Apropos of a case: "The strange and mysterious disappearance of the voice of Mr. K" 
Case report published by Gustavo Dessal, psychoanalyst in Madrid.
K. came to me for the first time about six years ago. A man who currently has forty-two years, working in a technical trade a very large company. They work very seriously, and through a system of overtime and intensive sessions may take a week or ten days a month in the provincial town to which he belongs, with his family and his girlfriend.
K.
Life was very difficult. Whoever saw it, they make contact or conversation with him, at most could appreciate a taciturn man of timid and frightened. But imagine the inner torment in which he lived, where he has lived ever since his early childhood, as in the practical aspects of life is someone who works a normal and orderly. He lives alone, caring for her home and her person, physical exercise, is educated and apparently well adapted to the social faces.
However, K. relationship with peers was truly difficult. The humane treatment caused him anguish that at times reached the intensity of panic, but managed to conceal it with great effort. I could hardly bring any kind of conversation with your co-workers, and that the terror would stop and sometimes prevented him from uttering a word. This situation was exacerbated in the presence of male subjects, and was somewhat less severe with women. He had no friends, and out of work living in absolute solitude. This solitude is mitigated when he traveled to his hometown, where close to his family, especially her sisters, she consoled the suffering that afflicted the rest of the month. Whenever I had to return to Madrid, I felt a desperation that often made him think about suicide.
When we started talking, K. was convinced that his problem was to people before his voice disappeared. It was not easy to figure out what he spoke. For a long time I stayed in the position of not understanding what I was trying to explain. He insisted again and again for me retells his symptoms, and he answered with the certainty that his voice disappeared. There was a hoarse, nor a mute, but her voice, her true voice, was replaced by another, a voice that was not hers and that feeling drove him crazy, to the point of wanting to kill himself. On the other hand, he could not remember the beginning of this phenomenon. Your answers to my questions in this regard was vague and imprecise.
I should clarify that the patient that you have read a lot about psychology and psychiatry, let me know that it was not to listen to voices. Intruder's voice was a voice that no doubt he issued, but at the same time rejected because it was not "authentic." Sometimes I wondered if I could tell the difference between the tone of voice that he called his own, and the other the improper tone of voice, a voice that will steal your identity. As an example, could initiate a session as follows: "Do you realize that today you do not talk to my voice." For my part, I expressed my inability to perceive the difference, while accepting that there must be no doubt, though I could not grasp. During the first year of analysis discussed much on this issue, until one day he told me that his feeling was accompanied by another, who had not dared to say. Every time his voice disappeared, while he had the impression that your penis got smaller, as if to mess inside. I was quite aware that this idea was absurd and impossible to really happen, but could not avoid the physical sensation. This gave me the opportunity to ask if their terror to confront their peers was because he was not sure of being male or female, and I explained that, in effect, to the others he was experienced as a being devoid of definition sexual, but made it clear that he liked women and had no homosexual inclination. I clarified that completely lacked the "feeling of being a man", which should not be confused with any kind of homosexuality. However, with perfect rigor, adding that his inclination towards female not dispelled the feeling of being a child of indeterminate sex. He asked if I felt that he could be a repressed homosexual, and I said not at all like me. One can perceive here quite clearly that the problem is about sexual identity, but an inability to "declare" sex, ie, tie enjoyment to the unconscious.
