Anxiety and depression. Theoretical and clinical. Coordinates in a psychoanalytical perspective Edizioni del Cerro, Tirrenia (pi), 2007.

Anxiety and depression. Theoretical and clinical. Coordinates in a psychoanalytical perspective Edizioni del Cerro, Tirrenia (pi), 2007.

Paul-Claude Racamier, Simona Taccani

Those who had the privilege of knowing P.C.Racamier will recognize in this book the flavour of his creativity, together with his extraordinary capacity to link any complex theoretical problem with the clinical material as experienced in our work, and with our own psychic experience.

The editor’s choice to maintain the format of the Seminars as they were actually held allows the reader to participate in the atmosphere of continuous dialogue that Racamier established in the group.

It is not easy to select among the many important stimuli offered. It makes me a bit anxious. But, to quote Racamier “…it is impossible to preserve a sufficiently nourished psychic life and cultural life, without accepting a certain amount of anxiety”. So I feel in the right spirit to cope with the task. Racamier is like that. Even from the pages of a book he reaches out to your feelings, put them in their right place, so that you can give them their meaning, and go on working.

Anxiety and depression are two fundamental affects that, in Racamier’s view, give life to the psyche.

He leads us throughout the book to consider these affects in their manifestation both in heavy psychopathologies and in their appearance in normal life, never allowing us to forget the substantial unity inside the complexity of the human being’s mental functioning.

The second part of the book consists of a text published in 1968  “Two singular facets of the depression”. In it, besides illustrating the jealous and aggressive manifestations of the depressive affect, and discussing how to differentiate them from the jealous and aggressive manifestations of different origin, we are led to reflect on the fundamental problem of situating the depressive affect in the general order of the psychopathology, on the central place of the mourning, on the narcissistic quality of the depressive mourning. This text makes a link between the Racamier’s and Nacht’s  work on depression of 1959 and the Cortona’s Seminar of 1984, the one we find reported in the third part of the book.

In it the conceptual clarification and the diagnostic framework presented in the previous text, together with Racamier’s introduction to the Seminar, become the starting point for a rich and lively exploring of the many clinical situations we are confronted with everyday in our profession.

For in this third part we are invited to listen to many voices. Racamier’s voice, leading the way, opening up new sceneries, clarifying uncertainties, but also Simona Taccani’s voice, bringing out important points, often acting as a spokesman for the group, always careful to keep the group process going according to its purpose; the participant’s to the Seminars voices and, through their clinical report, also their patients’ voices.

While the participants offer clinical material, express their thoughts, ask questions, in a considerably informal way, you can feel in everybody the constant preoccupation to make meaningful links between the theory and the clinical experience, so that the best way to help the patient could be discussed. It is also through this group functioning that we have the possibility to understand the depressive affect in many of the different shapes it takes and the different roles it plays in an individual. Most of all we learn how a very sophisticated theoretical insight, can and must become embodied in a concrete therapeutic intervention, in a particular moment, for a specific patient.

I am not saying this is an easy task, but it is essential to keep it in mind, because then you are forced to be alert to any possibility of communicating with the patient, and so you are more likely to find it.

This task brings about also the necessity to pay attention to all possible way of communicating, and to how to use them. Racamier gave us many examples of his way of turning letters, telephone calls, and the like into therapeutic tools. What would he use today? And how?

Racamier tells us that he set up the Seminar about anxiety “under the sign of the comparison between yesterday and today, between what has been saved and what has been modified”.

It seems to me that what Racamier points to here is something we are called to perform in our everyday work, as rapid changes in society make more and more obsolete many traditional behaviours, and give a different dimension to time and space, perhaps different space for thinking.

For instance, Racamier teaches us the importance of offering mental representations to the psychosomatic patient who is unable to do that, and is forced to discharge in a body illness his difficulties. Is this more difficult or simply different today, for us and for the patient, because of the massive solicitation of our visual and auditory perceptions? How can we make use of this different environment?

Racamier says that analysis arouses the anxiety, and the analysis of the identifications arouses the sorrow. Today we must find a way to help patients who have very little tolerance to either feelings. There is a tendency to relay on drugs, that are more and more effective in eliminate the symptoms; but on the other hand they reduce the possibility for the patient to recognize his/her feelings and to tolerate them. A.Pandolfi takes up this point in the last part of the book.

It is necessary to follow different paths for different patients, but you may allow yourself to be creative, only if you are confident with your theoretical belongings.

This is a truth that Racamier held evident for us all the time.

In his theoretical approach, rooted in the original insights of Freud, he accepts and develops many of the important contributions of more recent authors, like Winnicott; this provides for him the solid basis for the building of his original way of exploring  deeper and deeper layers of mental functioning.

In his theoretical journey he finds sometimes necessary to express a new concept with a new word. Usually not a totally new word, but a familiar word in a new shape, so that we could link the new meaning to our previous knowledge, and confront and elaborate differences and implications for the technique.

In fact, the precious teaching Racamier gives us regarding the technique is not something disconnected from his original theoretical findings. What he does is not only to illustrate the meaning of a new concept in a clear way and to relate it to the clinical work. He is also preoccupied to make the concept acceptable to us. Referring to Winnicott’s concept of “a minimum of omnipotence”, he invites us not to delete the paradox, but to take it into account, and to think over the concept until we are able to say: “I can live with the idea of the paradox”.

This is most important, because it allows us to continue thinking and formulating questions, knowing that they will never be answered once and for all, but knowing also that to have questions is the only way to move toward a better understanding of ourselves and the others.

It was not unusual for Racamier to use an image to convey the meaning of a concept. One example among the many he gave us, is the description of the latent depression like a lava stream growing more and more black and thick until it petrifies. His images, beside conveying more vividly and immediately the meaning of a concept, are apt to hold a dialogue with the evolving concepts, as Gemma Pompei remarks.

In the last part of the book we have a sample of this dialogue. Some of the participants confront the themes of the Seminars with their clinical experience of today, adding remarks, posing questions, in continuity with the fruitful way of approaching problems that Racamier showed us.

Some of the Seminars of Monteguidi – as they are called from the name of Tuscany village where they were hold the first times – have been published. You can fid them in the website of the CeRP, Centro di Ricerca di Psicoterapia, Milan and Trento, www.ilcerp.com.

About the question of the “new words” which Racamier liked to create, in 1993 he published Cortège Conceptuel, translated in Italian by the Editions of the CeRP in 1995, Corteo Concettuale. A book particularly meaningful about the way of playing with words and images of this imaginative author.

Velia Bianchi Ranci

Collaboratore e docente del CeRP – Milano