Why psychosis?

There is a long and somewhat unfortunate tradition within psychoanalysis that appears to ‘downgrade’ psychosis.  In other words, psychosis is seen as something of an aberration in relation to the ‘norm’ of neurosis.   This is not to say that psychoanalysts don’t work with psychotics – far from it- but one often gets the impression when reading about psychoanalytic treatments of psychotic patients that somehow this isn’t ‘real’ psychoanalysis.

Much of this prejudice (for want of a better word) appears to be based on a particular reading of Freud; there are many references in the psychoanalytic and psychotherapeutic literature to remarks by Freud that it was not possible to work psychoanalytically with psychotic patients.  This is in spite of the fact that at least one of Freud’s most famous cases, the Wolf Man, was psychotic.  It is perhaps also worth pointing out that Freud wrote a number of key texts relating to psychosis; indeed, Lacan’s seminar on psychosis is in large part based on Freud’s analysis of Schreber.1

At this point, however,  I would like to offer a word of caution: I am not arguing that it is possible to work with psychotic patients in the same way that one would work with neurotic ones; rather, it’s the claim that one form of psychoanalytic treatment is somehow more ‘genuine’ or ‘real’ than another that I would question. Linked to this, I would like to counter the claim, which is still heard in some psychoanalytic and psychiatric quarters, that psychotic patients do not benefit from psychoanalytic interventions.  Referring back to Freud’s stance on psychoanalysis and  psychosis, I think it is more the case that Freud was arguing that the method of psychoanalytic treatment that he used with neurotic patients was not suitable for working with psychotic patients.    This is not the same as saying that one form of psychoanalysis is more ‘real’ than another. Jean-Louis Gault puts it rather succinctly when he argues that with the neurotic subject the psychoanalysis moves from the Symbolic to the Real, whereas with the psychotic it moves from the Real to the Symbolic. 2

However, I think there is another reason why we should take psychosis seriously – and this is quite apart from the fact that it appears to be on the increase.  I would contend that there is a lot to learn from psychosis.  In fact, there is something that psychosis can teach us which is simply not possible with neurosis.  This is the question of the Real: the Real in terms of the limits of reason and of language; the Real in terms of where the Symbolic order fails.3

The central problem for the psychotic revolves around his or her relation to the Real – and this is inextricably linked to his or her relation to the signifier of the Name-of-the-Father.  This is not to say that the neurotic subject doesn’t have problems with the Real –on the contrary.  However, this is a different relationship, which is tied up with the neurotic subject’s particular kind of relationship with the signifier of the Name-of-the-Father.   Both the neurotic and psychotic negate the Name-of-the-Father – but they do so in radically different ways.  With the neurotic subject the negation takes the form of repression, which means that he or she must first recognise and register the Name-of-the-Father; whereas with the psychotic subject the negation takes the form of foreclosure, which is essentially a failure to register the Name-of-the-Father in the first place.

This failure to register the Name-of-the-Father means that the psychotic subject’s relationship to the Symbolic order is extremely tenuous to say the least.   Conversely, his or her relationship to the Real is problematic in the opposite sense: the Real is too present, too overwhelming.  This is why the ‘work’ of psychosis (both in and outside of analysis) often revolves around trying to develop forms of stabilisation in order to mitigate the effects of the Real, and to construct at least a semblance of meaning and identity for the subject.  For example, the often complex systems of delusion that are so characteristic of the paranoid subject are essentially attempts at stabilisation.   They give the subject a sense of meaning and identity, a place in the world.

One of the problems, however, with these attempts at stabilisation is that they are, at best, temporary; in fact, one could argue that they are forms of imaginary symbolic constructions, which can collapse at any moment.  This is why it is not possible to talk of a psychoanalytic ‘cure’ for psychotic subjects; rather, it’s a matter of helping them develop forms of stabilisation which allow them to cope with the demands of a symbolic and social universe.

However, the fact remains that the psychotic subject has something of crucial importance to tell us.  Not in the sense of trying to romanticise madness, à la antipsychiatry and Anti-Oedipus, but rather in terms of reminding us that there is something beyond the Symbolic order, and that in many ways the symbolic world, the social bond, is quite fragile.

  1. Lacan, J. (1993) The Seminar of Jacques Lacan: Book III 1955-1956 The Psychoses. London, Routledge. []
  2. Gault, J.-L. (2007) Two Statuses of the Symptom: ‘Let Us Turn to Finn Again’. In: Véronique Voruz & Bogdan Wolf eds. The Later Lacan: An Introduction. State of New York, Sunny Press, pp.73–82. []
  3. The Real is often portrayed as being outside of language; indeed as being outside of representation; it is also often portrayed as being extra-discursive.  However, this can often belie the relationship between the Real and Symbolic, and the fact that in some ways the Real could be viewed as an effect of the Symbolic. []

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