Difference between revisions of "Psychoses, chronic and delusional"

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In psychiatry the term <i>psychosis</i>, first used to refer to mental illnesses in general, was later restricted to the major clinical forms: schizophrenia, chronic and delusional psychoses, and manic-depressive psychoses. Unlike the neurotic, the psychotic subject does not "criticize" the disorders of his or her thought. In 1845 Baron Ernst von Feuchtersleben used the term <i>psychosis</i> to refer to mental illness in his manual of medical psychology. At the end of the nineteenth century, alienists defined psychosis as the loss of reason and mental alienation.
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In 1890 the "science of language" had not yet become "general linguistics," the "fundamental science" of the humanities it would become following the work of Ferdinand de Saussure (1857-1913). Philologists studied <i>scripta</i> (written traces) and the history of languages but not their origins or that of the original language (<i>Ursprache</i>), a search that was felt to be irrelevant to the science of language, according to the first article of the bylaws of the Société linguistique de Paris, composed in 1866.
Psychoanalysis seeks less to categorize mental illnesses than to identify their structures and mechanisms. A structural and dynamic definition of psychosis must be conceived on the basis of a primary disturbance of the libido's relationship to reality, through splitting and the reconstruction of an alternative, delusional reality. Eugen Bleuler, influenced by psychoanalysis, characterized schizophrenia as a dissociation of thought through withdrawal into the self, or autism. He posited as its basis splitting, linked to a loosening of associative texture. Skirted around by Sigmund Freud, who preferred the term <i>paraphrenia</i>, the notion of schizophrenia nevertheless became standard within psychiatry and psychoanalysis. A second variety of chronic psychosis, paranoia, is characterized by systematic delusions (delusions of persecution, jealous delusions, erotomania, delusions of grandeur), the
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From the point of view of linguistics, Hans Sperber's article on the "sexual origins of language" (1912) was more an application of Freudian theory than a form of linguistic research.Émile Benveniste's rebuttal of Carl Abel's claims about the opposite meanings of words ("Über den Gegensinn der Urworte," 1885) starts from the same point: The discursive use of the euphemism or antiphrasis does not justify this claim. Moreover, there is no primitive language as far as linguists are concerned. Language is a system of signs, articulated through a process of differentiation, that organizes the first representation of the world by and for the speaking subject. At the beginning of the twentieth century, the distinction "<i>langage/langue</i>"—language as spoken versus language as system—used by de Saussure in his classes and published in the <i>Course on General Linguistics</i> after his death (1916), was not widely known.
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Some philologists, however, became interested in spoken language, in everyday words, in the nature of the "system" or internal structure of language (<i>langue</i>). By collecting slips of the tongue, Rudolf Meringer (1895) attempted to determine the laws of evolution and the internal operation of <i>Sprachorganismus</i> (the organism of language), comparing it to Freud's "language apparatus" (1891b). Freud borrowed eight examples from Meringer's corpus, including the opening and closing remarks of the president of parliament (1901b). Meringer failed to be amused (1907) by Freud's admiration for the quoted text. Freud in return wrote an ironic comment (1910e), distancing himself from Meringer on the basis of their divergent understanding of slips of the tongue. The two men held different points of view: Meringer prefigured the Saussurian break entailing the internal synchronic description of the structure of languages (that is, at the time of spoken use). His insistence on speech (<i>parole</i>)—which revealed the underlying structure—implied an emphasis on orality, the primary characteristic of languages.
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De Saussure thus gave the world approximately five thousand languages and rejected the notion of "primitive" languages, which were languages with no written tradition. According to de Saussure, a language should be considered a highly organized structure, a "system of internal relations," whose elements were arbitrary and differential and could be analyzed along two different axes: the paradigmatic (or associative) axis, the axis of elements that were "absent"; and the syntagmatic axis, the axis of elements that were "present." These elements were defined in negative terms: "In language there is only difference." On the plane of
  
