Psychosis

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French: psychose

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, hallucinations, and delusions. Types of psychosis include paranoia, manic depression, megalomania, and schizophrenia.


Jacques Lacan

History

Jacques Lacan's interest in psychosis predates his interest in psychoanalysis. Indeed it was his doctoral research, which concerned a psychotic woman whom Lacan calls Aimée that first led Lacan to psychoanalytic theory.[1] It is common to comapre Lacan's totured 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 signiifncant 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 exponds 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."[2] 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).


Treatment

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."[3] 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.[4] 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.[5] 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.

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]


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.[7] 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).[8] 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 "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."[9] 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."[10] This relationship of the subject to the signifier in its purely formal aspect constitutes "the nucleus of psychosis."[11] "If the neurotic inhabits language, the psychotic is inhabited, possessed, by language."[12]



Of all the various forms of psychosis, it is paranoia that most interests Lacan, while schizophrenia and mani-depressive psychosis are rarely discussed.[13] Lacan follows Freud in maintaining a structural distinction between paranoia and schizophrenia.


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.[14] Lacan's interest in psychosis predates his interest in psychoanalysis.

Indeed it was his doctoral research, which concerned a psychotic woman whom Lacan calls 'AimÈe', that first led Lacan to psychoanalytic theory.[15]

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

In other words, whereas Freud's first approach to the unconscious is by way of neurosis, Lacan's first approach is via psychosis.

It has also been common to compare Lacan's tortured and at times almost incomprehensible style of writing and speaking to the discourse of psychotic patients.

"Whatever one are stabilized in the delusional metaphor."[16]

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."[17]

This relationship of the subject to the signifier in its purely formal aspect constitutes "the nucleus of psychosis."[18]

"If the neurotic inhabits language, the psychotic is inhabited, possessed, by language."[19]

Of all the various forms of psychosis, it is paranoia that most interests Lacan, while schizophrenia and manic-depressive psychosis are rarely discussed.[20]

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

Defined in clincal psychiatry as a serious mental illness affecting the whole of the personality.

Unlike a patient suffering from neurosis, the psychotic cannot be treated on a consensual basis and may therefore have to be committed to a psychiatric institution.


The word Psychose has been current since the 1840s, but was originally used to refer to any form of mental illness.[21]

The distinction between psychosis and neurosis was introduced and gradually refined in the course of the nineteenth century, and is basic to psychoanalysis.

In psychoanalysis, 'psychosis' is used to describe conditions such as hallucinatory confusion, paranoia and schizophrenia.

Freud's theory of psychoanalysis was developed primarily with reference to neurosis.

Lacan, in contrast, began his career by working with psychotics in psychiatric hospitals before he became a psychoanalyst (1932) and therefore elaborates a more specific theory of the origins of psychosis.

Contrasting neurosis snad psychosis, Freud argues that, whilst both conditions originate in a conflict between the ego and other agencies of the psyche, psychosis results from a disturbance in the ego's relationship with the external world, neurosis from a conflict between the ego and the id.

In psychosis the ego withdraws from some part or aspect of the rela world, either fialing to perceive it or being unaffected by its perceptiuon of it..

Lacan draws on Freud's comment and remarks on the case of Daniel Paul Schrebe, an appeal court judge who wrote an autobiographicla account of his paranoid delusions, to elaborate the thesis that psychosis is trigged by the specific mechanism of foreclosure.[22]

A key signifier or the name of the father is expelled or foreclosed fromt he subject's symbolic world and a hole or rent is left in its ploace. The foreclosed signifier is not integrated into the unconscious thanks to an act of repression,a nd therefore cannot return on the form of a neurotic signifier. It returns, rather, in the real, usually in the form of persecutory hallucinations and delusions. A mental condition whereby the patient completely loses touch with reality.

Psychosis versus Neurosis

The term 'psychosis' denotes an severe form of mental illness, while 'neurosis' denotes less severe forms. Sigmund Freud elaborated a distinction between psychosis and neurosis.[23]

"[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."[24]

Psychosis and Lacan

Jacques Lacan studied psychosis for his doctoral research about a woman he calls "Aimee."[25] It is common to compare Lacan's style of writing and speaking to the discourse of psychotic patients. Psychosis has many different forms: paranoia, schizophrenia, and manic-depression.[26]

References

  1. Lacan, Jacques. De la psychose paranoiaque dans ses rapports avec la personalité, Paris: Navarin, 1975. [1932].
  2. Lacan, Jacques. The Seminar. Book III. The Psychoses, 1955-56. Trans. Russell Grigg. London: Routledge, 1993. p. 208
  3. Lacan, Jacques. Écrits: A Selection. Trans. Alan Sheridan. London: Tavistock Publications, 1977. p. 221
  4. Lacan, Jacques. The Seminar. Book III. The Psychoses, 1955-56. Trans. Russell Grigg. London: Routledge, 1993. p. 15
  5. Freud, Sigmund. p.1913c. SE XII. 123-4
  6. Lacan, Jacques. p. 1957-8b
  7. Lacan, Jacques. The Seminar. Book III. The Psychoses, 1955-56. Trans. Russell Grigg. London: Routledge, 1993. p. 92
  8. Lacan, Jacques. Écrits. Paris: Seuil, 1966. p. 167
  9. {E}} p. 217
  10. Lacan, Jacques. The Seminar. Book III. The Psychoses, 1955-56. Trans. Russell Grigg. London: Routledge, 1993. p. 250
  11. Lacan, Jacques. The Seminar. Book III. The Psychoses, 1955-56. Trans. Russell Grigg. London: Routledge, 1993. p.250
  12. Lacan, Jacques. The Seminar. Book III. The Psychoses, 1955-56. Trans. Russell Grigg. London: Routledge, 1993. p. 250
  13. Lacan, Jacques. The Seminar. Book III. The Psychoses, 1955-56. Trans. Russell Grigg. London: Routledge, 1993. p.3-4
  14. Freud, 1924b and 1924e
  15. Lacan, 1932
  16. Lacan, Jacques. Écrits: A Selection. Trans. Alan Sheridan. London: Tavistock Publications, 1977. p.217
  17. Lacan, Jacques. The Seminar. Book III. The Psychoses, 1955-56. Trans. Russell Grigg. London: Routledge, 1993. p.250
  18. Lacan, Jacques. The Seminar. Book III. The Psychoses, 1955-56. Trans. Russell Grigg. London: Routledge, 1993. p. 250
  19. Lacan, Jacques. The Seminar. Book III. The Psychoses, 1955-56. Trans. Russell Grigg. London: Routledge, 1993. p.250
  20. Lacan, Jacques. The Seminar. Book III. The Psychoses, 1955-56. Trans. Russell Grigg. London: Routledge, 1993. p.3-4
  21. Laplanche and Pontalis 1967
  22. Lacan 1957-8, 1981
  23. Freud, 1924b and 1924e
  24. 5.202
  25. Lacan, Jacques. De la psychose paranoiaque dans ses rapports avec la personalité, Paris: Navarin, 1975. [1932].
  26. S3, 3-4














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References



Index