FROM FREUD S COCAINE TO KRAMER S MODERN PROZAC A Look at an Epistemic Rupture from a Lacanian Perspective Diego E. Londoño

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1 Powered by TCPDF ( FROM FREUD S COCAINE TO KRAMER S MODERN PROZAC A Look at an Epistemic Rupture from a Lacanian Perspective Diego E. Londoño Association Recherches en psychanalyse «Recherches en psychanalyse» 2014/1 n 17 pages 35a à 45a ISSN Article disponible en ligne à l'adresse : Pour citer cet article : Diego E. Londoño, «From Freud s Cocaine to Kramer s Modern Prozac. A Look at an Epistemic Rupture from a Lacanian Perspective», Recherches en psychanalyse 2014/1 (n 17), p. 35a-45a. DOI /rep Distribution électronique Cairn.info pour Association Recherches en psychanalyse. Association Recherches en psychanalyse. Tous droits réservés pour tous pays. La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que dans les limites des conditions générales d'utilisation du site ou, le cas échéant, des conditions générales de la licence souscrite par votre établissement. Toute autre reproduction ou représentation, en tout ou partie, sous quelque forme et de quelque manière que ce soit, est interdite sauf accord préalable et écrit de l'éditeur, en dehors des cas prévus par la législation en vigueur en France. Il est précisé que son stockage dans une base de données est également interdit.

2 Miscellanea 2014 Varia 2014 From Freud s Cocaine to Kramer s Modern Prozac A Look at an Epistemic Rupture from a Lacanian Perspective De la cocaïne de Freud au Prozac moderne de Kramer Un regard sur une rupture épistémique au travers d une perspective lacanienne Diego E. Londoño Abstract: This is an analysis on the epistemic change between both the approach initiated by Freud after experiencing cocaine, and the ones pursued by biological psychiatry and psychopharmacology which led to the contemporary vision of antidepressants taken by P. Kramer, linked to the iconic book Listening to Prozac. A comparative and analytical assessment between Freud s works and the new listening is proposed here within the scope of Jacques Lacan s jouissance and the three registers. Résumé: Il s'agit d'une analyse sur le changement épistémique entre les deux démarches initiées, d un côté par Freud, après avoir connu la cocaïne, et celles poursuivies par la psychiatrie biologique et la psychopharmacologie qui ont conduit à la vision contemporaine des antidépresseurs prises par P. Kramer, liées au livre emblématique, Listening to Prozac. Une évaluation comparative et analytique entre les œuvres de Freud et la nouvelle «écoute» est proposée ici dans le cadre de la jouissance et les trois registres de Jacques Lacan. Keywords: psychopharmacology, subjectivity, three registers, jouissance, psychoanalysis, biological psychiatry Mots-clefs: psychopharmacologie, subjectivité, trois registres, jouissance, psychanalyse, psychiatrie biologique Plan: Introduction Western cocaine and mythical coca The new way of listening to psychiatric drugs Lacan on Prozac Conclusion Introduction In this paper we will make a comparison between the experiences and outcomes of Freud and cocaine with those of psychopharmacology and biological psychiatry at present, more precisely through Prozac (SSRI), the most famous and controversial selective serotonin reuptake inhibitor in the last twenty years. I will pursue a presentation and analysis of three pre-analytical texts by Freud, and try from a lacanian perspective to interpret and visualize the legacy of this 36

3 experience for psychoanalysis and psychopathology. Then I will briefly discuss the key points from psychiatrist Peter Kramer s book, Listening to Prozac 1 which is perhaps nowadays the most optimistic and indulgent of all the written works on this medication, just as Über Coca 2 was to cocaine and the ways in which current psychopharmacology is created and prescribed. This article is about comparing the approaches, ideas and outcomes of the two lines of work, which though in principle remain similar, will ultimately differ when compared in the field of psychopathology. However, what can be seen in the biological and pharmaceutical approach is the clear division that will be generated between the detachment of Freudian psychoanalysis from the discourse of medical science through psychotropic drug experimentation and the approach continued through this means by pharmacology and biological psychiatry. Despite the fact that Freud initially undertook a similar approach with cocaine, pondering how the effects and dosages of the alkaloid could be parameterized and operationalized, and believing that the drug could be stripped of its share of contingency and indeterminacy, delimiting the space between