  
  
predominance of interpretation, and the absence of intellectual deterioration.
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sound as well as on the plane of meaning, each element is what the others are not (this was de Saussure's concept of "value"). The axis of the spoken chain can be used to postulate the temporal linearity of the sound (or acoustic) aspect of signs, that is, the "linearity of the signifier." A language is, thus, a set of articulatory, acoustic, and representative (or symbolic) conventions that are socially imposed on the speaker, a <i>Weltanschauung</i>, a treasure deposited in the individual by the mass of speakers.
In Manuscript H (1894), Freud designated three conditions as psychoses: hallucinatory confusion, paranoia, and hysterical psychosis (which he distinguished from hysterical neurosis). In his texts on the neuropsychoses of defense ("The Neuro-Psychoses of Defence" [1894a] and "Further Remarks on the Neuro-Psychoses of Defence" [1896b]), he took the distinction between neurosis and psychosis as given. From his earliest writings, he undertook to characterize the psychopathology of the psychoses through his successive theories of the psychic apparatus. His only study of a case of psychosis is his commentary on Daniel Schreber's <i>Memoirs of My Nervous Illness</i>. Freud's correspondence with Carl Gustav Jung illustrates the development of Freudian doctrine between 1909 and 1911, and the essays "On Narcissism: An Introduction" (1914), "Fetishism" (1927), and "The Loss of Reality in Neurosis and Psychosis" (1924) show the further elaboration of his theories.
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The same position is found in the work ofÉdouard Pichon (linguist and psychoanalyst, founding member of the Paris Psychoanalytic Society, then its president in 1938), from whom Jacques Lacan borrowed the idea of "foreclosure" (<i>Verwerfung</i>). From de Saussure's work, Lacan derived the concepts of the "treasure of signifiers," the unconscious structured as a language, and the condition of the unconscious. From Roman Jakobson (1963) he derived the concepts of metaphor (paradigmatic) and metonymy (syntagmatic), and reworked the concepts of condensation and displacement. Lacan also borrowed from de Saussure the idea of the arbitrariness of the sign and its duality: signified and signifier. The signified is the mental image, the concept; the signifier the acoustic image (or phonetic form). This relationship is reversed and hierarchized in Lacan (S/s) with an extreme (non-linguistic) expansion of the signifier.
Freud examined the individual's relationship to reality from the vantage point of a consideration of the libidinal cathexes. In the psychoses, the loss of reality—and the changed relationship to others following a radical decathexis of the objects of everyday reality ("the end of the world," for Schreber)—must necessarily be considered in a way other than descriptive, taking into account the attempted reorganization of reality by the psychotic processes.
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Saussurian arbitrariness—which is what makes his work so original—does not refer to the lack of motivation between object and sign (word) (<i>Sache/Zeichen</i>) discussed in Plato's <i>Cratylus</i>, but to the absence of a one-to-one relation between elements of the system of signifieds and signifiers. The concept of "double articulation" (Martinet, 1960/1964) demonstrates this: for linguists no meaning can be attributed to a phoneme or letter, something a linguist shaped by psychoanalysis like Ivan Fonagy (1970) rejects. For Fonagy, for example, language and unconscious, language and drive, are contiguous.
All psychoses are characterized by the coexistence of two attitudes: one that takes reality into account, and another that "this same ego, under the influence of the id, withdraws from a piece of reality" (1924e, p. 183). Delusions affirm the subject's belief in the existence of an alternative reality that restores the primitive cathexes that archaically linked childhood awareness with an early love object. The reconstruction of reality in accordance with the "desires" of the id expresses both a defensive cancellation and a reparative force. This entails a process whose psychotic manifestation in no way excludes rearticulation in terms of the mechanisms defined by psychoanalysis. Thus, in Freud's view, hallucinatory psychosis could be considered as the expression of an imaginary maintaining of an early reality whose loss the ego finds unbearable. This theorization requires the refinement of concepts such as regression, which is above all conceived as a function of development of the ego and of the libido: In the one case, regression leads to primary narcissism, and in the other, to hallucinatory wish fulfillment.
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The same was true for Pichon, the author, with Jacques Damourette, of a voluminous grammar text and a large number of articles. It was Pichon who created the concepts of <i>pensée-langage</i>, which reflects the separation of form and content, and <i>sexuisemblance</i>, which reflects the connection between gender and sex. His work on negation (1928) and the grammatical person (1938), criticized by Benveniste as too "psychological," serves as the premise for the concept of the "shifter" in Jakobson's work, and research on "enunciation" for Benveniste. Among linguists, including contemporary linguists who speak of the (re)introduction of the subject into their field (through pragmatics, the analysis of meaning or discourse), the subject is always (or almost always) a controlling intentional subject. The failure to identify intentionality, moreover, is what ended the Saussurian analysis of anagrams (the search for a proper name buried—disseminated—in the poetic chain), although they can be understood as a search for an unconscious subject.
