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• Uniformed Services University of the Health Sciences
• Bethesda, Maryland

Infection prevention and control of epidemicand pandemic-prone respiratory infections in health care antimicrobial yoga pant discount trimox line. Efficacy of commercially available wipes for disinfection of pulse oximeter sensors bacteria lesson plan purchase generic trimox canada. Effectiveness of common healthcare disinfectants against H1N1 influenza virus on reusable elastomeric respirators antibiotics poop order cheap trimox on line. Poorly processed reusable surface disinfection tissue dispensers may be a source of infection antibiotics for sinus infection augmentin purchase trimox paypal. Lesser-known or hidden reservoirs of infection and implications for adequate prevention strategies: where to look and what to look for antibiotic cheat sheet purchase generic trimox canada. Assessing the efficacy of different microfibre cloths at removing surface micro-organisms associated with healthcare-associated infections antibiotic 9 fk unsri purchase trimox 250 mg visa. Evaluation of the decontamination efficacy of new and reprocessed microfiber cleaning cloth compared with other commonly used cleaning cloths in the hospital. Time-series analysis of the relationship of antimicrobial use and hand hygiene promotion with the incidence of healthcare-associated infections. Failure of gloves and other protective devices to prevent transmission of hepatitis B virus to oral surgeons. Importance of the environment in meticillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. An integrated approach to hospital cleaning: microfibre cloth and steam cleaning technology [Internet]. Working relationships of infection prevention and control programs and environmental services and associations with antibiotic-resistant organisms in Canadian acute care hospitals. Risk reference sheet: Infection control healthcare acquired infections [Internet]. The influence of patient room type, cleaning procedure, and isolation precautions on room cleaning times in Canadian acute care hospitals. Prevention of hospital-onset Clostridium difficile infection in the New York metropolitan region using a collaborative intervention model. Institutional control measures to curtail the epidemic spread of carbapenem-resistant Klebsiella pneumoniae: a 4-year perspective. More cleaning, less screening: evaluation of the time required for monitoring versus performing environmental cleaning. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Hand-touch contact assessment of hightouch and mutual-touch surfaces among healthcare workers, patients, and visitors. The type, level, and distribution of microorganisms within the ward environment: a zonal analysis of an intensive care unit and a gastrointestinal surgical ward. Viral contamination of aerosol and surfaces through toilet use in health care and other settings. Norovirus in the hospital setting: virus introduction and spread within the hospital environment. Blood pressure cuffs as a vector for transmission of multi-resistant organisms: colonisation rates and effects of disinfection. Ontario Hospital Association; Ontario Medical Association Joint Communicable Disease Surveillance Protocols Committee; Ontario. Asthma, chronic bronchitis, and exposure to irritant agents in occupational domestic cleaning: a nested case-control study. Asthma and exposure to cleaning products a European Academy of Allergy and Clinical Immunology task force consensus statement. Robens Centre for Health Ergonomics, European Institute for Health and Medical Sciences, University of Surrey. Healthcare laundry and textiles in the United States: review and commentary on contemporary infection prevention issues. Hospital outbreak of pulmonary and cutaneous zygomycosis due to contaminated linen items from substandard laundry. Choice framework for local policy and procedures 01-04: decontamination of linen for health and social care: management and provision [Internet]. Healthcare outbreaks associated with a water reservoir and infection prevention strategies. Planning guide to the implementation of safety engineered medical sharps: resource manual [Internet]. Workbook for designing, implementing and evaluating a sharps injury prevention program [Internet]. Cleaning hospital room surfaces to prevent health care-associated infections: a technical brief. The antimicrobial efficacy of copper alloy furnishing in the clinical environment: a crossover study. Disinfectants used for environmental disinfection and new room decontamination technology. Effectiveness of deep cleaning followed by hydrogen peroxide decontamination during high Clostridium difficile infection incidence. Comparison of the microbiological efficacy of hydrogen peroxide vapor and ultraviolet light processes for room decontamination. Evaluation of the biological efficacy of hydrogen peroxide vapour decontamination in wards of an Australian hospital. Evaluation of a pulsedxenon ultraviolet room disinfection device for impact on hospital operations and microbial reduction. Evaluation of an automated ultraviolet radiation device for decontamination of Clostridium difficile and other healthcare-associated pathogens in hospital rooms. Environmental decontamination of a hospital isolation room using high-intensity narrow-spectrum light. Terminal disinfection in hospitals with quaternary ammonium compounds by use of a spray-fog technique. Utilization and impact of a pulsed-xenon ultraviolet room disinfection system and multidisciplinary care team on Clostridium difficile in a long-term acute care facility. Effectiveness of a novel ozone-based system for the rapid highlevel disinfection of health care spaces and surfaces. Gaseous and air decontamination technologies for Clostridium difficile in the healthcare environment. An evaluation of the efficacy of four methods for determining hospital cleanliness. Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Emergency department visits related to Clostridium difficile infection: results from the nationwide emergency department sample, 2006 through 2010. Evaluation of an ultraviolet C light-emitting device for disinfection of electronic devices. Pseudo-outbreak of Legionella pneumophila serogroup 8 infection associated with a contaminated ice machine in a bronchoscopy suite. Nosocomial outbreak of Pseudomonas aeruginosa folliculitis associated with a physiotherapy pool. Institutional risk factors for norovirus outbreaks in Hong Kong elderly homes: a retrospective cohort study. Risk stratification-based surveillance of bacterial contamination in metropolitan ambulances. Transmission of metallobeta-lactamase-producing Pseudomonas aeruginosa in a nephrology-transplant intensive care unit with potential link to the environment. Multidrug-resistant Pseudomonas aeruginosa outbreaks in two hospitals: association with contaminated hospital waste-water systems. Elimination of biofilm and microbial contamination reservoirs in hospital washbasin U-bends by automated cleaning and disinfection with electrochemically activated solutions. Wastewater drainage system as an occult reservoir in a protracted clonal outbreak due to metallo-beta-lactamaseproducing Klebsiella oxytoca. Transmission of hepatitis C virus in dialysis units: a systematic review of reports on outbreaks. Determinant roles of environmental contamination and noncompliance with standard precautions in the risk of hepatitis C virus transmission in a hemodialysis unit. Recommendations for preventing transmission of infections among chronic hemodialysis patients. Control of carbapenemaseproducing Enterobacteriaceae outbreaks in acute settings: an evidence review. Clinical and cost effectiveness of eight disinfection methods for terminal disinfection of hospital isolation rooms contaminated with Clostridium difficile 027. Detecting hidden environmental reservoirs of Clostridium difficile during an outbreak associated with North American pulsed-field gel electrophoresis type 1 strains. Asymptomatic Clostridium difficile colonization as a reservoir for Clostridium difficile infection. Regretfully, although we opened one more lecture room than