us to join a human life, social or let the incestuous desire determine us (which can lead us to disease).
In tradicional medicine there is a long list of diseases whose etiology is unknown. Autoimmune diseases ( lupus, rheumatoid arthritis …) are a good example. There is an illusion that when research advances, ethology of those diseases will be discovered.
Research talks about possible causes , adjuvant factors… all theses models are models based on multiple determination.
These diseases of unknown etiology are the ones on which the psychoanalysis have studied the unconscious over determination the most.
If we think that several causes produce the symptoms, we are still in the preconscience - conscience instance. Remember that according to psychoanalysis, conscience is just a sense organ and as such, it makes mistakes. All conscience reasoning will make a mistake: to pay attention to the manifest: it only knows about the unconscious by the effects that the unconscious produces in the conscience.
Freud in “ Critique to anxiety neurosis” 1895, sets the etiological equation distinguishing: condition, specific cause, concurrent cause, immediate motivation or provoking cause:
Motivation or provoking cause: precedes immediately the effect.
Conditions: factors without which the effect would never appear but they are incapable to produce it by themselves.
Specific cause: it is always found in the cases in which the effect appears. It is enough to produce the effect if it reaches certain quantity or intensity as far as the conditions are fulfilled.
Concurrent causes: those factors which are not indispensable nor able to produce the effect by themselves but they collaborate with the conditions in the fulfilment of the etiological equation 9.
Freud’s contribution is that it exists an specific cause (condition sine qua non) in neurosis: the relationship of the individual with his unconscious desire. What does this means? That the effect which appears on the conscience (dream, symptom…) it is overdetermined by the Real impossible, by the way we encounter - always failed - with the Real unconscious.
What Freud proved is that psychic chance does not exist in the individual. Random is overdetermined 10.
Freud began to suspect overdetermination in “Studies on hysteria” 1895. Even when he had not formulated theoretically the concept of unconscious (that he formulates in the Interpretation of the Dreams) he sensed that the symptoms and the dreams are the outcome of the functioning of a complex apparatus. With Elizabeth 11 he says: “ it seems like all the symptoms were knitted in the same loom”.
When facing an everyday life event which seems to be absurd and inexplicable from a rational perspective, the individual try to rationalise it, make it reasonable. In “Psychopathlgy of everyday life” Freud bring other examples: slips are not random, they are overdetermined. If we try to explain an slip by tiredness, lack of attention… we are in the multiple causality field. Doing that would be so mistaken as if someone whose wallet gets stolen during night in a dark lonely street goes to the police station and reports that loneliness and darkness have stolen his wallet. Once again, factors which can contribute to the symptom onset are mistaken for its true overdetermination.
If a psychoanalyst comes to the conclusion that many causes have produced the symptom, he has not understood the concept of overdetermination.
It is also important ti separate overdetermination from determinism. It is not about a fate we cannot escape from, because the determination we are talking about does not come from the past, it comes from the future. Future in the sense that only afterwards I will know. It is from the next sentence that the prior one makes sense. We cannot think the concept of over determination if we don’t take into account the new concept of time, the future perfect we explained before.
In an approach to the logic of the unconscious, in his work “The Ego and the Id”, Freud says: “ In a mythical being, all Id, it is from the contact with the outside world that the conscience is built”. That is why the conscience is no longer the centre of the psychic apparatus and it becomes a perceptual organ. We cannot mistake anymore the psychic for the conscience.
The speech of the patient, the free association, is not random, it is over determined. No matter what he talks about, his speech is over determined by two ending representations: his disease and his analysis - therapy - that includes the psychoanalyst. Patient’s free association is over determined by his unconscious, which is governed by the laws of the unconscious working: it needs to be read by the psychoanalysis.
When thinking about the process to sicken: psychic, somatic (organs) and psychosomatic, we need to take into account that Freud established that the mechanism of the psychic apparatus are the same for healthy and for sick individuals: repression, foreclosure, denial.. are psychic mechanism, they are not pathological in themselves. What overdetermines are the laws of the unconscious 12 and the laws of the physiology cannot escape from the Law of then Language. In fact, Freud believed that the biological subject dies when the psychic subject stop wishing. The desire which over determine is always the same, we all wish in the same way. What varies is the way in which we renounce to the incestuous wish.
Health a as production
According to psychoanalysis, health is something that has to be built, it was not there previously, it is not an status to be recovered.
Two different readings give place to two different realities. It wont be the same a medical reading of the disease than a psychoanalytical one.
Medicine is the science of diseases, it helps humanity to live longer in better conditions
Psychoanalysis, is the science of health. Human being is not only subject to biological laws. We now know that psychic processes alter the biological balance and that everything in the human being is touch by the word. A science which produces health, needs to take into account that the human being talks.
Psychoanalysis understands disease and health as a process in which the psychic subject is included. Health is production and it is also related with producing qualified professionals to achieve it.
Freud clarifies that the real finding is the treatment. He does not invent the diseases, he does nit invent hysteria but he comes up with the psychoanalitical theory, from which the method and technique derive. The key ending is the treatment: health is something to be built. Patient begins to heal because the psychoanalysis does not treat him as a diseased but a speaking individual, an individual undertaking psychoanalysis.
In the texts regarding “Psychoanalysis and Medicine” written by Freud, Lacan and Menassa, the three of them physicians and psychoanalysts, the three of them emphasise the importance of the education.
