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In the 1970s [[Lacan]] reformulates his approach to [[psychosis]] around the notion of the [[borromean knot]].
The three rings in the knot represent the three [[orders]]: the [[real]], the [[symbolic]] and the [[imaginary]].
While in [[neurosis]] these three rings are linked together in a particular way, in [[psychosis]] they become disentangled.
This [[psychotic]] disassociation may sometimes however be avoided by a [[sinthome|symptomaatic formation]] which acts as a fourth ring holding the other three together.
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[[Lacan]] follows [[Freud]] in arguing that while [[psychosis]] is of great interest for [[psychoanalytic theory]], it is outside the field of the classical method of [[psychoanalytic treatment]], which is only appropriate for [[neurosis]]; "to use the technique that [[Freud]] established outside the experience to which it was applied (i.e. neurosis) is as stupid as to toil at the oars when the ship is on the sand."<ref>{{E}} p.221</ref>
Not only is the classical method of [[psychoanalytic treatment]] inappropriate for [[psychotic]] [[subject]]s, but it is even contraindicated.
For example [[Lacan]] points out that the technique of [[psychoanalysis]], which involves the use of the couch and [[free association]], can easily trigger off a latent [[psychosis]].<ref>{{S3}} p.15</ref>
This is the reason why [[Lacan]]ian [[analyst]]s usually follow [[Freud]]'s recommendation to begin the [[treatment]] of a new [[patient]] with a series of face-to-face interviews.<ref>{{F}} p.1913c. [[SE]] XII. 123-4</ref>
Only when the [[analyst]] is reasonably sure that the [[patient]] is not [[psychotic]] will the [[patient]] be asked to lie down on the couch and [[free association|free associate]].
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This does not mean that Lacanian analysts do not work with [[psychotic]] [[patient]]s.
On the contrary, much work has been done by [[Lacanian]] [[analyst]]s in the [[treatment]] of [[psychosis]].
However, the method of [[treatment]] differs substantially from that used with [[neurotic]] and [[perverse]] [[patient]]s.
[[Lacan]] himself works with [[psychotic]] [[patient]]s but left very few comments on the technique he employed; rather than setting out a technical procedure for working with [[psychosis]], he limited himself to discussing the questions preliminary to any such work.<ref>{{L}} p.1957-8b</ref>