the pathological and the normal, he was to end up breaking with this conception. He would branch off into another epistemic path that would lead him to the invention of psychoanalysis. We will see how in a different way, he experienced cocaine, which was regarded as an experimental multipurpose compound in the late 19th. century. Finally, this paper will elaborate on Lacan s appraisals of his three registers the Symbolic, the Imaginary and the Real which offer the possibility to observe the ways in which the pharmacological substance articulates with this triad, constituting reality for each subject, and how an individual can come to deal with its effects in a unique and idiosyncratic manner. Western cocaine and mythical coca Freud s first experiences with the alkaloid date from In a letter, he speaks about this substance as a therapeutic project [that] has hope. He is basing this largely on Aschenbrandt s tests on soldiers and how cocaine increased their energy and endurance during workouts. According to the existing literature of the time, Freud thought he had found unique properties for the alkaloid and that was when he decided to self-experiment with it. He discovered a terrific substance changing his mood, giving him energy, vitality, providing self-control and lessening the sensation of hunger. At the time he was suffering from neurasthenia a very popular and over diagnosed contemporary disease characterized by chronic fatigue. He felt relieved by frequent use of cocaine, especially in moments of anguish and social encounter when he had to talk with scholars and colleagues. He hoped to discover through cocaine the biological basis of neurosis or nervous disease, and to establish the alkaloid as a specific-drug in the field of neurology and psychiatry. He believed that the model offered by the South American Indians could be transposed to European culture. For him this stimulant synthesized and transformed into something completely different to what was consumed by the Indians coca leaves. It should offer the same capacity of work and resistance. However, Freud had to face disappointment by the time he wrote his third assessment on cocaine, contrasting with that of Über Coca, his first article on the matter in which he recounted the experiences of cocaine on himself, attributing to the alkaloid an enormous capacity of action and finding a form of satisfaction and jouissance in the use of it at least as it is also said in his letters to his fiancée Martha. For him, there was an elimination of the symptom: depression and fatigue; and the satisfaction brought by the effects of toxic jouissance is a substitute of the symptom on a body, which as Jacques Lacan reminds us, is made to enjoy, enjoy from itself. But Freud was to discover the other side of the coin, and how this jouissance has a deadly aspect: the 37

4 repetitive compulsion in the addiction and its Thanatos which is consubstantial. This would be the case with his dear friend Ernst von Fleischl- Marxow; although Freud regarded cocaine as a substitutive element promoting a form of pleasure, relieving anxiety, and a miraculous cure for neurosis that restored the ideal of normalcy, it would show its self-destructive face on von Fleischl. Ernest was addicted to morphine after having his hand partly amputated, and the intense pain caused by amputation made him become addicted to this opioid. Freud, after reading an article by W.H. Bentley in the Detroit Therapeutic Gazette, was convinced that cocaine would be a great way to cope with the withdrawal symptoms of morphine addiction. He advised his friend to take it regularly by subcutaneous injections, but this was an ill-advised decision: not only did he fail to shake his morphine addiction, but he became dependent on cocaine and his general condition deteriorated. He later died in 1891 due to a cocaine overdose, probably a suicide. Freud was soon to realize how placing the effect of the psychoactive substance in the standards of the scientific discourse was not necessarily a means of avoiding deleterious outcomes, nor was it a means of reaching a clear definition of its effects. The case of von Fleischl would be one of the principal foundations of what he wrote 35 years later in his essay Beyond the Pleasure Principle, where he depicts the repetition compulsion as a result of the death drive. It is here that Lacan locates jouissance as an element which is contradictory to pleasure and that goes beyond the pleasure principle. Lacan usually positions jouissance as something that follows the same logic as the drive. There is undoubtedly jouissance at the level where pain begins to occur, and we know that only at this level of pain can it be experienced a dimension of the body that otherwise remains veiled. 