The Chinese Chronicle: The Two Ways of Speech by Jean-Louis Gault 

From LQ 73 – 29.10.11 – Translated by Frances Coates-Ruet

                                              link to french version


Psychiatric Hospital of Qingdao, State of Shandong, China

Monday the 24th of October, the Doctor Zhang Shao Li, a Psychiatrist of the Hospital, presented the observations of one of her patients, M. L., whom she wanted us to meet. He is a man, 50 years of age, who has consulted the service for the past nine years, for what he calls “a depression”. This is his sixth hospitalisation. During his five previous hospitalisations, he stayed for several weeks, where, under the effects of his medication, an anti-depressant and an anxiolitic, he got better, but once at home “the depressive illness” progressively took over. At each hospitalisation, it was necessary to change his medication in order to obtain an improvement of his state. This time, he has been in the service for four months, and despite the prescription of a new molecule, he has remained “depressed”.

During the course of the interview, in response to my initial questions on the motive of his hospitalisation, the patient explains that he is suffering from a “depressive illness” and that he expects his medication to cure him. We then quickly decided to abandon this way of questioning the illness in order to direct our interest towards his life, strictly speaking.

He is the last of three boys. Born a few years before the beginning of the Cultural Revolution, he says that he had suffered greatly during this period. His father was a former Superior Officer in the Red Army. In the beginning of the sixties, his father decided to abandon a military career, in order to respond to the desire of his own mother who cried, to the extent of going blind, for her son who had known the trials of the long war of the Liberation. She no longer wanted him to take the risk of being exposed to another conflict. He leaves the Army and successfully converts himself to industry, but his bourgeois origins catch up with him at the time of the Mao offensive of 1966. Belonging to the landed gentry, he is exposed to the vengeance of the Red Army guards, deported to the country, robbed of his property, subjected to the humiliation of self-criticism and beaten.

Our patient, whilst still a schoolboy in elementary school, takes upon himself the paternal fault. He feels ashamed each time he has to fill out a school administrative form and indicate the social origins of his father. When he writes the word funong “wealthy farmer and land owner”, he feels the weight of a reproachful gaze upon him. He begins to isolate himself from his classmates from whom he dreads the teasing, which he undoubtedly attributes to the paternal fault of not being born a poor farmer.

It is during this period, around the age of five or six that an incident happens, that was reported to his doctor, but from which we have not succeeded in extracting the veritable subjective mainspring. It is summer, he is on the beach, amongst a group of children, gathering shellfish. Suddenly, a storm breaks out, thunder rolls and the frightened children scatter, he then makes out two children lying on the sand before fleeing the beach and taking refuge at home alongside his mother. She tells him that the two children are dead, struck by lightening. The memory of this drama was to pursue him for several years and he will not succeed in forgetting it until just before the end of high school.

Since his childhood he has a fear of dogs, which he still has to this day. He was afraid of being bitten, particularly by the dogs one encounters in the country, and he attributes this fear to the fear he had felt when he learnt that his father was being humiliated and beaten; but this phobia had not been interpreted during the interview.

The beginning of his present episode, which led to his hospitalisation, goes back to a road accident which happened nine years ago. At the time, he was an appreciated manager of a filial of the group for which he worked. He has a reputation for being serious and has forged a successful career. On the day of the accident he held a meeting with his workers to encourage them to improve their productivity. As is the custom, in order to bring together the personnel and to train them towards obtaining better results, one offers toasts to the glory of the company, which are accompanied by the consummation of the equivalent number of glasses of beer. When he leaves the meeting in order to return home, when he gets on his motorbike, he has already had a lot to drink. He will not get very far. He loses control of his motorbike and is projected onto a heap of stones. He loses consciousness, his chin is broken and he has facial injuries. When he wakes up in the hospital he understands the full extent of what has happened to him, he severely reproaches himself and fears being sanctioned. Instead, exactly the opposite happens. His superior calls him to inquire about his health and to ask after him, without any reproach. He recovers from his injuries but does not get over his misdemeanor. He can neither sleep nor go back to work. He is finally transferred to psychiatry, where began the journey which has led him to today’s encounter.

