In a fantastic paragraph in his 1986 article Lacan and the Ethics, John Rajchman says,
Psychoanalysis is not a medical treatment any more than the unconscious is a medical disorder —a dysfunction or maladaptation. Rather the unconscious is a “structural or constitutive fact about ourselves as speaking subjects, and analysis is the work through which one comes to terms with this fact (p. 42).
When I read this, I was impressed by how concise and accurate this statement is.
Rajchman goes on to elaborate:
Analysis does not consist in diagnosis and prescription. It is made possible by a certain “ethical” position: A sort of suspension or epoche of the analyst in the face of the madness of another’s desire, combined with the neural “listening.” This stance makes possible the transference that structures the analytic process of articulating this madness in speech (p. 42).
Breaking this down a bit:
The first point is that psychoanalysis is not part of the medical model. It offers those who use it a different way of finding relief from the things that are making them suffer. That relief comes via psychoanalysis, where the analysand speaks to the analyst about what has happened to them.
The analyst, unlike other people, does not expect that the analysand will fix the problem. Instead, the analyst just asks that the analysand speak to say something about it. That is it.
The analyst provides a very particular kind of presence to the analysand that the analysand does not find in other relationships.
As the analysand speaks, they have to take all these different experiences that don’t make sense and put them into an order that does make sense. Ergo, by talking about what has happened, the analysand literally “makes sense” of what has happened to them. Often, this means they make sense of what does not make sense.
This goes on for a time and many things that did not make sense start to make sense. (This would be the therapeutic effects of psychoanalysis that happen as a bonus rather than as the aim of the analysis.) However, if it goes on long enough, the analysand will run into something they can’t make sense of. This would be the “madness of their desire,” which does not make sense and will not make sense. However, the analysand might learn to live with this madness that resists any attempts to be rendered sensical.
If the analyst were to judge, diagnose, or attempt to act as an authority, the process would not work. The ethic of the analyst is to listen and be receptive without having a vested interest in producing a fix, cure, or different behaviors in the analysand.