In his memory, the life of K. was always the same. There was a before and after a moment of rupture, a point which might place the onset of symptoms. However, over time we discovered that this was not exactly true. According to the testimony of his family, he was a child apparently "normal" to three years, cheerful, sociable, and playing with other children in the street. But after that age, something happened to him. Became fearful, introverted and stopped talking. His father, a neighborhood police spent most of his time on the street, but K. grew not part of the outside world. The patient has always had the impression that there was for his father, and that he did nothing to put your child in life. Despite being a quiet and caring man, the father inspired a supernatural terror. This transformation, which we consider as a release of the Other, an effect of foreclosure, was accompanied by a symptom that has a major clinical interest because it constitutes an element of continuity in the case. For many years, until puberty, suffered a diurnal and nocturnal enuresis, which had used the diapers, and recalls with perfect clarity the intense sexual excitement that gave her contact his mother when he changed his clothes wet. By interrogating these memories, I discovered that it was not exactly a bed-wetting, ie a lack of control, but even during the day anywhere urinated in a "deliberate." I think that this behavior was more like a passage to the act, which highlighted the emergence of a untied drive, a separate enjoyment of the unconscious, which by all means trying to evacuate out of the body. We can state, then the following sequence: foreclosure, release of the Other, loss of narcissistic image, relocation of enjoyment, and an attempt at defense.
After some reconstruction the past, we conclude that the onset of urinary symptoms coincided with the birth of the sister who follows him, when he was three. Did not retain the slightest memory of the birth, although he could remember other things from that era. The hypothesis of the birth of the sister as a traumatic event in his life he liked it, and incorporated as an important element for the understanding of your case. But he added something else that I have explained in a simile. One day I said that a father is someone from the child reaches a certain age should take the hand and lead to a brothel to start in sexual life and manhood. I explained that it was a metaphor, which once it was done really, but what he tried to explain is that he lacked the symbolic gesture of his father, who was something his father did, not transmitted, and that That is why "I am the way I am." Help build a replacement family novel has been a fundamental aspect of the cure, because the patient said from the beginning of treatment is considerable interest in investigating the cause of his illness and, as we shall see, the construction of a artificial Oedipus complex has been of great value. Urethral symptoms ceased at the beginning of puberty and it was probably then when the problem of voice, although I have not been able to verify this hypothesis.
For primary schooling, K. went through an experience of solitude. With great effort, and helped by the compassion of teachers, managed to complete these studies. As currently happens in moments of relaxation at work, when to socialize with peers in the school playground stood alone in a corner without speaking or close to anyone. That loneliness was the greatest source of pain, a searing pain, despair, which often led to my query in the form of a compulsive sobs choked by shame and hatred life. K. believed that his father was to blame for what happened to him. I thought I had not given permission to be a man or, rather, to feel as such because if a man had no doubts. His father opened the way to the street to the outside world. Has now changed his mind and believes that this lack father was unintentional, but the product of not knowing how to do better, but for years to his father experienced a hatred and bitterness without limits. All this construction
pseudo-Oedipal, conducted in a totally spontaneous, allowed K. organize a discreet delirium, and provided a number of references to place the problem of the cause, that he is concerned above all else. For him there is sufficient relief from their symptoms, but is determined to get to the bottom of things. I should add that the patient has never taken medication, and flatly refused to receive such assistance.
During the analysis, K. met his girlfriend, a woman then married with two girls, which remained the first and only sexual and emotional relationship. A mother with two daughters, a suitable partner that plays your family history. Of course, K. is well aware of this, and do not need interpretation. About two years ago, she has been divorced and continues maintaining a link with my patient.
After a long time we turn to the issue of voice, there was a significant shift that changed the symptom, and also allowed a purification of the structure. The phenomenon of voice had the disadvantage of involving a very difficult to reintroduce enjoyment in his family novel. We know, according to Lacan's observations, that the ear is a hole that can not be closed, which means it is very difficult to defend against the invasion of the called object. I suggested that since he was convinced that others saw the disappearance of his voice, that made him more vulnerable to the gaze, and therefore the feeling of shame. Immediately accepted my words, and he told me something I never dared to say: I was quite sure that his colleagues knew that he had enjoyed his enuresis, and that was why he could not stand being with them. The other was the look of a father, the disapproving gaze, the gaze that condemned its existence. But at the same time, returned that look to be some consistency. Be guilty of a forbidden pleasure was preferable to being invisible, absent, or not entitled to it, which was undoubtedly linked to phi zero and the effects of this foreclosure at the level of feeling of life. Very slowly the issue of his guilt replaced the phenomenon of voice and retraction of the penis. But the possibility of introducing such a feeling in the oedipal meanings allowed to resolve the terrible shame that caused him to show her naked body (eg in the gym locker room or the bedroom with his girlfriend), and decreased aggressive tension underlying all ties social. Discovered how to profit from its image as it is a handsome man, and use it in their favor, which has functioned as a screen against the enjoyment of the Other. Mr. K.
