译《新拉康派视角下的精神分析临床实践》（引言）
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EVOLVING LACANIAN PERSPECTIVES FOR CLINICAL PSYCHOANALYSIS
On Narcissism, Sexuation, and the Phases of Analysis in Contemporary Culture
Raul Moncayo
《新拉康派视角下的精神分析临床实践》
——关于自恋、性欲以及当代文化下的分析历程
by罗尔·蒙卡约
INTRODUCTION
引言
This book is the product of over twenty years of work in clinical and academic settings, both in the public and private sectors of the San Francisco Bay Area. I was born in Chile and attended a British school. I began psychoanalytic training in Buenos Aires, Argentina, in the early seventies, under the direction of Roberto Harari. In the U.S., I obtained a Ph.D. from the Wright Institute in Berkeley, in the tradition of the Frankfurt School of critical theory, and completed Lacanian training in the Lacanian School of psychoanalysis also in Berkeley. I am bi-cultural, thanks to my Chilean father and North American mother. My mother's ancestry is French so the interest in a French form of psychoanalysis may not be a coincidence. In addition to a French perspective, I represent a Lacanian-American, and a Latino-American perspective on psychoanalysis. Lacanian-American does not solely refer to the United States, but to the entire American continent, including Latin America and Canada.
这本书是超过二十年的临床工作和学术研究的产物，在旧金山湾区的各公共和私人场所写成。我出生于智利，后在英国上学。我在罗伯托·哈拉里的指导下开始精神分析训练是七十年代早期，在阿根廷的布宜诺斯艾利斯。在美国，我在伯克利莱特学院取得博士学位，主攻法兰克福学派的批判理论，并且同样也在伯克利，我完成了拉康学派精神分析的训练。我有着双重文化背景，这得益于我的智利籍父亲和北美籍母亲。我母亲祖上是法国人，因此对精神分析有着法国学派的兴趣可能也并非偶然。除了法国派视角，我还是个拉康派的美国人，而在精神分析方面我又是拉丁美洲视角。拉康派的美国人不仅仅指美国，还包括整个美洲大陆，包括拉丁美洲和加拿大。
Establishing a school of Lacanian psychoanalysis in California has been an interesting journey. Up until now in the United States Lacanian psychoanalysis has primarily come to light as part of the wave of French influence on academic culture in the humanities. Whether in Philosophy, Rhetoric, Literature, English, or French departments, Lacan has become a household name alongside Foucault, Derrida, and Deleuze, among others. At the same time, secondary to deep divisions or splits within North American academia, Lacanian thought has been largely ignored within the social science departments that train clinicians in the mental health professions. As a legacy of empiricism clinicians often are of the opinion that abstract thought or theory is of no relevance to best practices within the field of mental health. Even within North American and Anglo-Saxon psychoanalysis, Lacan is recognised as a theoretician but not as a clinical innovator,
在加利福尼亚建立一所拉康派精神分析学院是一段有趣的经历。到现在，美国的拉康派精神分析已经成为受法国学派影响的学术文化思潮中的一部分而为人所知。无论在哲学、修辞学、文学、英语或法语领域，拉康已成为一个家喻户晓的名字，与福柯、德里达、德勒兹等比肩。但与此同时，由于与北美学术圈有很深的隔阂，拉康思想在社会科学领域被严重忽视，比如在训练精神健康专业的临床医生方面。出于实证主义的临床医生的传统观点，他们通常认为抽象的思想或理论对于精神健康领域的实践来说没什么实用性。甚至在北美和盎格鲁-撒克逊的精神分析圈中，拉康被视为理论家，而非一个临床革新者。
English and Anglo-American culture are known for empiricism, pragmatism, and utilitarianism. It is also well known that English empiricism severed the link between philosophical and scientific discourse. Although this was an important moment for the development of the natural sciences, it may have come at a high price for the social sciences. French culture or continental European thought never defined a social science exclusively through the methodology of logical empiricism. In other words, within the social sciences, continental Europe preserved the link and continuity between scientific and philosophical theory.
英国和英美文化以实证主义、实用主义和功利主义著称。众所周知，英国经验主义切断了哲学和科学话语之间的联系。虽然这对自然科学的发展是个重要的节点，但可能会令社会科学付出很大的代价。法国文化或欧洲大陆思想从未以逻辑实证主义的方法论来定义过独立的社会科学概念。也就是说，在社会科学领域中，欧洲大陆保留了科学与哲学理论之间的这种联系和延续。
Despite being a former English colony, the United States is renowned as a country of immigrants, the site of the English vision of a New World, and as the great social experiment of democracy with regard to ideas, social classes, and cultural formations. The melting pot not only means the place where all cultures are reduced or assimilated to Anglo-American culture, but more importantly, the place of meeting and in-gathering of all nations and cultures. Like the English, the French and the Spanish were defeated militarily, as competing colonisers on North American soil. However, the vanquished always become incorporated into the psyche of the victors. In addition, the different Western powers would probably agree that knowledge must expand to encompass a more universal human dimension rather than simply remaining within the relativity of a particular cultural or national interest, whether cognitive, economic, spiritual, or political. It is also true that the latter are usually disguised under a pretence of objectivity and universality. I define universal as that which includes everything; its own lack, limitation, or emptiness. A tendency to violently reduce everything to a single numerator or master signifier can never attain the status of enduring universality.
美国作为曾经的英国殖民地，众所周知是一个移民国家，同时也是英国人梦想的新世界，是关乎民主的理念、社会阶层以及文化形态的伟大社会实验。这个大熔炉不仅意味着在这里所有文化都被削弱或向英美文化同化，更重要的意义是，它也是各种民族和文化相遇聚集之地。就像英国，法国和西班牙作为竞争北美疆土的殖民者，他们在军事上被英国打败了。但是，被战胜者总是会融入到胜利者的精神中。此外，其他西方大国想必也很认同，知识必然会扩展到覆盖一个更普遍性的人文尺度，而不只是维持与特定文化或国家利益有关，无论是在观念、经济、精神或政治方面。并且，后者通常掩饰在一个客观性和普遍性的伪装之下。我所说的普遍性指包括一切事物：包括它自身的缺失、局限或虚无。若要使用暴力将一切弱化为单一分子或主能指，这是永远不可能达到持续普遍性状态的。
What then is the relevance of Lacanian theory and practice to the English-speaking world and the New World? This question has to be answered first by addressing the relevance of theory. As already stated, empiricism is known for accepting "scientific" rather than "philosophical" theories. The consequence of this within the clinical mental health or behavioural field as it is now called, is that clinicians feel comfortable with a series of techniques applicable to different types of pathologies and treatment, but that do not require them to think theoretically in any way, shape, or form. Even universities (what Lacan calls the university discourse) do not teach critical thinking skills in psychology or psychiatry. It is only in the humanities that critical and theoretical discourses are cultivated and appreciated.
那么拉康理论和实践与英语系国家及这个新世界的关联是什么？要回答这个问题，首先要讲到理论的相关性。如前所述，实证主义被认为是更采用“科学的”而非“哲学的”理论。在心理健康临床或行为领域，这导致的结果是现在我们说的，医生对于不同的病理和治疗掌握了一系列的应用技术而感觉良好，但是那不需要他们做任何形式或内容的理论思考。甚至大学里（也就是拉康所说的普适性话语）也不教导心理学或精神病学的批判性思维能力。只有在人文学科中批判性和理论性的话语才会被栽培和欣赏。
The consequence of the repression of critical clinical theory within the social sciences is the continuation of a split within the culture and within the psyche. There are the academics in their ivory tower on one side and the clinicians in the trenches on the other. Clinicians sometimes will say, "Oh! That is academic," as if theory did not have any relevance to clinical practice. Clinicians are left then with a series of fragmented techniques that are applied to clinical diagnoses that are themselves fragmented and disconnected from other diagnoses. What is missing from empiricist scientistic culture in psychology and psychiatry is a structural theoretical understanding. This would bring continuity and coherence to and among psychological development, family and psychical structure, social phenomena, brain function, spiritual development, and psychopathology.
