Abstract
What is currently nominated “residential treatment” for serious mental illness (SMI) has a long and varied history. From its earliest version as houses for the unproductive, to confinement of and with the unruly and criminally dangerous, to asylumdom, residential treatment has always sought to protect society from those it perceives as actively trying to revoke it. Consequently, the remedies prescribed in defense of civilization have also ranged from the gruesome to the utopian and the seat of responsibility for maintenance of the social order has vacillated between the family and the church, the local community and the state, the psychiatric hospital and the correctional facility, the volunteer and the physician, as well as the non-profit organization and the for-profit entrepreneur. Moreover, the long-term efficacy of modern day treatment modalities employed within RTCs suggest that meaningful progress in treating SMI remains elusive. For example, in 2014 the Agency for Healthcare Research and Quality reported that psychiatric and medical forms of treatment for SMI is “frequently inadequate” (pg.1). Consider a recent review by James (2017), which identifies 20 specific evidenced based treatment approaches currently employed in RTCs. While nothing contraindicates the development of treatment approaches for addressing SMI per se, the sheer number of approaches themselves reveals the lack of clinical efficacy present within current treatments themselves.
This paper focuses on The MendCenter’s approach to residential treatment, which is unabashedly psychoanalytic. To be precise Freudo-Lacanian Psychoanalysis. But what does this clinical orientation apport the residential treatment of persons with SMI? To state it simply, the creation of an unconscious. Following Lacan, The MendCenter believes that the aim of residential treatment is to raise the patient’s need-based communication to the beyond of the demand and in so doing, to presuppose a subject of the unconscious there where traditional treatment approaches revoke it.
Recommended Citation
Garcia, D. (2026). Creating an Unconscious: Toward a New Ethic of Residential Treatment. Middle Voices, 3 (2). Retrieved from https://dsc.duq.edu/middle_voices/vol3/iss2/4