July 21, 2022

Politics in the Clinic

Gabriel Tupinambá

Closeup of Maxwell Alexandre, Éramos as cinzas e agora somos o fogo, da série Pardo é papel (We were the ashes and now we are the fire, from the series Brown Is Paper), 2018.

This essay is part of an e-flux Notes series called “The Contemporary Clinic,” where psychoanalysts from around the world are asked to comment on the kinds of symptoms and therapeutic challenges that present themselves in their practices. What are the pathologies of today’s clinic? How are these intertwined with politics, economy, and culture? And how is psychoanalysis reacting to the new circumstances?


When I first began my clinical practice, I had all the financial support I could hope for; my parents helped me rent a nice office, with some cool-looking furniture to go along with it, in a very central location in Rio de Janeiro. But since I had no patients, the room was mostly used as a meeting space for the political collective I was part of, a communist organization that greatly influenced my interest in the economic dynamics within psychoanalytic institutions and, on account of that interest, my increasing disenchantment with the Lacanian School where I did my analytic training. I did not study psychology, medicine, or psychiatry in college, so the more I distanced myself from the psychoanalytic community, the more insecure I became about what legitimately authorized me to engage in clinical work. Of course, we all repeat the famous Lacanian adagio about “analysts authorizing themselves,” etc., but this slogan itself can help to increase the superegoic pressure: I came from a family of psychologists and psychoanalysts, I had the privilege of getting my own clinical space without having worked for it at all, I didn’t have any formal study dealing with mental health, plus I had barely finished my training at an institution I didn’t identify with anymore—so what the hell was I doing calling myself a psychoanalyst? Did I use my parents’ money to just buy a permit to psychoanalyze? It isn’t hard to anticipate that every potential patient who came to see me at the time was served a large plate of analytic platitudes coming from a young man who was more concerned with his desire to appear as a psychoanalyst than with anything that remotely qualified as a desire for analysis to take place. I met most of these people only once.

The reason I mention this rather ordinary initial misstep is because of how my political life actually influenced what happened next. At the time, I was involved with a number of urban occupations in downtown Rio; we used to meet with the squatters once or twice a week, to help out with legal and political issues. Once, while I was there, someone asked me what I did for a living. Embarrassingly, I said, “I am a psychologist.” I guess saying I was an analyst just sounded off, for all the reasons I already mentioned, so I went with the statement that I felt could most easily command some recognition. It didn’t matter, nobody cared: “Ah, so you’re a doctor,” the woman replied, before taking me aside and introducing me to her husband, who had just come back from a drunken bender and was having a hard time convincing his wife he didn’t cheat on her with a fellow squatter. I sat down and we started to chat—and for the first time I felt like I was ready to listen to someone on their own terms, indifferent to the demand to be seen as a real psychoanalyst.

But this is not a story about how politics can help our clinical work—at least not only that. Even though my political position certainly influenced my commitment to sit down and listen to what that man had to say about his own predicament, there was also something else at play, something more embarrassing. As I slowly realized in my own analysis, my political worldview and militancy had also helped to devalue that encounter, making it more bearable—very much like one of those deflating strategies that Freud discusses in “On the Universal Tendency to Debasement in the Sphere of Love.” I could risk acting as an analyst there because, in some sense, I believed the stakes were lower: Whatever I can offer is good enough for this person.

It’s worth mentioning all of this because it makes no sense to think about the politics of analysts and how our political commitments can inform our clinical listening without also thinking about all the new problems and challenges that come along with it. In fact, I have the impression that when an analyst’s politics effectively help inform how we listen to patients and intervene clinically, on the face of it the clinical work actually looks like business as usual. And this makes sense: the effect we are looking for is, after all, psychoanalytic, so the best that politics can do, within the clinical setting,1 is to help us further disengage both ourselves and the analysand from constraints that get in the way of a subject’s encounter with their own desire. Politics makes itself much more clearly felt in psychoanalysis when things go wrong.