At one moment the patient points out the consequences of his accident that remain, he explains that he was operated on his face and passes his hand over his face in order to show us where. In fact, no scar can be seen, the healing seems perfect. But he continues and articulates precisely what he wants to say : “I feel humiliated to have had this accident, I have lost face”. We congratulate him for having found this expression, which says exactly what he is suffering from since his accident, that “he has lost face”. We add that we do not think that he suffers from a “depressive illness”. He cheerfully welcomes this announcement but adds that he wonders if he should not still continue to take his medication, all the same. We do not contradict this. We finish by encouraging him to speak with his doctor about this feeling of losing face.

During the discussion it was necessary to justify what had made us say to him that he wasn’t “suffering from depression”. To this we responded that the patient certainly presented all the signs of a state that we can qualify as being depressive, but that the question was more about knowing what his state was due to. Could it come under natural illness, like tuberculosis for example, likely to be cured by medication or could it be attributed to another cause? We then referred ourselves back to Lacan’s teaching: “One is depressed because of having given up on one’s desire. One comes out of depression when one finds again the way of desire”. We attempted to back up this severe formula by referring it to the experience of each and every one, where desire is what we believe we must do according to our commitments in our public or private lives. This dimension of subjective responsibility did not escape the participants of the seminar.

In order to give an account of this dimension accorded to the interview we exploited a Chinese reference and emphasised two ways of speech. On the blackboard we drew the Chinese character of the way, the “Tao”, which gives its name to a tradition that had especially held Lacan’s attention. Thus, there are, we said, two ways in which to approach the patient. The first way is through natural illness. From the patient’s responses it expects to gather a bundle of facts which tend towards objectivity, and from which one may get an idea of the illness according to the physical causes. The second way is through an illness that we have proposed to call moral illness, where the subject is implicated in his responsibility. This results in a notion of illness where one suffers because of what one has done, or from what one hasn’t done. The patient, we have underlined, has given a testimony to this moral register, where what has happened to him is taking place. The sequels that he wears on his face are very much the consequences of this accident, but are not inscribed in the physical order. They belong to the moral dimension, which makes him say that he has “lost face” because of this accident, for which he feels responsible, which is why he reproaches himself so harshly.

We concluded that the choice between one and the other of the two ways of speech conditions that which we are likely to gather during the interview with the patient. If one follows the way of natural illness, one obliges oneself to hold a certain type of speech, in the research of objective data, where the responses of the patient will necessarily find their place, but where the patient will not be implicated as such. The way of the so-called moral illness leads to the implication of the patient. The patient is thus lead to speak on his own behalf, not to give useful information to the diagnostic inquiry, but to judge for himself what he does or does not do.

This presentation is inscribed in the program of a seminar, for a week, in autumn, organised for the fourth time in Qingdao by the clinical section of Nantes. From Monday to Friday, every morning a presentation of a patient will take place. The interview will be held in French and assisted by an interpreter who will ensure the simultaneous translation in Chinese. This year, a graduate from the University of Qingdao will be present, who also studied in Brest. A seminar on Freudian and Lacanian studies will take place in the afternoon. We have chosen to present and comment the Rat Man case. In return, each year, four or five Chinese psychiatrists will be invited to Nantes for a week, where they will participate in the practical, clinical and theoretical teaching, and join in one of the sessions of the clinical section.

Qingdao, is pronounced in French “Tsintao”. The city gives its name to one of the most popular beers in the world. The town inherited the presence of a German concession, from 1898 to 1914, a brewing tradition that Qingdao has considerably developed. Situated on the same latitude as the Balearic Islands, on the Yellow Sea, facing South Korea and the Japanese island of Kyushu, surrounded by tens of kilometres of beautiful beaches, the region is a part of the Chinese Riviera. Prized as a seaside resort since the beginning of last century, the President Mao passed his summer holidays here.

The Peninsula of Shandong is one of the cradles of the Chinese civilization. Three hours by road to the west of Qingdao is the small town of Qufu where Confucius was born in 551 BC. After the dark period of the Cultural Revolution, the town has again found its academic traditions and one crosses many young people who have come to study the Master’s thought. At thirty kilometres to the south of this town one comes across the village of Zoucheng, where Mencius was born a century after the Master Kong.



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