planned, we were forced to limit the number of free oral presentations. We have optimized the E-poster utility through careful selection and categorization with an increased number of reading stations and availability online. When selecting this topic, although we were primarily thinking of our younger colleagues, we believe that senior experts will beneft from it. The course book was realized in a perfect collaboration with our publishers Thieme and with the generous contributions of many prominent experts. Of course, all these achievements would have been impossible without the support and contributions of the medical industry. And so, thank you to the submitters, lecturers, supporters and participants We hope that you will enjoy your stay in the wonderful city of Copenhagen and, when you leave, that you will feel enriched in your knowledge and passion of our fantastic medical subspecialty. Future is not only new techniques, but also the next generation and some sessions are specially devoted to young hand surgeons with lectures and free papers. Teaching and training is one of the most important goals and in order to make all contents available also after the meeting, for the frst time, the presentations will be streamed online and uploaded on the website. During the congress we will also have the Delegates Assembly and I sincerely hope that all of you are going to join this central event of our Federation. The president of the congress, Michel Boeckstyns, the Organising Committee and the Scientifc Committee have been working hard in the last years to prepare a wonderful event in a wonderful city and we are looking forward to your participation. Jensen Camilla Ryge Claus Moger Niels Soe-Nielsen Pernille Leicht Robert Gvozdenovic Torben Bfik Hansen Niels B. A laptop will be provided at each presentation hall that should be used for presentation. If your presentation contains videos, make sure to embed them in the presentation fle or upload them also during slide check. Slides must be clear and easy to read from a distance charts with detailed data are to be avoided. Please report to this room to upload your presentation not later than 2 hours before your talk. The fle is copied on the main server, on the backup server and immediately in the right room. Speakers who want to change their presentation material will be able to do so in this area. As a safety measure, bring with you a second pen drive with a back-up copy of your presentation. For viewing the e-posters big screens will be provided at the e-posters area of the congress venue. Mireia Esplugas1, Marc Garcia-Elias2, Alex Lluch-Bergada2,3, Nuria Fernandez-Noguera4, Inma Puig de la Bellacasa5. Ferrero Matteo1, Giacalone Francesco1, Cosentino Pier Luigi1, Di Summa Pietro2, Battiston Bruno1|1S. Igor Shvedovchenko1,2, Andrej Koltsov1, Boris Kasparov1 | 1Federal State Institution St. Albrecht of the Ministry of Labour and Social Protection of the Russian Federation; 2Department of Medical Physics, St. Joakim Stromberg1, Johanna Wangdell1, Carina Reinholdt1, Jan Friden1,2 | 1Centre for Advanced Reconstruction of Extremities (C. Romain Detammaecker, Sophie Sabau, Lionel Athlani, Hugo Maschino, Gilles Dautel | Department of Hand Surgery, Plastic and Reconstructive Surgery. Sauerbier1|1Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Germany;2Zentrum fur Handchirurgie Ravensburg im Arztehaus am Krankenhaus St. Leong3, Filip Stockmans4,5, Peter Axelsson6, Rodrigo Moreno7, Allan Ibsen Sorensen8, Jesse B. Petersburg Scientifc and Practical Centre of Medical and Social Expertise, Prosthetics and Rehabilitation named after G. Hruby1, Agnes Sturma1, Johannes Mayer1, Stefan Salminger2, Anna Pittermann3, Oskar C.

Th e f a t h e r i s c o n c e r n e d a b o u t t h e b e h a v i o r a l p r o b l e m s h i s s o n h a s d e v e l o p e d antibiotics for acne weight gain order trimox 500 mg online. He re p orts that for the p ast m onth bacteria yersinia pestis order trimox with a mastercard, afte r the p atie nt g oe s to b e d and to sle e p bacteria yersinia pestis generic trimox 250mg line, the parents hear him get up in the middle of the night antibiotics how long purchase trimox 500mg on-line. On the se occasions virus 98 order cheap trimox line, the child is found st and ing somewhere in the house antibiotic diarrhea treatment purchase cheapest trimox and trimox, crying and seemingly disoriented, with rapid breathing and p rofuse swe ating. Whe n the p are nts atte m p t to com fort him or re turn him to his room, he b e com e s q uite up se t, striking out at t he m and scre am ing lo u d ly. He co n t in u e s t o scre a m a n d fig h t fo r se ve ra l m in u t e s b u t t h e n st o p s spontaneously. Once he is awakened, he continues to act frightened and cannot share any dream content. Once the child is calmed, the parents put him back in his bed, and he sleeps through the rest of the night without incident. In t h e m o r n in g, h e w a ke s u p in h is u s u a l h a p p y m o o d a n d d o e s n o t re m e m b e r what occurred the previous evening. The parents are worried that he might be having seizures or developing a severe behavioral problem. H e wakes at night, screaming and has autonomic hyperarousal, and his parents are unable to soothe him. Most likely diagnosis: Nonrapid eye movement sleep arousal disorder, sleep terror type. It t ypically manifest s itself as emot ional and behavioral disturbances at night. T hese event s usually occur early in t he night ly sleep cycle during delta (slow-wave) sleep. In nonrapid eye movement sleep arousal disorder, sleep terror type, the affected child does not remember the episodes in the morning. Fever, sleep deprivation, and central nervous system depressants may increase frequency of sleep terror episodes. The episodes are usually self-limit ing wit hout t reat ment, and t he prognosis is very good. Be h a v io r a l e xh ib it io n o f in t e n s e e m o t io n, o f t e n w it h e x t r e m e a u t o n o m ic r e s p o n s e s s e e n. Pa t ie n t is o ft e n u n re sp o n sive t o e ffo rt s t o so o t h e o r ca lm. Li t t l e m e m o r y o f e p i s o d e i n t h e m o r n i n g a f t e r a n o r m a l a w a k e n i n g. Some recent studies have demonst rat ed a st rong correlat ion of night terrors and other parasomnias with the presence of additional sleep disorders, such as sleep-disordered breathing and restless leg syndrome. In virtually all the children studied, the parasomnia, primarily sleep terrors and sleepwalking, was eliminat ed when appropriat e int er vent ions for t he addit ional sleep disorder were implement ed. It has been suggest ed t hat t he sleep disorder may trigger the parasomnia, and when t he t rigger is eliminated, t he parasomnia resolves. In addit ion, st udies have also indicat ed a very st rong correlat ion of sleep t errors wit h a family history of other parasomnias. A recent Canadian study looked at the correlation of sleep terrors among monozygot ic and dizygot ic t wins and showed a considerable heritable component of this disorder. Delta sleep has been divided into Stages 3 and 4 by some, depending on the number of delta waves seen. Sleep disorders are classified and defined based on their occurrence and manifestation in the context of the sleep cycle. Dyssomnias are disorders characterized by excessive sleepiness or difficult y init iat ing or maint aining sleep. They include such disorders as sleep t errors, sleepwalking (somnambulism), rhyt hmic movement disorder, sleep talking, nightmares, sleep paralysis, bruxism, and enuresis. N ight terrors and somnambulism tend to occur during periods of arousal from delta sleep. As a result, these disorders are more common in children (who have more delta sleep) and they often occur during the first half of the night when there is more delt a sleep occurring. Patients wit h bot h disorders are difficult to awaken, confused if t hey are awakened during a parasomnia, and typically do not remember the incident. Sleepwalking (somnambulism) is characterized by repeated episodes of rising from bed and walking during sleep. O ft en pat ient s have a blank look on t heir faces and seem indifferent t o wh at is