Introduction: A New Psychoanalytic Treatment for Psychotics

Willy Apollon, Danielle Bergeron, and Lucie Cantin are, with other colleagues, the founders of the Interdisciplinary Group of Freudian Research and Clinical and Cultural Intervention [Groupe Interdisciplinaire Freudien de Recherche et d’Intervention Cliniques et Culturelles] (GIFRIC) and they are the co-founders of the 388, a Psychoanalytic Treatment Centre for Young Adult Psychotics in Québec City. Approximately one hundred people (who are between the ages of eighteen and thirty-five when admitted) who experience schizophrenia and psychosis are treated and provided services there, which includes treatment of the crisis. The Centre was founded in 1982 in collaboration with the Robert-Giffard Psychiatric Hospital. The 388 (this number refers to the street number of the centre) provides an alternative to hospitalization in the form of an intensive program including social, cultural, and artistic activities along with psychiatric and psychoanalytic treatment.

Psychiatrists or other mental health professionals may refer an individual to the centre, but each person who attends the centre must ultimately call the centre him- or herself, independently, to express their own request for treatment. The 388 also has five beds for the intensive treatment of those who are experiencing a psychotic crisis. Available to users of the centre twenty-four hours a day, seven days per week, these temporary beds help prevent hospitalizations. Unlike many hospitals, there are no restraints or locked rooms on the premises of the 388.

Each patient in the program has access to a clinical team consisting of a “clinical intervenant,” a social worker, a psychiatrist, and a psychoanalyst.[1] Patients are involved in some of the day-to-day operations and are able to use the kitchen to cook for themselves and the living rooms to sit with others. Throughout treatment, each patient works with a team of professionals who approach them as a person who must have a specific understanding and relationship to the events that have occurred in his or her own life. Part of this work helps the person articulate their experience not only through speech, but also through other creative forms of expression. The centre provides daily activities including workshops in painting, ceramics, and music, as well as socio-cultural activities, cooking activities, and a walking club for exercise. Each patient usually meets with his or her psychoanalyst once or twice every week.

Lucie Canton writes that “Willy Apollon has opened up a set of new perspectives within Freudian metapsychology and operated a number of major displacements in the approach to psychosis, which have allowed for the thinking of the conditions necessary for the treatment and psychoanalytic cure of the psychotic. Among these decisive contributions, let us note the redefinition of transference and of the position of the analyst; an approach to psychosis whose logic is rethought from the structure of the subject’s experience, from the “spontaneous work” of psychosis, and from the enterprise in which the psychotic is engaged; a conception of the psychotic crisis and its treatment within the framework supported by transference; and lastly, the work of the dream and the logic of the analytic cure. At the same time, a daily practice with psychotics—linked with this work for thirty-seven years through weekly discussions and seminars—has permitted Danielle Bergeron and Lucie Cantin to establish, develop, and put into practice the means, strategies, and procedures of this psychoanalytic clinic of psychosis. Cantin refers most notably to what concerns the installation and handling of transference, the interpellation of the psychotic subject and the support of his speech at different stages of the analytic cure, the utilization of the dream in the calling into question of the delusion and the psychotic enterprise, the management of the crisis within transference, and the ethical constraint that arises when confronted with the new knowledge (savoir) produced in the analytic cure” (cf Cantin, 2008, 87-120).

“Since its creation, we have wanted to offer a treatment to the psychotic by proposing an analytic work to him wherein he is engaged, guided by the psychoanalyst, in reconsidering his entire psychic life. The objectives of this treatment are the profound reorganization of the mental universe, the reappropriation of speech and subjectivity, the disappearance of the psychotic symptomology, the resolution of the stakes governing the triggering of the crises, the restoration of an autonomy in personal and social functioning, and the return to an active life of civic participation (work, studies, volunteer work, artistic work, familial responsibilities). The analytic treatment—which is at the heart of the work undertaken by the psychotic at the 388—is at the center of a treatment’s structure, which receives, frames, and treats the effects of this work through a set of services, all of which are determined by the logic of the analytic experience and the ethics it commands. These services include: a personalized psychiatric follow up, articulated and adapted to the evolutionary stages of the analytic treatment; the in-house accompaniment and treatment of the crisis—the Center has beds available for this end; daily clinical supervision and support by clinical intervenants who are trained to ensure a “long-term psychoanalytic follow-up”; art workshops run by artists who come in order to practice their art with the patients of the Center; and finally, an activities program that aims at the restoration of the social link and the preparation for a return to an active life” (Cantin, 2009, 286-287)

“Aside from the novelty of the psychoanalytic treatment offered, the originality and success of the 388 lie in a management structure whose connection with the clinic is guaranteed by the active presence and authority of psychoanalysts in strategic decision-making roles. Thus, by being heavily implicated in maintaining the conditions that have proven to be essential for obtaining clinical results, the psychoanalysts frame the set of clinical practices and guarantee their connection to psychoanalytic ethics” (Cantin, 2008, 87-120).

“One of the first surprises for the psychotic who comes to The 388,” writes Willy Apollon, “is doubtless discovering for the first time someone who is prepared to listen to him, instead of being only interested in his symptoms, his behavior, and his reaction to medication” (“The Treatment” 212). In the past, psychiatrists and psychoanalysts used to suggest that the psychotic or schizophrenic person was incapable of dreaming or could not dream in relation to the psychoanalytic treatment as the person’s imaginary was supposedly absorbed in delusion or hallucination. For GIFRIC and the 388, dreams are particularly important for psychoanalytic treatment of psychosis as dream content can be a valuable way to gain access to the analysand’s history, but also may significantly help to the analyst and analysand work around the delusion. The dream also importantly allows for the analyst and analysand to occupy a position of questioning without directly challenging the certainty in the structure of psychosis. Images and events recounted from dreams may help the patient piece together the past to better understand symptoms and behavior in the present, helping to manage and contain the onset of a crisis. “[I]n contrast to the delusion to whose certainty the psychotic clings for survival against the void,” writes Bergeron, “the dream is a sort of neutral territory” (74).

Additionally, Bergeron writes that the retelling of a dream will produce “signifiers which recall events that marked the psychotic’s life because they operated a rupture in that life by remaining non represented, unassimilable, and unspeakable” and the “memories derived from dream-work, then, uncover the gaps, loose[n] threads in the fabric of the delusion, and thereby put the delusion into question” (74). Ultimately, the aim of the dream-work in the treatment of psychosis is to enable doubt to gradually weaken the delusion and for certitude to fall away. Therefore, the patient’s delusion is never confronted directly, but rather the person is provided with a different way of working on the delusion with a supportive team who listens and helps the patient to speak. Further, when the person experiences moments of crisis during the dissipation of the delusion, the clinical team is present to provide the necessary support. With the assistance of the 388, many patients have been able to restore their relation to the social link, return to school and work, and live independent lives.