3 It was in the struggle against pain that von Fleischl would play out the inevitable predicament of the relationship between poison and jouissance. There is the whole dimension of pain and the impossibility of homeostasis that became elusive to Freud at that time. The pharmakon 4 comes as a replacement of pain by bringing in another jouissance that releases the subject from the physical world and from his body. This last statement opens up an examination related to substance abuse and the excess of medication nowadays. One of many errors committed by Freud was his confusion between the coca leaf and cocaine. Besides sharing a very different chemical structure (the stimulant alkaloid, cocaine hydrochloride is only present between 0.1% and 0.8% in the coca leaf, whereas in cocaine it can represent almost 80-90%) the cultural and social differences of both substances are quite the opposite. The coca leaf comes from an ancient tradition in which its use is exclusive to rituals and symbolic conventions belonging to native cultures. The use of coca relies on a mythical register, within a fiction, and even though Freud was aware of this he did not seem to acknowledge this important aspect at the time. Therefore, his willingness to translate the properties of coca into the western world was an attempt to introduce cocaine in the structure of a scientific discourse. By this means, the substance could be desecrated and drawn out of a mythic universe. In the isolation of the main stimulant compound through complex scientific methods one could assume that it is possible to extract from the leaves the covetable attributes of coca, but things were more complicated than a simple reductionism of the properties of the plant. We pass from a remedy, a stimulant and an almighty substance, to an undesired poison that will finally end up being prohibited and penalized. Removing the mythical constituent and the symbolical codes in which the rituals of the coca leaf are circumscribed seems to be a mistake committed by the whole western civilization. This is not far from what happened to mescaline extracted from peyote, and the use of the latter in Native American and Mexican tribes, and of the former on hippy and countercultural groups that led to its prohibition. 38

5 Lacan pointed out that the function of myths is to structure something that revolves around a truth belonging to a culture. This something is the direct relationship of man to nature, being, death and birth, and especially his relationship to sex and the body. In cultures where the mythical world is so rich, the body image is the result of an artificial construct in which the subject confirms that its existence is authorized in the locus of the symbolic by being supported in the structure of the Other. Therefore, the body would have the consistency of a fiction, which is nothing but an attempt to compensate an impossible task: to defend itself against the jouissance of the Other. Under this assumption, the imaginary meaning is essential to the establishment of a unified body, thus the mirror stage plus the symbolical confirmation conveyed by the Other. Consequently, coca, within a ritualized framework that is managed by a symbolic universe of fictions and myths, works as a barrier to the jouissance of toxic overflows. The particularity of Freud s experiences with cocaine is the way he manages to apprehend the confrontation with otherness and how it universalizes the effects of psychotropic drugs on humans is almost impossible. Subjectivity and idiosyncrasy play a very important role; the individual variations that are found within the experiment conducted by Freud and those conducted by other researchers such as Schroff or Aschenbrandt, reflected the difficulty that arises when predicting the effects of the drug in humans accurately. This was a very distant approach compared with the design and prescription of modern psychotropic drugs such as Prozac. In his Contribution to the Knowledge of the Effect of Coca Freud believed he could capture the effects of the alkaloid through numbers, and the quantitative measurement was for him a necessary step prior to determining the effects of the drug. This symbolic chicanery 5, as Allouch calls it, would encounter an obstacle, something impossible to capture: the real is the remains of the history, which befall the subject, and which at the same time exceed him and alienate him; the very condition of subjectivity. The fact that sensitivity to cocaine was specific to each subject, and extremely variable even within a single individual, made it difficult or impossible to predict the effects of the product and therefore the factors that would determine intoxication or addiction. Thus Freud wrote: It is important to note that some toxicity also occurs with small doses of cocaine. So the sensitivity of certain individuals to cocaine, together with the absence of any reaction to larger doses in other cases, has aptly been labeled idiosyncrasy. I believe this one unreliability of cocaine that one does not know when a toxic effect will appear is very intimately connected with another, which must be attributed to the drug itself that one does not know when and with whom a general reaction is to be expected. 