The most immediate way this can happen is probably when, rather than helping us expand what might count as a significant part of a patient’s speech, the way we articulate our own political commitments ultimately restricts what certain signifiers might mean for others. In 2018, during the electoral campaign that led to Bolsonaro becoming president, a recurring theme with many patients was to recount “dinner scenes” where they confronted their parents’ reactionary political views while trying to get them to vote for the opposition Workers’ Party (PT) candidate, Fernando Haddad—a situation that usually ended up badly and led to intense sessions afterwards. For an analyst who just comfortably expects the world to burst through the couch, regardless of their own political position, this is an easy one: since we couldn’t care less about the political leanings of our patients, all that is left is to focus on the familiar dynamic where a subject questions the shortcomings of idealized authority only to better find a place within the Other’s lack. Sounds “structuralist” enough—that is, independent enough from determinations we don’t care about—and so, after listening to a dozen of these situations, our conservative analyst might end up writing yet another paper on “the new forms of subjective alienation in the family, in a time of the decline of the father function.”

But a more politically engaged analyst might also commit a similar mistake: since we admit that politics introduces a consequential difference into the picture—for example, depending on our particular leftist reading of the world, “Haddad” could signify “democracy,” therefore allowing more space for otherness, and “Bolsonaro” could signify “fascism” and less space for desire—we might simply disregard how those signifiers are mobilized by different patients, and we might end up treating all of them in same way. I had some analysands who really did subsume the whole national political turmoil into their miniature neurotic drama and who would conclude the tales of these vicious dinner debates by saying something like “… and that’s why I have the political duty to live with my parents, to keep them from having these reactionary ideas!” If I were to hasten to the conclusion that the political colors of the family feud pointed to the subject’s separation from the Other as a totalizing figure—since my patient had sided with the democratic emblems against a discourse of hate and exclusion—I might then intervene to say, “But conflict is sometimes the price we need to pay for taking political positions, etc. etc.,” and, in the guise of reinforcing the patient’s political independence, just reproduce the underlying alienating structure.

Other analysands, however, were going through something quite distinct at the time: for them, this sort of situation did not confirm their place in a certain symbolic dynamic, but rather dissolved the exceptional status of that confrontation in the broader hardships of political activism. They had been campaigning, desperately talking to people on the streets to try to get more votes for the Workers’ Party, and they learned, through this process, that people have all sorts of problems with the PT in Brazil today, issues that cross in complex ways with their personal histories. And, all of a sudden, their own parents appeared to them as part of that series, as people with past personal and political histories that they had never previously considered. Quite often, however, this connection would just loom in the background of their sessions, creating a sense of unease in the patients’ speech, and it would take an intervention to point out that there were similar traits between those dinner conversations and their militant activities elsewhere. But if I did not believe that politics exists—that is, that there is a singular power to social experiences of commonality that can lead a subject to paths and places foreign to their own identity—I would not have risked an intervention that would further dissolve the family drama into a broader political sphere, in the hope that new contradictions and associations might appear.

So there are both cases where the politics of analysts come in to lump together distinct subjective experiences, and others where it helps us further differentiate them. And there are also cases where it is the political distinction between the analyst and the analysand that is suddenly at stake. For example, situations where our political commitments seem to compel us to say something not because this intervention might open new associative paths for the patient but because we want to distance ourselves from them and their politics, because we can’t stand to be confused with it even for a second. It is not uncommon to hear analysts proudly talking about how they interrupted a racist, sexist, or reactionary monologue from their patients—sometimes prompting the end of the treatment altogether—without concerning themselves with whether this could produce any anti-racist, anti-sexist, or progressive effects on the actual bigot in the room.

A paradigmatic example of this happened, again, around the time of Bolsonaro’s election, when many psychoanalysts used to brag about the fact they did not have any “bolsonaristas” as their patients. Here, politics does not inform clinical listening; it rather compels us to distance ourselves from elements of the patient’s discourse for the sake of the consistency of our own political identities. The situation got to a point where, for a time, Lacanian Schools were issuing political statements condemning Bolsonaro and all he stood for, a move that certainly made clear that we preferred to avoid having to deal with these “toxic” patients. It goes without saying (or it should) that criticizing these institutional declarations does not imply saying that analysts should be apolitical or neutral—but what is the purpose of issuing these statements as analysts, rather than just signing other petitions and collective texts, like most people do? It seems to me that the point of these documents was rather to send a clear message about what sort of patient we want to listen to—just in case the price and the location of our clinical practices did not drive the point home already.

