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Psychosis

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{{TopToppp}}psychose]]|-|| [[German]]: ''[[Psychose{{Bottom}}
[[Psychosis]] is a nosological [[category]] distinct from [[neurosis]] and [[perversion]]. It is brought [[about]] by the [[foreclosure]] of a primordial [[signifier]], the [[Name-of-the-Father]].
=====Mental Illness=====In his seminar of 1955-56 ([[Seminar III|Seminar III, ''The Psychoses'']]), Lacan argues that there is a [[defense mechanism]] specific to [[psychosis]] on the grounds that the peculiarly invasive and devastating [[nature]] of psychotics' delusional systems and hallucinations indicates major [[structural]] differences between [[psychosis]] and [[neurosis]].<!--The term [[psychosis]] is used in many ways, but in general refers to [[people]] [[suffering]] from so-called [[schizophrenia]], with [[hallucination]]s and [[delusion]]s; manic [[depression]]; various [[paranoia|paranoid states]]; and severe hypochondrial, [[obsessional neurosis|obsessional]], or [[narcissism|narcissistic states]]. The term "[[Psychosispsychosis]]" is a term first used in '''[[psychiatry|clinical psychiatrypsychoanalysis]]''' to refer to describe a '''severe [[mental illness']] disorder'' , more serious than [[neurosis]], characterized by disorganized [[thought]] [[processes]], disorientation in general[[time]] and [[space]], [[hallucination]]s, and [[delusion]]s. Types of [[psychosis]] include [[paranoia]], [[manic depression]], [[megalomania]], and [[schizophrenia]]. [[Psychosis]] has many different forms: [[paranoia]], [[schizophrenia]], and [[manic-depression]]. Common features are difficult to define exactly, but psychoanalytically [[speaking]] one can see [[three]] broad features in psychotic patients:
The term was first used in '''# A [[psychiatry|clinical psychiatryparticular]]''' relation to refer reality# A special relation of the subject to his [[speech]];# A particular structure of the subject-->==Sigmund Freud==It is [[true]] that Freud had found that the [[discourse]] of the psychotic and the apparently bizarre and meaningless phenomena of psychosis could be deciphered and [[understood]], just as [[dreams]] can. Freud's [[analysis]] of the psychotic [[Schreber]]''mental illness''' in generals memoirs thus broke with contemporary approaches to psychosis, which regarded psychotics as beyond the limits of [[understanding]] (Freud, 1951).
=====Neurosis=====However, as Lacan points out, the fact that the psychotic's discourse is just as interpretable as that of the neurotic leaves the two disorders at the same level and fails to account for the major differences between [[them]], thus the [[distinction]] between the two remains to be explained. It is around this issue of the different mechanisms in psychosis and neurosis that Lacan's major contribution to the study of psychosis revolves.
Freud claims that in both neurosis and psychosis there is a [[withdrawal]] of investment, or [[object]]-[[cathexis]], from [[objects]] in the [[world]]. In the [[case]] of neurosis the object-cathexis is retained, but is invested in fantasized objects in the neurotic's [[internal]] world. In the case of psychosis the withdrawn cathexis is invested in the ego at the expense of all object-[[cathexes]], even in [[fantasy]]. This turning of [[libido]] upon the ego accounts for [[symptoms]] such as [[hypochondria]] and megalomania. The delusional [[system]], the most striking feature of psychosis, arises in a second [[stage]]. Freud characterizes the [[construction]] of a delusional system as an attempt at recovery in which the psychotic re-establishes a new, often very intense, relation with the people and things in the world by way of a delusional [[formation]].
==Jacques Lacan==
===History===
[[Lacan]] discussed [[psychosis]] throughout his [[Jacques Lacan:Bibliography|work]]. His interest in [[psychosis]] predates his interest in [[psychoanalysis]]. [[Jacques Lacan]] studied [[psychosis]] for his doctoral research about a [[woman]] he calls "[[Aimee]]."<ref>{{1932}}</ref> Indeed it was his doctoral research, which concerned a [[psychotic]] [[woman]] whom [[Lacan]] calls [[Aimée]] that first led [[Lacan]] to [[psychoanalytic theory]].<ref>{{1932}}</ref> It is common to compare [[Lacan]]'s tortured and at [[times]] almost incomprehensible style of [[writing]] and speaking to the discourse of [[psychotic]] [[patient]]s. [[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 ''[[Seminar III|The Psychoses]]''. It is here that he expounds what come to be the main tenets of the [[Lacan]]ian approach to [[madness]].
