The Chinese Chronicle: Me Phunai by Jean-Louis Gault

 From LQ 91 – 16.11.11. – Translated by Frances Coates-Ruet  

                   link to french version

We are continuing our presentation of the lessons drawn from our clinical experience in China, with a case of a patient who was presented on Friday the 28th of October, by his Psychiatrist, Doctor Li Jing.

This patient, 28 years of age, comes from the southern Chinese province of Fujian, situated several thousand kilometres from Qingdao.  He was admitted into Hospital in mid-August.  For the last ten years or so, he is suffering from anxiety and a symptom of verification, which he must carry out just before going to bed. In 1999, he left his village in order to attend a high school in a neighbouring town, where he was a boarder. This is when the verifications began, he was anxious and could no longer sleep. When he entered into University the anxiety and the sleepless nights got worse. Before going to sleep, he had to neutralise any possible source of noise, he verified that he had turned off his mobile phone, to the extent of removing the battery. He verified that all the doors were locked and that no book was left on the edge of his desk with the risk of falling off during the night. There was nothing to be done. Exhausted by his symptoms, he interrupted his studies during his third year. His doctor prescribes antidepressants; his state improves a little. He looks for work. He finds numerous jobs, which he abandons after a week or two, because each time he is invaded by his anxiety. His family sends him to a temple but this has no effect either. One day, while watching a television program, he hears about a Professor at the Qingdao Hospital renowned for his success in the treatment of psychological problems. He leaves his faraway province and comes to the Hospital for treatment. He is the last of four children. His parents lived in the country, so as to escape from the strict law of an only child that was applied in the city. In the country a second child is tolerated, but they had four, and he was the last born. He considers that he should never have been born. 

During the interview the patient explains that his difficulties began when he entered into high school. He was a boarder, there were eight in the dormitory, and he was bothered by the noise that his fellow boarders made. They spoke together and this is what prevented him from sleeping.  As he couldn’t bear it any longer he left the boarding school and went to live with his mother who rented an apartment in which she could house him. This didn’t suit him either, because there was a neighbouring factory where the workers were noisy, which prevented him from resting in the day, when he wanted to take afternoon naps. Eventually, the simple apprehension of noise had become in itself a source of anxiety. Hence the multiple verifications with which he had to proceed before going to bed, in order to try to neutralise beforehand any possible cause of noise during the night. It is noise that happens unexpectedly, by surprise, which is distressing and wakes him up suddenly. At University he undertook his studies in robotic engineering, but dropped out in the last year.

An episode in early childhood was to mark the beginning of his life. He was three months old, he had been entrusted to the care of his maternal grandmother. He has a heat stroke, develops a very high fever, is hospitalised, and is between life and death. He recovers but is of fragile health for a few years. When he is three, he only weighs nine pounds. Even today he is still very thin. He speaks slowly with a mechanical, shaky voice, pronouncing the characters one by one. Sometimes he stops and for a while looks for the right word, which he does not always find, then starts speaking again. His mother tongue is a dialect of the Fuzhou region and close to Taiwanese. He speaks in Mandarin, but our interpreter notices certain expressions or turns of phrase borrowed from his mother tongue, of which she doesn’t immediately grasp the meaning. At elementary school his classmates made fun of him, because of his sickly appearance. In his mother tongue, he tells us a few of the nasty nicknames, of which the translation in Mandarin gives something like shou gu ling ding, which is, “skinny bag of bones”. The registration of his birth was, in itself, a muddle of language and writing. According to Chinese tradition, the given name is a syntagm elaborated by the parents, which translates, in the signification of and in writing, their wishes for the being to come. The parents of our patient had chosen to call him jian ming, “a bird’s cry as sharp as a sword”. The employee at the registrar’s office, undoubtedly reluctant to give in to the fantasies of these good-for-nothing peasants, pretended to ignore these complicated characters, and immediately stuck  on the child the similar given name of jian sheng, “to build a life”, which stayed with him.

