Doctor Nagpal, Psychotherapist and Psychoanalyst

Growing up in India, there were too many engineers in my family. And at that time middle class people knew only three professions, engineering, medicine or accountancy. And so I was told you better be a doctor. I did not demur.

But then, one day, at 15 years of age, I read Sigmund Freud, at my boarding school in Simla, . I read his book, The Interpretation of Dreams. And I was surprised to find that it made huge sense. I was able to interpret several of my own dreams, in a most convincing way. And it helped me feel better, make changes to my behaviour and personality. That decided me. They want me to be a doctor. Great. I was going to be a psychoanalyst and a psychiatrist.

But then, shortly after, I listened one night to a programme on the BBC, on my home-made crystal radio set, under my blanket, in my dormitory. It was a discussion programme with three or four top psychiatrists from the most famous London and American hospitals, discussing Freud. And one and all completely dismissed him: “ his theories are completely wrong, unproven, a waste of time....all this stuff about dreams, all wrong. Dreams are just random thoughts that the mind is churning at night. Psychiatric illness is a neurological, biological problem”.

I was shocked. And my own experience with my own dreams had shown me the validity of Freud's ideas.

I realised I had a mission. To be a psychiatrist and psychoanalyst, to prove these people wrong!

After school in Simla, life took me to England, Cambridge, Oxford and then Paris, to the new school of psychoanalysis, founded by Jacques Lacan, who I met at length. Lacan had done some important new thinking in Freudian theory in the 1950s and 1960s. In particular he had argued against the American school of ego psychologists, who believed the cure involved boosting the ego of the subject, making him identify with the ego of the analyst. This was a deviation and led to a split in the movement.

Lacan developed many ideas in Freud, in particular he showed us that the whole system of the Uncoscious is made of words, and not of energies as in the physical metaphor that Freud had used. That we are made into boys and girls by the word system that we are forced to enter as human beings. We are not just biological animals, but talking animals. And this means that the whole of existence is coloured, governed, conditioned by our entry into the world through a system of symbolic words, a system of red lights, a software, that governs what we can and cannot do. Even the most elementary biological things in man have to go through words: eating, seeing, toilet, sex. There is a hidden architecture in there, that produces this subject that we think we are, the ego, the “I” that is talking and acting, as if in total freedom. In fact this “ I” is an effect, a linguistic and biological effect, of a complicated software, most of which is hidden. We are teleguided from elsewhere. And the center piece of this software is the Oedipus Complex, the incest barrier, that makes us the sexed boys and girls we are. But this process is not automatic, but put into place in the mind of each new boy or girl, by the parents, with their own Oedipus Complex and hangups. And things can and do go wrong. There can be faults, mistakes, as in any machine. And this is what we deal with in life -- the consequences of the process of humanisation as sexed boys and girls. Giving us the more or less awkward people we become, the more or less male or female gender we acquire.

Why should our clients choose you?

To be a good therapist it is not enough to be kind, empathetic and non judgemental. You also have to know about the unconscious software which determines our behaviour. This is why psychoanalysts have to be psychoanalyzed themselves, in order to see first hand the nature, strengths and faults of their own machinery, and conquer, or at least control, their own demands, hungers, needs from others, including from their patients ( counter transference). This may include the need to love and be over kind to everybody! So a psychotherapist needs to have not just a bookish knowledge, degrees and diplomas, but a knowledge of his own Unconscious.

For the same reasons, only kindness and sympathy, on the part of the therapist, are dangers. The patient will already be trying to relieve his or her mental pain by asking for love and sympathy from everybody around them. He or she will also try to extract this love from the therapist. This is to be avoided. Of course, the psychoanalyst is kind and sympathetic, and in certain acute situations this can be very important ( bereavement, shock, loss, ) but to stay at this level in chronic cases would be a mistake. It keeps the patient stuck where he is, in an asking, begging position. Instead of love, the analyst offers a rereading of the patient’s own words and their demand for love. Posing the questions : What are you really asking for? From whom? Why? Since when?