===Clinical Structure===
[[Psychosis]] is defined as one of the three [[clinical structure]]s, one of which is defined by the operation of [[foreclosure]]. In this operation, the [[Name-of-the-Father]] is not integrated in the [[symbolic order|symbolic universe]] of the [[psychotic]] (it is "[[foreclosed]]"), with the result that a [[hole]] is [[left]] in the [[symbolic order]]. To [[speak]] of a [[lack|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."<ref>{{S3}} p. 208</ref> 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 function]] is reduced to the [[image]] of the [[father]] (the [[symbolic]] is reduced to the [[imaginary]]).
===The Psychotic Relation to Reality===
In his articles on [[psychosis]] [[Freud]] noted the [[psychotic]]'s altered relation to [[reality]]. The 'imaginary [[external]] world' of a psychosis attempts to put itself in [[place]] of the 'external world'. (In Lacanian [[terms]], there are altered relations between [[the Imaginary]] and Real Orders, in parallel with an alteration in [[the Symbolic]] Order).
In studying [[psychosis]] Lacan stated, following [[Freud]], that "the problem lies not in the reality that is lost, but in that which takes its place."<ref>{{E}} p. 188-9</ref> Lacan emphasized the 'rent' or [[gap]] that appears in the relation of the psychotic subject to the world, and the nature of the 'patch' which the psychotic subject applies over this gap.<!-- ====Psychotic Phenomena====Jacques --><!-- In [[Lacan]]ian [[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."<ref>{{E}} p. 217</ref> 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."<ref>{{S3}} p. 15</ref> 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]] [[hallucination]]s. When both conditions are fulfilled, the [[psychosis]] is "triggered off," the latent [[psychosis]] becomes [[manifest]] in [[hallucination]]s and/or [[delusions]]. --><!-- ==[[Borromean Knot]]===--><!-- In the 1970s [[Lacan]]'s interest 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]] predates his interest in they become disentangled. This [[psychotic]] disassociation may sometimes however be avoided by a [[sinthome|symptomaatic formation]] which [[acts]] as a fourth ring holding the [[psychoanalysisother]]three together.-->
Indeed it was ===Schreber===In his doctoral research, which concerned a [[psychoticseminar]] on [[psychosis]] ([[woman{{Y}}|1955-6]] whom ) [[Lacan]] calls tackled [[AiméeFreud]] that first led 's case [[Lacanhistory]] of [[Judge Schreber]], a [[paranoid]] to [[psychoanalytic theoryschizophrenic]].<ref>{{L}} who wrote a fascinating account of his illnesss entitled ''Memoirs of My Nervous [[Works of Jacques Lacan|De la psychose paranoiaque dans ses rapports avec la personalitéIllness]],'' Paris: Seuil, 1975 (1903). Lacan's essay "On a question preliminary to any possible treatment of psychosis (1957-8)' enlarged on the [[ideas]] of this [[1932seminar]</ref>].
It is often remarked ===Treatment===[[Freud]] was skeptical about the possibility of practising [[psychoanalysis]] with [[psychotic]] [[patients]]. [[Lacan]] follows [[Freud]] in arguing that while [[Lacanpsychosis]]'s debt to this is of great interest for [[patientpsychoanalytic theory]] , it is reminiscent [[outside]] the field of the classical method of [[Freudpsychoanalytic treatment]]'s debt to his first , which is only appropriate for [[neuroticneurosis]] ; "to use the [[patienttechnique]]'s (who were also that [[femaleFreud]]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>
In other words<!-- 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]], whereas 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 first approach recommendation to begin the [[unconscioustreatment]] 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]]. -->This does not mean that Lacanian [[analysts]] do not work with [[psychotic]] [[patient]]s. On the contrary, much work has been done by way [[Lacanian]] [[analyst]]s in the [[treatment]] of [[neurosispsychosis]]. However, the method of [[treatment]] differs substantially from that used with [[neurotic]] and [[perverse]] [[patient]]s. [[Lacan]]'himself works with [[psychotic]] [[patient]]s tortured and 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><!-- [[Lacan]] rejects the approach of those who [[limit]] their analysis of [[psychosis]] to the [[imaginary order]]; "[[nothing]] is to be expected from the way psychosis is explored at times almsot incomprehensible style the level of the [[imaginary]], since [[the imaginary]] [[mechanism]] is what gives psychotic [[alienation]] its [[form]], but not its dynamics."<ref>{{S3}} p. 146</ref> It is only by focusing on the [[symbolic order]] that [[Jacques Lacan:Bibliography|writing]] 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 [[speech|speakingsymbolic order]] which leads [[Lacan]] to the [[discoursevalue]] of above all the [[psychoticlinguistic]] phenomena in [[patientpsychosis]]s: "the importance given to language phenomena in psychosis is for us the msot fruitful lesson of all."<ref>{{S3}} p.144</ref> -->
Whatever one makes ===The Relation of such comparisons, it is clear the Subject to his Speech===Lacan asserted that [[Lacan]]'s discussions the failure to take account of [[psychosis]] are among the most significant and original aspects relation of the subject to his speech had resulted in a failure to [[Jacques Lacan:Bibliography|workunderstand]]psychotic phenomena.
