The title of the Symposium is "Hospitalization, before and after". We usually hear these words with the hospitalization being the point of reference. Hospitalization is the decisive event which, as it forms a point in someones life, it also makes After to differ from Before. We could say that hospitalization enacts a Before and an After as it forms a turning point in habit, in the familiar, indifferent passing of time. We meet a similar condition in the so called "psychic trauma", in a serious illness, in a misfortunate relationship, in an abuse etc. Such an event can be a milestone in our lifetime, so that we can say that after it our life is not the same anymore, that we have become another person. In another level, an example of such a chief point for the Christian world is the birth of Christ. Since then time is divided in years before Christ and years after Christ. Proportionately hospitalization may interfere in someone's life so that it becomes a point in his life and forms a Before and an After.

Today I will hear the title of the Symposium with a different intonation, that is with emphasis in Before and After, where the In-Βetween, in our case hospitalization, not be a cross point of reference, not be even an issue. And I will not limit my speech in hospitalization but I will try to describe this other hearing where, I repeat, Before and After is there without their In-Βetween becoming an issue. An example: During psychotherapy one day one finds out, often to his surprise, that a phobia or an antagonism with his father or an obsessive self-observation or a depressive mood simply don’t exist anymore. Here there is again a Before and an After, but if we now ask him "Before what?", "After what?" he will not be able to give us an answer. In the field of the first hearing there would of course be an answer. The "what" would be an interpretation or some other intervention of the therapist that caused the change. We may draw on such interpretations, our client may give emphasis to some In-Βetween which is due to us or to him or to something else. So the Before and After would be placed to a reference. But the other hearing is valid too: Such changes, if we stay to what happens and not cover it with our own conceptions, come from nowhere.

I started with the example of hospitalization, which is the subject of our Symposium. How can I say that in nursing the remission of the symptoms comes from nowhere, when it is a fact that pharmaceutical treatment, to get limited to that, has obvious and undoubted results? The question was put on a seminar during the reading of a draft of this speech and it gives me the opportunity for a clarification: The first hearing concerns the image we have, therapists and patients, for the situation of the last. The therapists form the image according to the model they follow, e.g. nursing as diagnosis and pharmaceutical therapy. The image that the patients form about their situation is part of the problem itself, e.g. hospitalization as refuge or as prison. Everywhere here the relevant image is also an answer to How and Why, setting an In-Βetween: diagnose and medicine, refuge and confinement, that becomes the point of reference for Before and After (in our case the hospitalization).

I don’t intent to oppose to this view. My speech wants only to draw your attention to another aspect too. Nothing more. I remind you, we are talking about an aspect in which the Before, the After appear without mediation, that is without explicit or implicit reference to something which intervened and caused the story of an individual or of a civilization to be divided to a Before and an After.

I will mention now some other relevant experiences which may be more familiar to one or the other. Such an unmediated Before and After occurs when the teenager finds out that he is not anymore the little child in front of his grown-up parents. A woman during her childhood once in a while was beaten by her mother. Once, in her adolescence, when her mother tried to beat her again, she beat her back. The mother never tried to beat her again. The child was no longer a child. This had been translocated to a Before. Just that. From one moment to another.

Another example: I catch my wife cheating on me and I kill her. I feel shaken, speechless and the only I can stutter is: "It is me who did that?" In the end there is nothing else to say than: "It was the fatal moment". Here time is split in a Before and an After too. The In-Βetween? The fatal moment. Just that.

And now I will try to describe these events otherwise. Let’s take the first hearing, according to which Before and After are mediated by an In-Βetween. Let’s take the example of my wife’s murder. A psychiatrist or a psychologist of course would not take my words about the "fatal moment" seriously. They would speak perhaps about a repressed aggressiveness which a disorganized superego was not able to tame; they would speak about a psychotic episode, about death drive etc. In the court room would be examined my motives and my psychic situation, there would be given answers to why I killed her. Now which is the difference? What is introduced by such explanations other than the case of the "fatal moment"? An In-Βetween is introduced which bridges the emptiness of the fatal moment and restores a continuity between the Before the murder and the After it. The unsubstantial "fatal moment", its fleetingness, its emptiness obtains substance and meaning. Before and After, having being linked by their In-Βetween come in an order, in a continuity. Their continuity forms the coordinate of time.