around t h em. T h ey t ypically are not very react ive and t hus do not sh ow t h e behavior (such as screaming and violent thrashing), seen in sleep terror disorder. The potential for harm to self or others from a sleepwalker (falls, walking into st reet s, st art ing a fire) means t hat families must t ake st eps t o prot ect t hese ch ildren. Individuals with nightmare disorders have dreams of a very frightening nature ch ar act er ized by limit ed ver balizat ion an d m ovem ent. The absence of screaming and t hrashing, plus t he det ailed memory of t he dream, different iat es t h is disorder from sleep t error disorder. Pat ient s wit h post t raumat ic st ress disorder may have frightening dreams or dissociative experiences, because this disorder is one of autonomic reactivity and an exaggerated startle response following exposure t o a t raumat ic experience. H owever, t hese pat ient s t ypically remember the frightening dreams and/ or flashbacks and these do not occur exclusively at night. Temporal lobe epilepsy is a type of seizure disorder that includes active, often violen t, m o t or r esp on ses, b u t t h ese t yp ically o ccu r d u r in g wakin g h ou r s. The treatment of enuresis in childhood is best approached by diagnosing the core problem correctly and advising the parents to be supportive of and not punish the child. Primary enuresis is defined as nighttime urination in a child with no previous significant period of dryness. Secondary enuresis is nighttime urination following a period of dryness (usually at least several months). Secondary enuresis is often because of a physical problem, such as a urinary tract infection, or a psychological st ressor, such as regression associat ed wit h t he arrival of a newborn sibling. Relief of the symptoms of sleep terror disorder is also shown in patients who have a demonst rat ed coexist ing sleep disorder which is successfully t reat ed. T here have been case reports using drugs such as diazepam or imipramine to treat this disorder, but no controlled studies. Primary enuresis can be treated in a number of ways, although the developmental level of the child should be considered. G en er ally, ph ar macologic or ext en sive beh avior al t r eat ment should not be considered prior to age 7. When t he sensor is act ivat ed, t he alarm goes off, waking t he child as well as t he caret aker. This method of enuresis control has a 75% success rate, as well as a low rate of recidivism after the alarm is removed. Buzzer ulcers sometimes can develop and should be discussed as a potential adverse effect. It was used successfully in both tablet and nasal form to control enuresis in children. Again, it is an effective short-term treatment for enuresis, but t here is a high rat e of recidivism once t he medicat ion is discont inued. Given in relatively low doses, it is very effect ive in controlling nighttime wetting. H owever, there is a high rate of recidivism after the medication is discontinued. Panic disorder pat ient s may awaken abrupt ly from a deep sleep wit h fearfu ln ess, bu t t h ese ep isod es pr odu ce r apid an d complet e awaken in g, wit h ou t con fu sion, am n esia, or t h e mot or act ivit y t ypical of n on r apid eye movement sleep arousal disorders. The child is 3 years old and often wakes up at night screaming loudly, appearing ver y fright ened, st riking out wh en t ouch ed, and incon solable. W hat t reat ment for t he sleep t error might best be con sid er ed at t h is p ointfi H owever, t his part icular disorder is categorized as a nonrapid eye movement sleep arousal disorder. The best treatment for night terrors with the documented presence of anot her sleep disorder is definit ive t reat ment of t hat sleep disorder. In t his case, an ad en oid ect omy or t on sillect omy sh ou ld be con sid er ed in con su lt ation with an ear, nose, and throat specialist. Nearly all cases of sleep terrors resolve if the primary sleep disorder is addressed appropriately. He c la im s t h a t h e h a s a d o p t e d a ll t h e m a n n e ris m s o f a w o m a n, in c lu d in g d re s s in g like o n e, sin ce le a vin g h o m e a t a g e 16. He st a t e s t h a t h e a lwa ys wo u ld h a ve dressed this way but was forbidden to do so by his parents, from whom he is now estranged. His first sexual encounter with a man occurred when he was 18 years old, and he is curre nt ly in a re lation sh ip with an oth e r m an lastin g for th e p ast 4 ye ars. On h is m e n t a l st a t u s e xa m in a t io n, t h e p a t ie n t a p p e a rs a le rt a n d o rie n t e d t o person, place, and time. He is dressed in a blouse, skirt, jacket, nylons, and high heels and purports himself to be a woman. H e h as a st ron g, persist ent desire t o be female an d h as dressed as a woman since age 16. Most likely diagnosis: G ender dysphoria Options other than sex reassignment surgery: Pat ient s can t ake est rogen t o create breast s and ot her feminine contours and undergo elect rolysis to remove their male hair. Co n s i d e r a t i o n s this patient has had a persistent desire to be female and has always been uncomfor t able wit h h is male body. As soon as h e cou ld, h e adopt ed female dress an d man nerisms, although this resulted in estrangement from his family. True gender dysphoria will present with a history of having the cross-gender identity from a very young age. Th e d is t u r b a n c e is n o t c o n c u r r e n t w it h a p h ys ic a l in t e r s e x c o n d it io n. Th e d is t u r b a n c e is d is t r e s s in g t o o r im p a ir s t h e fu n c t io n in g o f t h e in d iv id u a l. The decision is made based on presence and adequacy of what genital structures are present, expected sexual fu n ct ion alit y of t h ese st r u ct u r es, an d p ar en t al pr efer en ce wit h complet ion of su r gical r econ st r u ct ion by age 3. Female sex is mor e comm on ly assign ed (con st r u ct in g a funct ional vagina more likely t han funct ional penis) and most children adopt assigned sex. These individuals oft en suffer int ernal and ext ernal conflict and ridicule and need t o be approached with sensit ivit y. T hey often face barriers to gett ing help in the health car e syst em r an gin g fr om st igmat izat ion by h ealt h car e pr ovid er s t o in su r an ce n ot cover in g n eed ed pr ocedu r es t o pr ovid er s wh o ar e sen sit ive t o t h eir sit u at ion but lack t h e exper t ise t o effect ively h elp. Patients may not always be aware of their medical history of ambiguous genit alia if sexual assignment surgery was performed as an in fant. Approximately 45% of patients presenting with cross-gender identification are eventually found to have this as part of another psychiatric disorder, most commonly personality disorders, mood disorders, dissociative disorders, and psychotic disorders. According t o t h e minimum st andards of t h e H arry Benjamin Int ernat ional Gender D ysphoria Associat ion, the real-life experience of living in the communit y in the desired sex role for at least 3 mont hs before hormonal reassignment, and 12 months before surgical reassignment, is recommended. When participation in a real-life experience is successful, there is a much higher probabilit y of a posit ive outcome for sex reassignment. Following protocols of this type, 85% to 97% of individuals report being sat isfied wit h t heir rehabilit at ion. The most common issue in the differential diagnosis for gender dysphoria is recognizing simple nonconformity with stereotypic sex role behavior. Transvestic fetishism, cross-dressin g in t h e clot h es of t h e ot h er sex, ser ves t o create sexual excitement. Patients displaying these behaviors generally do not have other symptoms of gender identity disorder such as childhood cross-gender behaviors and t heir gender ident it y matches t heir assigned sex. In schizophrenia, delusions can occur in which patients believe that they are members of the other sex. H owever, these individuals actually believe that they are members of the other sex. Patients with gender identity disorder usually say that they feel as if they are members of the other sex but do not actually believe that they are.

