On the Signal of Anxiety in Emergency

On the Signal of Anxiety in Emergency
Elena Levy Yeyati

Psychoanalysis can inform other disciplines, particularly psychiatrists, that beyond the use of pharmaceuticals it is possible to acquire tact and judgement in the management of anxiety in emergency admissions.

“Everyone has heard about the role played by signals among social animals like those that live in herds. When a predator shows up, the cleverest animal, or the one in the herd that is keeping watch, notices, smells, and locates it. Gazelles and antelopes raise their muzzles, make a little bellowing sound, and without delay the whole herd dashes off in the same direction. A signal as a reaction to a danger in a social complex, at the biological level, can thus be grasped in an observable society. Well, the same is true of anxiety as a signal – the subject can receive the signal from the alter ego, from the other who constitutes his ego.” [1]

If the signal of anxiety is what brings defence into play before the desire to repress, the desire of the analyst would be a desire that does not arouse anxiety. In whom? To start with, in the analyst themselves. This is a definition of decided desire. Nevertheless, it is not certain that the desire of the analyst does not provoke anxiety in the analysand. But it has to be dosed. The analyst, in relation to the anxiety of the other, is there to keep an eye out for too much enjoyment of a masochistic fantasy. We should distinguish between the surprise of interpretation (which indicates an unexpected meaning, the loss, or absence, of the customary meaning) and the anxiety that forces new repressions, unbearable negative transference or interruptions to the treatment.

The moderation of anxiety (individual or collective) is especially necessary in consultations for emergency admissions, which pose the necessity of immediate limitation. In this context, the citation chosen from Lacan is also useful for thinking that we can make use of the signal of anxiety to make an assessment of “clear and immediate” risk. If the signal of anxiety is not simply “interior” to the subject we can understand that, like communicating vessels, we might also find it between the members of the “herd” (the entourage or immediate family). This signal is always received and transmitted as bad news. Everyone knows that it is good practice to interview those accompanying the patient seeking consultation in an emergency room, not so much in order to receive “more details” (in the measure that the patient speaks they are always our best source of “information”) but rather to localise these signals.

Translated from Spanish by Roger Litten

1 Lacan, J., The Seminar, Book VIII, The Transference, transl. B. Fink, Polity, 2015, p. 364.