6 The new way of listening to psychiatric drugs In the mid-1950s, in Europe and the United States the fortuitous discoveries of antidepressant effects of two molecules, imipramine and iproniazid, opened the door to chemists and pharmacologists to investigate at a microscopic level the actions of these drugs on the nervous system. Pharmacologist Julius Axelrod began an important era in the production and synthesis of psychiatric drugs which allowed the pharmaceutical industry to develop new components without resorting to statements or direct assessment on human guinea pigs, as was formerly done, or as Freud did on himself. When Axelrod studied the sympathetic nervous system and effects of norepinephrine on it, he discovered the effects of MAOI and tricyclic antidepressants in blocking the reuptake of catecholamines in the presynaptic clefts. Later, serotonin, another neurotransmitter, was also reported to be blocked in its synaptic reuptake by MAOIs and tricyclics, but on a lower scale. In the 1960s, it was known that two monoamines affected mood: norepinephrine 39

6 and serotonin. Once pharmacologists had understood how it worked, they worked to develop an antidepressant as effective as imipramine but with a specific action and fewer side effects. That is when different laboratories began an intensive pharmacological research in trying any kind of product which should not show its effects on humans through the subject's signifiers, neither through the way this subject ties these signifiers to his body, but a product that would respond to the blocking of specific neurotransmitters in the synaptic clefts of nerve cells. Prozac was not so much discovered as planfully created, through the efforts of a large pharmaceutical firm, using state-ofthe-art animal and cellular models and drawing on the skills of scientists from diverse disciplines. [ ] The story of Prozac is typical in another way as well. Chemists working today to develop drugs for the mind start not so much with diseased patients as with models of nerve transmission, and they tailor molecules to affect a basic process. The goal is clean drugs drugs that are ever more potent and specific in their effects on nerve transmission. The likely result of this form of research is not medicines that correct particular illnesses but medicines that affect clusters of functions in the human brain, often both in well and ill persons. 7 Psychiatrist Peter Kramer was to go beyond all this scientific babble and to restore some status to the drug. He would depict it as the same miraculous social enhancer that Freud believed cocaine was. By rendering it more human-like, Kramer improved the image of a molecule that was to become an economic success. Different from cocaine, which is the result of a millenary tradition and the adventures of 19th century chemistry, Prozac was conceived by modern psychopharmacology and neurochemistry to be specific and clean (no side effects). Eli Lilly promoted a drug like Prozac as something more than perfect, infallible and without any inconvenient side effects. It was designed to be different from other antidepressants, since it was a result of a well-planned project by a scientific laboratory, as described in Kramer's promotional and very controversial book. He would present Prozac as a perfectly-acting drug for psychiatric syndromes such as depression, anxiety, or OCD, but delivering a surplus in slightly disordered biological systems, making people better than well. 8 Not only would the patients on Prozac revert to their original or healthy state, comfortably installed in the silence of the organs, but they would also improve their character and personality. For Kramer, the antidepressant brings a significant change to the identity and to the subject s social relationships. We are facing a cosmetic psychopharmacology, which is identical to the use of illegal psychotropic drugs and drug addiction. 