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It is because it comes into play under the species that had already been located antibiotics cipro 250mg trimox with visa, not without reason antibiotic before surgery purchase 500 mg trimox otc, by religious minds virus malware removal order trimox 500mg online, it is because the cupido sciendi was situated where it should be by Freud that everything has changed in the dynamics of ethics antibiotic 50s cheap trimox 500mg with visa. That one is found to be in a dependent position by being at the level of narcissism right antibiotic for sinus infection discount 250mg trimox mastercard, that the other bacteria types order 500 mg trimox with mastercard, the desire for jouissance is precisely there to manifest for us what I would call the duplicity of desire. For, far from desire being desire for jouissance, it is precisely the barrier that keeps you at the distance that is more or less correctly calculated from this burning hearth, from what is precisely to be avoided by the thinking subject and which is called jouissance. Will I go so far as to tell you that I began for them something that will be the next step of what I am going to have to present to you. Namely, taking into account the following of which, of course, I was only able to speak from the angle, namely, from the locus of the Other, the positioning point of the truth, as a locus where there is put in question the truth of the demand, as a locus also where there appears and emerges at the same time the dimension of desire, I was able to begin what, as I have just told you, is going to be the continuation of my discourse and which, consisting of specifying the fact that desire, this desire whose locus I articulated for you at first by saying that desire is first of all the desire of the other, topology is going to teach us to make function this sort of turning [inside-out, back-to-front] (retournement) which is (28) properly the one that I will try to display, at the level that I will show you, such as they are, as it can be done, as one turns a glove inside out, at the level of the structure of the torus, that if desire is to be located, to be measured in function of a demand of the other, the structure is going to allow us to see, the structure which is the structure of the torus, the fact is that there is a structural foundation that is perfectly I am minimising in saying that it is illustrated by the structure of the torus, it is sustained by the structure of the torus, the torus is the substance, the upokeimenon of the structure in question concerning desire, the torus may appear, obviously, this is what I will show you with a piece of chalk the next time, that there is inscribed in it in the clearest fashion the relationship that there is of the sustaining of a desire, not at all by a demand but by a repeated demand or by a double demand. And the fact that this figure which is properly the one that I am drawing for you here, the turning inside-out (retournement) of the structure of the torus can display, materialise before your eyes what can be obtained from it and we will see what turning inside-out signifies in function of what happens to turning inside-out when we are dealing with other topological structures, namely, the cross-cap and the Klein bottle. This duplicity of desire with respect to demand is at the root of everything that in the analytic field extends as far as to what is called confusedly ambivalence, which can find its reason only there. This is what I will have the opportunity of developing for you in a fuller fashion the next time. And you see already that what is involved is the function of a cut, that in the three shapes that I will have to take up from this angle, it is the same shape of cut, namely, what I called the S or the inverted eight, which gives us its key and its shape and that there are different functions. In short, to conclude and to say what I was trying above all to get across to the ears of my audience in America, that there is a domain that can be isolated in the field called psychological up to now which is the domain of what is determinable as the field of language and excels in this field which is the word, that this is definable. It is the function of the subject, the function of the subject which is not, as I saw written recently, a function of absence but on the contrary a function of the intense presence of something hidden, which is what brings us back to the Freudian foundation of the unconscious and it is on this that I will leave you today and give you a rendezvous for the open seminar next week. In effect, contrary to what is the principle of these closed seminars, namely, that it ought to be, it can be in any case, someone else other than myself who, at first at least, poses the question; well then, I shall be the one who speaks to you today, even if only in order to compensate, to tie together again what was interrupted by my monthfis absence in the last trimester, and also, I hope, in order to begin for the next time, a collaboration which will give to this closed seminar the next time, its proper character as a seminar. I will begin, because moreover this time of vacation brought me back to the problems, already present in my first remarks, of my relations with my audience, well then, I said to myself, because it was yesterday evening that I got it to be corrected, that I was going to see in that a sign, and that I was first of all going to read you something (2) which you see here is still a galley-proof which is meant for the year book of the Ecole des Hautes Etudes. Every year there appears, from each of those who collaborate in the teaching of the Hautes Etudes, a little summary of their course. This summary is not of course that of this year, it is that of last year; it is not ahead of time, as you can see. But after all, there is still enough time since, moreover, it is going to give me the opportunity of sharing it with you. I am going to share it with you because, as you are going to see, in drafting it, I thought of you. What is in question is what, last year was called: Crucial problems for psychoanalysis. It is from the combinatorial of these knots that there is broken through the censorship, which is not a metaphor, brought to bear on the material of these knots of language. For this hypothesis is only the mortgage (hypotheque) that a being of knowledge takes on the being of truth that the child has to incarnate, starting from the signifying battery that we present him with, which Vigotsky faithfully presents to him, as such, and which constitutes the law of the experiment. This is what is provided for us by this meshing of the one with the zero which came to us from the point at which Frege set about founding arithmetic. I am designating a date in the history of philosophy, philosophy, as they say, ever since it has been related to science. That is why only the analysis of this object the bandaging can confront it in its reality. I would like to throw something like a seed into what I might call your fundamental attitude as a listener. It must be the case that mine do not lose all that much by being endlessly repeated, because it is effectively necessary for me to repeat them and to announce them. We express it by saying that the message is only emitted here at the level of the one who receives it. It is justified because commitments are part of being and not of thought, and the two aspects of the being of the subject are diversified here because of the divergence between truth and knowledge. The difficulty of the being of the analyst comes from the fact that he encounters, as being of the subject, namely the (8) symptom, that the symptom is a being of truth, everyone agrees with this in so far as they