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| − | "[[psychosis]]" ([[Fr]]. ''[[psychose]]'')
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| − | ==Sigmund Freud==
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| − | The term [[psychosis]] arose in [[psychiatry]] in the nineteenth century as a way of designating mental illness in general.
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| − | 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.
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| − | This basic distinction between [[neurosis]] and [[psychosis]] was taken up and developed by [[Freud]] himself in several papers.<ref>Freud, 1924b and 1924e</ref>
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| − | ==Jacques Lacan==
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| − | [[Lacan]]'s interest in [[psychosis]] predates his nterest in [[psychoanalysis]].
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| − | Indeed it was his doctoral research, which concerned a psychotic woman whom [[Lacan]] calls [[Aimée]] that first led [[Lacan]] to [[psychoanalytic theory]].<ref>{{L}} p.1932.</ref>
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| − | It is often remarked that [[Lacan]]'s debt to this [[patient]] is reminiscent of [[Freud]]'s debt to his first [[neurotic]] [[patient]]'s (who were also [[female]]).
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| − | In other words, whereas [[Freud]]'s first approach to the [[unconscious]] sis by way of [[neurosis]], [[Lacan]]'s tortured and at times almsot incomprehensible style of writing and speaking to the [[discourse]] of [[psychotic]] [[patient]]s.
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| − | Whatever one makes of such comparisons, it is clear that [[Lacan]]'s discussions of [[psychosis]] are among the most significant and original aspects of his work.
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| − | [[Lacan]]'s most detailed discussion of [[psychosis]] appears in his [[seminar]] of 1955-6, entitled simply ''[[Seminar III|The Psychoses]]''.
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| − | It is here that he expounds what come to be the main tents of the [[Lacan]]ian approach to [[madness]].
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| − | [[Psychosis]] is defined as one of the three [[clinical structure]]s, one of hwihc is defined by the operation of [[foreclosure]].
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| − | 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]].
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| − | 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."<ref>{{S3}} p.208</ref>
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| − | 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 funciton is reduced to the [[image]] of the [[father]] (the [[symbolic]] is reduced to the [[imaginary]]).
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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]].
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| − | 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>
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| − | 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>
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| − | In the [[absence]] of the second condition, the [[psychotic]] [[structure]] will remain latent.
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| − | It is thus conceivable that a [[subject]] may have a [[psychotic]] [[structure]] and yet never develop [[delusions]] or experience [[hallucination]]s.
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| − | 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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| − | In the 1970s [[Lacan]] reformulates his approach to [[psychosis]] around the notion of the [[borromean knot]].
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| − | The three rings in the knot represent the three [[orders]]: the [[real]], the [[symbolic]] and the [[imaginary]].
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| − | While in [[neurosis]] these three rings are linked together in a particular way, in [[psychosis]] they become disentangled.
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| − | 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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| − | [[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.
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| − | 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>
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| − | 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>
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| − | 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.
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| − | On the contrary, much work has been done by [[Lacanian]] [[analyst]]s in the [[treatment]] of [[psychosis]].
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| − | However, the method of [[treatment]] differs substantially from that used with [[neurotic]] and [[perverse]] [[patient]]s.
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| − | [[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 imagianry 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>
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| − | 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.
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| − | 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 [[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>
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| − | 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>
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| − | In 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 "casscade 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>
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| − | Another way of desribing 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>
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| − | This relationship of the subject to the signifier in its purely formal aspect constitutes "the nucleus of psychosis."<ref>{{S3}} p.250</ref>
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| − | "If the neurotic inhabits language, the psychotic is inhabited, possessed, by language."<ref>{{S3}} p.250</ref>
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| − | Of all the various forms of psychosis, it is [[paranoia]] that most interests Lacan, while schizophrenia and mani-depressive psychosis are rarely discussed.<ref>{{S3}} p.3-4</ref>
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| − | Lacan follows Freud in maintaining a structural distinction between paranoia and schizophrenia.
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