Initially, Melanie Klein, like Karl Abraham, tended to base her clinical work on a psychopathological theory of the points of fixation and temporal regression of the libido. In addition to this temporal regression, Freud distinguished a topographical regression that made it possible to compare the mechanisms of dreams with those put into play in psychosis. "In schizophrenia, it is words that become the object of elaboration by the primary process; in the other, the dream, it is the thing-presentations: representations of things to which the words have led." In schizophrenia, circulation is cut off between the preconscious cathexis of words and unconscious thing-presentations. The fundamental mechanism of paranoia is projection. The feeling of hatred toward the object is projected outward and then turned back onto the subject in the form of persecutory hatred.
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This conscious and controlling subject marks the difference between linguistics and psychoanalysis. Here, their epistemological terrain is distinct. Linguists and psychoanalysts apprehend the same words in different ways. Linguists first try to describe languages and construct a scientific theory of their workings. Their concern is one of generalized objectivity, which could be described as an Aristotelian approach. Consequently, they attempt to eliminate any subjectivity, while psychoanalysts acknowledge it as part of the process of association. The analysts' goal is not to put forth a theory of language but of the unconscious. This is why there are so many differences between the two fields in spite of the many borrowings by psychoanalysts from linguists (philologists for Freud) in the first half of the twentieth century.
In the final stage of his work, in describing the splitting of the ego, Freud was on the way to defining an original mechanism of the repudiation of reality in psychosis: denial of the reality of castration. This notion of the <i>Verleugnung</i> (denial) of castration, which he opposed to repression, goes back to the primal experience of loss. Thus, Jacques Lacan, taking up the term <i>Verwerfung</i> (rejection) in his discussion of the "Wolf Man," translated the German <i>Verwerfung</i> as <i>foreclosure</i> and, on the basis of this notion of a primordial excision of a fundamental signifier, elaborated his conceptualization of psychosis. The phallus as the signifier of castration is not inscribed within the symbolic order. Not integrated into the psychotic's unconscious, it returns to the real, especially in the phenomenon of hallucinations. Through Lacan's paternal metaphor, it can be considered that foreclosure of the Name-of-the-Father is the hole in the symbolic that is inherent in all psychoses.
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Today, however, the situation is reversing itself, and some psychoanalysts consider the near "assimilation" of the mental apparatus to the language apparatus to be a failure (Green, 1984, 1989). Moreover, the number of linguists and semiologists who acknowledge the influence of psychoanalytic theory in the humanities is growing. For example, research on the contiguity between these two fields (Michel Arrivé, Jean-Claude Milner) has been conducted by linguists who have undergone analysis or who are analysts themselves; they have introduced psychoanalytic ideas into research on sign systems, writing, enunciation, modes of text analysis, meaning, and so forth. Links between the fields exist despite the fact that their founders never met. Freud may have seen de Saussure's name quoted by Meringer; de Saussure may have seen Freud's in a report on <i>The Interpretation of Dreams</i> written by one of his colleagues at the University of Geneva (Théodore Flournoy). And although Freud never read de Saussure, it is certain that he heard him referred to as the "father" and author of the <i>Course of General Linguistics</i>. For one of Freud's patients was Raymond de Saussure, the son of Ferdinand, and Freud wrote a preface to Raymond's <i>The Psychoanalytic Method</i> (1922), where his father's book is mentioned.
The psychoanalytic elaboration of a theory concerning chronic and delusional psychoses runs up against the difficulty and complexity of a concrete approach. It becomes diversified into a theoretical eclecticism bringing together the considerations through which each school of thought, and indeed each analyst, refines and consolidates the foundations of the transference relationship. For all the intrinsic interest of the original viewpoints of John N. Rosen, Frieda Fromm-Reichmann, Marguerite Sechehaye, Gisela Pankow, Gaetano Benedetti, or Piera Aulagnier, among others, it is impossible to recognize their particular relevance without having access to the specific techniques used in their respective therapeutic approaches.
 