know what psychoanalysis means, even though it is constructed to confuse the matter. I only read this little piece for you to give you the opportunity of getting to know it because, in any case, you would never have gone looking for it in this yearbook. But after all, in effect, it may be of use to you because it is a tiny little text to which I gave enough care for it to be considered as having a little function as a hinge. If I begin again, if I take things up again, if I link up, if I recall, starting from this text, to continue, in fact what I will most easily begin from is, of course, naturally, from the end, this will only make it easier to highlight for you something people do not often think about: it is the pride which is hidden behind the promotion, as it is ordinarily carried out, of every step towards relativism. I am proposing, I am indicating that the problem of the analyst is precisely his implication in the symptom which is put before him and questions him, for his part, as a being of knowledge, as a being of truth, I am (10) saying in short that the drama of the analyst, is that necessarily, his being of knowledge is inflected, is implicated in this confrontation, that Oedipus, whatever he does gives his hand, at least for a while, to the Sphinx, since this is what is in question. By having manifested himself, in the final analysis, as superior, as a being of knowledge, it is precisely this which makes a hero of him. Immediately, this thinking jumps very easily to this function of this presence of the observer in the observation which is also what the progress of our physics indicates to us, and which gives us the idea, as they say, that we are not uninvolved. Even in the theory of relativity in physics, whether it is special or general, it does not at all mean that it is the observer who settles the affair. Everything that is accentuated in this perspective, whether it is that of the progress of science or that of our own experience as analysts, is that it is impossible for us to get out of this illusion, except precisely [by] what we would call a little bit more than very (11) great precautions except for the radical, structural, absolutely total recasting of the topology of the question. And to introduce, into something which cannot in any way be called another kind of knowledge which would get around the difficulty, something which is not at all of the order of knowledge, something which is of the order of calculation, of the combinatorial, something which we no doubt make function but which for all that does not surrender itself to us, to the impulse in such a way that it would allow us to start again quite simply with a lighter step on the same path considered as enlarged and more perfect. There are many things to be said, and in particular something to which I would like all the same to give a little bit of care to today, because it is at once to face up to objections that, faith, are not very efficacious, one can always allow it to be said, to get around, when all is said and done, that a fashion like mine of tackling psychoanalysis has something, as people say, that is too intellectual, or even verbal, and then, moreover, about the use that is made in analysis of the famous power of words. As usual, malevolent powers, and this one in particular, the power of the word which is still magical, as they say, with a magical all-powerfulness, whether it is a matter of thinking or of words it comes back to the same thing, it is always the other, of course, who falls into it. Of course, that we have to deal, always, with this operation of demythification which consists in taking up terms which, traditionally, were grasped in certain words and put them in question. When we go as far as to say, even with our means, which only allow us an extrapolation of an elegance which goes beyond what he had access to , by designating some support for this soul, in the shadow of the body, the one which the character of Charmides left on the way, what more will we dofi What it is a matter of knowing is whether one gets out of it or whether one does not get out of it. By means of which everything is structured according to this form of envelopes enveloping one another, the topology of the sphere, capable of reduplicating itself as identical from simply what is called in topology, mapping, namely, to overlap like a lining, which goes as far as the terminal point of the envelope of all the envelopes, on which there is presented, as opposed to the identity of two beings, the content of knowledge. Only there is a remark which, just by itself, may put the conditions of simply accepting to let fall again into darkness, all of these things that are in suspense, by pointing out to you that if, undoubtedly, the shadow disappears, if there is no longer any sun, the body, for its part, is still there. One can feel around it in the darkness and recommence the experiment on a new footing. It is not a matter of knowing what imaginary lure words give a consistency to , by giving them their cachet. If the soul, in order to take things up at the key point where we think the affair has been cleaned up, is an entity which has some consistency, it is not, we are saying this year, in so far as we are studying the object of psychoanalysis, it is not because the soul is something which is either the shadow of the body, or its idea, or its form, which is properly speaking what falls away from it, forms a waste scrap, a fall, it is what, from the body, falls under the blade of this something which is produced as an effect of the signifier. It is not therefore a sanction through the language of some imaginary mirage, which is produced, but an effect of language, which by being hidden under these mirages, gives them their weight. This is what constitutes the novelty of the psychoanalytic approach, founded on this fact that the effect of language goes beyond, because it precedes it, any subjective apprehension which may authorise itself as being a conscious apprehension. And every critique of the power of words, as it is put, which attacks it as such, what perdures under the academic label of psychology is never anything other than this voice, it is by beginning from the verbal status, incontestably because it is traditional, of a certain function of the soul, and by putting it in question as word, and by questioning, starting from there, what is real in it, which leaves standing perfectly well the framework of the power of words, while what it is a matter of questioning, is what has language produced as an inaugural effect on which there reposes the whole montage, which gives the setting of the state of the subject. That is why the relationship of the being of knowledge to the being of truth is founded on what, to speak here of the very one who is speaking to you, means precisely that my discourse is not sustained by any. If I say that there is no metalanguage, I emphasise it by the fact that I am not attempting to introduce one, a new one, which would always be (15) subject to the fact of being, like every metalanguage, made up of language. The first condition to grasp that it is indeed a matter of the relationship to a being of truth, is that, in discourse, it is articulated as an enigma, and I greatly regret if this, at all times and to Freud himself who admitted it and recognised it as such when he wrote the Interpretation of dreams, Umschreibung, he said, enraged at not being able to reproduce the style of his previous little scientific reports, Umschreibung, which means: mannerism. Throughout the historical cases of the crisis of the subject, the literary and aesthetic explosions in general of what is called mannerism always corresponds to a reorganisation of the question about the being of truth. It is a