Separate from the activities from the 388, GIFRIC provides courses and training programs in Lacanian psychoanalysis for clinicians who come to study from across North America. GIFRIC also conducts research on the outcome data of the 388, which conveys highly successful results as many patients who attend treatment go on to lead generative and self-sufficient lives. Here in this interview, Apollon, Bergeron, and Cantin discuss their clinical backgrounds, the direction of treatment at the 388, and the challenges in maintaining the centre despite dominant approaches to psychosis in psychiatry.

[1] We choose to keep the French term “intervenants” (or clinical intervenant) to designate the professionals trained by GIFRIC to ensure the long-term psychoanalytic follow-up, on a daily, weekly, or monthly basis depending upon the evolution and stages of the treatment. The clinical intervenants have different backgrounds (psychology, anthropology, nursing, philosophy, etc.) previous to the psychoanalytic training given by GIFRIC.

Interview

This conversation was recorded at GIFRIC in Québec, QC on 15 December 2018.

Chris Vanderwees: How did each of you discover Lacan? Also, how did you discover each other?

Willy Apollon: I studied philosophy in Paris. Michel de Certeau, who knew that I was in analysis with Louis Beirnaert, suggested that I should go to the seminars that Lacan was giving. I also had a friend who insisted that I meet Lacan. So, I went to the seminars. I met Lacan. It all happened very quickly. Over the years, I greatly appreciated the work that Lacan was doing at the school. During my internship at the hospital, I had the occasion to participate in the presentation of cases given at the Sainte-Anne, under Dr. Daumezon. These were generally psychotic cases. It was there that I became interested in psychosis. Michel de Certeau wanted to organize a working group on psychoanalysis and history in Paris. It was proposed that I would do the psychoanalysis component for the working group.

When I left Haiti, which was under François Duvalier, to go to France, I wanted to see Québec.  What happened in October 1970 reminded me of what I had experienced in Paris in May 1968. I visited Laval University and a chance encounter with two people changed things for me. One of these people, who I did not know before, was the dean of the theology school. A few days later he proposed to me that I stay in Québec to do what I had tried to do in Paris. I explained to him that psychoanalysis and theology were not exactly operating on the same level. The theology professor explained that what he really wanted was a place that the students from psychology as well as theology could learn more and take a course in psychoanalysis. The chair of the psychology department had already accepted to help with this. In the first six months, some friends in psychology, anthropology, and philosophy began to work together. This is how I stayed in Québec.

At the same time that I was giving a course on psychoanalysis in the psychology department, I was also teaching philosophy at College Garneau, and I participated in a research group at Laval University in the Institute of Human Science, directed by Fernand Dumont. With some colleagues, we decided that it would be good to have a space for research that was not governed by the rules of the university because these are rules linked to subsidies and funding and not for research itself. This is how I created GIFRIC with some colleagues and students. I met Lucie Cantin in my philosophy class and I met Danielle Bergeron in the class I gave in psychoanalysis in the Department of Psychiatry at Laval University. I taught philosophy at College Garneau, and psychoanalysis at the university to students in psychology, philosophy, anthropology, and psychiatry. This is how it started.  

Danielle Bergeron: After studying medicine, I specialized in psychiatry. In my first year of specialization I became very interested in psychoanalysis with psychotics when, during my internship, I encountered a very smart psychiatrist who was using a Kleinian approach to treat psychotics at the mental hospital in Québec. During my second year of studies in psychiatry the program offered us a course on psychoanalysis that was given by Willy Apollon. It was great! I was interested in this new approach to the human being that went outside what Freud proposed as Oedipus—beyond the triangle of the child, mommy, and daddy—and also beyond the Kleinian approach, which stays far too much in the imaginary. The Kleinian approach was perhaps useful to understand mental processes in young children, but in fact, with the adults on whom it was beginning to be applied I realized that its efficacy was limited because it evacuated the dimensions of the real and of the symbolic. What interested me in the courses that Willy Apollon was giving was the concept of the Other, not the little other as in Oedipus but the big Other, which comes from Lacan. What was new coming from Willy Apollon was this concept of the human being as promoted by a culture, a society, and a civilization. This was a new idea for psychoanalysis. During my four years studying psychiatry, there was a moment where Willy Apollon invited me to participate in a group discussion about psychoanalysis and connected disciplines, such as ethnopsychiatry, philosophy, sociology, etc. This was the beginning of GIFRIC without it yet being called GIFRIC. I also went to Paris for my final year where I worked with a renowned researcher and professor of psychiatry, Pierre Deniker, who developed the use of chlorpromazine as a treatment for psychosis. With Jean Delay, Deniker was the first to use this drug for the treatment of psychotics, which had been previously used as an anaesthetic.  While it was psychoanalysis that captured my interest, I also wanted to be up to date with advances in neuropsychiatric research in order to be better armed to defend the psychoanalytic approach in the psychiatric clinic. 

At the very beginning of my year in France, I remember having had the opportunity to meet with Jacques-Alain Miller who welcomed me very warmly. It was he who offered me the opportunity to participate in the clinical section of psychoanalysis at the Freudian School of Paris. During the activities of the clinical section, Lacan came two or three times to meet us and to speak to us. This was for me a very enriching experience. Once, Lacan presented a mathematician to us, Michel Thomé, with whom he was collaborating at the time. Thomé gave us a presentation on the mathematic theory of knots. This was in 1977 and 1978. 

I also took advantage of my year in Paris to participate in classes on psychoanalysis at the University of Vincennes, in the department founded and directed by Lacanians. I went there to take classes when I was not working at the hospital. I also want to mention that I had the chance to participate in Francoise Dolto’s seminars on the psychoanalysis of children at the Institut Océanographique.[1] I had already read her books, which I had very much appreciated. I was able to discover that she was an important clinician. At that time, I felt the Lacanian approach was what we needed. 

During this year, I also went to visit La Borde, which is an institution in the French countryside dedicated to the treatment of psychotics, within institutional psychotherapy. It was founded by Jean Oury, a psychoanalyst and psychiatrist.[2]Visiting La Borde gave me the idea of doing something like that for psychotics here in Québec city, but, rather than in the country, in the heart of the city, and not within the institution of a hospital, but in an open center integrated into the urban community network.

I had the pleasure of meeting Lucie Cantin when we founded GIFRIC formally signing the paperwork. This was in summer of 1978. Since then we have become diligent collaborators and partners for the advancement of psychoanalysis.

Lucie Cantin: We were the students Willy Apollon was talking about earlier. I first knew Willy Apollon as a professor of philosophy at the Cégep. He was a professor of philosophy who left no one indifferent. We had the impression that he was not just talking about theory, and we all recognized something in his teaching that touched our own experience. I had read Freud in secondary school, which had particularly interested me. When I went to university to study psychology, I took the courses that Willy Apollon was giving in psychoanalysis in the anthropology department. When I did my Master’s in psychology, I completed my internship at the psychiatric hospital here in Québec. I was already particularly interested in everything that concerned psychosis. At the same time we started to work towards GIFRIC, and I knew that what I was passionate about, above all, was psychoanalysis. These two things were happening at the same time. I wrote my Master’s thesis on a Québécois poet, Émile Nelligan, who was psychotic, and Willy was one of the readers. At this time, we were starting to work together. GIFRIC was founded in 1978 and the 388 was opened in 1982. 