在社会科学中压制批判性的临床理论，其结果是造成了在文化和精神层面持续的分裂，一边是象牙塔中的学者们，一边是战壕中的临床医生们。临床医生有时会说，“哦！那只是理论上。”就好像理论与临床实践没有任何关系。于是医生们保留着一堆碎片化的技术应用于临床诊断中，而那使得他们自己也变得碎片化，且与其他病症断裂。在心理学和精神病学中，实证主义的科学文化所缺失的是一种结构化的理论知识。这将为心理发展、家庭和精神结构、社会现象、大脑机制、精神发展，以及精神病理学各领域带来连贯一致性。
The notion of the psyche held the promise of psychiatry being a bridge between the natural sciences and the social sciences. As it stands now, under the banner of scientistic empiricism, biological psychiatry has become a market tool of pharmaceutical companies and Wall Street capitalism. Empirically validated forms of treatment present their findings as foundations for "evidence-based" clinical practices. However, most clinical studies are only six weeks long and are done with subjects who are quite different from the clinical populations that most clinicians encounter. The success rates of many medications do not prove to be nearly as accurate with patients treated in clinical practice. This is particularly the case for antidepressants with chronically and severely depressed populations. I do not mean to question the merits of psychotropic medications but simply to point out that the evidence is not as clear and definite as it is usually presented. The so-called evidence is in the realm of the Imaginary (videre in Latin) and in the presentation of a believable image. In actual practice the reliability of the study depends on how the studies are designed, the assumptions behind the questions
asked, the populations used, and how the results are presented. The fact that a treatment has proven effective in a clinical trial is no guarantee that it will be effective with a clinical population.
精神的概念使得精神病学必然成为自然科学和社会科学之间的一座桥梁。就像如今在科学实证主义的名义下，生物精神病学已成为医药公司和华尔街资本主义的市场工具。实证检验的治疗模式将他们的发现称为“基于实证”的临床实践。但是，大部分临床研究只有6周时间，并且被试者与大部分医生遇到的临床群体很不一样。许多药物的成功率与病人在临床治疗中的实际情况大相径庭，比如抗抑郁药物应用于长期的严重的抑郁人群。我并非质疑精神类药物的优点，只是想指出，实证检验并非如它通常所称的那样清楚明确。所谓的实证检验只是在想象中(拉丁语中的videre) ，用某种可信的画面呈现出来。在真实的实践中，研究的可靠性应该是基于研究是如何设计的，问题背后的假设是什么，所实施的人群对象是谁，以及结果如何解释。而即使某种疗法被证实在临床试验中是有效的，也不能保证在病人们身上也同样有效。
Conversely, a treatment that has not been empirically studied in a clinical trial could also be effective with a clinical population. Brain research has already made many positive contributions to psychiatry but these advances are presented, especially in the media, as completely new findings. In actuality many new findings are things that were already well known within psychoanalysis and psychiatry. The only difference is that now we have an expanded understanding of how things may work in different areas of the brain. The problem with scientism in the social sciences is not empirical research, or knowledge derived from the senses, but how it fragments human knowledge and posits one form of knowledge or logic as the sole legitimate and dominant form of knowledge. I agree with the Frankfurt school and critical theory that this is not done for the sake of objective knowledge but to protect political and economic interests.
反之，某种疗法并未在临床试验中实证研究过，对病人们来说也可能是有效的。大脑研究对精神病学已有诸多积极的贡献，但是这些进展只是作为一些全新发现发表在媒体上。实际上许多新发现都是那些在精神分析和精神病学中早已众所周知的事。唯一的不同就是，现在我们有了扩展知识，知道了大脑不同区域是如何运作的。社会科学中的科学主义的问题，并不在于它是实证性的研究，或从感觉中衍生出认识，而是它割裂了人类的认识，并且假定某种观点或逻辑就是唯一正确合理的认识。我认同法兰克福学院及其批判理论，这不是出于客观认识的缘故，而是为了保护政治和经济利益。
Psychoanalysis relies on the case study method to test the truthvalue and effectiveness of the theory. The single clinical case represents the point of articulation of theory and practice. From a Lacanian perspective, psychoanalysis needs to be reinvented on a case-by-case basis, beginning with the personal analysis of the clinician himself or herself. Therefore, psychical causality and symbolic effectiveness within psychiatry, psychology, and psychoanalysis need not be studied statistically to be effective within clinical practice.
精神分析依靠案例研究的方法来检验真伪以及理论的有效性。单一的临床案例反映了其与理论及实践之间的契合点。以拉康派的视角看来，精神分析需要以单个案例为基础，被重新发明一遍，就从医生他/她自己的个人分析开始。因此，在精神病学、心理学以及精神分析中，心理的因果关系，以及象征性质的有效，不需在统计意义上去研究它对临床实践的有效性。
If the behavioural field is reduced to evidence-based practices, then entire dimensions of subjectivity will be neglected and ignored to the detriment of the individual and society. What will remain is what Marcuse called a one-dimensional society of robotic people who have eyes but cannot see (seeing also requires the symbolic eye of a theory). Rather than statistics, it is the consumer of services who needs to be the final arbiter of whether a treatment is helpful or not in addressing a particular problem or condition. On the other hand, statistical studies can democratically co-exist side by side with clinical case studies and theoretical formulations, so long as the former are not tyrannically positioned as the sole valid form of knowledge determining practice guidelines and reimbursements or payments. In addition, theory construction requires a different set of cognitive skills than empirical research. To read and understand complex theory requires many years of study and reflection utilising abstract thought. In this sense it may be difficult to be a good empirical researcher and a good theoretician because the cognitive skills tend to exclude each other.
如果行为领域也简化为循证式的实践，那么整个主观维度都将被忽视忽略，从而损害到个人和社会。那么余下的就成了马库塞所说的机器人般的单一维度社会，他们有眼睛但看不见（看也需要理论的符号之眼）。不同于统计学，只有接受服务的消费者才能成为最终的裁决者，来判断某种疗法是否有帮助，或者尚有一些问题及适用条件。另一方面，统计学研究可以与临床案例研究和理论公式并列共存，只要前者不那么专横地将自己定位于知识的唯一正确形式，从而主导操作手册和保险赔付或收费标准。此外，理论建设还需要有不同于实证研究的另一套思维能力。阅读和理解复杂的理论要求多年运用抽象思维来学习和思考的训练。在这个意义上说，做一名优秀的实证研究者兼优秀的理论家可能很难，因为两种思维能力是互不兼容的。
The same may be true for being an empirical researcher and a clinician. To be a clinician one needs to practice clinical skills and the time allotted to this activity may conflict with the time needed to engage in empirical research. Most empirical researchers are not clinicians or vice versa. Reading and writing theory are more amenable activities for clinical practice. One can read and write between clients and in the evenings and on weekends. This is where democracy with regards to knowledge and power becomes allimportant. A democratic society is one in which different forms of knowledge and logic are supported and allowed their full development and implementation.
要做一个实证研究者兼医生可能也是如此。作为一个医生，你需要练习临床技能，分配给这项活动的时间可能和要投入实验研究的时间相冲突。大部分实证研究者并不是医生，反之亦然。阅读和撰写理论是更适合临床实践的活动，你可以在就诊间隙以及晚上和周末读读写写。在此，知识和权力的民主平等就变得非常重要。在一个民主的社会中，不同形式的知识和道理能够被支持和允许，它们得以充分发展和实施。
A theory needs to be scrutinised in the light of a critical analysis of the coherence of its own postulates and how they succeed or fail to explain clinical and/or phenomenological observations. In addition, clinical theory must not only explain/interpret the facts of the field but also must be of help in their treatment and modification. Although there is no punctual correspondence between structural theoretical elements and empirical facts, theoretical knowledge enables a clinician to work with mental representations and behavioural presentations. No therapy manual will be able to exhaust the wide variety of permutations and combinations possible within human behaviour. Similar phenomena can present themselves in many different forms and conditions. It is a sound theory of subjective structures that helps a clinician understand and treat the many polyvocal manifestations of psychopathology in each specific circumstance and individual encountered.