matter of finding a short circuit to rediscover our o-object, since, moreover, an idea of it comes to me: it was furnished me, refurbished, refreshed not too long ago by Guilbaud with whom I have been having weekly conversations for some time now, he reminded me that it was Franckel, I believe, who played this trick on his listeners: 1,2,3,4,5, what is the smallest whole number that is not written on the boardfi Are you sure that zero is a whole number, that (16) could be debated (written on the board: the smallest whole number that is not written on the board). Well then, that it is precisely what is in question, that this should surprise you. This reinstates, this shows you, that reintroduces you since this is what is at stake, it is in the question of language, founded, as you see on writing, the oobject. Does that mean, with that, it knocks you out, if we have here everything that is involved, about castration. In order that something written should in fact hold up, you have to pay your dues, namely, that if I only put down written things, for example, my scientific discourse from the start of set theory until nothing stops me up to the end, I will exhaust the whole trajectory of modern physics, this will in no way hold up unless I accompany it with a discourse which presents it to you. There is no means of presenting a discourse, even the most formalised one that you may imagine, there is no means of presenting if you like, Bourbaki without preface or text. You only have to take Schreberfis text and see distinguished in it, as I did, what I called the message of the code and the code of the message, to see that there is here a means of grasping, in a fashion that is not abstract but already perfectly phenomenologised, the function of the voice as such. By means of which one can begin to detach oneself from this really unbelievable position which consists in putting in question the objectivity of the voices of the hallucinator. Why should his voices be less objective; why should his voices, on the pretext that they are not sensorial, belong to the unreal, to the unreal. It is a prejudice which dates from some extremely archaic stage of the critique (18) of so-called knowledge. Is the voice unreal, are we going to affirm, are we going to say from the fact that we submit it to the conditions of scientific communication, namely, that he cannot make this voice that he hears recognised. The status of the voice is properly speaking still to be established, but not alone is it to be established, it has to be brought into the mental categories of the clinician of whom we were speaking, precisely, earlier, who very certainly even when he succeeds, I noted it in the same text, in doing something as fortunate as to perceive things which probably had been seen a long time ago with the naked eye, but that no one ever picked out, namely, that there are these voice phenomena which are accompanied by laryngeal and muscular movements around the phonetic apparatus and that this, of course, has its importance, this certainly does not exhaust the question but, in any case, gives a method of approach to it. Here, I would like all the same to remark that it is a great ingratitude for anyone who has, a little bit, the clear sense of what Nietzsche called, precisely, the genealogy of morality or of something else, it would be complete madness to overlook what the status of science, precisely, I am speaking about ours, owes to Socrates who, precisely, consulted his voice. When it is Socrates who is in question, it seems to me difficult not to grasp the consistency of the totality of his system, given especially that this system functioned all the time in the open. We may have the idea, precisely, that in fact, the question of the subject as I am posing it, is perfectly and totally open at the level of Socrates whatever we may think about the fashion in which there were transmitted to us these conversations which were the basis of his teaching, however they have been arranged, modified, enriched as we may suppose by one or other person and by Plato especially, it nevertheless remains that their schema is clear, that there is a perfect decantation between the being of knowledge and the being of truth. But let us leave to one side for a moment that what Socrates responds to is the following: what is the being of truth of this desire to know. But it is not for nothing that I am evoking Socrates here, that I recall moreover only this key: the being of knowledge and the being of truth. I will also leave to one side today a remark that I could make about this use of the term key even though I said earlier that my teaching did not contain key words. I want simply to make a remark which is one that, of course, anyone here could bring up. The response, of course, is already implied in an earlier part of my discourse: because our established science did not exist. If I underlined the degree to which psychoanalysis depends on an assured, sutured, status of the being of knowledge, I think that this might already be seen as a sufficient response if, precisely, the question did not refer back simply to why there was not in Socratesfi time, as a starting point, a science having the status of our science, of the one that I defined in a certain fashionfi I will not go very far, given the time today, in this direction, but since it is on the path of something which is very important for us to bring us back to what is involved, namely, the position of the psychoanalyst, namely, what I would want someone here to make some contribution to the next time, let us take one of the best, one of the greatest, and on the point to which he contributed to things their greatest relief, I would ask someone to take up again here my article on the theory of symbolism which was written as a commentary on Jonesfi article and then connect up with it what is also implied, simply indicated in my article, namely, the way in which Jones had to sort himself out on the problem of female sexuality in so far as it involves the status of the (21) phallic function. Start from the manifest inconsistencies into which his discourse ceaselessly slips, or from the way the very symptom he is dealing with corrects him and in a way reintegrates, and does more than suggest, imposes, in a way, clearly written and contrary to his intention the same topological formula as ours, I would like if someone were to devote himself to this little manoeuvre and not force me once again to get involved in it myself. What an extraordinary text is the one that I attacked in this article of which I speak, this article on symbolism. It consists in short of telling us you will see it in the text of saying, in conformity, when all is said and done, with things that I managed to say after him, that it is not a metaphor to say that symbolism is constructed like a metaphor, that it is a true metaphor, that here, the metaphor, instead of distancing itself, as he expresses it, from the concrete, approaches it under full sail. Except that in the end it is false all the same because it is not a metaphor, it is a metonymy. So we can ask ourselves why it is that science, Greek science, which already knew how to construct such admirable automata, did not take on its status as science. The fact is that there is another voice which plays its role in the Socratic questioning. It is the one that he calls on to give evidence from time to time, in a rather exemplary, rather scandalous fashion perhaps, we will never know anything about it, for contemporary ears, it is the voice of the slave. How does it happen that the slave then always responds so correctly, responds always so well and goes straight to the truth, to the quality of the irrational number which corresponds to the diagonal of the square.