CV: What was it that interested you about Lacanian psychoanalysis?

WA: I was preoccupied with the relationship between voodoo, African civilization, Haitian civilization, and Francophone civilization. I first looked in anthropology and history but went towards psychoanalysis because they spoke of voodoo. Haitian psychiatrists explained voodoo through the idea of mental illness. Carried forward by the ideas of philosophy and science, I thought rather that there was something operating at the level of civilization. I went toward psychoanalysis to better understand it. When I became interested in psychoanalysis, I went to do a psychoanalytic cure with Louis Beirnaert who was in the Lacanian direction. It seemed like a pertinent approach.

LC: From the very beginning of GIFRIC, there was a Tuesday seminar directed by Willy Apollon that was in the Lacanian direction of things. At the university, psychoanalysis was taught in a Freudian manner, but it was a vulgar Freudianism. It was really centered on interpretation in the sense that the analyst was the person who knew, interpreted, and gave meaning to what the patient said. At the same time, I had the experience of being in an analysis with a Lacanian, taking the clinical seminar with Willy Apollon, and taking psychoanalysis courses at the university. The psychoanalysis that they taught us at the University was a kind of explanation of Freudian concepts presented through a post-Freudian reading centered on the Ego, defence mechanisms, etc. and which became a kind of guide for interpretation applied to the clinic by the analyst. It was a psychoanalysis detached from the experience of the analysand.  Nothing of this resonated for me with respect to my own analytic experience, nor with respect to the clinic and the theory of the clinic as developed in the seminar that Willy Apollon directed at GIFRIC. These were two separate and irreconcilable universes. 

DB: During my studies in psychiatry, I was disappointed with how basic the treatment was for psychotics. People were basically inactive.[3] There was no engagement. There was a little bit of art, but the activities were like macramé and artisanal kinds of things. On the one hand, there was my experience in the hospitals, but on the other hand there were the seminars with Lacan and the seminars given by Willy Apollon, which were very much centered on practical experience. It was very theoretical, but very attached to experience. From my second year, I knew I wanted to do something else for psychotics. I wanted to find another way to work with people other than the way that was being done in hospitals.

To treat the problem of psychosis, you do not find what you need in Freud. There are not references or ways to orient yourself in Freud in order to treat psychosis. Lacan, like Freud, makes suggestions and proposes ideas, but none of them offer a global frame of treatment for psychosis. In the IPA, analysts talked about identifying with the psychoanalyst in order to become as normal as possible. But, we know that the psychotic contests that which is presented as normality, as what is normal. He or she is pushed by something inside that leads him or her to develop a world that would have no defect. What Willy Apollon brought was a proposition for, and an application of, a clinic to effectively treat psychotics. What we wanted to do with psychotics was to find a way that they could develop their own subjectivity and their own interiority so that they could rearticulate themselves to the social. In fact, what we proposed was the first theoretical and clinical framework for a logic of the treatment of psychosis, and this has proven itself, and has offered results, for more than thirty-five years.

LC: What was developed in psychoanalysis in the hospitals, in work like art therapy, always had to do with interpreting what the psychotic was doing and of giving an interpretation that came from the therapist or analyst. When Lacan took up the original question of the foreclosure of the name of the Father, he made advances with respect to psychosis that Freud could not have made. But this was done by placing the accent on something that was defective, something that was missing for the psychotic, the signifier of the name of the Father. What Willy Apollon brought was the idea of not beginning from what is missing in the psychotic, but rather beginning from the experience of the psychotic. What is the experience of the psychotic? And starting from this experience, how can we conceive of a clinic for psychosis?

CV: Many psychiatrists and psychoanalysts once believed and maybe many still believe that psychosis is unanalyzable. In Ontario, for instance, the primary healthcare approach to psychosis continues to be medications as has been the approach in North America since the 1980s. In opposition to this, you were able to create a centre that provides a much more humanistic approach to treatment including psychoanalysis. How did you begin to introduce this program in Québec? What were some of the obstacles in creating GIFRIC and the 388? 

WA: There are two things that are distinct here. There is the possibility of treatment and then there is the fight. The most important, of course, is the possibility of treatment, which we have established. They are right to say that the psychotic cannot be analyzed. Psychiatry does not have a treatment for psychosis. If psychiatry had a treatment for psychosis, we would have results. Psychoanalysis, as psychoanalysts practice it, is generally a practice for the neurotic. It is a psychoanalysis conceived within the field of neurosis and within Western civilization. In the process, all the mechanics of the cure rests upon on the idea of a relationship between two people. One person speaks and the other person interprets. The central concept is the concept of the transference. Freud and Lacan never went beyond this.

What we have done is to say that psychoanalysis conceived for the neurotic will not work for the psychotic, nor will it work with the perverse person. We had to go to the very heart of psychoanalysis to the question of the transference. We had to subvert the question of the transference. Lacan says that the question of transference with the psychotic necessarily tends towards erotomania. Lacanians remain within this perspective. Obviously, from this perspective, you cannot have a psychoanalysis of the psychotic. This idea of the transference as a relationship between the analyst and the analysand had to be dealt with. In this conception of the transference, the psychotic will think that the analyst is a person who is persecuting, or who is complicit with the person against whom the psychotic is fighting. The psychotic transcends the you-me relationship. And he or she is correct.

LC: To continue in this line of thought, we can take the idea of transference as “the subject supposed to know” as not applying to the psychotic person. It would be he or she who would be supposed to know. For example, the person you just met a little while ago, when you were visiting the Centre before the interview, spent all night writing a new conception of the world. It is he who knows. The psychotic does not think that you know. This is why at the 388, in the analytic cure with the psychotic, we don’t use a couch. The psychotic does not enter into a you-me relationship, and does not assume that the analyst knows. It is not necessary, as with the neurotic, for the analyst to efface him or herself, to subtract him or herself from the visual field of the patient in order to provoke a speech that is not an address to the other who is there and from whom the patient would expect a response. 