9 With Prozac we run into an energizer, a psychic steroid boosting social skills and personality, similarly to the way cocaine untied Freud s tongue at social gatherings, reassuring him and making him eloquent. Freud s Über Coca and Kramer s demarche coincide to some extent in that both are very optimistic about the potentials of a new drug that they or their patients would experience despite the almost absolute lack of knowledge these researchers had about it, but with the shared hope of drawing everybody beyond normalcy by making them feel better. Now, from the Lacanian perspective, we can analyze the unique ways in which the pharmakon can be articulated with the subject s symbolic, imaginary and real dimensions so that we can develop a better reading of idiosyncrasy. Lacan on Prozac The consequence of this bio-engineering is the absence of the subject s statements, his relation towards the binding of the jouissance, the body and the symptom. The medical drug is not just reducible to a chemical substance as it cannot just be separated from its definition and the ways it was designed by the clinical trials that outline its indications and contraindications, or even the reports describing its effects whether 40

7 desired or undesired. Hence, the symbolical network in which it was conceived cannot be ignored because it is a part of the way the drug circulates and affects the consumer. Nowadays what is biological and neurological is highlighted as a priority, and it is contrived by economical interests which eventually silence the regular consumers statements and complaints. And this leads one to conclude that Prozac enables a link between biological predispositions and social experiences; personality as biologically determined can be reordered by means of psychoactive substances according to the ideals of a society and of physicians: social and economic success, charisma, self-confidence, popularity, optimism and character-making seem to act as the Master signifiers of modern western cultures. Prozac is not just a chemical substance but a source of qualities and ideals ready to be injected into the nervous system. Kramer conveys through this conception of psychiatric drugs a moralistic bias and ideals that ultimately distort an analytical and critical approach. In Éric Laurent s paper 10 on psychiatric drugs he proposes a look of its effects through the three Lacanian registers that compose reality. According to Laurent, the drug binds in the imaginary register through its effects on signification; it is all about subjective expectations of drug effects and different effects evidenced by the subject and his own experience: feeling omnipotence, confidence, drunkenness, cheerfulness, drowsiness, obtundation, etc.; these are all the possibilities of meanings correlated to the drug effects. From this perspective, Laurent assimilates Kramer s cosmetic psychopharmacology in which the effects of Prozac resemble in many ways the effects already present in the psychoactive substances known for centuries to drug addiction and to the search for jouissance through the pharmakon; however, one could also think of Freud and his idea of cocaine as a social booster and a source of vitality. Freudian cocaine and the eloquent man with the untied tongue full of energy, as would be the case of his expectancies on neurosis, are also included in this imaginary register but that must also be observed in its suture with the real. The ego ideal plays an important part in the sense one will give to the drug s effects in one s body and one s fundamental fantasy. The changes of personality and the re-search for these mental states correspond to an imaginary position in which the ego ideal plays an important role. The field of application also comes under the spotlight especially when it is beyond the therapeutic indication and the drug becomes an object of comfort. In this register we can also place Moreau de Tours s experiences with hashish; the meaning attributed to the toxic effects is assimilated as dream states or fantasias. 11 Different from Freud s precautions in his last writing on cocaine, Craving for and fear of cocaine, Kramer sees no problem about fluoxetine, and even implicitly promotes its widespread use by supporting the expansion of its prescription beyond what is established in medical textbooks such as the DSM. He even suggests the possibility that certain kinds of common behavior should be regarded as symptoms or potential illnesses. Whereas Freud sees in von Fleischl the excess of cocaine and tempers his praise of the alkaloid, Kramer minimizes the outbreaks attributed to Prozac and recommends psychiatric medicines as drugs of comfort for well-being. Prozac comes neither from a mythological ethnic group nor from a significant ritual that can pose a limit to the jouissance; nonetheless, it is still inscribed in the Other, it comes from an engagement between third party payers, health civil servants, pharmaceutical companies, researchers, physicians and consumers and it is inscribed within a capitalist discourse of profit and selfimprovement at minimum costs. It is the result of an alliance between science, business and politics. What this symbolical chicanery misses is the real. On this matter, Freud writes: I suspect that the reason for the irregularity of the cocaine effect lies in the 41