某种理论需要用批判性分析的眼光来推敲它背后假设的一致性，以及它们为何成功或失败地解释了临床现象和观察。此外，临床理论不能只是用来解释某个领域的现象，它还必须对治疗和改进有所助益。虽然在结构化的理论原理与实验观察的现象之间还没有严格地一一对应起来，但是理论知识使得医生能够利用心理反应和行为表现进行工作。没有什么治疗手册可以彻底罗列人类行为表现各种不同的排列组合。相似的现象可能在许多不同的情况和形式下表现出来。比如通过关于主体结构的健全理论，帮助医生理解和治疗各种特定环境和个人境遇下的许多精神病理性的多语性（polyvocal）表现。
Lacan insisted on the point that the frame for treatment needs to be designed on a case-by-case basis. Standardised and manual based treatments cannot but end up applying the logic of "one size fits all" criteria. Not only the treatment needs to vary according to diagnoses, but he also insisted upon the variability of time for each session and for each singular treatment. The variability in the length of the session, and of the treatment, is not only related to what Lacan called logical time but also to the fact that psychiatric and psychological/ psychical interventions are interventions within language. Behavioural facts are discursive facts or facts within discourse. Thus Lacan privileged the understanding of language for the understanding of human development, and of psychopathology and its treatment.
拉康坚持一个观点，治疗的框架应根据每个实际案例来设计。标准化手册化的治疗必须停止“各种情况一刀切”的观念。不仅是治疗需要根据案例来调整，他还坚持每个小节每个特定治疗都使用弹性时间。治疗小节以及整个治疗的时长变化，不只是出于拉康说的合理时间，也是由于精神病学和心理学/精神的干预是语言的干预。行为上的事实就是话语的事实，或者话语中的事实。因此，拉康特别将语言的知识用于了解人类的发展以及精神病学及其治疗方法。
Lacan views language as an embodied language. Language is not only a cognitive function, but it is also intrinsically tied to emotional life and the familial context of human development. Language is acquired within the workings of what Lacan called the paternal function within Oedipal structure. In addition, the linguistic signifier is a regulator of what Lacan called jouissance (pleasure/pain). Although Lacan's theory of the function of the linguistic signifier within psychical structure is relatively well known, his theories of jouissance, of love, sexuation, and narcissism are less known. The latter refers to the formation of a sexed sense of self within culture and to the emotional underpinnings of subjective and psychical structure. Many people in the English-speaking world and in other places, both within and outside psychoanalysis, believe that Lacanian psychoanalysis overemphasises the linguistic and the intellectual to the detriment of the affective, non-symbolic, and clinical aspects of experience. In the later Lacan the signifier not only regulates jouissance but also is itself a form of phallic jouissance regulated or limited by a higher order jouissance beyond the phallus.
拉康将语言视为以身体表达的语言。语言不仅是一种认知功能，本质上也是源于人的发展过程中的情感和家族语境。语言从拉康所说的俄狄浦斯结构的父性机制的运作中获得。此外，语言的能指是拉康所说的享乐（愉悦/痛苦）的调节器。虽然拉康关于精神结构中语言能指的运作机制的理论相对为人所知，但他的关于享乐、爱、性欲和自恋的理论就不那么被知晓。后者与自我的性别意识在文化中形成以及主体和精神结构的情感基础有关。在英语系国家和其他地方的许多人，在精神分析领域内外，都认为拉康派精神分析在情感创伤、非象征性的以及临床方面的经验都过于强调语言学和思辨。在拉康后期，能指不仅调节享乐，它自身也成了阴茎享乐的一种形式，被一种超越阴茎更高级别的享乐所调节或限制。
I formulate a distinctly Freudian-Lacanian conception of narcissism that broadens the understanding of narcissism while highlighting its relationship to partial objects, formations of the ego and the subject, and different forms of jouissance within the registers of experience. The Lacanian concepts of the objet a, and of jouissance, allow for a re-formulation and articulation of Freud's drive theory that is not without intersubjective dimensions, but also beyond egoic, and personalistic constructs. Psychopathology is intrinsically intertwined with larger historical changes in family structure, cultural definitions of sex and gender, and the social regulation of impulses and emotional life. It is well known that the postmodern family in the West is in crisis. Relationships between the sexes are experiencing enormous difficulties, the culture is struggling between traditional and contemporary definitions of sex and gender, and spirituality has become an increasingly important aspect of human experience.
我制作了一个显然是弗洛伊德式拉康的自恋概念，拓宽了对自恋的理解，其中我突出了自恋与部分客体的关联、自我和主体中自恋的部分，以及在体验的表达中不同形式的享乐。拉康的客体a和享乐的概念，使得我们可以重新解读、并且契合弗洛伊德的驱力理论，它既是主体间性的，也是超越小我和人格结构的。精神病学本质上是与家庭结构、性和性别的文化定义，以及对冲动和情感的社会规范这些方面更大的历史变迁交织在一起的。我们都知道，在西方国家后现代的家庭正陷入危机。两性间的关系正在经历巨大的困难，传统与现代定义下的性与性别的观念之间存在着文化上的对抗，并且精神性已成为人类体验中越来越重要的方面。
This book is not only sensitive with respect to presenting Lacanian ideas within the context of current clinical practices within the mental health field, but also within the context of minority mental health (both ethnic and sexual), and within the context of contemporary non-Lacanian psychoanalytic thought. I engage in a'critical analysis and inclusion of many intersubjective, object relations, and attachment theories. In many respects, Anglo-Saxon object-relations theory, the prevalent version of psychoanalysis in the English-speaking world, has neglefcted both sexuality and the function of the father. This is partly in compensation for an alleged neglect of trauma, the mother, and the pre-oedipal in Freud's theory, but also because of the feminist critique of Freudian and Lacanian phallocentrism. However, the price paid for the neglect of sexuality and the function of the father is coextensive to the confusion and malaise regarding sex and gender prevalent in Western culture. Despite the many necessary advances in women's socio-economic conditions brought about by feminism, at a psychical/familial level, feminism confuses the difference between the imaginary phallus/father and the symbolic father/phallus. Lacan makes this distinction clearer and to a further degree than Freud. The master's discourse, the discourse of patriarchal domination and power, is the discourse of the imaginary father. By turning the critique of patriarchal domination on its head, it is possible to argue that certain versions of feminism, and mother-centric discourse, also help reinforce the discourse of the imaginary father, and the master.
这本书不仅在精神健康领域内的新近临床实践背景下阐述拉康的观点，也涉及少数人群的精神健康（少数民族和性少数人群），以及当代非拉康派精神分析思想。我从事严谨的精神分析，也包括主体间、客体关系和依恋理论。安格鲁-撒克逊的客体关系理论，这一英语世界中流行的精神分析流派，在许多方面都忽视了性欲和父性机制。这部分是出于对弗洛伊德理论中忽视了的创伤、母亲和前俄狄浦斯期的补偿，同时也是因为对弗洛伊德和拉康的阳具中心主义的女性主义式的批判。然而，忽略性欲和父性机制的代价是西方文化中蔓延着对性和性别的困惑与不适。尽管女性主义在女性的社会化经济环境下带来了许多必然的进步，但在精神性的/家族的层面上，女性主义混淆了阳具/父亲的想象和父亲/阳具的符号之间的区别。拉康使这一区别更清晰化，并且比弗洛伊德更深一步。权威的话语，父权统治和权力，是幻想父亲的话语。通过将父权统治的批判按在它头上，才有可能去争辩某种女性主义的观点和母性中心的话语，而这同样也加强了幻想父亲和权威的话语。
The question of cultural difference and diversity also has become of utmost importance for the mental health field in a postmodern world. Nowadays, clinicians must be culturally competent to treat individuals from many different cultures. The last chapter of this book addresses the issue of cultural difference from the point of view of a Lacanian reading of Latino American experience. Many people from traditional non-Western cultures rely on religion, spirituality, or culture, to address the questions posed by psychopathology and psychical or mental suffering. Most books on Lacanian topics do not address the relevance of Lacanian psychoanalysis for the treatment of ethnic groups.