<!-- ====Language Disorders==== -->
<!-- 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]].<ref>{{S3}} p. 92</ref> 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).<ref>{{Ec}} p. 167</ref> In [[{{Y}}|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 "cascade 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]]."<ref>{{E}} p. 217</ref> [[Another]] way of describing this is as "a [[relationship]] between the subject and the signifier in its most [[formal]] [[dimension]], in its dimension as a pure signifier."<ref>{{S3}} p. 250</ref> This relationship of the subject to the signifier in its purely formal aspect constitutes "the nucleus of psychosis."<ref>{{S3}} p.250</ref> "If the neurotic inhabits language, the psychotic is inhabited, possessed, by language."<ref>{{S3}} p. 250</ref> -->
==References ===Foreclosure and the Oedipus complex=====[[Lacan]]'s most detailed discussion of [[psychosis]] appears in his [[seminar]] of 1955-6, entitled simply ''[[Seminar III|The Psychoses]]''. It is here that he expounds what come to be the main tents of the [[Lacan]]ian approach to [[madness]]. [[Psychosis]] is defined as one of the three [[clinical structure]]s, one of which is defined by the operation of [[foreclosure]]. In this operation, the [[Name-of-the-Father]] is not integrated in the [[symbolic order|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."<ref>{{S3}} p. 208</ref> 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]]). ===Psychosis and Psychotic Phenomena==div style=In [[Lacan]]ian [[psychoanalysis]], it is important to distinguish between [[psychosis]] -- which is a ''[[clinical structure]]'' -- [[psychosis|psychotic phenomena]] -- such as [[delusions]] and [[hallucinations]]. Two conditions are required for [[psychosis|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]]."<ref>{{E}} p. 217</ref> In the absence of the first condition, no confrontation with the [[Name-of-thefont-Father|paternal signifier]] will ever lead to [[psychosis|psychotic phenomena]]; a [[neurotic]] can never "become [[psychotic]]."<ref>{{S3}} p. 15</ref> 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 [[hallucination]]s. When both conditions are fulfilled, the [[psychosis]] is "triggered off," the [[latent]] [[psychosis]] becomes [[manifest]] in [[hallucination]]s and/or [[delusions]]. ===Psychosis and the Borromean Knot===In the 1970s [[Lacan]] his approach to [[psychosis]] around the notion of the [[borromean knot]]. The three rings in the [[knot]] represent the three [[orders]]size: 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|symptomatic formation]] which acts as a fourth ring holding the other three together. ===Psychosis and the Classical Method of Psychoanalytic Treament===[[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]]. <blockquote>11px"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></blockquote> 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}} "[[Works of Sigmund Freud|On Beginning the Treatment]]," 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]]. class===Psychosis and the Lacanian Method of Psychoanalytic Treament===This does not mean that [[Lacan]]ian [[analyst]]s 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}} "[[Works of Jacques Lacan|D'une question préliminaire à tout traitement possible de la psychose]]," [1957-8b], in {{Ec}} pp. 531-83 ["On a Question Preliminary to Any Possible Treatment of Psychosis," trans. Alan Sheridan, in {{E}} pp. 226references-80.</ref> ===Psychosis and the Symbolic Order===[[Lacan]] rejects the approach of those who limit their analysis of [[psychosis]] to the [[imaginary order]]. <blockquote>"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."<ref>{{S3}} p. 146</ref></blockquote> 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 [[linguistics|linguistic phenomena]] in [[psychosis]]:  <blockquote>"The importance given to language phenomena in psychosis is for us the msot fruitful lesson of all."<ref>{{S3}} p. 144</ref></blockquote> ==Psychosis and Linguistic Phenomena==The [[language|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]].<ref>{{S3}} p. 92</ref> 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).<ref>{{Ec}} p. 167</ref> 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 [[slip]]page of the [[signified]] under the [[signifier]], which is a disaster for [[signification]]. <blockquote>There is a continual small"cascade 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."<ref>{E}} p. 217</ref></blockquote> Another way of describing this is as "a relationship between the subject and the signifier in its most formal dimension, in its dimension as a pure signifier."<ref>{{S3}} p.250</ref> This relationship of the subject to the [[signifier]] in its purely formal aspect constitutes "the nucleus of [[psychosis]]."<ref>{{S3}} p. 250</ref> <blockquote>"If the neurotic inhabits language, the psychotic is inhabited, possessed, by language."<ref>{{S3}} p. 250</ref></blockquote> ==See Also==* [[Foreclosure]] ==References==
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