Academic journal article International Journal of Psychoanalysis

The Abuses of a Certain Knowledge

Academic journal article International Journal of Psychoanalysis

The Abuses of a Certain Knowledge

Article excerpt

What we call psychiatric practice is a certain moral tactic contemporary with the end of the eighteenth century, preserved in the rites of asylum life and overlaid by the myths of positivism.

(Foucault, 1961-1972, p. 262)

On 6 November 2012, a decision of the administrative appeals court in Bordeaux rekindled the debate over the right to a sex life for psychiatric hospital in-patients.2 Such a debate is far too rare despite - or due to - the fact that it undoubtedly leads us back to the heart of the dialectic of the desiring subject. The sex act is too often a taboo topic when madness is what summons it. If inimical old age is added to madness, death overdetermines the taboo. The sex act in the elderly subject suffering from dementia is subject to prohibition; its obscenity is to be proscribed because it is such a violation of the rules of propriety proceeding from a moralizing discourse. Due to the frantic pathologization which our society, keen on normality, imposes on our elders, making them dread the mediatized Alzheimer's spectrum, the right to sexuality in demented individuals deserves a place in current debates. Hence our interest in the roots of this taboo on the basis of the clinical account that follows. But it is the psychiatric collective that this paper primarily probes. As underlined by François Marty (2007, p. 99), "the institution can be considered as a space containing the psychic dynamic of all the members it is made up of (staff and patients). As such, ... the institution becomes an object of analysis insofar as fragments of the psychic life of all the protagonist are projected and deposited in its midst." As a result, it is down to us, mental health practitioners, to analyse the dynamics in which we have engaged with our own subjectivity. What do we strive to silence by repressing these desires that seek to be satisfied? What are the effects of such subjugation of the desiring body? What are the hidden truths that seek to be heard on either side of the collective and what are the secret goals that are met in this way? Let us dare predict, from the outset, that a psychoanalytic exploration will allow us to lift the taboo by revealing the desires buried at the most secret core of the psyche, which the taboo obscures in the name of science.3

It is springtime when sexual claims arise among many of the patients in a geriatric inpatient psychiatry unit that accommodates elderly patients suffering from dementia. Couples are formed. Among them, Mr Y has for some time expressed his need to exercise his sexuality. Mrs X, for her part, actively seeks the company of men; she arouses them, especially Mr Y with whom she exchanges kisses and embraces. Such events are more or less well tolerated by the staff until the day when they are caught performing oral sex (cunnilingus). The couple is immediately split up.4 The incident is an occasion to set up a meeting in order to discuss the general measures that must be implemented in the face of such sexual unrest. The proposed arguments are very predominantly in favour of repressing sexual behaviour. Let us look at the main ones on the list: official regulations prohibit sexual relations in the context of the Institution;5 individuals considered to be vulnerable and fragile and to not be endowed with discriminating capacity must be protected (as a result, patients can no longer manage their bodies freely); the disapproval of adultery (Mrs X and Mr Y are both married); the - legit- imate - fear that the family might lodge a complaint; and finally, hygiene imperatives with the fear of sexually transmitted diseases are brought to mind. Even though it is tackled, the argument according to which the fulfilment of the sex act could be beneficial to the individual insofar as it leads to the satisfaction of a desire, is far from winning unanimous support.

Rational arguments, steeped in morality, thus veil and negate the distinct issues of each patient, as well as the psychodynamics of the complex relations that are woven within the psychiatric collective. …

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