Reflections on “Contact” and “The Gaze” in Clinical Practice

Abstract

GoalsThis article explores the semiological value of contact and of the gaze in clinical practices. It questions the subjectivity involved in the caregiver/patient relationship and in nosography. MethodologyThe authors examine the place of the gaze based on writings of 19th century alienists. Then, they question the clinician's subjective experience – through the concepts of “sentiment” (Binswanger, Minkowski) and “praecox Gefühl” (Rümke) from the accounts of early stages of the clinical encounter. ResultsThe gaze plays a specific role in the early stages of the clinical encounter, especially in the landscape of schizophrenia. A draft classification of different types of gazes (off-center gaze, white gaze, ecstatic gaze, black gaze) is proposed, then nuanced. DiscussionAny attempt to classify the gaze leads to the deconstruction of any fixed typology. The gaze resists verbalization and even meaning, and in this, belongs to the dimension of anguish, an essential affect in a practice that does not seek to do away with relationship. ConclusionAt a time of increasing research in “eye movement abnormalities” in schizophrenia, it seems essential to renew our interest in the relational and therefore subjective – dimension as a specificity in clinical psychiatry. The gaze, then, would be this area without a place, this primary area of contact where relationship begins or not.