DB: If I take a break for a holiday, sometimes some analysands will go see Lucie Cantin to ask if it is possible for them to continue the work with her. Sometimes this is because it is not important at the beginning to the analysand, who the person is who is there. The most important thing is to speak. It is asking to be said itself. I wanted to add also that at the beginning of our work in treating psychotics, other psychoanalysts said “psychotics don’t dream, there is no subject as subject of the unconscious, and they will develop erotomania.” They made these three affirmations. We decided not to ask them to identify with social and cultural ideals and prohibitions, concerning what it is to be a man, a woman, a husband, etc., but rather put the emphasis on what they were experiencing in themselves, this push to do something for the world. They started dreaming. So, if they were dreaming, there was a subject of the unconscious! The dream is one of the formations of the unconscious and we discovered that it was not right to say that the person cannot dream and that there is no subject. Psychoanalysts were saying that psychotic people did not dream, and that what they call dreams were just the transposition of the delusion into the form of the dream. At the beginning of the analytic cure the psychotic often brings a long, long dream that is a reconstruction of the world, but then there is a moment where the dreams that surge up are dreams that surprise the psychotic, because they are no longer linked to the delusion. This happens when the analyst does not take him or herself for the Other, does not act like the big Other who knows.

LC: Given that the analyst is not in a position of knowing or interpreting for the psychotic, we do not directly confront the logic of the delusion. At the moment when the psychotic takes the risk of speaking in the cure, real dreams surge up. What we call real dreams are those that allow the analysands to have access to experiences, memories, and mental representations that are fundamental to their subjectivity. These have to do with experiences that they never talked about before because they were impossible to speak about, or were non-receivable in the social link. What the person discovers works against the logic constructed in the delusion in order to explain and give a meaning to these intimate and unspeakable experiences that they lived through in solitude. They discover, little by little, the profound roots of what cut them from others and from common sense. And this does not come from an interpretation given by the analyst, but from something their unconscious produces in a dream.

WA: In other words, we have modified the concept of the transference, which also changed our approach to the unconscious. What is important for us is that this gave results. Out of more than six hundred psychotics over thirty-five years, we have only had four or five cases of erotomania. The modification we made in the concept of the transference was correct. It is the result that confirms for us that our position is correct. If we change the concept of the transference, you also have to change the logic of the cure, not only for the psychotic, but also for the neurotic or the perverse person. We arrive at results in the cure that are different from the results that other analysts arrive at, and this includes the analysts in Paris. We are Lacanian because we begin from the perspective of Lacan, but we have profoundly modified the logic of the cure. What is important for us are the results.

LC: To give the broad strokes of the logic of the cure, we begin from the logic of experience. We realized that the psychotic is working, is occupied in the work of constructing a new world, a new conception of the human, a new social link.  What people call their delusion is actually a personal “theory,” a justification, a meaning elaborated to account for their experience.

We have divided the cure into three parts. First, there is the establishment of transference, which allows the psychotic to take the risk of a true speech, saying something that he or she had never said before. Second, there is the challenging of the delusion, the falling away of the delusional certainty provoked by the new “savoir” elaborated in the analytic process. Third, there is a challenging of this “project” of constructing a new language, a new social link, a labour in which the psychotic was wholly invested and for which the psychotic believed that he or she was solely responsible. 

Speaking of the installation of the transference and this question of true speech, we are waiting for the psychotic to speak of that which he or she could never have been spoken about before, to refind, as we have said, experiences that have remained outside of language, and to speak of all of the unmotivated acts and of what happens during the crisis when he or she acts. In other words, what we call true speech is a speech about what has never before been able to find signifiers, and which could not come through except through acts and symptoms. 

DB: What Willy Apollon has just written on the board, shows the consequences of treatment that everyone at the centre can recognize in terms of the progression of the analytic cure. The progression of the cure has consequences for the way the user presents him or herself, and on the activities of the user, that everyone can observe who is in the centre. When he or she learns to speak truly, when he accepts to speak of events, of experiences that have happened, of acts that he has never spoken of, and could never have spoken of before, the consequence that this true speech will have is that it will allow the psychotic to experience the crisis at The 388 without being hospitalized or doing acts that will have potentially damaging consequences. Once the crisis can be linked to the possibility of having faith in the analyst, and after of having faith in all of the staff, there is the possibility of going through a crisis at the centre.

During a crisis, the staff members can hear what the psychotic says, see what the psychotic does, and return to this after the crisis, with the patient. After the first crisis, the intervenant who is in charge fills out a crisis form with the user. The next time, the patient will be able to be vigilant about a future crisis. The patient will be able to know what the symptoms are that suggest a crisis is coming because there are witnesses who can help the patient to speak of the crisis and about the signs that announce the psychotic crisis. When he or she speaks of these experiences in true speech that brings something that goes against or goes beyond the delusion, or when he or she notices that what is going on in the delusion is linked to certain experiences in childhood or that they have the same form, then he or she can question the delusion until the delusion falls. This is when there will be another crisis, which we call the second crisis. But it will not be the same type of crisis as was the first.

WA: There is too much for him or her to lose.

DB: Yes, too much to lose. This crisis, the second crisis, is where he or she is involved in an inner world, is delusional, and has hallucinations, but at the same time he is also an observer of the crisis.

LC: For example, a patient came to his cure and talked about how for the last week he has been doing very badly and had been very disorganized. Normally, when this happened, he became a resident, but this time, for the first time, he was able to live through this experience alone, at his house. So, I asked him if he noticed a difference. He said, “yes, I am doing badly, but I am exterior to this anguish.” The subjective position appears in the first step. It is as if the subject remains not overwhelmed by what is at stake in the unconscious. It is like a first internal division.

DB: Their mission or enterprise is to change what they see as a defect of the world, it could be prostitution, jealousy, killing, famine in the world…

WA: In the enterprise, what is at stake is what they want to do for humanity.

DB: When they enter this last phase of the treatment, they are able to go through the crisis just with the analyst. They have moments where they are destabilized. It is difficult. They can have a hard time sleeping, but they come to their analytic treatment. Sometimes they ask to come more often, but they go through the third crisis with only the support of the analyst.

LC: It is difficult.

WA: Very, very difficult.

LC: It is very difficult because they have to renounce their great project to be the one who will change something for all of humanity. They will have to find a way to do something within society and culture. They see this as just something banal. At that time, some patients will say that they have to distinguish between psychotic ideas and what, within those ideas, are their ethical values that they want to keep and to do something with. It is a difficult moment because they have to find a way to be with others, to be one among others, and to create, from their singular subjectivity and sensibility, a mode of articulation to the social link. This is a crucial time. Some of them have a lot to lose. It is much more difficult for patients who have been sick since their adolescence and who were not able to finish their degree in school. They don’t have a profession, but more importantly they have never been able to articulate themselves to the social link through any mode of participation.    

DB: Sometimes after two or three years of treatment they can recommence with society, get a job, return to their studies, move into an apartment. Sometimes it doesn’t work out and they have to try again. All of this is possible because of the treatment team and the training in psychoanalysis with the psychotic that the treatment team gets every week from Willy Apollon. There is a unity of the treatment team that comes from a shared recognition that each human is a subject who has the capacity to create his or her own life. 

LC: The unity of this approach also implies that the psychiatrists who work at the centre do not think that psychosis is the result of a defect in the brain. The psychiatrist is sensible to the fact that the analytic treatment has specific effects in the psychotic’s life, in the psychotic’s body, and that they must help the psychotic by treating these effects. This is very important. I would add that all of this work done with psychotics has profoundly modified our work with neurotics and with perversion.

