Manifest Content

A patient walks into the room, and, it seems, we both feel anxious. They fidget around in their chair a bit then look at me as though to suggest that I do something to begin the session. So I say, “So…”

“So I'm here because, it's really messed up, the psychiatrist at my school who I've been seeing is making me come here before I can be seen there again to get a refill because there's been a change in their insurance policy, and so it's been three days that I haven't had my prescription, so if I seem a little on edge that's why.”

They don't actually say all of this. I don't take notes during patient sessions, so I have no transcript of what Anna actually said, just some thoughts I typed into my laptop a moment after they left the room. There is something of a lie, I think, in clinical psychoanalytic writing that professes to convey session material verbatim—or, rather, that doesn't acknowledge its own fictiveness. The lie doesn't reside in this fictiveness per se, but in the clinician who, attempting to write in an empirical register, resists the brazenness of the phallic shield that is her own fiction.

Recreated from the echo in memory of the feeling I had during my first moment with Anna Grouse (name and gender fathomed with both poetic license and confidentiality in mind), the above speech reflects my best effort to convey both the patient's own exigency and my own confusion. This was one of my earliest sessions in the analyst's chair, and I was rather anxious. In a bit of time, after several more years of listening to a handful of analysands, I would become more comfortable with the degree to which any analyst is a fraud (supposed to know by the patient but routinely knowing next to nothing, nodding along); but I was far from “there.” I found the tenor of Anna's anxiety, however, to be oddly anxiolytic: not only was I not as nervous as they were, but the percapita density of the concerns they laid out immediately upon sitting down forced me to see the limits and bou