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According to [[Lacan]], [[psychosis ]] cannot be the result of [[repression]]. He argues that [[Freud]]'s classic studies on the [[unconscious]], that is, The [[Interpretation ]] of [[Dreams]], The [[Psychopathology ]] of Everyday [[Life]], [[Jokes ]] and their Relation to the Unconscious, indicate that the [[mechanism ]] of repression and the [[return ]] of the [[repressed ]] are [[linguistic ]] in [[nature]]. That the unconscious is [[structured ]] like a [[language ]] implies that for something to be repressed it has to have been previously acknowledged by the [[subject]], implying prior [[recognition ]] within the [[symbolic ]] [[register]].

When the [[child]]'s symbolic [[universe ]] is created it is possible for a [[signifier ]] to be excluded from [[the symbolic ]] altogether and thus never to [[form ]] part of it. It is this [[exclusion ]] or [[foreclosure ]] of a fundamental linguistic element, a key signifier, at the [[moment ]] of the genesis of the symbolic that results in a [[psychotic ]] subject. Foreclosure contrasts with repression, in that what is [[foreclosed ]] is excluded from the symbolic [[system ]] altogether; it has never been registered there and therefore, so far as the symbolic is concerned, simply does not [[exist]]. Yet what is foreclosed from the symbolic is not purely and simply abolished. It returns, but, unlike the [[return of the repressed]], it returns from [[outside ]] the subject, as emanating from his [[environment ]] in one form or [[another ]] – a phenomenon not to be confused with [[projection]], which is not specific to psychosis.

Psychosis involves a form of [[regression ]] – [[topographical ]] rather than [[chronological ]] – from the symbolic register to the [[imaginary]]. That is, what has been foreclosed from the symbolic reappears in the [[real]], which is not the same as [[reality]], and it is marked by theproperties of [[the imaginary]]. In [[particular]], relations with the [[other ]] are marked by [[erotic ]] attachment and [[aggressive ]] [[rivalry]]. Thus,Professor Flechsig becomes an erotic [[object ]] for [[Schreber ]] but also the [[agent ]] of Schreber's [[persecution]]. The [[homosexuality ]] in Schreber that Freud highlighted is therefore treated not as a [[cause ]] of Schreber's psychosis but rather as a [[symptom ]] produced by the psychotic foreclosure.

Foreclosure may well be a normal [[psychic ]] [[process]]; it is only when what is foreclosed is specifically concerned with thequestion of the [[father]], as in Schreber's [[case]], that psychosis is produced. Using a term to indicate that what is at issue is a signifierand not a person, and that this signifier is replete with [[cultural ]] and [[religious ]] [[significance]], Lacan refers to this signifier that is[[missing ]] in psychosis as the [[Name]]-of-the-Father. The Name-of-the- Father is a key signifier for the subject's symbolic universe,regulating this [[order ]] and giving it its [[structure]]. Its function in the [[Oedipus ]] [[complex ]] is to be the vehicle of the law that regulates[[desire ]] – both the [[subject's desire ]] and the omnipotent desire of the [[maternal ]] [[figure]].

Since foreclosure of the [[Name-of-the-Father ]] is an outcome of the [[Oedipus complex]], it follows that the psychotic structure is laiddown for a subject at the [[time ]] of negotiating the Oedipus complex. This implies that the psychotic structure will have existed all along, like a hairline fracture, for many years prior to the [[clinical ]] [[appearance ]] of the psychosis when it suddenly and dramatically appears. And we can see this in Schreber, who, after all, had up until the age of fifty-one led a relatively normal life, enjoying a successful career, and carrying out quite demanding duties on the bench.

Lacan holds that it is a certain type of [[encounter]], in which the Name-of-the-Father is 'called into symbolic opposition to thesubject', that triggers psychosis ([[Écrits]], 1977, p. 217). In the [[seminar ]] on psychosis there is a [[discussion ]] of the function of l'appel, the call, the calling, the appeal or the [[interpellation]]. The discussion is not related specifically to psychosis but rather to a quite general linguistic function. The basic [[idea ]] is [[captured ]] in the [[English ]] [[distinction ]] between, for example, the two statements: 'You are the one who will follow me', and 'You are the one who shall follow me.'

It is possible to take the first as a description of or prediction [[about ]] something that will come to [[pass]]: 'I predict that you will follow me.' The second, on the other hand, can serve as an appeal, where the interlocutor is called upon to make a decision, to pursue a course of [[action ]] that he must either embrace or repudiate. This latter case is for [[instance ]] exemplified by [[Jesus ]] of Nazareth's invocation to his disciples-to-be, where 'You are the ones who shall follow me' means something like this: 'I say to you, "You are the ones who shall follow me." Now, tell me, what is your reply, what do you say to this? Give me your answer, for now is the time to choose.' In this example Jesus is 'in symbolic opposition to' his disciples, he is asking [[them]], for 'symbolic recognition', since his [[speech ]] calls upon them to respond in a way that commits them to a decision, one loaded with [[practical ]] consequences, as to whether they are to recognize him as the Messiah.

For Schreber there is a momen when he is called, interpellated, by, or better, in the Name-of-the-Father, and the [[lack ]] of the signfier declares itself. This is sufficient to trigger the psychosis.

