Psychosis, meaning and therapy

There is a view in Lacanian circles that the best way to treat psychosis is to help the patient/client construct a structure of meaning, because the problem for psychotic subjects is precisely that they lack a stable structure of meaning.  Because of this they are continually having to construct and reconstruct such structures, some of which can be very elaborate.  Hence the complex ideologies and belief systems we often see in psychosis.   Psychotics are obsessed with meaning – because it continually eludes them.

In my view, however, it is a fundamental misreading of Lacan to argue that the treatment of psychosis involves the construction of meaning.  Or rather, it is a fundamental misreading to focus on the word ‘meaning’ in this statement.  Instead, the focus should be on the word ‘construction.’   In other words, it’s about helping the psychotic subject construct something that is relatively stable; and this something is essentially material, albeit in a discursive form.  Furthermore, this is a construction that takes place within a social relationship (or social bond as some Lacanians like to say).   This is important because another problem for psychotic subjects is their relationship to other people and society in general.  There is a deep irony here, however, because many psychotic subjects appear to thrive in senior positions in business, politics and other walks of life.

There is a theoretical underpinning to putting the emphasis on construction rather than meaning, although this only really emerges in Lacan’s later teachings.  This is the idea of the sinthome, which is a way of ‘knotting’ together the three registers of the Real, Symbolic and Imaginary.   In psychosis, according to Lacan, the three registers have ‘come apart’, which has serious consequences for the psychotic subject.  A particular problem is that the symbolic order no longer functions as an ‘anchor’ for the subject, i..e. in the form of the master signifier of the Name-of-the-Father.  Instead the Imaginary and Real orders tend to dominate the life of the subject, with sometimes (though not always) catastrophic consequences.  And here lies another problem with using meaning as a basis of treating the psychotic: meaning is on the side of signified, which is in the register of the Imaginary, so it cannot be used as a way of knotting the three registers and ‘anchoring’ the subject.   Instead, there needs to be something with more ‘substance’ to ground the subject; and this ‘something’, i.e. the sinthome, is essentially a supplement (or one might even say substitute) Name-of-the-Father.

Some Lacanians have argued that the Name-of-the-Father itself is just a particular form of sinthome, although this creates a number of conceptual problems which I won’t touch on here.  The key point, however, with regards to the possible treatment of psychosis is that it’s the work of construction (of the sinthome) that’s critical, not what it means, i.e. in terms of what it signifies.   To give one example, which is the basis of one of Lacan’s later seminars: the writer James Joyce produced work that was increasingly (to most readers) opaque and incomprehensible, the best example of which is probably Finnegan’s Wake.   The point about this material, however, is not about it ‘making sense’; rather, it is its function as a sinthome.  In other words, Joyce’s work, as a material construction, serves the ‘anchoring’ function that the Name-of-the-Father serves for the neurotic subject.   Essentially, Joyce’s writing is what holds his subjectivity together.  I suspect this also applies to a number of artists, writers, musicians and poets.

To reiterate: it is not a question of giving a psychotic subject meaning; he or she has enough of this already.  Rather, it is a question of helping the psychotic subject construct, in the therapeutic/analytic relationship something (a sinthome) that serves the function of the Name-of-the-Father.   Now, this construction may be, or may include, a system of meaning, e.g. some kind of belief system or ideology; however, it is not the meaning itself, i.e. the signification, of the material that constitutes the sinthome that matters, but rather the structure of the material.

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