Through a "psychotic transference" that moves from extreme avoidance to a relationship that is almost one of merging, demands are placed on the analyst that touch his or her own archaic unconscious dispositions; "falling in love-hate" and the preponderance of narcissistic investment over object investment make it difficult to manage. What place does this relationship have within the complexity of medication-based, institutional, or readaptive approaches? Analytic theory must certainly be remembered in a variegated context (families, care-givers, recipients of care) if one wants to maintain a certain structural coherence. José Bleger's notion of <i>framework</i>, Lacan's of <i>historization</i>, and the understanding of transference and counter-transference—both individual and institutional—must always be implemented when the challenge of treating the psychoses is undertaken.
 
 
 
==See Also==
 
* [[Ego Psychology and Psychosis]]
 
* [[Foreclosure]] * [[Historical truth]] * [[Hypochondria]] * [[Indications and contraindications for psychoanalysis for an adult]] * [[Infantile psychosis]] * [[Mathilde, case of]] * [[Paranoia]] * [[Paranoid psychosis]] * [[Paraphrenia]] * [[Persecution]] * [[Psychotic/neurotic]] * [[Schreber, Daniel Paul]] * [[Symbolization, process of]]
 
 
 
==References==
 
<references/>
 
# Freud, Sigmund. (1894a). The neuro-psychoses of defence. SE, 3: 41-61.
 
# ——. (1896b). Further remarks on the neuro-psychoses of defence. SE, 3: 157-185.
 
# ——. (1911c [1910]). Psycho-analytic notes on an autobiographical account of a case of paranoia (dementia paranoides). SE, 12: 1-82.
 
# ——. (1914c). On narcissism: An introduction. SE, 14: 67-102.
 
# ——. (1924e). The loss of reality in neurosis and psychosis. SE, 19: 180-187.
 
# ——. (1927e). Fetishism. SE, 21: 147-157.
 
# ——. (1974a [1906-13]). The Freud/Jung letters: The correspondence between Sigmund Freud and C. G. Jung (William, McGuire, Ed]] * [[Ralph Manheim and R. F. C. Hull, Trans.). Princeton, NJ: Princeton University Press.
 
# Lacan, Jacques. (1966). On a question preliminary to any possible treatment of psychosis. InÉcrits: A Selection (Alan Sheridan, Trans.). New York and London: W. W. Norton.
 
 
 
[[Category:New]]
 

Revision as of 01:16, 10 June 2006

In 1890 the "science of language" had not yet become "general linguistics," the "fundamental science" of the humanities it would become following the work of Ferdinand de Saussure (1857-1913). Philologists studied scripta (written traces) and the history of languages but not their origins or that of the original language (Ursprache), a search that was felt to be irrelevant to the science of language, according to the first article of the bylaws of the Société linguistique de Paris, composed in 1866. From the point of view of linguistics, Hans Sperber's article on the "sexual origins of language" (1912) was more an application of Freudian theory than a form of linguistic research.Émile Benveniste's rebuttal of Carl Abel's claims about the opposite meanings of words ("Über den Gegensinn der Urworte," 1885) starts from the same point: The discursive use of the euphemism or antiphrasis does not justify this claim. Moreover, there is no primitive language as far as linguists are concerned. Language is a system of signs, articulated through a process of differentiation, that organizes the first representation of the world by and for the speaking subject. At the beginning of the twentieth century, the distinction "langage/langue"—language as spoken versus language as system—used by de Saussure in his classes and published in the Course on General Linguistics after his death (1916), was not widely known. Some philologists, however, became interested in spoken language, in everyday words, in the nature of the "system" or internal structure of language (langue). By collecting slips of the tongue, Rudolf Meringer (1895) attempted to determine the laws of evolution and the internal operation of Sprachorganismus (the organism of language), comparing it to Freud's "language apparatus" (1891b). Freud borrowed eight examples from Meringer's corpus, including the opening and closing remarks of the president of parliament (1901b). Meringer failed to be amused (1907) by Freud's admiration for the quoted text. Freud in return wrote an ironic comment (1910e), distancing himself from Meringer on the basis of their divergent understanding of slips of the tongue. The two men held different points of view: Meringer prefigured the Saussurian break entailing the internal synchronic description of the structure of languages (that is, at the time of spoken use). His insistence on speech (parole)—which revealed the underlying structure—implied an emphasis on orality, the primary characteristic of languages. De Saussure thus gave the world approximately five thousand languages and rejected the notion of "primitive" languages, which were languages with no written tradition. According to de Saussure, a language should be considered a highly organized structure, a "system of internal relations," whose elements were arbitrary and differential and could be analyzed along two different axes: the paradigmatic (or associative) axis, the axis of elements that were "absent"; and the syntagmatic axis, the axis of elements that were "present." These elements were defined in negative terms: "In language there is only difference." On the plane of


