Psychosis

"psychosis" (Fr. psychose)

Sigmund Freud

The term psychosis arose in psychiatry in the nineteenth century as a way of designating mental illness in general.

During Freud's life, a basic distinction between psychosis and neurosis came to be generally accepted, according to which psychosis designated extreme forms of mental illness and neurosis denoted less serious disorders.

This basic distinction between neurosis and psychosis was taken up and developed by Freud himself in several papers.

Jacques Lacan

Lacan's interest in psychosis predates his nterest in psychoanalysis.

Indeed it was his doctoral research, which concerned a psychotic woman whom Lacan calls Aimée that first led Lacan to psychoanalytic theory.

It is often remarked that Lacan's debt to this patient is reminiscent of Freud's debt to his first neurotic patient's (who were also female).

In other words, whereas Freud's first approach to the unconscious sis by way of neurosis, Lacan's tortured and at times almsot incomprehensible style of writing and speaking to the discourse of psychotic patients.

Whatever one makes of such comparisons, it is clear that Lacan's discussions of psychosis are among the most significant and original aspects of his work. ---

Lacan's most detailed discussion of psychosis appears in his seminar of 1955-6, entitled simply The Psychoses.

It is here that he expounds what come to be the main tents of the Lacanian approach to madness.

Psychosis is defined as one of the three clinical structures, one of hwihc is defined by the operation of foreclosure.

In this operation, the Name-of-the-Father is not integrated in the symbolic universe of the psychotic (it is "foreclosed"), with the result that a hole is left in the symbolic order.

To speak of a hole in the symbolic order is not to say that the psychotic does not have an unconscious; on the contrary, in psychosis "the unconscious is present but not functioning."

The psychotic structure thus results from a certain malfunction of the Oedipus complex, a lack in the paternal function; more specifically, in psychosis the paternal funciton is reduced to the image of the father (the symbolic is reduced to the imaginary).

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In Lacanian psychoanalysis it is important to distinguish between psychosis, which is a clinical structure, and psychotic phenomena such as delusions and hallucinations.

Two conditions are required for psychotic phenomena to emerge: the subject must have a psychotic structure, and the Name-of-the-Father must be "called into symbolic opposition to the subject."

In the absence of the first condition, no confrontation with the paternal signifier will ever lead to psychotic phenomena; a neurotic can never "become psychotic."

In the absence of the second condition, the psychotic structure will remain latent.

It is thus conceivable that a subject may have a psychotic structure and yet never develop delusions or experience hallucinations.

When both conditions are fulfilled, the psychosis is "triggered off," the latent psychosis becomes manifest in hallucinations and/or delusions.

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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 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."

Not only is the classical method of psychoanalytic treatment inappropriate for psychotic subjects, 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.

This is the reason why Lacanian analysts usually follow Freud's recommendation to begin the treatment of a new patient with a series of face-to-face interviews.

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 associate.

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This does not mean that Lacanian analysts do not work with psychotic patients.

On the contrary, much work has been done by Lacanian analysts in the treatment of psychosis.

However, the method of treatment differs substantially from that used with neurotic and perverse patients.

Lacan himself works with psychotic patients 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.

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Lacan rejects the approach of those who limit their analysis of psychosis to the imagianry order; "nothing is to be expected from the way psychosis is explored at the level of the imaginary, since the imaginary mechanism is what gives psychotic alienation its form, but not its dynamics."

It is only by focusing on the symbolic order that Lacan is able to point to the fundamental determining element of psychosis, namely ,the hole in the symbolic order caused by foreclosure and the consequent "imprisonment" of the psychotic subject in the imaginary.

It is also this emphasis on the symbolic order which leads Lacan to value above all the linguistic phenomena in psychosis: "the importance given to language phenomena in psychosis is for us the msot fruitful lesson of all."

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The language phenomena most notable in psychosis are disorders of language, and Lacan argues that the presence of such disorders is a necessary condition for a diagnosis of psychosis.

Among the psychotic language disorders which Lacan draws attention to are holophrases and the extensive use of neologisms (which may be completely new words coined by the psychotic, or already existing words which the psychotic redefines).

In 1956, Lacan attributes these language disorders to the psychotic's lack of a sufficient number of points de capiton.

The lack of sufficient points de capiton means that the psychotic experience is characterized by a constant slippage of the signified under the signifier, which is a disaster for signification; there is a continual "casscade of reshapings of the signifier fromw hich the increasing disaster of the imaginary proceeds, until the level is reached at which signifier and signified are stablized in the delusional metaphor."

Another way of desribing this is as "a relationship between the subject and the signifier in its most formal dimension, in its dimension as a pure signifier."

This relationship of the subject to the signifier in its purely formal aspect constitutes "the nucleus of psychosis."

"If the neurotic inhabits language, the psychotic is inhabited, possessed, by language."

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Of all the various forms of psychosis, it is paranoia that most interests Lacan, while schizophrenia and mani-depressive psychosis are rarely discussed.

Lacan follows Freud in maintaining a structural distinction between paranoia and schizophrenia.