reached an important conclusion, as a result of deep processing. He realized that his mother is a woman who feels an intense dislike to the signs of masculinity. In the patient's memory came many memories, he says, are an unequivocal demonstration of this rejection. For example, the fact, undoubtedly linked to the phenomenon of voice that her father, voluble man in the street, became silent inside the home. I want to stress this interpretation of the wishes of the mother, although in my opinion has failed to evolve into a delusional metaphor.
This case has the interest of showing that an imaginary Oedipus can operate in certain cases as a point of van, and generate a reference direction. Is a solution that in my experience I have seen most frequently in the paranoid form of psychosis. It is neither the analyst nor those who interpret the unconscious Oedipus, since we are not talking about the symbolic structure, but an imaginative way to use scraps to produce a break in the continuous flow of symbolic and real.
In the beginning, we have the strange and the depersonalization caused by the real return of the voice, with the peculiarity that is not the classic phenomenon of verbal hallucination. The subject does not hear the voice of the Other, but listen to yourself, although not recognized in that voice. Is too close to foreign ownership of this object. We could say that in fact "the other voice" Otherness is the voice, separate from meaning. The phenomenon is not too different from what happens when we hear our voice recorded, but in this case there is something else, is the feeling that the penis becomes smaller and tends to disappear. The patient puts it absolutely clear: it says that somehow he can not understand, there is something that connects the penis and voice. For us, the connection is between the foreclosure of the signifier of the father, ie detached from the subject of discourse, and the production of phi zero. By contrast, the phallic significance hidden strangeness of the voice, and conceals the fact that one can not ever know from where. At the same time, signification "absorbed" the organ in the symbolic and the imaginary. Mr. K experienced a slight boost to women, but not articulated schreberiana mode, it is not a parafrénico. Think that the voice is also a sign virile, and that sometimes, in their confrontation of the Other, both voice and penis disappear. There is, stricto sensu, a frenzy developed around this. My hypothesis on the direction of the treatment is to separate the voice and look, at first confused. Start a new treatment period, dominated by the scopic object function and ordered by his elaboration of the family novel. There is then the encounter with the woman who will become his girlfriend. It is she who finds and seduces him while he is guided. It is through the scopic object, and with the help of Eros, and Mr. K. can regain some body image, initially in the form of shame, that recognize the traces of its past urinary, or discover that something happens to his penis, which can not control excitement. To be invisible, becomes too seen. Is in a third time finding something new: the dress. He had never given much thought to clothes, and begins to acquire an aesthetic of dress. Choose your clothes carefully and gradually develops a strategy of "Showing", which stands to be seen. Now the patient can be shown the Other, and to separate better from their sense of exclusion.
other hand, has initiated a new activity in your life: painting. In a first phase, was limited to drawing objects such as vases and vessels, which shows that Lacan knew what he was thinking when he decided to apply the optical experiment to mirror stage. For some time, copying paintings of famous artists. It does not feel able to create their own, and is content with imitation. In any case, the most important is undoubtedly the fact that the painting is a way to pacify the gaze. A particular feature of this treatment, and on the other hand we find in some psychotic patients, is that the patient belongs to what he called a "narrative subjectivity", ie something that makes you prone to historicizing-delirious with all that it can be-as a way to repair the failure of mental knot. These are patients who are not satisfied with a pragmatic function, and calling for a construction of meaning, a knowledge that is not limited to "accredited", but aims to "know why." Despite the positive effects of treatment, Mr. K calls for a "total cure" claim in which you can hear the silent voice of the death instinct. Of course, the loneliness is still his true companion. GUSTAVO