DB: For example, an emphasis is put on what is out of language and what acts in the unconscious. The psychoanalysis with the neurotic is no longer centered upon the discourse or the interpretation of the language of the patient, but rather the attention is focused on what is out of language and which acts in the life and body of the patient and has to be spoken about. One of the difficulties is that the psychotic person is out of language, everything happens in his or her body in terms of behaviours and acts and this takes priority during the session. Therefore, if the analyst is not “active”, nothing happens. To be “active” supposes that the analyst encourages the analysand to speak of what he or she has done and not only to expound about grandiose ideas, or about persecution. The analyst is then attentive to the logic of acts and to their consequences.  The analyst questions them to allow the psychotic to speak of the goals of acts and behaviours and to reveal the mission that the psychotic has given him or herself. In other words, we cannot, as some people say about the neurotic, wait until “it” speaks or until “the thing” speaks. With the psychotic person, you must support the speech as opposed to wait for it.

LC: This is an active work. And that supposes a specific position and an act of the analyst provokes a speech in the psychotic, without the analyst implicating him or herself personally.

WA: There have been many obstacles. From the second year of the centre, they demanded to evaluate the centre in order to close it. 

LC: After giving us patients who had been treated for years at the hospital, they demanded that we treat and cure these patients in six months.

WA: In 2002, the fight became very strong. I asked the minister to do an evaluation of the 388 compared to the hospital. The minister said, “yes.” They sent three independent evaluators to evaluate the centre. The evaluators were people that came from Montreal and Hull. They were not psychoanalysts. Two were psychiatrists and one was a director of a psychiatric hospital. They came to Québec. They met and discussed with a group of forty-two patients. They met with the relatives and some professionals in the city. They analyzed the files of the patients. They spoke to the intervenants and the psychiatrists at the Centre. They met us to discuss our way of working with the psychotics. The report was that this was the best. Each of the evaluators came from a different psychiatric hospital, but the minister never evaluated the hospitals of the people who wanted to close the 388.

LC: What we fought and are still fighting comes from a certain group of psychiatrists who are generally involved with research for pharmaceutical companies, or they are people who think psychosis is a lifetime condition that has to be managed with medication or cognitive behavioural therapy and that people should be controlled in the community and lead lives that are not engaged and do not stress them out.

WA: Right now, there are a lot of young psychiatric residents who come to training, here, at GIFRIC, and this irritates and makes angry those in Québec who want to get rid of psychoanalysis in the treatment of psychosis.

DB: In Montreal, there is very well known and respected psychiatrist, Dr. Alain Lesage, a researcher in social psychiatry, who is very invested and interested in the idea of what he calls the psychodynamic approach for psychotics. He proposed that I, as well as others who use a psychoanalytic approach with psychotics, along with residents in psychiatry who follow GIFRIC training, present symposia and workshops as part of the annual Congress of the Association of Psychiatrists of Québec this June. He says that, in the coming years, he wants people to know more and more about the psychoanalytic approach with psychotics. 

LC: There is also a group of psychiatrists in Sherbrooke, a university town. A group of four psychiatrists, who followed the training here in GIFRIC, are now professors and supervisors and work with residents in psychiatry. They tell their residents to come for the training. Now, there is a group of them that wants to open a centre like the 388 in Sherbrooke. We have worked with them on this project. It has been difficult to continue this work with them after the changes made by the former government in Québec, but they are continuing this work in Sherbrooke. 

WA: In the next two or three years, it will be difficult for the people who are against psychoanalysis for psychotics because there is a group of relatives of users of the 388 who wrote directly to the minister to talk about how there is no comparison between the services of the 388 and the services offered in the hospital. The patients who proceed through the four steps of the treatment, which is to say sixty-five percent, return to the social link. They have jobs, they pay taxes as any other citizen, and they don’t come back to the centre anymore. Some of them have become workers in public administration, or architects, lawyers, or university professors.

CV: What do you think about the state’s resistance to your approach? Is it an overinvestment in drugs?

WA: It’s not the government that is opposed to this, not the state. It is two or three groups of psychiatrists in Québec and Montreal who don’t like what’s going on and who criticize the 388 to government bureaucrats.

DB: It’s psychoanalysis that bothers them, and the psychoanalysis that we practice here in particular. The thing they don’t like is that the psychoanalysis that we sustain here is critical of a psychiatry that only sustains itself through the neurosciences, and that evacuates the importance of the speech of the subject who is sick, by putting forward from the beginning that psychosis is an illness of the brain. According to the guidelines of psychiatry, psychoanalysis is not considered as a recommended treatment for psychotics! But it is also recommended in the guidelines that the psychiatrist must find the best way to treat his or her patient. The antipsychotic medication helps to diminish the passages à l’actewhich have adverse repercussions for the patient or for others. It helps to preserve vital functions. In this sense it is useful. But antipsychotic medication also makes the patient shut up about delusional ideas and his or her mission when the patient knows that this is what psychiatry aims to do with the medicine. Indeed, the medication does not stop the patient from preserving his or her ideas: we know now, from experience, that despite the strong doses of medicine, the psychotic patient maintains his or her enterprise to reconstruct the world, and that it is better to give the patient a space for speech and reorient his or her actions that are both achievable and useful for society, rather than to try to stop the patient from thinking. 

LC: When the government evaluates what is going on here, they are not interested in the clinical orientation, but in the clinical results. It is really the psychiatric milieu that is fighting against psychoanalysis. Perhaps this is because what we are doing challenges what they are doing as clinical practice.

DB: When the evaluating team came in 2002, they wrote a piercing phrase in their report. They wrote that to see something like forty-two schizophrenics stand up and speak by themselves was extremely impressive.

WA: When they came, we put them in a room with forty-two patients. It was the first time in their lives that they had been in a room with forty-two psychotics.

LC: [Reads and translates the excerpt from the report] “We acknowledge that these are people with severe mental health problems and yet they make contributions to the interpersonal and social world. They are able to give their opinions about anything that concerns them as well as about the programs at the 388. During our two-hour meeting there were no problems. Everyone raised their hands, took their turns to speak, and the person running the meeting had no problems controlling the event.”

Before the evaluators came, the patients had written letters to the minister of health. People said, “Oh, it was not the patients that wrote this. It was probably the intervenants. It is too well written or maybe these patients are not actually sick.” This is why the evaluators make a specific point in the report by saying that the patients were well behaved, that they participated, and that they had no suspicion that it was not these people who wrote the letters. This is also why they add that these are people who have illnesses that are serious and persistent. Many other critical comments have come over the years. For example, they accuse the psychiatrist of not giving medication, which is not true. They have also accused us of choosing patients who are not really sick or of having good “Lacanian patients.” 

CV: You spoke about the preparation of the individual who goes through the program. How does someone arrive at the centre? How does the process begin?