文化差异和文化多样性的问题，也成为了这个后现代世界中精神健康领域内的头等重要问题。如今，医生们必须能够从文化层面上胜任，以治疗来自各种不同文化背景下的人们。本书的最后一章探讨文化差异的议题，从拉康派的视角来解读拉丁美洲人的体验。许多传统非西方文化背景的人会通过宗教、灵性或文化来谈这些精神病学以及心理或精神痛苦方面的问题。大部分拉康派思想的书籍也并不涉及拉康派精神分析对民族性群体的治疗。
Lacanian-American perspectives are also consistent with postcolonial theory in that, although careful and respectful with regard to Lacanian scholarship, analytical training, and the complexity of Lacan's thought, it dares to appropriate a European discourse, and present it in a distinctly continental American voice. To do otherwise is to continue to reinforce a colonialist mentality and a social transference whereby the French may be placed in the position of the master and the "one who knows/7 There is more than one way to interpret Lacan since Lacan left many contradictions open within his work and his thought also changed over time. Lacan purposefully wrote in a style that left the question of interpretation open rather than closed. Two, three, or perhaps four, individuals (but not many more than this), can arrive at different or opposite conclusions regarding what Lacan meant to say about a particular concept. Difference and diversity within interpretation is consistent with and predicted by the very logic of what Lacan called the Borromean knot. The Borromean knot is composed of two things: three dimensions that intersect one another and a fourth that tie the other three together.
美国拉康派的观点与后殖民主义理论的一致之处在于，尽管谨慎尊重地对待拉康派的学术、分析性的训练以及拉康思想的复杂性，但它敢于拥有一套欧洲的话语，并且发出一种明显的美洲声音。否则我们能做的只是继续加强殖民主义心态以及社会转型，其中法国可能被置于专家以及“全知者”的位置上。由于拉康在他的工作中留下了许多开放性的争议，他的思想也随着时间在变化，因此有多种方式来解读拉康。拉康有意使用某种写作风格，使得这些问题有开放性的解读空间而不是封闭的。关于某个特定概念上拉康真正想说的意思，人们可能会得出两个、三个或四个（但也多不了许多）不同甚至相反的结论。在拉康称之为“博罗梅安结”的特定逻辑中，解读中的差异性和多样性正符合这一逻辑，并得到了预见。博罗梅安结由两部分组成：三个环一个挨一个地相交叠，以及第四个环将其它三个串在一起。
A concept, word, or idea, can acquire different meaning according to the perspective of the register in question (Real, Symbolic, or Imaginary). In contrast to other books, the intent of this book is to provide the reader with a Lacanian or Borromean perspective rather than a closed or authoritative interpretation or introduction to Lacan's work. However, when deviating from accepted or supposedly authoritative interpretations of Lacan's work, I am careful to provide a rationale, and how I believe certain alternative formulations may help clarify dialectical tensions within Lacan's own thinking, but without ever pretending to provide a final synthesis or interpretation.
一个概念、词语或想法，根据对问题界定（现实、象征、想象）的视角可获得不同的含义。与其他著作相比，本书旨在给读者提供一个拉康式的或博罗梅安的视角，而不是对拉康思想的一种封闭的、权威式的解读或介绍。不过，如遇偏离了对拉康思想一般所接受或认同的权威解释时，我会谨慎地给出理论说明，以及我为何认为其它某种解释有助于厘清拉康本人的思想中的辩证矛盾之处，但我不会刻意提供一个最终结论或解释。
Lacan understood the name of the father, as the fourth dimension that ties the other three together, as the names (in plural) rather than THE name of the father (in the singular and exclusive version). On the other hand, the name of the father, to qualify as such, has to have something of the one, but primarily of the zero of castration. Otherwise plural versions of the father, without the zero of a symbolic debt or inheritance, would be no different than perversion (pere-version: the versions of the father).
拉康所理解的父亲之名，就像串起其它三个环的第四个环，就像名字（复数）而不是父亲的名字（单数，独有的）。另一方面，父亲之名，要具备这样的资格，必须拥有某种属一的东西，但首先要经过阉割拥有属零的东西。否则父亲的多个版本，缺失了象征性的责任或继承的零，就将与变态无异（文字游戏pere-version：父亲的多个版本）。
Lacan was expelled from the International Psychoanalytic Association for his clinical practices, and to this day, Lacanian clinical practice is not taught or practiced within the psychoanalytic institutes affiliated with the IPA. This is the final point of resistance to Lacan's contribution to psychoanalysis and psychiatry in general. Paradoxically, it may be that it is precisely the Lacanian approach to the psychoanalytic frame which may help psychoanalysis continue to be relevant for contemporary culture and clinical practice. Psychoanalysis nowadays is considered to be too long, rigid, and expensive to be of use for people with private insurance, ethnic groups, public mental health, the poor, and the severely disturbed with substance abuse problems. Lacan's return to Freud included not only a return to Freudian ideas, but also to Freud's more flexible clinical practices. From a Lacanian perspective, the classical frame for analysis can be regarded as a postfreudian rather than a Freudian development, and as only one of the possible formats/tools of clinical psychoanalysis. Lacan insisted on the singularity of each session, subject, and treatment. For cultural as well as clinical reasons, psychoanalysis cannot be practiced according to the "one size fits all" criteria.
拉康由于他的临床实践被国际精神分析协会除名，而且时至今日，拉康派的临床实践仍未在IPA下所属的精神分析学院中教学或使用。可以说这是否定拉康对精神分析和精神病学贡献的最后抵抗。矛盾的是，这可能又恰是拉康派分析框架下的方式，这将有助于精神分析继续与当代文化和临床实践保持关联。如今精神分析被认为太长程、严格，而且对一些人来说太昂贵而无法使用，比如买私人保险的人们、种族群体、公共精神健康，穷人，以及因物质滥用问题而严重困扰的人们。拉康说的回到弗洛伊德，不仅是返回弗洛伊德的思想，还包括回到弗洛伊德那种更灵活的临床工作方式。从拉康派的视角看来，分析的经典框架可被视为后弗洛伊德式的，并且是精神分析临床工作的唯一方法，而非对弗洛伊德的发展改良。拉康坚持维护每次谈话、每个主体和治疗的特殊性。出于文化的以及临床的原因，精神分析不可能按照“一刀切”的标准来进行操作。
Finally, in addition to presenting a multiform criterion to the psychoanalytic frame, this book also applies Lacanian ideas to the elucidation and treatment of depression. Lacan dedicated a seminar to the symptom of anxiety but did not focus on the problem of depression that has become the most widespread psychical malaise within contemporary culture. As anxiety was the malaise of traditional and modern Western culture at the turn of the century, depression has become the main symptom of a postmodern period linked to a loss of traditional ideals and aspirations..