sound as well as on the plane of meaning, each element is what the others are not (this was de Saussure's concept of "value"). The axis of the spoken chain can be used to postulate the temporal linearity of the sound (or acoustic) aspect of signs, that is, the "linearity of the signifier." A language is, thus, a set of articulatory, acoustic, and representative (or symbolic) conventions that are socially imposed on the speaker, a Weltanschauung, a treasure deposited in the individual by the mass of speakers. The same position is found in the work ofÉdouard Pichon (linguist and psychoanalyst, founding member of the Paris Psychoanalytic Society, then its president in 1938), from whom Jacques Lacan borrowed the idea of "foreclosure" (Verwerfung). From de Saussure's work, Lacan derived the concepts of the "treasure of signifiers," the unconscious structured as a language, and the condition of the unconscious. From Roman Jakobson (1963) he derived the concepts of metaphor (paradigmatic) and metonymy (syntagmatic), and reworked the concepts of condensation and displacement. Lacan also borrowed from de Saussure the idea of the arbitrariness of the sign and its duality: signified and signifier. The signified is the mental image, the concept; the signifier the acoustic image (or phonetic form). This relationship is reversed and hierarchized in Lacan (S/s) with an extreme (non-linguistic) expansion of the signifier. Saussurian arbitrariness—which is what makes his work so original—does not refer to the lack of motivation between object and sign (word) (Sache/Zeichen) discussed in Plato's Cratylus, but to the absence of a one-to-one relation between elements of the system of signifieds and signifiers. The concept of "double articulation" (Martinet, 1960/1964) demonstrates this: for linguists no meaning can be attributed to a phoneme or letter, something a linguist shaped by psychoanalysis like Ivan Fonagy (1970) rejects. For Fonagy, for example, language and unconscious, language and drive, are contiguous. The same was true for Pichon, the author, with Jacques Damourette, of a voluminous grammar text and a large number of articles. It was Pichon who created the concepts of pensée-langage, which reflects the separation of form and content, and sexuisemblance, which reflects the connection between gender and sex. His work on negation (1928) and the grammatical person (1938), criticized by Benveniste as too "psychological," serves as the premise for the concept of the "shifter" in Jakobson's work, and research on "enunciation" for Benveniste. Among linguists, including contemporary linguists who speak of the (re)introduction of the subject into their field (through pragmatics, the analysis of meaning or discourse), the subject is always (or almost always) a controlling intentional subject. The failure to identify intentionality, moreover, is what ended the Saussurian analysis of anagrams (the search for a proper name buried—disseminated—in the poetic chain), although they can be understood as a search for an unconscious subject. This conscious and controlling subject marks the difference between linguistics and psychoanalysis. Here, their epistemological terrain is distinct. Linguists and psychoanalysts apprehend the same words in different ways. Linguists first try to describe languages and construct a scientific theory of their workings. Their concern is one of generalized objectivity, which could be described as an Aristotelian approach. Consequently, they attempt to eliminate any subjectivity, while psychoanalysts acknowledge it as part of the process of association. The analysts' goal is not to put forth a theory of language but of the unconscious. This is why there are so many differences between the two fields in spite of the many borrowings by psychoanalysts from linguists (philologists for Freud) in the first half of the twentieth century. Today, however, the situation is reversing itself, and some psychoanalysts consider the near "assimilation" of the mental apparatus to the language apparatus to be a failure (Green, 1984, 1989). Moreover, the number of linguists and semiologists who acknowledge the influence of psychoanalytic theory in the humanities is growing. For example, research on the contiguity between these two fields (Michel Arrivé, Jean-Claude Milner) has been conducted by linguists who have undergone analysis or who are analysts themselves; they have introduced psychoanalytic ideas into research on sign systems, writing, enunciation, modes of text analysis, meaning, and so forth. Links between the fields exist despite the fact that their founders never met. Freud may have seen de Saussure's name quoted by Meringer; de Saussure may have seen Freud's in a report on The Interpretation of Dreams written by one of his colleagues at the University of Geneva (Théodore Flournoy). And although Freud never read de Saussure, it is certain that he heard him referred to as the "father" and author of the Course of General Linguistics. For one of Freud's patients was Raymond de Saussure, the son of Ferdinand, and Freud wrote a preface to Raymond's The Psychoanalytic Method (1922), where his father's book is mentioned.