Since he was very young, he fell in love easily with his little classmates but hushed up this feeling, which was not shared, and he suffered from this. Once he became bold. It was at University, he had enrolled in a theatre group that was run by a student. She had asked him to prepare a play. He wrote a comedy on university life and recruited the actors amongst his fellow students. Little by little, when the time came to put on the play, he had fallen in love with her. He liked her because she seemed to come from a good family, well-educated and elegant. He wrote to her and telephoned her, but she pushed away his advances and after his insisting she threatened to exclude him from the group. He was very affected by this and it led him to isolate himself in silence. This is the state he presently finds himself in.

He would like his doctor to speak to him with precise words. He considers himself a hesitant person, not confident, this is why he asks us to speak to him clearly. He read this in a magazine. A Japanese psychologist explained that patients were not able to be cured because one used words that have uncertain meanings, and he advised the development of an unambiguous vocabulary in order to help them. Our patient thinks that this is what he needs and this is what he expects from his therapist. He is about to leave the Hospital and return to his province, but beforehand he would like to spend some time at the temple, in order to recharge.

The first question asked during the discussion was why one was so interested in the patient’s love life. We responded that it is in the way that love was situated at the most intimate articulation of the subject’s relationship to speech, that our questioning was aiming at this exquisite point. The patient brought his testimony to this, in evoking the difficulties he had in declaring his feelings.

Another question concerned the illness that nearly took his life when he was three months old, and how this episode could have had such importance when he was too young to remember it? We underlined that effectively he knew because it had been told to him. Before it became an event for him, it had been an event for his mother, who had told him the story. She told him that he nearly died because his grandmother did not look after him very well. At that time she thought that she was going to lose her child, who, as a result, became her most precious object, whom she would now watch over by giving him all her care. He was to remain this overprotected child whom she shelters from the dangers that come from the outside world. 

We also questioned ourselves on the status to give to his verification symptom, which had been tied to the obsessional register. We gave in to our taste for binary oppositions, written on the blackboard, in order to accentuate a separation between the patient’s symptoms, and the important obsessive apprehension of the Rat Man shu ren, which was our study subject that afternoon. The main point in this differential clinic, we indicated, is to situate the first phenomenon that presides over the formation of the symptom, along a simple differentiation between outside and inside. Our patient is initially confronted with a phenomenon that happens on the outside, wai, of him, firstly by the noise of voices, before it concerns any noise likely to intrude by way of perception. The verifications come in second place in order to prevent the noise occurring. The Rat Man dealt with a phenomenon located on the inside, nei,of him, namely his desire, animated by the burning curiosity for looking at naked women’s bodies. Obsession is a way of defence against repressed desire. In our patient, the source of the symptom is on the outside whilst it is on the inside for the Rat Man. While one is invaded by noise situated on the outside, the other is the prey to his own desire. We added that this topical difference has an immediate influence on the conduct of the treatment. In the case of the Rat Man, the analytic treatment and the interpretation of the symptom open up for the subject an access to a desire that has until now been veiled. Our patient has direct access to a phenomenon of noise that no veil can cover up. The objective of the treatment is here opposed to that of the Rat Man, because it is about the patient elaborating a defence mechanism against these parasitic voices. Here, we do not have the steady support for the deciphering of symptoms that Freudian teaching has offered us, a new way of investigation thus opens itself up in which the singular solutions of the patient find their place.

In conclusion, we wanted to restore the dramatic weave which has governed the life of our patient into a fantasy likely to deliver its kernel of truth. His parents had chosen to name him jian ming, where ming is the character for a bird’s cry. A Chinese proverb came back to us, which we had recently heard. It is the story of a bird, alone in the midst of the forest in which other birds that can be heard singing. One doesn’t know that this bird exists because he is too shy to sing. One day, a great danger arrives, he then lets out a piercing cry which alerts all the other birds. To this day, he is the best known bird. Our patient is this bird, but he has not yet let out a cry. He was not able to assume his real given name and was born in violation of the law. The cry that should have come out of him, signalling his presence in the world – he had not made it heard because he had been deprived of his name. The illness that hit him shortly after his birth left him dependant on his mother, where he is but a sickly bird that needs to be protected. The cry that didn’t come out of his throat comes back on the inside in the form of this noise, at the edge of hallucination. This part of himself that had been essentially cut off has been taken away from him, forever.  This construction wanted to bring to the fore a necessary effort of poetry in any clinical approach, as an appeal to invention in order to respond to this dimension of the impossible inherent in any subjective experience. 


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