As a young psychiatry intern, I often heard my senior colleagues say sarcastically that psychiatry could have been a wonderful profession had it not been for the patients.
As I grew older and already a senior psychiatrist working in the closed ward in a large psychiatric center, I was upset by the ward’s director who, time and again, when interviewing new admissions who turned out to be very much psychotic, said “there is no one to talk to” and ended the interview. He could not listen to them, and he probably did not know or did not want to know how.
“Mentalism” and “Sanism” are terms that have been coined in order to describe discrimination and oppression against a mental trait or condition a person has, or is judged to have . It impacts on how individuals are treated by the general public and by institutions, but apparently, (not) surprisingly, also by mental health professionals and institutes. Like other forms of discrimination such as sexism and racism, it is a question of the relation to an Other as such, conceived in its difference. As in racism, it calls into play a hatred which goes precisely toward what grounds the Other’s alterity, in other words its jouissance. Thus, to rephrase J.-A. Miller’s notion regarding racism, we may say that Sanism is founded on what one imagines about the Other’s jouissance; it is hatred of the Other’s particular way of experiencing jouissance . Indeed, true intolerance, including intolerance towards the mentally ill, is the intolerance of the Other’s jouissance.
Hospitalized psychotic patients can be considered as that which is most intimate in a mental health facility. But in their distinct ex-istence outside the symbolic order, they are sometimes regarded by mental health professionals as foreign objects, as the radical Other, as foreign bodies of jouissance, and as such possess an extimate eminence. “Jouissance excludes meaning and that is why we call it opaque” . Without meaning, on the doorstep of the Real, these opaque bodies of jouissance which inhabit the psychiatric institute, are but petite objects a, inscribing a mode of jouissance cut off from a rapport with the Other. As all jouissance is posed in relationship to the hole, the objects-a-inpatients hollow the institute, they perforate it, leave senseless chaotic holes in its matrix, holes which refuse to be thought, holes which, as my former ward’s director discovered, are challenging to talk to.
As holes in the institute, the inpatients represent the difference between existence and essence; something that there is, but the essence of which one cannot define in the Other, a “being without essence” . The objet a is not a chapter of ontology. When we speak of objet a, we speak of another objectivity. When we speak about this type of object, the subject disappears. How then, nevertheless, can we listen to the residents of the psychiatric institute as subjects, as they try to be thought, to communicate?
In three sessions on 4th November 1971, 2nd December 1971, and 6th January 1972, Jacques Lacan gave a series of talks in the Chapel at the Sainte-Anne Hospital, for an audience of junior psychiatrists. In this text, “Je Parle Aux Murs” , Lacan said that “for anyone who dwells here within these walls, the walls of the clinical asylum, it would be as well to know that what situates and defines the psychiatrist as such is his situation in relation to these walls.” Towards the end of the last session he held that the first thing that psychiatrists could get from the reflection of his voice off these brick walls is to know what specifies them as psychiatrists as well as hearing something other than his voice, which can lead to the point of forming an accurate idea of what is involved in the object a.
This leads me back to the topic I am trying to deal with. Lacan’s speech not only reverberates back to him from these walls, but also resonates as something else for those in the audience as well. Can this give the psychiatrist an indication regarding the direction by which he may listen to psychotic inpatients? Impossible to connect to as objects a hollowing the institute, one nevertheless can hear their voices reverberating back to him from the walls. This is what the walls of the institute are for, this is what they enable. As Lacan hints, the psychiatrist learns something about his own jouissance, and so listening is not intolerable anymore; the objects-a-inpatients, these foreign bodies of jouissance, may be thought, and moreover, become “someone to talk to”. Nonsense can be payed attention to, and on occasion, an access to meaning becomes conceivable.
 “Extimity”, Jacques-Alain Miller, The Symptom 9, 2008.
 “Lacan’s Later Teaching”, Jacques-Alain Miller, Lacanian Ink 21, 2003.
 “Talking to Brick Walls: A Series of Presentations in the Chapel at the Sainte-Anne Hospital”, Jacques Lacan (2017). (A.R. Price, Trans.). Cambridge: Polity Press.