LC: From the beginning, we have always required that the person, him or herself, call to ask for a meeting, even if it is a psychiatrist or another professional who spoke to the patient about the 388. When he or she arrives, we give them a meeting, which we call the intake interview. We are two who meet the patient. I am always present along with one of the three psychiatrists. We do not ask for a previous file before meeting the patient. We take an hour and fifteen minutes, or an hour and a half, and sometimes even two meetings to let the person speak about their experience from their point of view. At what moment, according to them, did the difficulties begin? What happened in their lives at this moment? What ideas did then have during the crises? What are the acts they posed? What can they say of their childhood, adolescence, in other words of their subjective history and their own interpretation of what they have lived through?

WA: When a person meets a psychiatrist, they are usually required to do it. So, the psychiatrist has a power over this person. We do not want this.

DB: During the first interview, we also try to mobilize the patient to speak about something true. We help the patient to say something that is important for him or her. We try to know if he or she really wants to come to the 388, and if the person is ready to do what they will have to do. I remember an admission committee where we met with a patient who had been hospitalized many times. This man was always very aggressive before and during his hospitalizations. He frightened those around him, as well as the staff of the hospital. He said that his psychiatrist told him that if he was admitted at the 388 he could go through his crises there rather than going to the hospital. In his report the psychiatrist wrote that this patient usually arrived at the hospital with the police.

So, we told him, “This is not entirely true, not entirely correct. You can pass your crises at the 388, but this is on the condition that, with the support of the team, you change your way of managing your crisis. We can’t treat someone here who is violent, aggressive, who is speaking loudly, who is breaking things. Look around, here. Everything is fragile, there are valuable stained glass windows in the living room, there are other users who you have to respect, and there are intervenants who can support you as long as you don’t frighten them! We don’t accept that people yell here. You will have to talk about what is going on, and you will have to learn to recognize the signs that precede a crisis in order to find a way for things to happen in a different way.” 

Eight months later, the psychiatrist from the hospital called us about this patient. He had been hospitalized in the psychiatric ward for a few days. He had not slept in two days, and after a heated discussion with his father he had started to drink again, and he felt that he was loosing control. So, he had called the police during the night to ask them to drive him to the 388. But the police took him to the hospital. The psychiatrist at the hospital said: “we had never seen him like this. He was quiet right from the beginning, he collaborated with us, and tried to understand what was happening to him.” He was absolutely not aggressive nor threatening, as he had been before.  He was able to come to the 388 to finish the treatment of this crisis. Everything went well, and was calm. There was collaboration, and the discovery that being sensitive to the predictors of his psychotic decompensations allowed him to look for help in time, and that being able to speak of what disorganized him rather than acting aggressively, was beneficial.  

LC: In this first meeting, we want to engage the subject, and his or her responsibility, in the treatment. Often the person says that this is the first time that they have had this kind of interview. When they arrive, the people are welcomed by an intervenant who explains the various services to them. During the intake meeting, we explain what the psychoanalytic cure is. We explain that the cure is confidential and that they will also have a team composed of an intervenant, a social worker, and a psychiatrist. After this first interview, we ask for the patient’s previous file in order to integrate it with our data about both previous hospitalizations and about the psychiatric services that they received before their admission to the 388. When we think the person is going to be accepted, we tell them to call back in five or six days, which gives us time to discuss the admission interview with our colleagues. If we don’t think the person will be accepted, we call them back and refer them to a service that will be more appropriate for them. 

DB: After this, the patient has a first meeting with the psychiatrist and with the intervenant who will be responsible for the patient, and who will be the patient’s point of reference in his or her everyday life. This first meeting proceeds in the following manner:  The psychiatrist describes, to the intervenant, what was at the heart of the patient’s admission interview, and asks the patient to fill in details or add nuances, if necessary. From this, we make a first plan of intervention for the next six months based on what the patient says during the first meeting about his or her difficulties and about what he wants to fix in his life. We also talk about which art workshops the person will participate in and in which activities he or she will register for, to make sure that the activities are beneficial. Usually, we want them to participate in at least one art workshop. It is important that the person develop capacities that are not just in speech, but that are also aesthetic, because there are some life experience that can not pass through words. That’s how it starts.

CV: Does the person prepare for their analysis?

LC: Sometimes we let the team get to know the patient better before the beginning of the analysis. It can be difficult at the beginning of the treatment because often the patient who starts an analytic cure will not talk a lot outside of the analysis. This can be very hard on the team because the intervenants, psychiatrists, and social workers need to know what is going on to sustain the person during a crisis. 

DB: Normally, the person will start the analytic cure eight to ten months after their admission. There are some logistical concerns, but sometimes a person will start an analysis immediately when they begin to come to the 388 because without the analytic cure they would be at risk of rapidly disorganizing.

LC: The patients will talk amongst themselves when someone new arrives, explaining what the analytic cure is and what you need, like a little dream notebook.

DB: The users help each other. This is an important point.

LC: There is solidarity.

CV: How is the frame of the analysis structured in terms of frequency?

DB: It depends. We discuss it with the patient. It depends on how available they are. Some people are working and do not have a lot of time. Usually, it is one or two times per week. During a crisis, the person may ask to be seen more often at a frequency of three or four times per week. The sessions last twenty-five or thirty minutes, sometimes less, sometimes more. It is usually the analyst who decides when to end the session, but sometimes it is the patient who says, “I have said enough for today.” A person may say, “I have just said a big piece of something, so, I’m going to stop for now.” We have to respect that.

LC: During the first meeting of the cure, I say to them that this is a confidential place. I will not say anything to the psychiatrists, the intervenants, and I will not write anything in their official file. I tell them that this means that they have the responsibility to speak to the other members of the treatment team and to tell them if they need more support at a certain moment. I explain to them that the analytic cure is a space of free speech and that that they can say everything that they have never been able to say elsewhere. I explain to them, also, how, and from what basis, we will work: from dreams, thoughts, preoccupations, the context and playing out of psychotic episodes, acts that they pose, memories and important events in their lives, the moment that their first psychotic crisis was triggered, and etc. 

DB: Confidentiality is the necessary condition in order for the cure to function. This is the condition through which we can hear everything so long as they go for support when they need it.

LC: The patients respect this framework very well. Even when they are speaking about something like suicidal ideas, for instance, sometimes we can ask them, “did you speak of this with the psychiatrist?” We may tell them they have to speak with the psychiatrist and they always do.

DB: I remember a patient who came to a session and said, “why do you want to know me?” I asked him, “why are you asking this question today?” There was probably a reason. He said, “everyone I speak to uses what I say against me. The people who I talk to about my experiences use it against me afterwards. The people who want to know who I am, what my history is, use it against me when I respond.” I said, “I don’t want to know you. I want to help you to know something of yourself so that you can manage to have a better life. I don’t need to know you.” This calmed him. 