Everything happens as if antibiotics for acne bad 250mg trimox, to take our reference point antibiotic x-206 order 250 mg trimox with visa, which is not a metaphor zinc antimicrobial properties buy trimox 500mg lowest price, from the opposition in modern logic between the open set and the closed set antibiotic resistance lab high school discount trimox 250 mg without a prescription, namely infection jsscriptpe-inf trj discount trimox 250 mg amex, for centuries did not protect and protect so well the line of choosing uniquely the side of the open set antibiotics for uti cause yeast infection discount 500 mg trimox amex. You know that a closed set is what is conceived as uniting the open set with its limit in so far as topologically it is distinguished from it. The part of truth, is that of our limit between birth and death, a limit in so far as the subject, and everything that is involved in knowledge, is the open set which is comprised in the interval. This is why the poet in any case, and even if he does not know it, henceforth reintroduces that what he knows and what he manipulates is the structure of language and not simply the word, reintroduces in any case this topology of the edge and the articulation of the structure. It is through this that Dante, here, goes beyond what he borrows from the structure of knowledge of his time, and precisely in the measure of this ambiguity introduced because of the fact that he projects the cosmological forms of knowledge of his time into the field of what I call the final ends. It is having made of the cosmology of his time what he intends to sing about a beyond of knowledge, the proper field of truth, that he manages to bring out in two points chosen by a commentator, a commentator who is no doubt guided, enlightened,because he is situated in the modern epoch, allows us to pick out in two points, one of Hell, the other of Paradise, constellations that I would qualify as typical,which are properly speaking those of the relationship which links the word qua situated in the field of the Other as support of the truth and (31) the necessary, co-ordinated emergence of the o-object, that at the same point, a point whose depth I did not point out to you precisely enough earlier, even in deepest Hell, there are found joined together the one who made of the word the support of deception and the one who made counterfeit money. What a strange conjunction, what a singular necessity, for which we have to invoke the poetic double view, the fact is that Dante as regards whom, undoubtedly, the simple reading of this poem, marked by so many strange things, imposes on us the idea that he knows what he is saying, however strange there appear to us at every moment these excesses with regard to our common sense. It is not for nothing, it is not by chance that there are joined together to dialogue, in this sort of singular embrace the one who fundamentally has lied, and not in just any fashion whatsoever, has not simply lied, simply cheated, as you were told earlier but cheated in deceiving the trust of the other. This conjunction of the lie as an attack on faith with the fact of the reference of this something which is not truth but truth value, this thing whose reference it is so necessary to introduce when it is a matter of the truth, that when Heidegger proposes to us the von Wesen der Wahrheit, he also speaks about a coin. This indeed is why what is involved around this o-object is this function of the value of truth. It is here that it is striking, singular, to see that Dante in this vulgar dispute set up between two of the damned, makes there emerge from the mouth of one, precisely of the counterfeiter who addresses himself to the traitor, that he would still be quite content to succumb to this sort of miscognition which would be to lick the mirror of Narcissus, namely, to believe himself to be at least himself, while what is involved is precisely, as was very well articulated for you earlier, that at the very essence of himself which is to be a liar, he has lost it and that he can no longer rediscover any form of his being except by desiring passionately to rediscover before him the one who led him into his fundamental lie. In the same way, arriving in Paradise what Dante calls the error contrary to that of Narcissus is, apprehending oneself as something which is presented to him as an appearance, not to be able to do otherwise than turn around to see what he sees is the image of. In the field of God, in so far as it is from him that there emanate the substances, nothing that is an object is presented except as a darkening relative, in a way, to a pure look, a transparency against a background of transparency, and that this apparition can only be recognised, for the thinking of reflection, as they say, by seeking, by turning back to behind oneself where the original being may well be. In effect, when it appears against the transparent background of being, it is precisely at the same time to appear as an image and an image of nothing. This is what Dante accentuates in the second appearance of the reference to the mirror, (34) namely, that here where he believes there is a mirror-function, he comes to realise that when the (o) appears, if there is a mirror, there is nothing reflected in it. Such are the structures that Dantefis poetic construction brings to light and if he is able to do it, it is because he is a poet and that, being a poet, what he rejoins is not so much our science as what we are in the process of constructing for the moment and what I call theory. It is that of courtly love in so far as we can locate in it in an outstanding fashion the terms (I) the ego ideal, (o) the o-object, i(o) the image of o, foundation of the ego, and $. This privileged structure I can only here refer to my seminar on ethics those who attended it is linked to something which is courtly love and which is so important for us to reveal the structures of sublimation. The centre of Dantefis life and of his work is, as someone as well balanced as Monsieur (35) Etienne Gilson underlines strongly, his choice of Beatrice and the existence, the real existence of the person designated in his work by this name. It is in the measure that Dante, as the simple continuation of his work shows, and its origin in the Vita nuova, is a poet bound to the technique of courtly love that he finds, that he structures this elective place where there is designated a certain relationship to the other suspended as such on this limit of the field of jouissance which I have called the limit of brilliance or of beauty. It is in so far as jouissance I am not saying pleasure is withdrawn from the field of courtly love that a certain configuration is established there which allows a certain equilibrium between truth and knowledge. And in a thousand terms of the field thus defined in which the erudite lose themselves for want of being able to bring to it the slightest philosophical orientation, and here we find a thousand terms which designate for us topological references. The good neighbour, for me, if I had the time I could insist on it, is here as close as possible to what in the most modern mathematical (36) theory is called the function of neighbourhood. This point is absolutely fundamental to establish this dimension that I introduced earlier of the open set and the closed set. In the development that I shall have to pursue on the subject of structure, the one that I shall bring in again, after having introduced it last year in the shape that it has for the moment, it is a fact, that is what it is called, it is the Klein bottle, will allow there to be structured in a decisive fashion what I mean here about the relationship of the subject to the other. It is in so far as Dante, the courtly poet rejoins it, that he can achieve the encounters that I have now, I think, it is too late in any case to know whether I reached them that year, for what follows will prove to me whether I sufficiently mapped out what is in question. We are coming up to two oficlock and, consequently, what I was not able to do otherwise than announce to you earlier, and which I am now happy at not having said any more about, that way you will not have the feeling of being frustrated, what I. What decided me to start it is that I intend that there should be produced at it what is called more or less correctly a dialogue. The dialogue as it may be produced in the framework that I am trying to establish in this closed seminar has nothing privileged about it as compared to any other dialogue. Quite recently for example someone came to ask me for something, this something was in itself something so exorbitant and impossible to grant that I did not believe for a moment that this was what was being asked of me. The result is that, conceding something that I could quite easily grant, the person before me was convinced that I was granting him something that was in accordance with his desire and which, I repeat, was so much outside the limits of any possibility that I could not even think that this was what he was asking of me. These three works, which were very carefully prepared, were sufficient to fill the fourth Wednesday to which I have alluded that of the month of December. It is along the line of things and of what has been promised, that you will hear today a response from Stein. I heard from him yesterday evening, with pleasure, that he was asking me to speak for more than a half an hour; let him speak as long as he wishes provided he leaves half the session for the responses that I hope will manifest themselves. Since it appears that for some people it is the very presence