Image, corporality and analytical listening in remote care

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This subject was given to us by the Social Clinic of the Brazilian Society of Psychoanalysis of Rio de Janeiro for peer discussion. The tension of the encounter between the virtual world, atopy (absence of space) acronia (absence of time), and the subject of embodied memory, questions and challenges the field of psychoanalytic clinic by producing the passage from the sensitive and symbolic to the signs of the virtual without symbolization, space or time. 
 
Cyberculture offers to the processes of subjectivity production fluidity and sentient intensities by imposing an incessant work of simultaneous updating. Its relationship with the theory of psychoanalytic technique produces a deadlock in relation to the place of the subject of the repression because the virtual world produces the control of the desire for consumption in the passage of the symbol to the signific images guided by algorithms. 
 
Although, since the 1950s, there has been a literature on distance analysis justified by the need to follow social transformations, with the COVID pandemic, sanitary restriction measures presented this as the only possible modality of care. Would the difference in remote care by choice by the analytical duo confront us with a new object of investigation? 
 
The choice of psychoanalysts to isolate has become a space for projections of patients who are professionals in Covid care. Verbal threats, anger at asymmetry, and the statement that it would be better for patient and therapist to ‘quickly end’ with virtual care, were common. Added to the social representations offered by health policy, packed by images such as those of the communist virus, treatments without scientific basis (hydroxychloroquine, ivermectin) and anti-vaccine position-fueled defenses triggered by anxieties linked to the risks of contamination and consequent morbidity and mortality and, at the same time, responding to the suicide call as that of the message of the President of Brazil; ‘it’s just a little flu’. Only from the emotional recognition of symmetry imposed by the risks of contamination that equate the analytical duo in the face of death and dying, the destructiveness contained in denial and omnipotent fantasies do they find a space to be elaborated. 
 
The maintenance of isolation and privacy in virtual care brought characteristic difficulties in the situation of camera control and the production of images by the patient. Images of the public road, home or work environment introduced in the analytical scene a kind of imagery dramatization that made it difficult to observe non-sensory characteristics of psychic reality. The intrusion of the setting by external reality weakened the ability to listen and think analytically, due to the impact of the succession of images produced by the analysis, making the analyst, who was placed in the position of spectator, passive and not the dreamer of the session.The recommendation of the establishment of a fixed place for calls helped and protected the analytical process, limiting the excess of reality and restoring the conditions for reverie and, consequently the establishment of symbolic connections, to the detriment of the sign presentations.

Certain contents that presented themselves in the clinical material in a visual or figurative way were suspended in the transition from the physical to the virtual environment. The communication of images by the patient, if understood as an affective pictogram present in the waking dream, has creative potential because it is proposed for a dream for two. When this type of content ceases due to remote service, we notice a loss of depth in communication. What mental states would be accessible with the use of new technologies?  What contents would be kept in isolation and which would be lost with remote service? The complaint of tiredness of the virtual space and remote care was related to isolation as a component of external reality and understood as a consequence of a rupture of social rituals and their processes of staging and corporeity (going to the analyst, football, cinema, being with friends and family). However, it is also related to the interferences of technological devices (sound, image, signal) that produce in the patient an appeal for recognition: are you listening to me, seeing me...? The machine (and its flaws), a non-human, interacts with humans and positions the perception by the psychoanalyst’s patient as a pseudo-presence or as proof of absence (lost object), implying a mourning process that can bind the figures of emptiness and the negative. The negative is connected to the spectrum that goes from the hallucinatory realization of desire to the production of fantasies and self-knowledge, and emptiness brings the risk of catastrophes to the experience of creativity. The weariness of the virtual environment would be linked to the mourning for pseudo-presence or the absence of rituals of interaction between bodies. 
 
Finally, I recall that the neoliberal field of forced labor is now called telework. Becoming a homogeneous model, will it represent the crisis of the practice of psychoanalysis? Will it indicate the logic of power that begins a new stage of transformation in the organization of work through precariousness? The technical device of virtual care will be sustained, in the medium and long term, through knowledge and power related to the pedagogical processes of transmission of psychoanalysis. Will it become an indispensable part, from the pandemic, in the educational institutes of psychoanalytic societies? Will the relationship between virtual reality and psychic reality be a new object of investigation? 
 
References
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