And then we have to go to the causes of the problem, which may be recent or longstanding. This involves examining recent events that precipitated the crisis, and then also the fundamentals: Mummy, Daddy, food, body image, sex, hygiene, beliefs etc. We have to do this to repair the damaged software and extricate your own reserves , so that you become independent and self sufficient (again).

My new contribution to the art: the “writing cure”.
I have adapted the talking cure into a « writing cure ». I write verbatim, word for word, quickly, in shorthand, in pencil, the patient's discourse as he or she speaks in free association. At the next session we re-read the text before moving forward. Thus, the patient hears what they said, they get distance from themselves, and they must therefore choose their words carefully, speak their truth, from the most intimate part of themself.

Whenever we speak, we are also saying something else, something else about ourselves, about our present inner state, our present unsatisfied hunger, wishes, needs. When we speak , in between the words, something else is also trying to be said, heard. There is an Unconscious part of us that is trying to be heard, that is repeating itself.

And the Freudian technique of free association is based on the hypothesis that if remove the exigencies of rational or polite discourse, and talk freely, saying whatever comes to our mind, then this deeper, unconscious text will, sooner or later, come out. Because it is trying all the time to come out, if only somebody would listen.

And this is the same hidden part that is causing our symptoms ( eating, smoking, drinking, drugs, depression, procrastination, timidity, loudness, bossiness, attention seeking, jealousy, neediness, dependence..). Something is being played out, repeated, in a disguised way, in our symptoms. In other words, certain old or new needs, desires, wishes, hurts, conversations which have not been properly heard, expressed, understood are being said in this way, in the symptoms. The child inside is saying, demonstrating, sometimes screaming, his or her pain in this way, in these symptoms. The body itself is being scorched, wrought, marked.

So this Unconscious text, message is what we look for, listen for, in the written transcription of the session. What is really trying to be said? And to whom? Why? Since when? This hidden message is not available to the subject but is contained, in code, in the symptoms. Between the words is the true message, the true cause of the hunger, the true meaning of the anorexia, the origin of the anxiety, the origin of the depression, the interpretation of the craving for drugs, food, sweets, attention, sex.... And when it is heard, and in my technique, when it is written out and re read, it slowly dissipates. Attention: it takes a certain time, a certain work. Some 6-9 months of regular sessions. The hard disk is wiped clean, of certain unhappy childhood days, or certain bad relationships, so that you can write a new story, record a new song, build a new and better person. And you are immensely relieved.

As a point of information, each session implies over an hour of work. There is first of all the session itself, some 30 minutes, which I write in shorthand and fast. After the session I write it up in fair, to be able to read every word clearly, and then I study the text, to understand what is going on. At the next session I re read aloud the previous session. And we continue from where we left off. With this written record, we can also go back to all the material in the future. It is a hard labour.

This is my theory and practice, as a lacanian psychoanalyst who has thought about the subject and made this original contribution to the old Freudian technique of the talking cure. ( I will soon publish my work, but you are getting a preview!) You may like to reflect on it and compare my theory and technique with that of others. It is far from the kindly Counsellor who bucks you up, or the Behaviour Therapist who keeps telling you how you must stop doing what you obviously cannot stop doing (eating, drinking, being afraid, being jealous, being depressed,...). It is also far from the average psychiatrist, for whom your symptoms are the result of deranged neurotransmitters and biology. And who prescribes you antidepressants. In mild to moderate depression, antidepressants are no better than placebo. They are addictive and best avoided. And if you are tempted by the fashionable new drug, Ketamine, beware: this is an intravenous opiate and the risk of addiction is even greater.

This is my long answer to the question at the top of this column: why should our clients choose you? I am sorry for the tough read, but you are about to make a big, big decision, that could cost you months of effort and much money. So best to take this trouble to think about it and read a little about how your therapist thinks and works. We are not all the same, indeed we are very different. In fact if you find anybody else saying or doing the same things as me I would be interested to know.

I will confirm your appointment, taking into account the one hour time difference between the UK and France. I will come towards you first by Whatsapp. If you prefer we can also use Zoom or Facetime.

You probably know that if you cancel at the last moment (less than 48h) the consultation will be owed.