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Additional resources for Clinician Guide to Depression Assessment and Management in Primary Care

Sample text

The fulfilment of the wish has not yet come so how can the present wish determine this non-existent thing that will fulfil it? Imagining this, they feel tense and strive to fulfil this ‘gap’ between the two Paradoxes 25 ‘items’: one’s wish that is in one’s mind now and some extra-mental event that is the fulfilment of the wish. They are unable to understand that the fulfilment of a process is not on the same level as the process; we require metaphorical understanding to conceptualize a completed process (PI, para.

Why must this be therapeutic? There is a deep divide between how people come upon and speak of their conflicts, suffering and distress, and how psychoanalysts and psychiatrists describe them when they are in a theoretical mode. Patients emphasize their experience, telling their story, often in stuttering, meagre, and unsure language that expresses their feelings and confusions accurately. If experts translate this, as if they were the sole masters of language, they are dictating and interpreting the ‘real’ meaning.

This conceptual equation is analogous to confusions about desire. Both raise the question as to how to make sense of a rule that holds radically unlike terms in an intelligible relation; it involves a productive ambiguity. According to Freud, there is a type of primal experience consisting in the resolution of internal tension by the experience of satisfaction. Thus, he assumes a wish is a striving for an object that has been lost but which once brought real satisfaction (Freud, 1925). There is a state of hunger, a feeling of unsatisfaction, which I have now, which is satisfied by what I wished for.

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