In Freud the In-Βetween that bridges the gap of direct experience as we met it in the referred examples, is the "unconscious". In the text with the same title he writes: [The hypothesis of the unconscious] is necessary because the data of consciousness have to a certain degree gaps. [Freud here states the <by-acts and dreams in healthy people>, the <psychic symptoms in patients>. And he continues:]

Our most personal everyday experience notifies us ideas whose origin we don’t know […]. All these conscious acts would remain loose and ununderstable if we insisted in the claim of having to know with our consciousness any psychic act inside us. We subsume them into a demonstrable relation when we show the unconscious acts which have been revealed. However, benefit in meaning and relation is a completely justified motive, which can lead us beyond direct experience.

Freud here declares a more general axiom. The first hearing, which bridges the gaps by an emphatic In-Βetween, is not limited to the hypothesis of the Freudian unconscious. The issue of scientific thought in general, in which psychiatry and psychology belong, is "to be subsumed" the "gaps" of "direct experience" in a "demonstrable relation", to obtain "meaning".

The second hearing, for which the In-Βetween is not an issue, inhabits exactly the emptiness of these gaps. And it inhabits it in such a way that emptiness itself is not even an issue. The adolescent girl and the murderer do not ask to understand, meaning to link, to co-relate, and that is why they do not even think to speak about a gap where the link and the co-relation are missing. It is as in many child narrations: Then she dried to beat me / and then I beat her back / and then she didn’t beat me again. Or: Then she cheated on me. / And then I killed her. / And then I cried over her. Or: Then the phobias started. / And then I didn’t have phobias. etc. Here there is no continuity, coordinate of time. There doesn’t exist the In-Βetween of a "why" which links the one to the other, but the "And" which simply juxtaposes one after the other - the asyndeton "And": and then, and then, and then…

Listen to this too. It is an old german child song:

Hans Peterchen saddled his horse,

Climbed the high mountain.

The high mountain, the deep valley where Hans Peterchen will die.

Then he dies, and he is then dead.

We bury him under the red roses.

When the roses fade,

the nightingales will sing.

When the nightingales sing Hans

Peterchen will jump out of the grave.

Let us see our question again from another perspective. An example: Sometime ago I was at home, now I am here with you, then I will meet some friends. Here I speak about a time succession where the place of my presence and my role in the different places change. In this change something remains unaltered. It is the ego, which stretches beyond time and it speaks about before, now, after in the selfsame first person: I was, I am, I will be. In the coordinate of time the Ego stretches above it as a constant. We will find out the same in a psychological interpretation too. In the example of murder, as we said, the psychiatrist and the psychologist will not take seriously the wonder of the murderer "Is it me who did that?". They will perhaps perceive in the Before of the mild, patient and kind face some signs which would reveal the potential murderer, him who manifested himself "the fatal moment", whom the mild, patient and kind one would not like to know. They will speak about one and the same ambivalent ego which, through various mechanisms, comes to murder and then to the denial and depersonalization ("Is it me who did that?"). They will speak about "identification crisis" of one and the same ego. The Before of the "good" and the After of the "evil" bridge by the Between of the interpretation. The continuity of ego is reestablished, which is not of course only the "good", which the later murderer recognized and accepted as his own, but an ambivalent, two-faced ego. The "fatal moment" loses any meaning.

In the second hearing we don’t pass by the "fatal moment" but we listen to it. What happens when we say "fatal moment"? When does this expression have meaning? It has meaning when from the "Horai", hours, which "bring everything" (Heraclitus), one brought murder. Then the murder does not have its beginning either in me or in something else. The "fatal moment" is a name of the emptiness which so fanatically Freud fights. The expression "fatal moment" has then meaning when an Ego, that of the "good" or that of the "bad" one, or an ambivalent ego is not an issue. What does that mean? How does that happen? It happens when in my everyday life what occurs is not accompanied by the awareness of an Ego. I act, but not I, I suffer, but not I, I think, feel, but not I. I kill, but not Ι. And by the way this is in my opinion the only psychotherapeutic perspective of a radical solution from the ambivalence, from the so called "identity crisis", from anxiety, from guilt that may trouble us. Not a stronger Ego, no interpretations and admonitions and directions and advice which would address exactly the Ego, but detachment from Ego as point of reference. Simply: the fatal moment. Simply: and then, and then, and then…

In the same way perhaps would be possible an understanding of adolescence. The girl, one day raised hand at her mother. One day the boy masturbated, another day he kissed a girl for the first time, another he raced with his motorbike and hurt himself. First the psychologization renders adolescence a substantial In-Between, an identity crisis and a bridge between the child and the grown up. Correspondingly the child game becomes what Winnicott calls "transitional object".