最后要说，除了展现精神分析框架的多样性标准，本书也将给出拉康派对抑郁的观点和治疗。拉康致力于焦虑症状的研讨会，但并没有聚焦于抑郁的问题，而抑郁已成为当代文化中最普遍的精神痛苦。焦虑是传统和现代西方文化在世纪之交时产生的精神不适，而抑郁已成为后现代时期的主要表现，与丧失了传统的理想和抱负有关。
有些已公认的翻译措辞欢迎提出指正
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EVOLVING LACANIAN PERSPECTIVES FOR CLINICAL PSYCHOANALYSIS
On Narcissism, Sexuation, and the Phases of Analysis in Contemporary Culture
Raul Moncayo
《新拉康派视角下的精神分析临床实践》
——关于自恋、性欲以及当代文化下的分析历程
by罗尔·蒙卡约
INTRODUCTION
引言
This book is the product of over twenty years of work in clinical and academic settings, both in the public and private sectors of the San Francisco Bay Area. I was born in Chile and attended a British school. I began psychoanalytic training in Buenos Aires, Argentina, in the early seventies, under the direction of Roberto Harari. In the U.S., I obtained a Ph.D. from the Wright Institute in Berkeley, in the tradition of the Frankfurt School of critical theory, and completed Lacanian training in the Lacanian School of psychoanalysis also in Berkeley. I am bi-cultural, thanks to my Chilean father and North American mother. My mother's ancestry is French so the interest in a French form of psychoanalysis may not be a coincidence. In addition to a French perspective, I represent a Lacanian-American, and a Latino-American perspective on psychoanalysis. Lacanian-American does not solely refer to the United States, but to the entire American continent, including Latin America and Canada.
这本书是超过二十年的临床工作和学术研究的产物，在旧金山湾区的各公共和私人场所写成。我出生于智利，后在英国上学。我在罗伯托·哈拉里的指导下开始精神分析训练是七十年代早期，在阿根廷的布宜诺斯艾利斯。在美国，我在伯克利莱特学院取得博士学位，主攻法兰克福学派的批判理论，并且同样也在伯克利，我完成了拉康学派精神分析的训练。我有着双重文化背景，这得益于我的智利籍父亲和北美籍母亲。我母亲祖上是法国人，因此对精神分析有着法国学派的兴趣可能也并非偶然。除了法国派视角，我还是个拉康派的美国人，而在精神分析方面我又是拉丁美洲视角。拉康派的美国人不仅仅指美国，还包括整个美洲大陆，包括拉丁美洲和加拿大。
Establishing a school of Lacanian psychoanalysis in California has been an interesting journey. Up until now in the United States Lacanian psychoanalysis has primarily come to light as part of the wave of French influence on academic culture in the humanities. Whether in Philosophy, Rhetoric, Literature, English, or French departments, Lacan has become a household name alongside Foucault, Derrida, and Deleuze, among others. At the same time, secondary to deep divisions or splits within North American academia, Lacanian thought has been largely ignored within the social science departments that train clinicians in the mental health professions. As a legacy of empiricism clinicians often are of the opinion that abstract thought or theory is of no relevance to best practices within the field of mental health. Even within North American and Anglo-Saxon psychoanalysis, Lacan is recognised as a theoretician but not as a clinical innovator,
在加利福尼亚建立一所拉康派精神分析学院是一段有趣的经历。到现在，美国的拉康派精神分析已经成为受法国学派影响的学术文化思潮中的一部分而为人所知。无论在哲学、修辞学、文学、英语或法语领域，拉康已成为一个家喻户晓的名字，与福柯、德里达、德勒兹等比肩。但与此同时，由于与北美学术圈有很深的隔阂，拉康思想在社会科学领域被严重忽视，比如在训练精神健康专业的临床医生方面。出于实证主义的临床医生的传统观点，他们通常认为抽象的思想或理论对于精神健康领域的实践来说没什么实用性。甚至在北美和盎格鲁-撒克逊的精神分析圈中，拉康被视为理论家，而非一个临床革新者。
English and Anglo-American culture are known for empiricism, pragmatism, and utilitarianism. It is also well known that English empiricism severed the link between philosophical and scientific discourse. Although this was an important moment for the development of the natural sciences, it may have come at a high price for the social sciences. French culture or continental European thought never defined a social science exclusively through the methodology of logical empiricism. In other words, within the social sciences, continental Europe preserved the link and continuity between scientific and philosophical theory.
英国和英美文化以实证主义、实用主义和功利主义著称。众所周知，英国经验主义切断了哲学和科学话语之间的联系。虽然这对自然科学的发展是个重要的节点，但可能会令社会科学付出很大的代价。法国文化或欧洲大陆思想从未以逻辑实证主义的方法论来定义过独立的社会科学概念。也就是说，在社会科学领域中，欧洲大陆保留了科学与哲学理论之间的这种联系和延续。
Despite being a former English colony, the United States is renowned as a country of immigrants, the site of the English vision of a New World, and as the great social experiment of democracy with regard to ideas, social classes, and cultural formations. The melting pot not only means the place where all cultures are reduced or assimilated to Anglo-American culture, but more importantly, the place of meeting and in-gathering of all nations and cultures. Like the English, the French and the Spanish were defeated militarily, as competing colonisers on North American soil. However, the vanquished always become incorporated into the psyche of the victors. In addition, the different Western powers would probably agree that knowledge must expand to encompass a more universal human dimension rather than simply remaining within the relativity of a particular cultural or national interest, whether cognitive, economic, spiritual, or political. It is also true that the latter are usually disguised under a pretence of objectivity and universality. I define universal as that which includes everything; its own lack, limitation, or emptiness. A tendency to violently reduce everything to a single numerator or master signifier can never attain the status of enduring universality.
美国作为曾经的英国殖民地，众所周知是一个移民国家，同时也是英国人梦想的新世界，是关乎民主的理念、社会阶层以及文化形态的伟大社会实验。这个大熔炉不仅意味着在这里所有文化都被削弱或向英美文化同化，更重要的意义是，它也是各种民族和文化相遇聚集之地。就像英国，法国和西班牙作为竞争北美疆土的殖民者，他们在军事上被英国打败了。但是，被战胜者总是会融入到胜利者的精神中。此外，其他西方大国想必也很认同，知识必然会扩展到覆盖一个更普遍性的人文尺度，而不只是维持与特定文化或国家利益有关，无论是在观念、经济、精神或政治方面。并且，后者通常掩饰在一个客观性和普遍性的伪装之下。我所说的普遍性指包括一切事物：包括它自身的缺失、局限或虚无。若要使用暴力将一切弱化为单一分子或主能指，这是永远不可能达到持续普遍性状态的。
What then is the relevance of Lacanian theory and practice to the English-speaking world and the New World? This question has to be answered first by addressing the relevance of theory. As already stated, empiricism is known for accepting "scientific" rather than "philosophical" theories. The consequence of this within the clinical mental health or behavioural field as it is now called, is that clinicians feel comfortable with a series of techniques applicable to different types of pathologies and treatment, but that do not require them to think theoretically in any way, shape, or form. Even universities (what Lacan calls the university discourse) do not teach critical thinking skills in psychology or psychiatry. It is only in the humanities that critical and theoretical discourses are cultivated and appreciated.
那么拉康理论和实践与英语系国家及这个新世界的关联是什么？要回答这个问题，首先要讲到理论的相关性。如前所述，实证主义被认为是更采用“科学的”而非“哲学的”理论。在心理健康临床或行为领域，这导致的结果是现在我们说的，医生对于不同的病理和治疗掌握了一系列的应用技术而感觉良好，但是那不需要他们做任何形式或内容的理论思考。甚至大学里（也就是拉康所说的普适性话语）也不教导心理学或精神病学的批判性思维能力。只有在人文学科中批判性和理论性的话语才会被栽培和欣赏。
The consequence of the repression of critical clinical theory within the social sciences is the continuation of a split within the culture and within the psyche. There are the academics in their ivory tower on one side and the clinicians in the trenches on the other. Clinicians sometimes will say, "Oh! That is academic," as if theory did not have any relevance to clinical practice. Clinicians are left then with a series of fragmented techniques that are applied to clinical diagnoses that are themselves fragmented and disconnected from other diagnoses. What is missing from empiricist scientistic culture in psychology and psychiatry is a structural theoretical understanding. This would bring continuity and coherence to and among psychological development, family and psychical structure, social phenomena, brain function, spiritual development, and psychopathology.