8 individual variations in excitability and in the variation of the condition of the vasomotor nerves on which cocaine acts. Since little attention has been paid to this factor of individual predisposition, and the degree of excitability generally cannot be known, I consider it advisable to abandon so far as possible subcutaneous injection of cocaine in the treatment of internal and nervous disorder. 12 The different cases of acting out, suicidal or criminal, attributed to Prozac are questioned and softened at the end of Kramer s book. Some cases highlighted by Kramer that made the headlines in the late 1980s often refer to patients with complex pasts, engaged in hetero and self-aggressive conducts, depressions and suicidal ideas that are often imposed on them. This is the case of Joseph Wesbecker, former employee of a printing plant who ended up slaughtering eight people and wounding twelve others before killing himself. His family filed a lawsuit against the firm Eli Lilly since they considered that Prozac was responsible for his disastrous act. It turns out that in the past Wesbecker had been several times interned in a psychiatric hospital, he suffered from delusions of persecution, hypochondriasis, was short tempered and socially awkward; on several occasions, he attempted suicide. Once, he went over to the printing plant armed with a gun and threatened to kill one of his former superiors; he had repeatedly told his wife that he would go to shoot a bunch of people in the printing plant. Several psychiatrists diagnosed him with manic-depressive psychosis with paranoia, therefore it might be extreme to say that Prozac caused directly what the French psychiatry calls passage à l acte (passing to the act) or acting out. Nonetheless it can be argued that it can break down defenses against anxiety, allowing for a total disinhibition and leaving the psychotic subject directly confronted with an unbearable persecutory object and for which no mediated relationship is possible; the subject faces an object towards which he has no choice other than to respond with an act. If the mediating function of language fails in psychosis, the subject is confronted in the real to the anguishing presence of the Other of the jouissance. Here, one can analyze the way the drug is influenced by and comes from the real. For Laurent, the ways in which the drug may be linked to the real are through its effects on the body and nomination in the real. Nomination in the real is not like imaginary signification, rather it goes beyond. For each subject there is his own individual system of signs, a system that refers to what Lacan calls in one word lalangue, as the special and unique way in which each subject incorporates the common langue that builds the relationship with his modes of jouissance and how he treats his real. The effect of the drug may be a return to the real or also as we believe a return from the real, allowing lalangue to name, in a unique way, a nodal point or an impossible. But this articulation can be seen as a non-sense or senseless thing coming from the real; it is the case in medication with some psychotic patients when the drug comes from the real as a persecutory object or as Prozac and the enigmatic effects it produces in the body and the non-sense manner the subject experiences this ineffable jouissance. But the real can also be named or nominated and thus bound to a subjective event or affect. The real effect of the drug is a nonsense effect Through the drug, the subject carves his organism differently. He carves it with this instrument of knowledge that is the drug. If the signifier carves the body in its own way, the knowledge contained in the drug shears it otherwise. It reveals to the subject an unknown jouissance, absolutely unknown, and that is accessible only by this means. Before neuroleptics and antidepressants were developed we did not know how to enjoy from serotonin or dopamine... The drug exceeds the therapeutic indication provided by a diagnosis. It is a product of knowledge, a machine, an instrument to explore the body. Through the drug, the subject is able to enjoy from new parts of his body. 13 The bad trip can be another way to see the inclusion of the drug in the register of the real, 42

