Psychosis

Psychosis and Psychotic Phenomena

In Lacanian psychoanalysis, it is important to distinguish between psychosis -- which is a clinical structure -- 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.

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: 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 symptomatic formation which acts as a fourth ring holding the other three together.

Psychosis and 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.

"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.