在社会科学中压制批判性的临床理论，其结果是造成了在文化和精神层面持续的分裂，一边是象牙塔中的学者们，一边是战壕中的临床医生们。临床医生有时会说，“哦！那只是理论上。”就好像理论与临床实践没有任何关系。于是医生们保留着一堆碎片化的技术应用于临床诊断中，而那使得他们自己也变得碎片化，且与其他病症断裂。在心理学和精神病学中，实证主义的科学文化所缺失的是一种结构化的理论知识。这将为心理发展、家庭和精神结构、社会现象、大脑机制、精神发展，以及精神病理学各领域带来连贯一致性。
The notion of the psyche held the promise of psychiatry being a bridge between the natural sciences and the social sciences. As it stands now, under the banner of scientistic empiricism, biological psychiatry has become a market tool of pharmaceutical companies and Wall Street capitalism. Empirically validated forms of treatment present their findings as foundations for "evidence-based" clinical practices. However, most clinical studies are only six weeks long and are done with subjects who are quite different from the clinical populations that most clinicians encounter. The success rates of many medications do not prove to be nearly as accurate with patients treated in clinical practice. This is particularly the case for antidepressants with chronically and severely depressed populations. I do not mean to question the merits of psychotropic medications but simply to point out that the evidence is not as clear and definite as it is usually presented. The so-called evidence is in the realm of the Imaginary (videre in Latin) and in the presentation of a believable image. In actual practice the reliability of the study depends on how the studies are designed, the assumptions behind the questions
asked, the populations used, and how the results are presented. The fact that a treatment has proven effective in a clinical trial is no guarantee that it will be effective with a clinical population.
精神的概念使得精神病学必然成为自然科学和社会科学之间的一座桥梁。就像如今在科学实证主义的名义下，生物精神病学已成为医药公司和华尔街资本主义的市场工具。实证检验的治疗模式将他们的发现称为“基于实证”的临床实践。但是，大部分临床研究只有6周时间，并且被试者与大部分医生遇到的临床群体很不一样。许多药物的成功率与病人在临床治疗中的实际情况大相径庭，比如抗抑郁药物应用于长期的严重的抑郁人群。我并非质疑精神类药物的优点，只是想指出，实证检验并非如它通常所称的那样清楚明确。所谓的实证检验只是在想象中(拉丁语中的videre) ，用某种可信的画面呈现出来。在真实的实践中，研究的可靠性应该是基于研究是如何设计的，问题背后的假设是什么，所实施的人群对象是谁，以及结果如何解释。而即使某种疗法被证实在临床试验中是有效的，也不能保证在病人们身上也同样有效。
Conversely, a treatment that has not been empirically studied in a clinical trial could also be effective with a clinical population. Brain research has already made many positive contributions to psychiatry but these advances are presented, especially in the media, as completely new findings. In actuality many new findings are things that were already well known within psychoanalysis and psychiatry. The only difference is that now we have an expanded understanding of how things may work in different areas of the brain. The problem with scientism in the social sciences is not empirical research, or knowledge derived from the senses, but how it fragments human knowledge and posits one form of knowledge or logic as the sole legitimate and dominant form of knowledge. I agree with the Frankfurt school and critical theory that this is not done for the sake of objective knowledge but to protect political and economic interests.
反之，某种疗法并未在临床试验中实证研究过，对病人们来说也可能是有效的。大脑研究对精神病学已有诸多积极的贡献，但是这些进展只是作为一些全新发现发表在媒体上。实际上许多新发现都是那些在精神分析和精神病学中早已众所周知的事。唯一的不同就是，现在我们有了扩展知识，知道了大脑不同区域是如何运作的。社会科学中的科学主义的问题，并不在于它是实证性的研究，或从感觉中衍生出认识，而是它割裂了人类的认识，并且假定某种观点或逻辑就是唯一正确合理的认识。我认同法兰克福学院及其批判理论，这不是出于客观认识的缘故，而是为了保护政治和经济利益。
Psychoanalysis relies on the case study method to test the truthvalue and effectiveness of the theory. The single clinical case represents the point of articulation of theory and practice. From a Lacanian perspective, psychoanalysis needs to be reinvented on a case-by-case basis, beginning with the personal analysis of the clinician himself or herself. Therefore, psychical causality and symbolic effectiveness within psychiatry, psychology, and psychoanalysis need not be studied statistically to be effective within clinical practice.
精神分析依靠案例研究的方法来检验真伪以及理论的有效性。单一的临床案例反映了其与理论及实践之间的契合点。以拉康派的视角看来，精神分析需要以单个案例为基础，被重新发明一遍，就从医生他/她自己的个人分析开始。因此，在精神病学、心理学以及精神分析中，心理的因果关系，以及象征性质的有效，不需在统计意义上去研究它对临床实践的有效性。
If the behavioural field is reduced to evidence-based practices, then entire dimensions of subjectivity will be neglected and ignored to the detriment of the individual and society. What will remain is what Marcuse called a one-dimensional society of robotic people who have eyes but cannot see (seeing also requires the symbolic eye of a theory). Rather than statistics, it is the consumer of services who needs to be the final arbiter of whether a treatment is helpful or not in addressing a particular problem or condition. On the other hand, statistical studies can democratically co-exist side by side with clinical case studies and theoretical formulations, so long as the former are not tyrannically positioned as the sole valid form of knowledge determining practice guidelines and reimbursements or payments. In addition, theory construction requires a different set of cognitive skills than empirical research. To read and understand complex theory requires many years of study and reflection utilising abstract thought. In this sense it may be difficult to be a good empirical researcher and a good theoretician because the cognitive skills tend to exclude each other.
如果行为领域也简化为循证式的实践，那么整个主观维度都将被忽视忽略，从而损害到个人和社会。那么余下的就成了马库塞所说的机器人般的单一维度社会，他们有眼睛但看不见（看也需要理论的符号之眼）。不同于统计学，只有接受服务的消费者才能成为最终的裁决者，来判断某种疗法是否有帮助，或者尚有一些问题及适用条件。另一方面，统计学研究可以与临床案例研究和理论公式并列共存，只要前者不那么专横地将自己定位于知识的唯一正确形式，从而主导操作手册和保险赔付或收费标准。此外，理论建设还需要有不同于实证研究的另一套思维能力。阅读和理解复杂的理论要求多年运用抽象思维来学习和思考的训练。在这个意义上说，做一名优秀的实证研究者兼优秀的理论家可能很难，因为两种思维能力是互不兼容的。
The same may be true for being an empirical researcher and a clinician. To be a clinician one needs to practice clinical skills and the time allotted to this activity may conflict with the time needed to engage in empirical research. Most empirical researchers are not clinicians or vice versa. Reading and writing theory are more amenable activities for clinical practice. One can read and write between clients and in the evenings and on weekends. This is where democracy with regards to knowledge and power becomes allimportant. A democratic society is one in which different forms of knowledge and logic are supported and allowed their full development and implementation.
要做一个实证研究者兼医生可能也是如此。作为一个医生，你需要练习临床技能，分配给这项活动的时间可能和要投入实验研究的时间相冲突。大部分实证研究者并不是医生，反之亦然。阅读和撰写理论是更适合临床实践的活动，你可以在就诊间隙以及晚上和周末读读写写。在此，知识和权力的民主平等就变得非常重要。在一个民主的社会中，不同形式的知识和道理能够被支持和允许，它们得以充分发展和实施。
A theory needs to be scrutinised in the light of a critical analysis of the coherence of its own postulates and how they succeed or fail to explain clinical and/or phenomenological observations. In addition, clinical theory must not only explain/interpret the facts of the field but also must be of help in their treatment and modification. Although there is no punctual correspondence between structural theoretical elements and empirical facts, theoretical knowledge enables a clinician to work with mental representations and behavioural presentations. No therapy manual will be able to exhaust the wide variety of permutations and combinations possible within human behaviour. Similar phenomena can present themselves in many different forms and conditions. It is a sound theory of subjective structures that helps a clinician understand and treat the many polyvocal manifestations of psychopathology in each specific circumstance and individual encountered.
