The treatment of anxiety through fantasy and delusion

Abstract

This article proposes that psychoanalytic treatment focuses on the ways each subject has established to deal with the anguish derived from their original encounter with the real. More specifically, it argues that these responses are linked to the structure of each subject and that the analytical work will take place within the scope of fantasy, in cases of neurotic patients, and within the scope of delirium, in cases of psychotics. To support the notion that anguish is a sign of the original encounter with the real, this paper shows how Lacan draw consequences to the second Freudian theory of anguish, which no longer considers it as a derivative of repression, but as a reaction to a danger perceived as real. To demonstrate the differences between neurotic and psychotic strategies for treating anguish, the paper compares two clinical cases: one in which a neurotic woman’s questioning of her fantasmatic position allows her to leave a complaining position and enter into analysis, and another in which a psychotic patient formulate a delusion that allows him to no longer be so intensely assaulted by anguish, enabling him to better sustain his desire.