In psychosis this symbolic opposition, this call for symbolic recognition, is brought about by an encounter with 'a real father, not necessarily by the subject's own father, but by A-father' – a [[situation ]] that arises under two [[conditions]]: when the subject is in a particularly intense relation with a strong [[narcissistic ]] component; and when, in this situation, the question of the father arises from a [[third ]] [[position]], one that is [[external ]] to the erotic relation.

It may occur, 'for the [[woman ]] who has just given [[birth]], in her husband's face; for the penitent confessing his sins in the person ofhis confessor, for the [[girl ]] in [[love ]] in meeting "the young man's father"' (Écrits, 1977, p. 217). It can also occur in [[analysis]], wherethe [[development ]] of the [[transference ]] can precipitate a psychosis.

Once the psychosis is triggered, everything will have changed for [[good]], but what about before the onset? It is in pursuing this question that Lacan discusses Hélène Deutsch's [[work]], in which she refers to the 'as if' phenomenon, where, for example, an adolescent boy [[identifies ]] with another youth in what looks like a [[homosexual ]] attachment but turns out to be a precursor of psychosis. Here there is something that plays the [[role ]] of a suppléance, a [[substitute]], a stand-in, for what is missing at the level of the symbolic. Lacan use an analogy to explain this [[notion ]] of a substitute or stand-in for what is [[lacking ]] in the symbolic:

<blockquote>Not every stool has four legs. There are some that stand upright on [[three]]. Here, though, there is no question of their lacking any, otherwise things go very badly indeed ... It is possible that at the outset the stool doesn't have enough legs, but that up to a certain point it will nevertheless stand up, when the subject, at a certain crossroads of his biographical [[history]], is confronted by this lack that has always existed ([[Seminar III]], The [[Psychoses]], p. 265).

It is intriguing that some psychotics have been capable of making important [[scientific ]] or artistic contributions. Cantor, the mathematician, is a famous example we [[know ]] about because of the documented psychotic episodes he underwent. But Lacan also speculates that there may be cases where the psychosis never declares itself and the clinical phenomena never eventuate. Perhaps in these cases the (pre-)psychotic subject may find a form of substitute for the foreclosed signifier that enables the subject to maintain the minimum symbolic [[links ]] necessary for normal, even for highly original and creative, functioning.

Lacan argues in Le [[Sinthome ]] (1976) that there are a [[number ]] of indications suggesting that [[James ]] [[Joyce ]] was probably such a case: a psychotic who was able to use his [[writing ]] as an effective substitute that prevented the onset of psychosis. Though necessarily speculativ , such a line of [[thought ]] raises important issues here to do with the diagnosis of psychosis – could, for example, the so-called borderlines be situated here?

Lacan admonished [[psychoanalysts ]] not to back away from the [[treatment ]] of psychosis. Lacan received psychotics, and today most [[Lacanian ]] [[analysts ]] are prepared to work with psychotics. Indeed, there are [[psychoanalyst]]-psychiatrists in [[France ]] and elsewhere who have instituted the regular and systematic treatment of psychotics in [[State ]] [[psychiatric ]] services – services, note, that receive no special funding vis-à-vis those employing more typical psychiatric approaches. Two major issues are raised by the treatment of psychotics: the handling of the transference and, the aim of the treatment, and these have been extensively addressed by Lacanian analysts.

The main points of Lacan's [[theory ]] of psychosis can be summarized as follows:

symbolic system, leaving a [[hole ]] where this signifier would normally be.

• Foreclosure occurs, under circumstances not discussed here, at the moment of the Oedipus complex. It is one [[resolution ]] of theOedipus complex, and contrasts with [[neurosis ]] and [[perversion]].

• The psychosis eventually stabilizes into a delusional system, or 'delusional [[metaphor]]', involving imaginary phenomena in the [[place ]] of the missing signifier.

See also: [[aggressivity]], Borromean [[knot]], [[desire, ]] [[discourse]], foreclosure, imaginary, Name-of-the-Father, real, symbolic, treatmentOther [[terms]]: neurosis, [[Oedipal ]] complex, perversion, repression, structure, suppléance, symptom, transference, unconscious

[[Freud, S. ]] (1951) [1911] '[[Psycho]]-[[Analytic ]] [[Notes ]] on an Autobiographical Account of a Case of [[Paranoia ]] ([[Dementia ]] Paranoides)', (vol. 12, p. 3) [[Standard Edition]], The [[Complete ]] [[Psychological ]] Works of [[Sigmund Freud]]. [[London]]: Hogarth Press. Freud, S. (1986) [1900-01] The [[Interpretation of Dreams ]] (SE vols 4, 5). Freud, S. (1986) [1905] [[The Psychopathology of Everyday Life ]] (SE vol. 6).

Lacan, J. (1977) [1959] 'On a question preliminary to any possible treatment of psychosis', [[Écrits: A Selection ]] (trans. A. [[Sheridan]]). London: Tavistock.Lacan, J. (1976) Le Sinthome, Séminaire XXIII (1975-76), [[Ornicar]]? 6, 7, 8, 9, 10, 11 [Provisional transcription].