9 and the impossible to be captured through the symbolic and the imaginary. It is another way in which the toxic affects the body. The drug enables us to envisage another way to deal with the real of the body in illness, suffering, and the sexual as an impossible relationship. As Gonon suggests from other studies, the relapse rate in antidepressant treatments is of almost 70% and the difference between them and placebos is barely significant except in cases of severe depression. 14 Therefore, the drug fails in most of the cases to achieve what the medical discourse expects from this substance: the elimination of the symptom and the recovery of the subject. This point of real with the pharmakon should not be ignored by the pharmacologists and physicians nowadays. Conclusion We can observe that there is a different perspective to the one undertaken by biological psychiatry and pharmacological dissection ; for Lacanian psychoanalysis it is about how we discover other ways of exploring the body to be distinguished from the organism through the unknown jouissance promoted by molecules. This is not about revealing diseases or syndromes through the drug, as biological psychiatry or as Moreau de Tours, but rather to see how the drug helps to regulate, block or multiply the jouissance contained in the bond of the symptom with the body and the language. Others have tried to asses SSRI through phenomenological experiences. 15 Nor is it a position of the analyst, nor of the psychotherapist, to agree or disagree with medication, but rather see its outcomes, analyze the way it bounds with the three registers and how the subject experiences its effects in a unique way. Kramer s model goes even further by picturing the defects of social and personality characteristics as biological dysfunctions in the brain; he actually considers that the disorders catalogued in the diagnostic manuals such as the DSM do not represent the neurochemical areas of the brain considered abnormal or imbalanced. The distinctions I have outlined between Prozac and cocaine can be stressed considering they were designed and accepted with their respective effects and toxicity, despite the fact that both drugs share neither time nor context. If the former enjoys today a wide profusion and popularity due to the scientistic discourse that precedes it and the intensive marketing that expands it, the latter was rapidly doomed due to the effects that quickly revealed the Thanatos in many patients and the manner it transcended the medical indications. The future of Prozac may be threatened if it continues to be seen as a drug of comfort and if the toxic aspects and excesses that may result in certain subjects are swept aside or minimized. The promotion of a disease-centred model of drug action 16 is an epistemic position that stands in contrast to the position taken by Freud when he decided to weaken the concept of cocaine as an all-powerful remedy, when he left aside the idea that through the pharmakon the biological bases of neurosis could be deduced. In the same way that the disease-centred model tries to apprehend the drug from a scientific framework, Freud realized that by this means the knowledge of the drug was not reliable and did not necessarily unveil the hazards nor the contingencies of mass consumption. The idiosyncrasy and the social and cultural characteristics of each subject dictate how each individual would grasp and experience the effects of a drug 17, but beyond this, the teaching of Lacan shows us how the subject has to deal with his own jouisssance through these molecules and his relationship with the real of the body, the imaginary signification and the symbolical rules that embed the drug. If modern psychopharmacology appears to be pursuing a universalizing approach where statistics and probability would have the final word on what is medication and how it should be classified, designed and prescribed, Freud seemed to quickly assume that the drug is much more complex than that and that it rapidly resists being forced into homogenization and analysis. It results in an impasse that he 43

