Difference between revisions of "Psychosis"

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{{Toppp}}psychose]]
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|| [[German]]: ''[[Psychose{{Bottom}}
  
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[[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]].
  
A mental condition whereby the patient completely loses touch with reality. Freud originally distinguished between neurosis and psychosis in the following way: “in neurosis the ego suppresses part of the id out of allegiance to reality, whereas in psychosis it lets itself be carried away by the id and detached from a part of reality” (5.202).
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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]].
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<!--
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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 "[[psychosis]]" is used in [[psychoanalysis]] to describe a ''severe [[mental]] disorder'', more serious than [[neurosis]], characterized by disorganized [[thought]] [[processes]], disorientation in [[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:
  
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# A [[particular]] relation to reality
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# A special relation of the subject to his [[speech]];
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# A particular structure of the subject
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-->
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==Sigmund Freud==
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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]]'s memoirs thus broke with contemporary approaches to psychosis, which regarded psychotics as beyond the limits of [[understanding]] (Freud, 1951).
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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.
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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]].
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==Jacques Lacan==
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===History===
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[[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]].
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===Clinical Structure===
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[[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]]).
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===The Psychotic Relation to Reality===
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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).
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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.
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<!-- ====Psychotic Phenomena==== -->
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<!-- 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]]. -->
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<!-- ==[[Borromean Knot]]== -->
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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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===Schreber===
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In his [[seminar]] on [[psychosis]] ([[{{Y}}|1955-6]]) [[Lacan]] tackled [[Freud]]'s case [[history]] of [[Judge Schreber]], a [[paranoid]] [[schizophrenic]] who wrote a fascinating account of his illnesss entitled ''Memoirs of My Nervous [[Illness]]'' (1903).  Lacan's essay "On a question preliminary to any possible treatment of psychosis (1957-8)' enlarged on the [[ideas]] of this [[seminar]].
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===Treatment===
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[[Freud]] was skeptical about the possibility of practising [[psychoanalysis]] with [[psychotic]] [[patients]].  [[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>
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<!-- 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>
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<!-- [[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 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 [[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."<ref>{{S3}} p. 144</ref> -->
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===The Relation of the Subject to his Speech===
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Lacan asserted that the failure to take account of the relation of the subject to his speech had  resulted in a failure to [[understand]] psychotic phenomena.
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<!-- ====Language Disorders==== -->
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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]].<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]]''. -->
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<!-- 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 ==
 
== References ==
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[[Category:Lacan]]
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[[Category:Jacques Lacan]]
 
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[[Category:Treatment]]
 
[[Category:Concepts]]
 
[[Category:Concepts]]
 
[[Category:Psychoanalysis]]
 
[[Category:Psychoanalysis]]
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__NOTOC__

Latest revision as of 19:12, 23 May 2019

French: psychose
German: Psychose

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.

In his seminar of 1955-56 (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.

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's memoirs thus broke with contemporary approaches to psychosis, which regarded psychotics as beyond the limits of understanding (Freud, 1951).

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 work. His interest in psychosis predates his interest in psychoanalysis. Jacques Lacan studied psychosis for his doctoral research about a woman he calls "Aimee."[1] Indeed it was his doctoral research, which concerned a psychotic woman whom Lacan calls Aimée that first led Lacan to psychoanalytic theory.[2] It is common to compare Lacan's tortured and at times almost incomprehensible style of writing and speaking to the discourse of psychotic patients. 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 tenets of the Lacanian approach to madness.

Clinical Structure

Psychosis is defined as one of the three clinical structures, one of which 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."[3] 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."[4] 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.

Schreber

In his seminar on psychosis (1955-6) Lacan tackled Freud's case history of Judge Schreber, a paranoid schizophrenic who wrote a fascinating account of his illnesss entitled Memoirs of My Nervous Illness (1903). Lacan's essay "On a question preliminary to any possible treatment of psychosis (1957-8)' enlarged on the ideas of this seminar.

Treatment

Freud was skeptical about the possibility of practising psychoanalysis with psychotic patients. 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."[5]

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.[6]

The Relation of the Subject to his Speech

Lacan asserted that the failure to take account of the relation of the subject to his speech had resulted in a failure to understand psychotic phenomena.


References

  1. Lacan, Jacques. De la psychose paranoiaque dans ses rapports avec la personalité, Paris: Navarin, 1975. [1932].
  2. Lacan, Jacques. De la psychose paranoiaque dans ses rapports avec la personalité, Paris: Navarin, 1975. [1932].
  3. Lacan, Jacques. The Seminar. Book III. The Psychoses, 1955-56. Trans. Russell Grigg. London: Routledge, 1993. p. 208
  4. Lacan, Jacques. Écrits: A Selection. Trans. Alan Sheridan. London: Tavistock Publications, 1977. p. 188-9
  5. Lacan, Jacques. Écrits: A Selection. Trans. Alan Sheridan. London: Tavistock Publications, 1977. p. 221
  6. Lacan, Jacques. p. 1957-8b