某种理论需要用批判性分析的眼光来推敲它背后假设的一致性，以及它们为何成功或失败地解释了临床现象和观察。此外，临床理论不能只是用来解释某个领域的现象，它还必须对治疗和改进有所助益。虽然在结构化的理论原理与实验观察的现象之间还没有严格地一一对应起来，但是理论知识使得医生能够利用心理反应和行为表现进行工作。没有什么治疗手册可以彻底罗列人类行为表现各种不同的排列组合。相似的现象可能在许多不同的情况和形式下表现出来。比如通过关于主体结构的健全理论，帮助医生理解和治疗各种特定环境和个人境遇下的许多精神病理性的多语性（polyvocal）表现。
Lacan insisted on the point that the frame for treatment needs to be designed on a case-by-case basis. Standardised and manual based treatments cannot but end up applying the logic of "one size fits all" criteria. Not only the treatment needs to vary according to diagnoses, but he also insisted upon the variability of time for each session and for each singular treatment. The variability in the length of the session, and of the treatment, is not only related to what Lacan called logical time but also to the fact that psychiatric and psychological/ psychical interventions are interventions within language. Behavioural facts are discursive facts or facts within discourse. Thus Lacan privileged the understanding of language for the understanding of human development, and of psychopathology and its treatment.
拉康坚持一个观点，治疗的框架应根据每个实际案例来设计。标准化手册化的治疗必须停止“各种情况一刀切”的观念。不仅是治疗需要根据案例来调整，他还坚持每个小节每个特定治疗都使用弹性时间。治疗小节以及整个治疗的时长变化，不只是出于拉康说的合理时间，也是由于精神病学和心理学/精神的干预是语言的干预。行为上的事实就是话语的事实，或者话语中的事实。因此，拉康特别将语言的知识用于了解人类的发展以及精神病学及其治疗方法。
Lacan views language as an embodied language. Language is not only a cognitive function, but it is also intrinsically tied to emotional life and the familial context of human development. Language is acquired within the workings of what Lacan called the paternal function within Oedipal structure. In addition, the linguistic signifier is a regulator of what Lacan called jouissance (pleasure/pain). Although Lacan's theory of the function of the linguistic signifier within psychical structure is relatively well known, his theories of jouissance, of love, sexuation, and narcissism are less known. The latter refers to the formation of a sexed sense of self within culture and to the emotional underpinnings of subjective and psychical structure. Many people in the English-speaking world and in other places, both within and outside psychoanalysis, believe that Lacanian psychoanalysis overemphasises the linguistic and the intellectual to the detriment of the affective, non-symbolic, and clinical aspects of experience. In the later Lacan the signifier not only regulates jouissance but also is itself a form of phallic jouissance regulated or limited by a higher order jouissance beyond the phallus.
拉康将语言视为以身体表达的语言。语言不仅是一种认知功能，本质上也是源于人的发展过程中的情感和家族语境。语言从拉康所说的俄狄浦斯结构的父性机制的运作中获得。此外，语言的能指是拉康所说的享乐（愉悦/痛苦）的调节器。虽然拉康关于精神结构中语言能指的运作机制的理论相对为人所知，但他的关于享乐、爱、性欲和自恋的理论就不那么被知晓。后者与自我的性别意识在文化中形成以及主体和精神结构的情感基础有关。在英语系国家和其他地方的许多人，在精神分析领域内外，都认为拉康派精神分析在情感创伤、非象征性的以及临床方面的经验都过于强调语言学和思辨。在拉康后期，能指不仅调节享乐，它自身也成了阴茎享乐的一种形式，被一种超越阴茎更高级别的享乐所调节或限制。
I formulate a distinctly Freudian-Lacanian conception of narcissism that broadens the understanding of narcissism while highlighting its relationship to partial objects, formations of the ego and the subject, and different forms of jouissance within the registers of experience. The Lacanian concepts of the objet a, and of jouissance, allow for a re-formulation and articulation of Freud's drive theory that is not without intersubjective dimensions, but also beyond egoic, and personalistic constructs. Psychopathology is intrinsically intertwined with larger historical changes in family structure, cultural definitions of sex and gender, and the social regulation of impulses and emotional life. It is well known that the postmodern family in the West is in crisis. Relationships between the sexes are experiencing enormous difficulties, the culture is struggling between traditional and contemporary definitions of sex and gender, and spirituality has become an increasingly important aspect of human experience.
我制作了一个显然是弗洛伊德式拉康的自恋概念，拓宽了对自恋的理解，其中我突出了自恋与部分客体的关联、自我和主体中自恋的部分，以及在体验的表达中不同形式的享乐。拉康的客体a和享乐的概念，使得我们可以重新解读、并且契合弗洛伊德的驱力理论，它既是主体间性的，也是超越小我和人格结构的。精神病学本质上是与家庭结构、性和性别的文化定义，以及对冲动和情感的社会规范这些方面更大的历史变迁交织在一起的。我们都知道，在西方国家后现代的家庭正陷入危机。两性间的关系正在经历巨大的困难，传统与现代定义下的性与性别的观念之间存在着文化上的对抗，并且精神性已成为人类体验中越来越重要的方面。
This book is not only sensitive with respect to presenting Lacanian ideas within the context of current clinical practices within the mental health field, but also within the context of minority mental health (both ethnic and sexual), and within the context of contemporary non-Lacanian psychoanalytic thought. I engage in a'critical analysis and inclusion of many intersubjective, object relations, and attachment theories. In many respects, Anglo-Saxon object-relations theory, the prevalent version of psychoanalysis in the English-speaking world, has neglefcted both sexuality and the function of the father. This is partly in compensation for an alleged neglect of trauma, the mother, and the pre-oedipal in Freud's theory, but also because of the feminist critique of Freudian and Lacanian phallocentrism. However, the price paid for the neglect of sexuality and the function of the father is coextensive to the confusion and malaise regarding sex and gender prevalent in Western culture. Despite the many necessary advances in women's socio-economic conditions brought about by feminism, at a psychical/familial level, feminism confuses the difference between the imaginary phallus/father and the symbolic father/phallus. Lacan makes this distinction clearer and to a further degree than Freud. The master's discourse, the discourse of patriarchal domination and power, is the discourse of the imaginary father. By turning the critique of patriarchal domination on its head, it is possible to argue that certain versions of feminism, and mother-centric discourse, also help reinforce the discourse of the imaginary father, and the master.
这本书不仅在精神健康领域内的新近临床实践背景下阐述拉康的观点，也涉及少数人群的精神健康（少数民族和性少数人群），以及当代非拉康派精神分析思想。我从事严谨的精神分析，也包括主体间、客体关系和依恋理论。安格鲁-撒克逊的客体关系理论，这一英语世界中流行的精神分析流派，在许多方面都忽视了性欲和父性机制。这部分是出于对弗洛伊德理论中忽视了的创伤、母亲和前俄狄浦斯期的补偿，同时也是因为对弗洛伊德和拉康的阳具中心主义的女性主义式的批判。然而，忽略性欲和父性机制的代价是西方文化中蔓延着对性和性别的困惑与不适。尽管女性主义在女性的社会化经济环境下带来了许多必然的进步，但在精神性的/家族的层面上，女性主义混淆了阳具/父亲的想象和父亲/阳具的符号之间的区别。拉康使这一区别更清晰化，并且比弗洛伊德更深一步。权威的话语，父权统治和权力，是幻想父亲的话语。通过将父权统治的批判按在它头上，才有可能去争辩某种女性主义的观点和母性中心的话语，而这同样也加强了幻想父亲和权威的话语。
The question of cultural difference and diversity also has become of utmost importance for the mental health field in a postmodern world. Nowadays, clinicians must be culturally competent to treat individuals from many different cultures. The last chapter of this book addresses the issue of cultural difference from the point of view of a Lacanian reading of Latino American experience. Many people from traditional non-Western cultures rely on religion, spirituality, or culture, to address the questions posed by psychopathology and psychical or mental suffering. Most books on Lacanian topics do not address the relevance of Lacanian psychoanalysis for the treatment of ethnic groups.