10 declared early in Contribution to the Knowledge of the Effect of Coca, and this impasse paved the way for the discovery of the peculiarity of dreams and the unconscious years later. He would come to outline the common structural elements of the psyche. Freud would realize that these scientific processes mediated by the drug and what it represented at the time, and in large part still today the element compressing a bio-medical truth, free from any contingency, rationally organized and constructed, tracing the boundary between normality and pathology is only an unstable and volatile representation. 18 Wesbecker s case shows exactly how personalized medicine fails to minimize the importance of idiosyncrasy, especially when ignoring the real of the jouissance conveyed by the pharmakon. Bibliography: Allouch, J. (1984). Lettre pour lettre. Transcrire, traduire, translittérer. Toulouse: Erès éditions. Assoun, P.-L. (2011). Freud avec la cocaïne. Préhistoire toxicologique de la psychanalyse. Alcoologie et Addictologie, 33 (4), Coblence, F. (2002). Freud et la cocaïne. Revue Française de Psychanalyse, 66 (2), Dagognet, F. (1964). La raison et les remèdes. Paris: PUF. Freud, S. (1974). Cocaine Papers. New York: Stonehill Publishing Company. Gonon, F. (2011). La psychiatrie biologique: une bulle spéculative? Esprit, Hadreas, P. (2010). Husserlian Self-Awareness and Selective Serotonin Reuptake Inhibitors. Philosophy, Psychiatry & Psychology, 17 (1), Healy, D. (2004). Let them eat Prozac, The unhealthy relationship between the pharmaceutical industry and depression. New York & London: New York University Press. Healy, D., Herxheimer, A. & Menkes, D.B. (2006). Antidepressants and Violence: Problems at the Interface of Medicine and Law. PLoS Medicine, 3(9): e372. doi: /journal.pmed Kramer, P. (1993). Listening to Prozac. New York: Viking, Penguin Books. Lacan, J. (1966). La place de la psychanalyse dans la médecine, leçon du 16/02/1966. Conférence et débat du Collège de Médecine à la Salpetrière. Cahiers du Collège de Médecine, 12, Laurent, E. (2003). Comment avaler la pilule? Ornicar? Revue du champ freudien, 50, Markel, H. (2011). Über Coca: Sigmund Freud, Carl Koller, and Cocaine. Journal of the American Medical Association (JAMA), 305 (13), Moncrieff, J., Cohen, D. (2006). Do Antidepressants Cure or Create Abnormal Brain States? PLoS Medicine, 3(7): e240. doi: /journal.pmed Moncrieff, J. (2009). The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. London: Palgrave MacMillan. Moreau de Tours, J.J. (1973). Hashish and Mental Illness. New York: Raven Press. Nordenfelt, L. (2010). On Concepts and Theories of Addiction. Philosophy, Psychiatry & Psychology, 17 (1), Rego, M. D. (2010). Subjective Knowledge, Mental Disorders, and Meds: How to Parse the Equation. Philosophy, Psychiatry & Psychology, 17 (1), Williams, C.R. (2008). Vice and naturalistic ontology. Philosophy, Psychiatry & Psychology, 15 (1), Notes: 1 Kramer, P. (1993). Listening to Prozac. New York: Viking, Penguin Books. 2 Freud, S. (1974). Cocaine Papers. New York: Stonehill Publishing Company. 3 Lacan, J. (1966). La place de la psychanalyse dans la médecine, leçon du 16/02/1966. Conférence et débat du Collège de Médecine à la Salpetrière. Cahiers du Collège de Médecine, 12, In Plato s Phaedrus the word pharmakon is used to indicate at the same time both the remedy and the poison. 5 Allouch, J. (1984). Lettre pour lettre. Transcrire, traduire, translittérer. Toulouse: Érès éditions, Freud, S., Op. cit., p Kramer, P., Op. cit., p. 60, Psychiatrist Joanna Moncrieff and psychologist David Cohen think very differently about SSRI antidepressants. See references. 9 Nordenfelt, L. (2010). On Concepts and Theories of Addiction. Philosophy, Psychiatry & Psychology, 17(1), Laurent, E. (2003). Comment avaler la pilule? Ornicar? Revue du champ freudien, 50, Moreau de Tours, J.J. (1973). Hashish and Mental Illness. New York: Raven Press. 12 Freud, S., Op. cit., p

11 13 Laurent, E., Op. cit., p Gonon, F. (2011). La psychiatrie biologique: une bulle spéculative? Esprit, Hadreas, P. (2010). Husserlian Self-Awareness and Selective Serotonin Reuptake Inhibitors. Philosophy, Psychiatry & Psychology, 17 (1), Moncrieff, J. (2009). The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. London: Palgrave MacMillan. 17 Rego M. D. (2010). Subjective Knowledge, Mental Disorders, and Meds: How to Parse the Equation. Philosophy, Psychiatry & Psychology, 17 (1), Dagognet, F. (1964). La raison et les remèdes. Paris: PUF, The author: Electronic reference: Diego E. Londoño, PhD Clinical psychologist, Consultación externa, Clínica la Inmaculada, Cra. 7 N 68-70, Bogota, Colombia. Associate member of the Research Laboratory, «Recherches en psychopathologie : nouveaux symptômes et lien social» (EA 4050). Université Rennes 2. Place du Recteur Henri Le Moal C.S Rennes Cedex, France. Member of Psyconex, Grupo de Investigación, Departamento de psicología. Universidad de Antioquia. Cll. 67 N Medellín Colombie Diego E. Londoño, From Freud s Cocaine to Kramer s Modern Prozac A Look at an Epistemic Rupture from a Lacanian Perspective, Research of Psychoanalysis [Online], published June 20, This article is a translation of De la cocaïne de Freud au Prozac moderne de Kramer Un regard sur une rupture épistémique au travers d une perspective lacanienne Full text Copyright All rights reserved 45