of this word which puts them in a position of not wanting, I am summarising, it is much more complex, to expose themselves to some comparison or other whose reference on such an occasion seems to me to be absolutely at the limit of the analysable. I will succeed or I will not succeed, but it is not at all a question for me of the value of the work that I have done for you here, I will succeed or I will not succeed in getting people to intervene. So I would ask you now to give your attention to what Stein is going to say to you and I give the floor to him immediately. Dr Stein: I will take as a starting point for my replies the very precise and very relevant remarks that Conte made the last time and, at the same time, I will be led to respond to a certain number of questions by Melman in order subsequently to take up a problem which concerns very particularly Melmanfis presentation. I believe that the centre of Contefis preoccupations in connection with two articles by me which he analysed is found in this notion of a fusional situation. This is what Conte picks out first and what he insists on from the beginning and he quotes two. He is thus led to ask me: Whether I refer these states to a particular neurotic structure, How I situate these states with respect to the totality of the treatment. My response could be the following: it is true that I refer these states to a particular structure, to a particular neurotic structure but this particular structure concerns all patients, the totality of all the patients who are capable of transference. I would say again: yes, I refer all of these states to a common structure which is defined by this category that I am going to try to elucidate a little later on. I will reply no, if you have to take the structure as neurotic structure in the strict sense of the term, namely, what distinguishes one form of neurosis from another. I do not think that these states are only encountered in one of the forms of neurosis that one can distinguish. As regards the totality of the treatment I must say that the question is a little bit more difficult given that in these works, in the works that I have provided up to now, the totality of the treatment is not yet taken into consideration in terms of what differentiates it in its successive phases. On the contrary what is indeed in question are things, phenomena, which are met from one end to the other of the treatment, namely, that in this first stage I took into consideration something which is common, which concerns not the treatment but (6) which concerns the analytic session whatever it may be, namely, that I try for my personal use in the first place moreover, to find reference points which are valid for the first session of a treatment just as much as for a final one. The replies that I have thus just given to Conte are in contradiction with the notion that I privilege according to Conte, rare states. I could object to this: either it does not matter whether these states are rare if they are exemplary I could also object to this, that I for my part encounter them very frequently. You will not fail to find that both one and the other response are too subjective to serve as a basis for a discussion and this subjective character of my reply would be still further increased if you recalled that it is a matter here of limit states which cannot be realised, what one can perceive are only the states that can be, this is what I have done, be described as tending more or less towards this limit. To abandon this too subjective register we must realise that these limit cases in question, which cannot be realised, are by very definition imaginary. We are thus led to define this imaginary state, which comes back more precisely to (7) defining the sense of the proposition: it speaks. It is in connection with the definition of the sense of this proposition that I am going to be led to present to you an. I am thus obliged to ask you for a particularly sustained attention for a few moments because I am obliged to state to you a certain number of propositions in a rather arid form. Let us call predication any proposition which designates a subject by means of its predicate. Now let us agree that in every proposition, the subject of the predicate is the term which designates a particular patient once and for all. In the analytic situation, it is a matter of someone that one habitually calls the patient and if one wished to examine (8) with this method the content of any dialogue whatsoever, the one of which Lacan spoke to you earlier, well then, the patient may be chosen arbitrarily but he ought always to remain the same. The patient must always remain the same whether he is being spoken about, whether he is being spoken to , or whether he speaks himself. I would respond to you that this shows us that it is not indifferent that the subject of the predicate should figure in one manner or in another. We do not have to study these second degree predications especially but (9) we do have to know clearly that when we speak, we are speaking about words which are spoken in the session. Because he does not speak, he does not speak to his psychoanalyst in the imaginary sense that we have to consider. The patient can pronounce words that he can suppose to be addressed to himself by his double or by a third party, for example, by his psychoanalyst. First remark I, predicating subject, is always of the same order as another I, predicating subject. Second remark When it is the patient who speaks, the predicating subject is by definition the same as the subject of the predicate. Third remark When the predicating subject is the same as the subject of the predicate, the latter is always in the first person. In connection with this reflective form of the first person, me, we ought to note, it is very important, that it (11) implies a reference to the predication of the second person. There is therefore in the reflective form of the first person, me, a certain degree of contamination of the I, the first person properly speaking, by a reference to the second person, you. If I point out to you this degree of contamination that exists in this reflected form, it is because it leads us easily, by a transition, to the imaginary case that we have to consider where there is no longer contamination of I by the reference to a you, I and you always designating the same subject, the subject of the predicate, but where there is a confusion between the two. It designates as emitter of the word, a unique person, there are always two Ifis, there is only one it; a unique person and an unnamed person in the sense that he does not name himself. The imaginary case is precisely the one where, contrary to the law that I presented to you under the form of a remark earlier, where contrary to the law, the subject of the predicate is in the second person while the predicating subject is the same as the subject of the predicate. One can only give it in a very approximate manner obviously, for example, the patient speaking through the mouth of his psychoanalyst. I mean, not in the figurative sense of the formula speaking through someone else mouth but the patient speaking through the mouth of his psychoanalyst, saying really, because there is nothing as real, in the sense that what we are dealing with in psychic reality, as the imaginary. The patient speaking through the mouth of his psychoanalyst is something, if one takes the term in its proper and not figurative sense, evidently impossible in any other domain than the one of psychic reality . In his predicating, he will designate himself as the subject in the second person, saying you to himself. It speaks and the discourse which makes itself heard, just like a predication, does not have its status by reason of the ubiquitous character of the subject which is designated there. Now it is perhaps a good thing to note that we have distinguished two registers of the word: the formal register from which he speaks and the imaginary register from which it speaks. We must add that these registers admit subdivisions, very numerous subdivisions but it is not our purpose today to examine all the possible subdivisions of these registers, it would moreover be a very interesting project to carry out. I would like simply to mention three registers which constitute subdivisions of the formal register: he speaks; three registers because they will be of immediate use to us. The word in this case is obviously the creation of the other, the one who says you. This register, in very rough approximation, in a first approximation, the one which is privileged in the interpretation of the psychoanalyst who says to his patient, you. Here it is indeed the patient who speaks about himself designating himself by means of the supposed statement of his psychoanalyst which constitutes the predicate. This register of the designation of the subject in the reflected first person, of the subject of the predicate, is that of the supposed interpretation of the psychoanalyst, it is the register, which in a still very approximate manner, and in a privileged manner, of transference. Now you will say to me, there exists all the same an extremely simple register which we have already spoken about earlier and which must be taken into account, it is that of the designation of the subject of the predicate in the first person, in the case of psychoanalysis, the one in which the patient speaks saying I. For I would propose to specify all of this for you by replying to a certain number of (15) questions by Conte. He also said that I presented the word as exhausting the psychic flux without a gap or a cut.