CV: There is a new category that Jacques-Alain Miller speaks about, “ordinary psychosis”. It is an expansion of the way we think of psychosis. Is this category useful to your thinking or your clinical work?

LC: For now, it is not very useful for us. I have read many things about this. They describe the category of psychosis where there are no elementary phenomena: no delusion, no triggering, and no hallucinations. It’s interesting but for us, in our clinical practice, this is not very useful. Maybe this is because we also have patients who are not presenting a true delusion or hallucination, but when we listen to them in the analytic cure we are able to see that there is a kind of psychotic work, an enterprise, someplace.

WA: Either we think that psychosis is an illness in a medical perspective or we think psychosis is what a psychoanalyst calls a structure. Maybe people who think that psychosis is an illness find this idea of ordinary psychosis useful because they are usually treating neurotics. For us, psychosis is not an illness. It is a structure. The psychotic may be sick and he may not be sick. Jean-Jacques Rousseau was a psychotic. Auguste Comte was a psychotic. Mackenzie King was a psychotic. President Wilson was a psychotic. The psychotic can be sick, but it is a structure.

LC: Psychosis is a certain way for a subject to be in relation to both jouissance and the believable, having been directly confronted too early with the defect in language though fundamental experiences of his or her subjectivity. 

DB: There are patients who take months or years before they talk about their projects, the experiences they are currently living through, or that they previously experienced in their bodies, or about what we call “the internal object,” which they refer to as the little things that have been installed in the backs of their necks, the little things in their bodies that connect them to certain beings in the universe, or to influential, and often imaginary, people at the level of global socio-politics. I think that if you start from the position of thinking that psychosis is a disease, then you are the one who knows and the psychotic has to speak to the one who knows! In such a situation, the person is not going to speak about what is true for them. 

On the subject of the concept of ordinary psychosis, it may be true that this is a useful concept for the French, and maybe even a good thing for them, but we don’t use this category.

WA: It is the sign that these are not people who treat psychotics.

LC: I think that this concept was developed from a group of clinicians, Lacanians, who were meeting to present cases. They presented cases where it was difficult to know if the person was psychotic or neurotic. They had three big “conversations” over ten or fifteen years. It was in this context that they collaborated on cases to develop the category of “ordinary psychosis”.

DB: I remember a man. We met him some years ago. He was a thirty-five year old teacher, who was still working. He did not have a delusion, but he was following a movement in physics that said that electromagnetic waves can act on your body and give you many kinds of health problems. What we learned from him was that, in order to preserve his health, he slept at home every night in a tent that protected him from those waves.

LC: He was not able to come to the 388 because, if he needed to be a resident, he could not install his tent.

DB: Was he delusional? Some scientists say that it is true, that there are waves that can have effects like this. What we would say is that his life was becoming more and more difficult for him because of all the restrictions that he gave himself because of his conviction that there were waves that were destroying his organism. 

LC: All of his life became centered on this.

DB: He showed us paintings that he had done on the interior walls of his house. The entire home was painted. It was magnificent, extraordinary, a true artist’s work. But he was no longer functioning with others. People were finding him to be bizarre. The French psychoanalysts might have said that he was an “ordinary psychotic”.

WA: For us, this is a psychotic person.

DB: This man had found a transitory solution to go through life, but now he had hit a rock. He had too much of a hard time with the functioning of his organism, and with his vital functions, and it was disturbing him too much. What he had elaborated was at the limit of delusion. Now, contrary to what we thought thirty years ago, when someone asks us if we think that there are extraterrestrials, we might say, “maybe!” Now we know that before his death, Stephen Hawking, the well-known astrophysicist, was not working to find out if there were extraterrestrials in the universe, but rather where they were in the universe!

LC: Someone may tell us that someone is watching them through the computer. A patient once said that, because of the things that he bought on the Internet, he had a visit from the provincial police. Later, the police actually told him that they had been watching him for six months. The delusion is not a criteria for determining if the person is psychotic. The criteria of ordinary psychosis are finally criteria that are close to the criteria of psychiatry. 

DB: It is when we say that the person is having a hard time in his or her life because he or she, alone, is in charge of some kind of enterprise to improve all of humanity, that we say that this is a structure of psychosis.  

LC: This work is at the heart of psychosis and the delusion is a theory that the person has elaborated to explain this work.

CV: At the centre, the community, which includes the programs for art, music, cooking, literature classes, and the walking club seems to be crucial for the treatment. How do you see the relationship between psychoanalysis and therapeutic communities?

DB: A patient once said, “knowing that I can call anytime, day or night, knowing that there is someone there who will listen to me, who I can talk to, this helps me. It helps to know that it is there even though it won’t solve my problem.” The mutual aid and support is important, but there also needs to be a work on experiences. The community side of treatment does not suffice in itself.

LC: The patients don’t think of it as a social place, but rather as a real place of work where they come to do a certain kind of work. Often as the work progresses, they will stop coming because they want to be out in the world, not in this place of treatment. Even if it is true that there is a scene of mutual support and solidarity in the centre, these are things the patients will begin to develop outside of the centre. It is important for them to articulate themselves to the social link. 

DB: For several years, for instance, the intervenants prepared Christmas baskets for users who live alone, or people who live with a family member, but live in difficult financial conditions and do not have the means to offer themselves any little treats for Christmas. The GIFRIC foundation takes care of this. Before bringing the Christmas baskets, which are brought by the intervenants and a user, we decide who the users are who will most benefit from a basket. Right now, we are looking at the information we have collected over the past two years. One of my patients works very hard, he does not make a lot of money, his family lives outside of the province, and he was on the list this year. When they offered him a basket, he said, “thanks very much, but I work now. I do not need it.” He is taking steps to be in the social rather than staying in a position that he identifies as being someone who would be sick or unable to do things for himself.

CV: Thank you for having me. I admire your care, compassion, and seriousness with this work. It is an inspiration. You’ve created something of a dream, here.

DB: One for the museum!

[1] Francoise Dolto (1908-1988) was a French pediatrician and psychoanalyst known for her theories on child development and the unconscious body image. She was a close friend of Jacques Lacan and a member of his school. 

[2] Jean Oury (1924-2014) was a French psychiatrist and psychoanalyst as well as a member of the Freudian School of Paris. He founded La Borde clinic in 1953, emphasizing principles of therapeutic community and institutional psychotherapy. Psychotherapist and philosopher, Félix Guattari (1930-1992), also worked for much of his life at La Borde under Oury’s direction. For an interview with Guattari on La Borde, see “La Borde: A Clinic Unlike Any Other” in Chaosophy: Texts and Interviews, 1972-1977. Belinda S. Mackie also has written an excellent work, Treating People with Psychosis in Institutions: A Psychoanalytic Perspective, which provides an overview of both the La Borde clinic in France and The 388 in Canada.