On the other hand, there are also situations where this restless indistinction between analyst and analysand, brought about by politics, can actually be quite productive. I know we all like to think that Lacanian psychoanalysis operates in a movement that goes from connection to disconnection: patients arrive and address us directly, asking for help with making some symptom go away; as transference is established, that “imaginary” rapport is broken and a new partnership emerges between the subject and the “symbolic” Other, a ghostly dialogue that reveals itself to be equally subject to the messiness of language as analysis goes on, to the point that the solitude of the subject’s encounter with “real” contingency can finally acquire a new dignity. That is all true, I suppose. But it is also true that all of this is also conditioned by the fact that the analyst is equally caught up in the same process. More important to me than the mythical question of “who analyzed Freud” is the fact that he too needed analysis—that is, that psychoanalysis, from the get-go, implies a common ground between analyst and analysand, as the unconscious cuts a diagonal across both, informing not only why we need to listen to patients, but also our awareness of the pitfalls of listening itself. This commonality is not a positive one, for sure, but it is crucial enough to imply an additional axiom to all our dealings with the “clinic of the real” or all the talk of “non-relations” in Lacanian psychoanalysis: be suspicious of every bit of the “real” that could only ever bother your patients but not yourself.

So when it comes to politics in the clinic, sometimes interesting interventions can emerge precisely by pointing to something that makes us politically indistinguishable from our patients—not because of the imaginary bond this creates (we saw already how that can go wrong), but because it can help to empty out some political fantasy while preserving the political form. Sometimes when faced with great tragedies—like the devastating flood that destroyed half of Petrópolis earlier this year2—an analysand might evoke their political ideals and the need to “do something about it” as a reproach against themselves and others, motivated by their indignation and impotence before the state’s blunt disregard for the situation. It might be hard, in these cases, to dislodge the libidinal incorporation of the political sphere into an inhibiting neurotic dynamic without also putting into question these political commitments themselves, referring political impotence back to personal impasses and obscenely reducing it to the subject’s phantasmatic drama. Instead, by intervening so as to include ourselves amongst those who are limited by the political possibilities afforded by the current leftist ecosystem, we might be able to move from idealized to real politics, from personal inhibition to the space of collective actions that are effectively possible—but these only appear as possible outlets for our discontent if they stop being directly compared to the grand political gestures we privately imagine as solutions to our feelings of impotence.

Part of what allows us to punctuate a certain ambivalence in speech—for example, equivocating some word or sentence, submitting it to the indetermination inherent to language—is precisely the belief that no one is exempted from this uncomfortable slipperiness of signifiers. If this were not the case, these interpretations could never create breathing room for our patients—a tear in the fabric of discourse, inviting some creative re-stitching—as these interventions would rather confirm the power of the analyst and his capacity to anticipate where these punctuations would lead the subject. The ins and outs of actual political organizing can play the exact same function: submitting political fantasies to the uncomfortable constraints and ambivalences that political life entails preserves the quality of the subject’s discontent—rather than reducing their indignation about a social catastrophe or a political injustice to some private affair—while possibly creating some space for political invention precisely because the analyst, like everyone, is also traversed by the contradictions and shortcomings of actual political struggles.

In some cases, the political belief in this common dimension might appear as the conviction that we can take some patients’ political idealizations seriously and help them flesh out their ideas, exposing an isolated construct to the imposing constraints of following through and working together with others. Usually, when we uphold the conviction that our patients are capable of thinking politically, a distinction slowly emerges between those obstacles that are a product of the real existence of other people—of people we need to consider, convince, and work together with if we want do get anywhere politically—and those phantasmatic impasses that prevent us from ever engaging in any form of collective organization to begin with. It’s the challenges of free association between people coming to the aid of free association between words. And sometimes this same political conviction can lead to actual solidarity—like joining an analysand in raising funds to help victims of the flood in Petrópolis and therefore democratizing the anxiety over how small or inconsequential this action might turn out to be—because we trust that this common ground does not necessarily reinforce an imaginary connection, but sometimes throws a light on everyone’s submission to the hardships of political organization, including—above all—the hardships of economically maintaining our own clinics.3 It doesn’t always work—and it surely cannot work if we disregard the specificities of each clinical situation—but sometimes it can.

I have focused until now on how the politics of analysts adds new and interesting variables to the picture. One might say that these variables lead to an expanded theory of countertransference, with the caveat that, with the introduction of politics, our usual Lacanian reduction of the common to the imaginary needs to be dropped. I decided to focus on the analyst’s side of the equation first because I really believe it is the only way to avoid falling back into the conservative position which, when faced with new challenges in the clinic, cannot but conclude that it is the world that has gone off the rails, rather than suspect that it might be we who haven’t managed to keep up with it. However, this is not an argument meant to dispel the possibility that novel symptoms and impasses might emerge; it should rather help us clarify the conditions for the intelligibility of some of these novelties.

