The general practitioner, secretary of the alienated subject?

This paper asks what Lacanian psychoanalytic theory might offer a general practitioner working over many years with highly complex patients. I reflect on 25 years of practice with patients who attend frequently, suffer significantly and are difficult to help by conventional medical means. Many of th...

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Publicado en:Psychoanalytic Psychotherapy Vol. 40; no. 2; pp. 142 - 146
Autor principal: Beug, Anna
Formato: Artículo
Publicado: Taylor & Francis Ltd Jun2026
Materias:
Acceso en línea:Ver este registro en EBSCOhost
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      dt: Jun2026
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      pub: Taylor & Francis Ltd
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        193835381
        10.1080/02668734.2026.2651136
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        atl: The general practitioner, secretary of the alienated subject?
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        au: Beug, Anna
        affil: Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
      su:
        Treatment of borderline personality disorder
        Work
        Occupational roles
        Defense mechanisms (Psychology)
        Social alienation
        Psychoanalysis
        Physician-patient relations
        Physicians
        Psychoses
        Psychosocial factors
        Experiential learning
        General practitioners
        Psychoanalytic theory
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        subj:
          Treatment of borderline personality disorder
          Work
          Occupational roles
          Defense mechanisms (Psychology)
          Social alienation
          Psychoanalysis
          Physician-patient relations
          Physicians
          Psychoses
          Psychosocial factors
          Experiential learning
          Offices of physicians
          Offices of Physicians (except Mental Health Specialists)
          General practitioners
          Psychoanalytic theory
      keyword:
        borderline personality disorder
        lacan
        ordinary psychosis
        primary care
        psychoanalysis
        borderline personality disorder
        lacan
        ordinary psychosis
        primary care
        psychoanalysis
      ab: This paper asks what Lacanian psychoanalytic theory might offer a general practitioner working over many years with highly complex patients. I reflect on 25 years of practice with patients who attend frequently, suffer significantly and are difficult to help by conventional medical means. Many of these patients are diagnosed with borderline or emotionally unstable personality disorder and treated with antipsychotic medications. Drawing on Darian Leaders discussion of Lacan's Concept of the analyst as 'secretary of the alienated subject' and related writings on 'ordinary psychosis', I explore how psychoanalytic ideas may illuminate aspects of clinical work in primary care that might otherwise seem futile or menial. The idea of 'secretarial duties', such as writing letters, documenting details and providing punctuation through regular short appointments are elaborated with clinical examples. This reflective paper suggests that Lacanian theory may offer a way to conceptualize and articulate the delicate nature of this work so often undertaken in primary care with patients the system has largely abandoned.
      pubtype: Academic Journal
      doctype: Article
      src: R
    language: English
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