文化差异和文化多样性的问题，也成为了这个后现代世界中精神健康领域内的头等重要问题。如今，医生们必须能够从文化层面上胜任，以治疗来自各种不同文化背景下的人们。本书的最后一章探讨文化差异的议题，从拉康派的视角来解读拉丁美洲人的体验。许多传统非西方文化背景的人会通过宗教、灵性或文化来谈这些精神病学以及心理或精神痛苦方面的问题。大部分拉康派思想的书籍也并不涉及拉康派精神分析对民族性群体的治疗。
Lacanian-American perspectives are also consistent with postcolonial theory in that, although careful and respectful with regard to Lacanian scholarship, analytical training, and the complexity of Lacan's thought, it dares to appropriate a European discourse, and present it in a distinctly continental American voice. To do otherwise is to continue to reinforce a colonialist mentality and a social transference whereby the French may be placed in the position of the master and the "one who knows/7 There is more than one way to interpret Lacan since Lacan left many contradictions open within his work and his thought also changed over time. Lacan purposefully wrote in a style that left the question of interpretation open rather than closed. Two, three, or perhaps four, individuals (but not many more than this), can arrive at different or opposite conclusions regarding what Lacan meant to say about a particular concept. Difference and diversity within interpretation is consistent with and predicted by the very logic of what Lacan called the Borromean knot. The Borromean knot is composed of two things: three dimensions that intersect one another and a fourth that tie the other three together.
美国拉康派的观点与后殖民主义理论的一致之处在于，尽管谨慎尊重地对待拉康派的学术、分析性的训练以及拉康思想的复杂性，但它敢于拥有一套欧洲的话语，并且发出一种明显的美洲声音。否则我们能做的只是继续加强殖民主义心态以及社会转型，其中法国可能被置于专家以及“全知者”的位置上。由于拉康在他的工作中留下了许多开放性的争议，他的思想也随着时间在变化，因此有多种方式来解读拉康。拉康有意使用某种写作风格，使得这些问题有开放性的解读空间而不是封闭的。关于某个特定概念上拉康真正想说的意思，人们可能会得出两个、三个或四个（但也多不了许多）不同甚至相反的结论。在拉康称之为“博罗梅安结”的特定逻辑中，解读中的差异性和多样性正符合这一逻辑，并得到了预见。博罗梅安结由两部分组成：三个环一个挨一个地相交叠，以及第四个环将其它三个串在一起。
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博罗梅安结，四个环的没找到图 |
A concept, word, or idea, can acquire different meaning according to the perspective of the register in question (Real, Symbolic, or Imaginary). In contrast to other books, the intent of this book is to provide the reader with a Lacanian or Borromean perspective rather than a closed or authoritative interpretation or introduction to Lacan's work. However, when deviating from accepted or supposedly authoritative interpretations of Lacan's work, I am careful to provide a rationale, and how I believe certain alternative formulations may help clarify dialectical tensions within Lacan's own thinking, but without ever pretending to provide a final synthesis or interpretation.
一个概念、词语或想法，根据对问题界定（现实、象征、想象）的视角可获得不同的含义。与其他著作相比，本书旨在给读者提供一个拉康式的或博罗梅安的视角，而不是对拉康思想的一种封闭的、权威式的解读或介绍。不过，如遇偏离了对拉康思想一般所接受或认同的权威解释时，我会谨慎地给出理论说明，以及我为何认为其它某种解释有助于厘清拉康本人的思想中的辩证矛盾之处，但我不会刻意提供一个最终结论或解释。
Lacan understood the name of the father, as the fourth dimension that ties the other three together, as the names (in plural) rather than THE name of the father (in the singular and exclusive version). On the other hand, the name of the father, to qualify as such, has to have something of the one, but primarily of the zero of castration. Otherwise plural versions of the father, without the zero of a symbolic debt or inheritance, would be no different than perversion (pere-version: the versions of the father).
拉康所理解的父亲之名，就像串起其它三个环的第四个环，就像名字（复数）而不是父亲的名字（单数，独有的）。另一方面，父亲之名，要具备这样的资格，必须拥有某种属一的东西，但首先要经过阉割拥有属零的东西。否则父亲的多个版本，缺失了象征性的责任或继承的零，就将与变态无异（文字游戏pere-version：父亲的多个版本）。
Lacan was expelled from the International Psychoanalytic Association for his clinical practices, and to this day, Lacanian clinical practice is not taught or practiced within the psychoanalytic institutes affiliated with the IPA. This is the final point of resistance to Lacan's contribution to psychoanalysis and psychiatry in general. Paradoxically, it may be that it is precisely the Lacanian approach to the psychoanalytic frame which may help psychoanalysis continue to be relevant for contemporary culture and clinical practice. Psychoanalysis nowadays is considered to be too long, rigid, and expensive to be of use for people with private insurance, ethnic groups, public mental health, the poor, and the severely disturbed with substance abuse problems. Lacan's return to Freud included not only a return to Freudian ideas, but also to Freud's more flexible clinical practices. From a Lacanian perspective, the classical frame for analysis can be regarded as a postfreudian rather than a Freudian development, and as only one of the possible formats/tools of clinical psychoanalysis. Lacan insisted on the singularity of each session, subject, and treatment. For cultural as well as clinical reasons, psychoanalysis cannot be practiced according to the "one size fits all" criteria.
拉康由于他的临床实践被国际精神分析协会除名，而且时至今日，拉康派的临床实践仍未在IPA下所属的精神分析学院中教学或使用。可以说这是否定拉康对精神分析和精神病学贡献的最后抵抗。矛盾的是，这可能又恰是拉康派分析框架下的方式，这将有助于精神分析继续与当代文化和临床实践保持关联。如今精神分析被认为太长程、严格，而且对一些人来说太昂贵而无法使用，比如买私人保险的人们、种族群体、公共精神健康，穷人，以及因物质滥用问题而严重困扰的人们。拉康说的回到弗洛伊德，不仅是返回弗洛伊德的思想，还包括回到弗洛伊德那种更灵活的临床工作方式。从拉康派的视角看来，分析的经典框架可被视为后弗洛伊德式的，并且是精神分析临床工作的唯一方法，而非对弗洛伊德的发展改良。拉康坚持维护每次谈话、每个主体和治疗的特殊性。出于文化的以及临床的原因，精神分析不可能按照“一刀切”的标准来进行操作。
Finally, in addition to presenting a multiform criterion to the psychoanalytic frame, this book also applies Lacanian ideas to the elucidation and treatment of depression. Lacan dedicated a seminar to the symptom of anxiety but did not focus on the problem of depression that has become the most widespread psychical malaise within contemporary culture. As anxiety was the malaise of traditional and modern Western culture at the turn of the century, depression has become the main symptom of a postmodern period linked to a loss of traditional ideals and aspirations..
最后要说，除了展现精神分析框架的多样性标准，本书也将给出拉康派对抑郁的观点和治疗。拉康致力于焦虑症状的研讨会，但并没有聚焦于抑郁的问题，而抑郁已成为当代文化中最普遍的精神痛苦。焦虑是传统和现代西方文化在世纪之交时产生的精神不适，而抑郁已成为后现代时期的主要表现，与丧失了传统的理想和抱负有关。