For example, it happens that political life produces its own subjective impasses, singularly tied to some particular political practice, its forms of material and symbolic organization. One of my patients was part of a collective that actively fought for transformations to our patriarchal social mores and for the legal recognition of more forms of amorous association than just monogamic heterosexual partnership. However, the dynamic of her personal relationships didn’t immediately line up with her values and strategic principles. Sometimes intense jealousy snuck in, along with a desire to control her partners’ lives; other times she felt a deep uneasiness with the way sexuality has latched onto images of power and violence. And things can get even more complicated when the way we collectively articulate our political mapping of the world does not leave much space for even naming these contradictory tendencies without putting other important distinctions at risk, a tension that often adds an anomic dimension to suffering.

But is there anything new here? I believe that, without conceptual and technical tools to help us navigate the imbrication of politics and the unconscious, it would be simply impossible to say. For instance, if an analyst simply lacked the political conviction that the scope of possible amorous relationships exceeds the confines of heteronormativity, they could simply portray this patient’s redoubled difficulty with her own outbursts of jealousy as proof that politics had become a refuge from castration for her and that sexual difference, as we know it, is bound to return with a “hysteric” vengeance. It would be the contemporary against the sexual, the critical times of leftist politics as denegation.

Rather than thinking of psychoanalysts as passive receptacles whose unbiased ears function like sensitive seismographs to the shakings and stirrings of the world at large, we could rather think of analysis as an encounter where we “meet the world halfway”—where changing times appear to analysts caught up in those same changes. But meeting the world halfway and allowing the political commitments we maintain as our own to enrich our clinical listening in no way entails that we should join the superegoic chorus that tormented this militant, further punishing her for not living up to her ideals. Instead, the political widening of what we consider to be possible could actually help us shed light on the novelty of the singular problem she faced: the challenge of how to construct new libidinal arrangements without ignoring the real forces that shape our personal histories and forms of satisfaction. This is an open, common, and real problem—she faced it, and so have I.

I remember many years ago a patient who had an intense militant life as a member of a leftist party in Rio—funnily enough, the same party I used to belong to. He was the first person in his family to go to college, where he got involved with the student movement and then with a Trotskyist tendency within a socialist political party. This increasing political engagement took a substantial financial toll on his life, as he lived far away from where party meetings took place and, being unemployed, he had to rely on his parents’ help to both continue his studies and get around town. He always mentioned the precarious conditions his parents had been subjected to all their lives as one of the main motivations for getting involved in politics—but felt guilty that the economic costs of this engagement either fell back on them or made him lose focus on getting his diploma, something his mother valued deeply. Within his party cell, these questions did not exist: he was seen as a model militant—what we call a tarefeiro, a “tasker”—and so, even if it would have been possible to elaborate his personal impasse more publicly, this would probably have stained his image amongst his peers, who served as an important source of recognition and support outside of the family.

One day, the minister of education came to Rio for a public appearance. This group of militants organized a demonstration in front of the building where the event was happening. At some point during the protest, things got heated, and chanting and banners did not seem to be making any impact, so the protesters started throwing things against the side of the building, to make their presence felt. My patient picked up something from the ground to join in the new tactic and, right when he was about to throw it at building, he remembered that he had recently sent a CV to that same address in the hope of getting a paid internship. Feeling a burst of deep anxiety, he just passed out, then and there.

But when this militant woke up, after fainting in the protest, he was faced with a decision that also confronts me and every other psychoanalyst interested in what’s new in our clinical practices: we can either return home, or we can invent new signifiers to share these contradictions with our comrades.


A whole separate text could be written on how to think the difference between analytic and political effects, and the limits of clinical practice—but it will have to wait.


See Katy Watson, “Petrópolis: Deadly Landslides Wreak Havoc in Brazilian City,” BBC News, February 17, 2022 .


I’ve dealt briefly with the political economy of clinical practice, especially the role of money, in my book The Desire of Psychoanalysis (Northwestern University Press, 2021), but there is a much longer and interesting discussion to be had about the actual working conditions of psychoanalysts—especially in places like Rio de Janeiro—and how they often pose singular challenges to clinical practice.

Psychology & Psychoanalysis
Contemporary Clinic

Gabriel Tupinambá is a psychoanalyst based in Rio de Janeiro, Brazil. He is a member of the research collective Subset of Theoretical Practice and the author of the book The Desire of Psychoanalysis (Northwestern University Press, 2021).


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