The Ethics of Care: Expanding Psychoanalytic Responsibility Beyond the "Discourse of the Analyst"

Introduction

Psychoanalysis has long been characterized by its dual commitments to theory and clinical practice. While the theoretical dimensions often dominate discussions, the ethical stakes of clinical care are no less crucial. This essay seeks to explore how psychoanalytic theorists, particularly Jacques Lacan and Alan Bass, have shaped our understanding of subjectivity and difference while falling short of addressing the ethical dimensions of care within the clinic. In doing so, it develops a framework for an ethics of care that applies not only to severe trauma but to all forms of analytic practice and all analyzable analysands.

Lacan’s Discourse of the Analyst and the Absence of Care

Jacques Lacan’s contributions to psychoanalysis are foundational, particularly his development of the Real, Symbolic, and Imaginary (RSI) registers. These registers provide a framework for understanding the subject’s relationship to desire, language, and reality. The discourse of the analyst, one of Lacan’s four discourses, emphasizes the analyst’s role in facilitating the analysand’s traversal of the fantasy—a process in which the subject confronts the lack or void at the heart of their existence. Lacan’s discourse resists the comforting illusions of mastery and resolution, focusing instead on the subject’s encounter with the Real as a space of radical alterity.

While this theoretical innovation is profound, Lacan’s emphasis on the traversal of the fantasy often neglects the lived experience of the analysand and the ethical demand to provide care. By focusing on the structural dimensions of subjectivity and the confrontation with lack, Lacanian psychoanalysis risks becoming detached from the complexities of the clinical encounter. The ethics of care, as I argue, calls for a deeper engagement with the analyst’s responsibility to help the subject navigate not only the void but also the process of reconstructing meaning and resilience.

Alan Bass and the Generalization of Fetishism

Alan Bass builds on Lacanian and Derridean insights in his work, particularly through his generalization of fetishism. In "Psychoanalysis and Difference: Alan Bass’s Generalization of Fetishism," Bass explores how fetishism operates as a defense mechanism that allows the subject to manage the lack inherent in desire. Drawing on Derrida’s notion of “economy,” Bass extends fetishism beyond its traditional psychoanalytic boundaries to address the subject’s relation to difference and absence.

This generalization is a significant theoretical contribution, yet it, too, fails to engage adequately with the ethical stakes of clinical practice. While Bass highlights the ways in which fetishism disavows difference, he does not address how the analyst might help the subject confront and work through this disavowal. As I argue in my paper "Let Us Not Forget the Clinic," Bass’s focus on theoretical elaboration overlooks the ethical responsibility to care for the analysand in their confrontation with radical complexity.

The Ethics of Care and Radical Complexity

The ethics of care I propose emphasizes the analyst’s dual responsibility: to help the subject engage with the Real and to support the reconstruction of meaning in the wake of its disruptions. This framework applies not only to severe trauma but to all forms of analytic care. Trauma—whether acute or diffuse—often amplifies the radical complexity inherent in the subject’s experience, but all analysands confront the challenge of negotiating the Real, Symbolic, and Imaginary in their own ways.

Psychoanalysis has historically questioned whether victims of severe trauma are analyzable, given the exponential amplification of radical complexity in their experiences. I argue that they are—precisely because the ethics of care can hold space for this complexity without reducing it to simplistic explanations or superficial solutions. Care in this sense is not about offering comfort or resolution; it is about creating a space where the analysand can confront their ruptures, glitches, and disavowals while being supported in the process of reconstruction.

Barnaby Barratt, Derrida, and the "I-Now-Is"

Barnaby Barratt’s concept of the "I-now-is," as well as Derrida’s engagement with it in Psychoanalysis and the Postmodern Impulse (1993), provides a valuable lens for understanding this ethical responsibility. Barratt captures the precariousness of the subject’s temporal self-construction, which binds identity through repetition and difference. For Derrida, the RSI registers function as a dynamic “ball of activity and repetition” that simultaneously registers and repudiates reality. Trauma disrupts this fragile equilibrium, exposing the subject’s inability to sustain the fantasy of a seamless “I-now-is.”

Combat trauma offers a vivid example. The Real “smashes” into the steady repetition of the RSI, creating a breakdown or “glitch” in the subject’s ability to sustain coherence. This disruption is not merely the encounter with the Real but the repeated failure of the RSI to restore its rhythms. The ethical question for the analyst, then, is how to navigate this breakdown while supporting the analysand in rebuilding their capacity to function.

Kohut and the Reconstruction of the Imaginary

Heinz Kohut’s theory of healthy narcissism offers crucial insights into this process. Kohut emphasizes the importance of selfobject functions, such as mirroring, idealization, and twinship, in maintaining a cohesive self. Trauma often shatters these functions, leaving the subject exposed to the Real without the protective mediation of a functioning Imaginary or Symbolic.

In this context, Kohut’s work suggests that the analyst’s ethical responsibility includes helping the analysand repair the narcissistic fantasy—the Imaginary—that allows them to navigate disruptions to their RSI functioning. This repair does not mean restoring the old fantasy wholesale or denying the subject’s confrontation with lack. Instead, it involves building a better, more adaptive framework for negotiating the Real.

Traversing and Reconstructing the Fantasy

Lacanian theory often emphasizes the traversal of the fantasy—the process of confronting the void or lack at the heart of subjectivity. However, this is not sufficient, particularly in the context of trauma. Without a functioning Imaginary to mediate the encounter, the subject risks fragmentation. Kohut’s perspective complements this by insisting that the analyst must also support the reconstruction of the Imaginary, enabling the analysand to traverse the fantasy without being overwhelmed by the Real.

Ethics of Care as a Dual Responsibility

The ethics of care, then, has two intertwined responsibilities:

Confrontation: Helping the subject engage with the Real and work through the traumatic disruptions of the RSI.
Reconstruction: Supporting the subject in rebuilding the Imaginary and selfobject functions necessary for resilience and growth.

This dual approach ensures that psychoanalytic practice remains attuned to the complexities of the clinical encounter while fostering the subject’s capacity for transformation.

Conclusion

By integrating insights from Lacan, Bass, Derrida, Barratt, and Kohut, this essay develops an ethics of care that addresses the full spectrum of psychoanalytic practice. Trauma amplifies the ethical stakes of care, but all analysands confront the challenges of negotiating the Real, Symbolic, and Imaginary. The analyst’s role is to hold space for these negotiations, not only by facilitating confrontation with the Real but also by supporting the reconstruction of meaning and cohesion.

This expanded ethics of care honors the subject’s suffering and complexity while remaining grounded in the clinical realities of psychoanalysis. By bridging theory and practice, it offers a compassionate and effective framework for engaging with the radical complexity of the human psyche.

References

Bass, Alan. Psychoanalysis and Difference: Alan Bass’s Generalization of Fetishism.
Barratt, Barnaby. Psychoanalysis and the Postmodern Impulse.
Kohut, Heinz. The Restoration of the Self.
Laplanche, Jean. Essays on Otherness.
Lacan, Jacques. The Four Fundamental Concepts of Psychoanalysis.