Thus the delusion is not the 'illness' of paranoia itself, but rather, the paranoiac's attempt to heal himself, to pull himself out of the breakdown of the symbolic universe by means of a substitute formation.
"What we take to be the pathological production, the delusional formation, is in reality the attempt at recovery, the reconstruction."
One common form, the "delusion of persecution," revolves around the Other of the Other, a hidden subject who pulls the strings of the big Other (the symbolic order), and who controls our thoughts, conspires against us, watches us, etc.
Psychosis linked to a psychopathologic organisation of the personality manifested by troubles of perception and by the production of delirious ideas.
Délire, illusion :
Conviction erronée basée sur des conclusions fausses tirées des données de la réalité extérieure, maintenue bien que tous les autres individus pensent différemment (hallucinations). The first essential feature that defines a delusion is that it concerns something that appears to be external to the subject. It is thereby distinguished from obsessive ideas and idées fixes. More precisely, wecan say that in a delusion, an internal experience appears in theperceptual field. Delusion therefore concerns reality as a whole, which distinguishes it from phobia, where the distortion of reality is more circumscribed, because projection manages to localize conflict, and keep the rest of the subject's mental life intact. In delusion, conversely, the whole of reality is affected, and indeed the delusion, for the subject, is the whole of reality.
In this sense, delusion represents a critical risk. Sigmund Freud speaks accordingly of a necessary restoration of the object (1924e), whether it is a matter of the high level of libidinal or narcissistic tension evidentin extreme cases, or a fundamental questioning of identity and relationswith others that is at stake.
Delusion is therefore something other than error. Being delusional remains compatible with an accurate apprehension of reality. We can even consider the delusional individual as deprived of the freedom to establisha flexible relationship between reality and truth, as Paul-Claude Racamierhas said.
From this general perspective, we can differentiate the two main modalities for the expression of delusions. In one, this involves a disturbance of consciousness, whose heightened character can have different causes: a consciousness that is captive and agonized; or a delirium tremens, which externalizes metabolic disturbances in the form of images; or the dream-like upheaval of acute psychotic delusions; or the psychedelic intoxication of hallucinogens. In the other mode, the same reversal of reality can express the refusal that occurs during hallucinatory confusions that seek to isolate a repressed complex, and keep it in a shadowy, hysterical state.
There are occasions, however, when acute delirious moments are experienced in isolation, as in the "primordial delusional fact" described by Jacques Moreau de Tours, or the "primary delusional experience" described by Karl Jaspers, where the strange and uncanny appears, sometimes in the form of illuminating moments in which a perception takes on a revela-tory quality, or a moment of questioning emerges without yielding any sense. These seem to be direct confrontations between unconscious fantasy and reality, like a topographical short-circuit that requires a return of the preconscious from the exterior world, within the delusion of interpretation.
In yet another dynamic of delusion, less sharp in its temporal unfolding, the dominant issue concerns the limit between inside and outside. During moments of mental automatism, thought grows heavy with the weight of words that have lost their meaning. The schizophrenic seeks in hallucination to exteriorize an internal life that is invasive and does not seem to belong to him. Chronic delusions, in the French systems of classification, or in Kraepelin's paraphrenias, are more likely to create delusions that are simultaneously persecutory and protective, sometimes to the point of allowing a reconstruction of the entire world (Schreber, 1903).
Passion also, with its affective power to dominate, can provide material for delusions, along other lines. The paranoiac projection of homosexual impulses can turn into delusions of persecution, jealousy, or erotomania, depending on whether it is the subject or the object of the fantasized investment that is affected by the delusional force. However, emphasis should be placed on the narcissistic demand, the lack of an object, and the shortcoming, within the primary homosexual relation, that eroticization compromises and which the delusion of persecution maintains as both present and distant (Jenneau, 1990). In other cases it is the superego that returns in the "delusion of reference," where the shame and guilt of voyeurism blend together in projection (Kretschmer, 1927).
One sees in this brief description that delusion cannot be explained simply in terms of a certain way of treating instinctual life at the expense of reality. One also has to take into account the patient's need to express conflict, in a single-minded way, within this reality. It is the causality of delusion that remains the foremost question, even within radically different accounts.
See also: Aimée, case of; Amentia; Certainty; "Claims of Psychoanalysis to Scientific Interest"; Construction-reconstruction; "Constructions in Analysis"; Erotomania; Hypochondria; Illusion; Infantile omnipotence; "Metapsychological Supplement to the Theory of Dreams"; Need for causality; Negative hallucination; "Notes upon a Case of Obsessional Neurosis (Dementia paranoides)"; "On Narcissism: An Introduction"; Paranoia; Paranoid psychosis; Persecution; Projection; Psychoanalytical nosography; Psychoses, chronic and delusional; Psychotic defenses; Psychotic potential; Superego.
- Freud, Sigmund. (1924e). The loss of reality in neurosis and psychosis. SE, 19, 180-187.