The thesis would be that the candidate to psychoanalyst is responsible for his health, the group’s health and the health of the population. If that is the case, what do we understand by “health of the psychoanalyst? It is the outcome of the following matter under the framework of his education:
Analysis of the analyst
Study of the psychoanalysis as science in Freud and Lacan works
Writing (by the psychoanalyst) of some work which gives an account of the mode of production which made it possible that psychoanalysis was transmitted to him
The psychoanalyst at some point t of his professional career would practice as patient in the group analysis (because according to Freud, the psychic subject is at the same time, social)
He will be part of the education change contributing to the education of others psychoanalyst
Regarding the connection between money and health, according to Freud: “ There is nothing more expensive that disease and nonsense”. Money allows the psychoanalyst to leave the realm of necessity and join the realm of desire.
Freud poses health criteria in several of his works, he insists that “ health is the ability to love and work”. Freud took the notion of symptom from K. Marx, not from the medicine. We should think that if all individual subjects are group subjects, health should be linked to groupality. A social subject is the one which is capable of transforming reality, why? Because we know about a social subject thanks to his productions. Freud explained that a healthy individual is the one who transforms the reality he knows: health implies the production of a new life. Health criteria goes beyond the absence of disease.
In “The loss of reality in neurosis and psychosis” Freud talks about health regarding the relationship of the individual with reality:
Neurotic individuals, know the reality but scape from it.
Psychotic individuals, transform a reality they do not know.
Normal healthy individuals, know reality and transform it.
When Freud studies the limits between normal and pathological, he makes a key contribution: psychic mechanisms are the same in healthy and sick individuals, there is no damage, no degeneration in the psychic apparatus. Both, healthy and sick individuals suppress, foreclose, deny. Desire is the same fro everybody, the difference is how they renounce to it. Sometimes, insanity is just the exaggeration of a sentence, most of the times, normal. This approach to health and disease allows opens up the chance to cure. Incurable illness for medicine have cure in psychoanalysis. Disease is not considered to be hereditary and hence imposible to be modified.
Another health criteria proposed by Freud in his work “ Mourning and melancholia” is the ability to substitute when facing the loss of an object: the individual can identify himself with the object, losing part of his ego and then falling into melancholia, or he can substitute the lost object.
Lacan critizises the medical approach to health as harmony, balance: there is no harmony in the psychic subject, in fact is the lost harmony what we try to find during all our lives and exactly because we do not find it, we live. Life is the small space between the tendency to achieve harmony and not to achieve it.
We are sick because we talk, that is the only disease of the human being. All the facts in our life are aimed not to realise of that, and when we realise it, we sicken. Because I tea, I was born from mother and father. Health is exactly when we can live knowing that we are going to die.
Disease allows the human being to believe that he lacks of health but in reality his lack is immortality. In order no to accept the real lack, we get involved on another one. Same with money, job, partner… I am not healthy, I don’t have money, I dint have a job a boyfriend… to maintain the phantasy that if I had it, I would be a full being, but the I get it… still there will be something missing… some day, I will die.
In the language, everything is possible: any word can be linked to any word. That is my health or my disease. Whatever I articulate, that is my being. In fact, even aging is related with feeling in the body what I should have felt in the word.
Getting sick is a coarse, clumsy way of feeling the body: exactly the same as the hysterical patient does not joy her facial neuralgia but the psychic position that that symptom allows her (taking offence i the case that the sentence behind the facial neuralgia was: “ I feel that sentence as a slap”), the psychosomatic patient does not joy his body injury but that injury is his way to joy the body.
We know that in all disease there is a primary benefit, the pulsional satisfaction; a secondary benefit: disease as a way to resolve the psychic situation and a tertiary benefit: the ones that institutions provide him because of being sick. Health is related to what the individual does with the disease, no matter if it is organic or psychosomatic. In his first works “ Studies on hysteria”, he already poses that the trauma is not decisive because what is traumatic for someone and can lead to disease might not new for someone else: what matters is what the individual does when facing that situation.
There are not mistakes, all those were steps needed to make progress, is not that the very last deletes and surpasses all the previous ones; It was thanks to all the previous ones that achieving the very last was possible.
This is what the psychoanalyst does during the session. The patient associates freely and the psychoanalyst builds, interprets the Unconscious of that particular individual.
Reality through the eyes is equally misleading as percepcion of reality through conciousness (or through a feeling). Example: if I look at the sun, my eyes tell me that the sun goes around the earth but, in reality, thanks to Copernicus we know that in fact is the earth which goes around the sun
Fullfilment of wishes in the psychic reality, not in the objective one
It does not matter what happened in the objective reality, what matters is what the patient says abut it.
Psychoanalytic listenings means that the psychoanalyst listens with “poetical listening” to the free association of the patient. Poetical listening means that the psychoanalyst needs to be open: any word can be linked to any word. Free association of the patient and floating listening of the psychoanalyst: they need to connect what the patient says to the psychoanalytical texts and theories, to their psychoanalysis and to their supervision but never to their own lives. In that case, they would not be acting as psychoanalysts.
The time of the unconscious is like the historical time in the sense that from the Medieval age, we can’t foretell the bourgeoisie, but we can, from the bourgeoisie, read in the Medieval ages those changes
because the characteristics of the unconscious , from which we can only see his effects, determines that the method has to be of construction-interpretation, using the apres-coup, the unconscious is the interpretation.
Example: Pulmonary tuberculosis —> Condition: hereditary - organic constitution-. Specific cause: Koch bacillus (it is not possible to get the disease without the presence of this bacteria). Concurrent causes: cold, emotions, infections.
In “Psychopathology of everyday life” (1856-1939) Freud gives examples of numbers aparently randomly chosen. However, the psychoanalysis of the individual proved that those numbers where overdetermined: there was a reason why the individual has chosen those numbers and not other ones.
One of Freud’s hysterical patients
Laws of the language: metaphor and metonym