[3] In a 1952 article outlining the use of chlorpromazine for the treatment of psychosis, Deniker and Delay wrote a detailed description of the effects of the drug on a patient: “Seated or lying down, the patient is motionless on his bed, often pale and with lowered eyelids. He remains silent most of the time. If questioned, he responds after the delay, slowly, in an indifferent monotone, expressing himself with a few words and quickly becoming mute. Without exception, the response is generally valid and pertinent, showing the subject is capable of attention and of reflection. But he rarely takes the initiative of asking a question; he does not express his preoccupations, desires, or preference. He is usually conscious of the amelioration brought on by treatment, but he does not express euphoria. The apparent indifference, or delay in response to external stimuli, the emotional effect of neutrality, the decrease in both initiative and preoccupation with an alteration of conscious awareness or in intellectual faculties constitute the psychic syndrome due to treatment” (qtd. in Moncrieff 32). Since the early uses of chlorpromazine, a second generation of antipsychotic medications has been produced, which are more preferable given the lower risk of side effects. Chlorpromazine, however, remains on the list of the World Health Organization’s List of Essential Medicines and continues to be prescribed throughout the world as a generic drug for treatment of psychosis.

Willy Apollon, Ph.D. is a senior psychoanalyst at GIFRIC and philosopher (Paris, Sorbonne). He is supervising analyst and consultant analyst at the Psychoanalytic Treatment Center for Psychotics Adults, the 388. He is past president and founder of GIFRIC, director of the Psychoanalytic Center for the Family, and has been responsible of a control seminar for the training of analysts and of a seminar on globalization and psychoanalysis in Montreal and Québec City. He has published widely on topics including psychosis, the formation of analysts, the psychoanalytic clinic, perversion, aesthetics, family, and the analysis of cultural, social and political practices. He is the author of Voodoo, A Space for the Voices (Éditions Galilée, Paris, 1976) [Le Vaudou, un espace pour les Voix] and Psychosis: The Offer of the Analyst (1999) [Psychoses: l’offre de l’analyste], Sexual Difference at the Risk of Kinship [La difference sexuelle au risque de la parenté] (1997), and The Universal, Psychoanalytic Perspectives [L’Universel, perspectives psychanalytiques] (1997), all published by Éditions du GIFRIC, Québec.

Danielle Bergeron, M.D. is a senior psychoanalyst and psychiatrist. She is medical chief for the Psychoanalytic Treatment Center for Psychotics Adults, the 388. At GIFRIC, she is supervising analyst and responsible for training; she also conducts a control seminar of the analytic act with clinicians analysts and teaches a seminar in short term analytic treatment. Associate professor for psychiatry at Laval University, she teaches psychoanalytic concepts and is supervisor of a Fellowship program for psychiatrist at the 388. She is now a Distinguished Life Fellow of the American Psychiatric Association. She has published on psychoanalytic treatment of psychosis and neuroses, ethical questions, the analyst facing aesthetics and the Thing, femininity, science and psychoanalysis.

Lucie Cantin, M.Ps. is a senior psychoanalyst and psychologist. She is psychoanalyst at the Psychoanalytic Treatment Center for Psychotics Adults, the 388. She is a supervising analyst and is co-responsible for teaching at GIFRIC. She is also responsible for a control seminar for the training of analysts and a seminar on Psychoanalysis and Clinical Psychology. She is Vice-President of GIFRIC, where she is the editor of Savoir, a journal of psychoanalysis and cultural analysis. Further, she is the supervisor for the Doctorate Program in Psychology at Laval University, Supervisor in the Master program in Psychology at the University of Ghent (Belgium), and at the Université Libre of Bruxelles. She is additionally responsible for the Orientation Council of the Freudian School of Québec. She has published on the psychoanalytic treatment of psychosis, the clinic of neurosis, on mysticism, femininity, masculinity and perversion.

Chris Vanderwees, Ph.D. is a practising psychotherapist in Toronto and was recently a postdoctoral fellow at Western University. He is the reviews editor of the Canadian Review of American Studies (University of Toronto Press) and a member of Lacan Toronto (Affiliated Psychoanalytic Workgroups).

Daniel Wilson, Ph.D. lives in Montreal where he teaches English language classes. He is interested in the relationship between the history of psychoanalysis and the contemporary clinic. He received a PhD in English from Cornell University.

References and Further Reading

Apollon, Willy; Bergeron, Danielle, and Lucie Cantin. After Lacan: Clinical Practice and the Subject of the Unconscious. Ed. Robert Hughes and Kareen Ror Malone. New York: State University of New York, 2002. 

Apollon, Willy; Bergeron, Danielle, and Lucie Cantin. Un Avenir Pour le Psychotique: Le Dispositif du Traitement Psychoanalytique. Québec: Collection Nœud and GIFRIC, 2013.

Apollon, Willy; Bergeron, Danielle, and Lucie Cantin. La Cure Psychanalytique du Psychotique: Enjeux et Stratégies. Québec: Collection Nœud and GIFRIC, 2008.

Apollon, Willy; Bergeron, Danielle, and Lucie Cantin. “Problems of Femininity in the Psychoanalytical Treatment of Psychotic Women.” Lacan on Psychosis: From Theory to Praxis. Ed. Jon Mills and David L. Downing. New York: Routledge, 2019. 

Apollon, Willy; Bergeron, Danielle, and Lucie Cantin. The Subject of Lacan: A Lacanian Reader for Psychologists. Ed. Kareen Ror Malone and Stephen R. Friedlander. “The Treatment of Psychosis.” New York: State University of New York, 2000. 209-229.

Apollon, Willy and Richard Feldstein, eds. Lacan, Politics, Aesthetics. New York: State University of New York, 1996.

Ban, Thomas A. “Fifty Years Chlorpromazine: A Historical Perspective.” Neuropsychiatric Diseases and Treatment. 3.4 (2007): 295-500. 

Cantin, Lucie. “An Effective Treatment of Psychosis with Psychoanalysis in Québec City, Since 1982.” Annual Review Of Critical Psychology. 7 (2009): 286-319. http://www.discourseunit.com/arcp/7.htm

Cantin, Lucie. “Comment penser l’évaluation du traitement psychanalytique des psychose” in La cure psychanalytique du psychotique: Enjeux et Stratégies.. Québec: Collection Nœud and GIFRIC, 2008, 87-120.

Guattari, Félix. “La Borde: A Clinic Unlike Any Other.”Chaosophy: Texts and Interviews, 1972-1977. Los Angeles: Semiotext(e), 2009. 176-194.

Mackie, Belinda. Treating People with Psychosis in Institutions: A Psychoanalytic Perspective. London: Karnac, 2016.

Moncrieff, Joanna. The Bitterest Pills: The Troubling Story of Antipsychotic Drugs. New York: Palgrave Macmillan, 2013.

Roudinesco, Élisabeth. Jacques Lacan. Trans. Barbara Bray. New York: Columbia University Press, 1997.

“Treating Psychosis in Québec: A Conversation with the Founders of GIFRIC and the 388” by Chris Vanderwees © December 2019