Speaking about the perspective according to which Ego becomes an issue, I started out with an example: Before I was at home, now I am with you, then I will meet some friends. I discussed it firstly from the aspect of a trans-temporal Ego which extends throughout Before, Now, After. How can this Ego not be an issue? It can as long as I stay where I am each time: Home. Symposium. Tavern. In the same light hospitalization can be also seen: I have a problem; and then this becomes a dead-end; and then I enter or am taken in a clinic; and then they give me some medicine; and then I feel better; and then I go back home. In all the examples I stay by what is happening now. I do not supervise, I do not trace back and I do not dwell in scenarios, I don’t live in a Before and in an After, I do not compare and I do not co-relate. Before and After are not anymore points in the coordinate of time, they are not defined this way. There is no continuity: The Before becomes something like "once upon a time", the After is left to a "it will show…". Perhaps this way, like a fairy tale, we could see, beyond persons and situations, our very existence too. Then our life would not be only a sac on the backs of an Ego-porter but also a balloon in a child feast. Then perhaps death would not mean anything more than what it means for the balloon sometimes during the game to burst out or to go away up the sky.

I spoke about the In-Between of Before and After from two perspectives. In the first it becomes an issue that co-relates Before and After on the ground of an Ego. In the second perspective In-Βetween is not an issue. Before and After are placed one beside the other and therefore connections, co-relations, and the Ego as their carrier are left with no object. Possibly, we could resemble the facts of our life to Rorschach figures. [Psychological test with undefined figures where one is called to identify them to forms of things, animals, people.] The first perspective interprets the figures, it sees in them bears, dances, blood etc. The second perspective leaves the figures as they are and does not ask to transform them to familiar forms, does not intend to give them a name. When I spoke about hospitalization in the field of the first hearing, I said that therapists and patients have in mind an image of it, which concerns us. We could also think of this image as the form which is each time projected on the undefined figure of illness and treatment. A corresponding form would be also the "demand" of the person who goes to psychotherapy, but also the concept of the therapist about his patient’s situation. Another example: if my nature would be an undefined Rorschach figure, I would have proceeded to an interpretation of it by becoming a doctor. In this first perspective I would have to tell a lot of things about my history, the conditions under which I grew up, the things I met, that led me to this choice, which became a landmark in my life. In the second perspective I stay in my origin, in the unidentified of my figure, and about the how and why I became a doctor I have nothing more to say than: "It just happened".

I unfolded to you some elements of the two perspectives. Coming to an end I have to stress that they are not different and opposite. Naturally, I had to get up at a certain time, be here and then go to the tavern at a certain time. But at the same time the Before of my being home now is too remote, and equally remote is the After of the tavern and my friends. The study of medicine is a landmark which in my history enacts a Before and an After, and at the same time it is nothing more and nothing else than a hole in the water.

What does this "at the same time" mean? How do the two perspectives go together? When one seems to invalidate the other? How can the In-Βetween have substance and at the sane time remain unsubstantial? An Arab, shortly before he died, calls his three sons and divides his 17 camels to them. The eldest, he says, will take the ½, the second 1/3 and the youngest 1/9. And then he dies. The sons remain with the question how to divide the 17 camels to 1/2 , 1/3 and 1/9 according to their father's commands. The calculation does not lead anywhere. Finally, they go to an old man and they present their problem. The old man has a camel and he gives it to them. They now have 18 camels: the eldest takes ½, that is 9, the second ⅓, that is 6 and the youngest 1/9, that is 2. 9 and 6 and 2 give 17, and the old man takes his camel back. The In-Βetween, the old man's camel, has substance and essence - it enters the calculation, and at the same time it gets lost from the calculation, it stops being an issue. This way we could see the playing of the two perspectives that detained us. And thus the way of the old Arab taught me how to be a therapist. If I may put it more concretely: A man tells me: "At the beginning I wanted you to give me a hug and tell me <don’t worry, it does not matter…everything will be ok…>; and although I did not hear this phrase, [here he slightly laughs] I took the hug."