In my previous post on psychosalvation I argued that psychotherapy, and, to a certain extent, psychoanalysis, were grounded in an ideology of ‘psychosalvation’, by which I meant that therapy offers the possibility of ‘saving’ the human subject from the secular equivalent of Christian hell and damnation. On this reading, ‘hell’ and ‘damnation’ seem to equate with mental breakdown, a descent into madness, with psychosis. And even if we don’t quite go to these extremes, at the very least ‘hell’ and ‘damnation’ could be thought of in terms of varying degrees of psychological dysfunctionality.

All this seems to suggest that the ‘salvation’ promised by therapy equates with some notion of ‘mental health’ or ‘psychological wellbeing’. But this immediately begs the question as to what such ‘mental health’ or ‘psychological wellbeing’ actually looks like. As I pointed out in my post on psychosalvation, there seem to be, broadly speaking, two different conceptions of ‘mental health’. The first draws on the legacy of humanistic psychology and much of the radical ethos of the ‘1960s’, where the focus was (and still is in some circles) on ‘self actualisation’ and human emancipation. Remember also that the late 1960s marked the beginning of the ideology of ‘the personal is political’ which over the subsequent decades has morphed into the ideology of identity politics and, closely linked to this, the ideology of political correctness.

Anti-psychiatry, another product of the late 1960s, also plays a key role in the whole argument over ‘mental health’. In fact, as I have argued elsewhere, the legacy of anti-psychiatry lives on in a great deal of contemporary psychotherapy and even within some schools of psychoanalysis, including some sections of Lacanian analysis. Here, the focus is more on challenging established notions of ‘mental health’, and especially those propagated by mainstream psychiatry and clinical psychology, which, argue the critics, essentially define ‘mental health’ in terms of conforming to the norms and values of a particular culture, and especially those of a liberal, capitalist, globalised one.

And here, of course, we have the other main ‘answer’ to the question of what constitutes ‘mental health’ and ‘psychological wellbeing’. Essentially it is about conformity to established norms and values, and also, closely linked to this, being able to cope and live with such norms and values. And once ‘mental health’ becomes defined in terms of ‘coping’ rather than some concept of ‘self-actualisation’ or even, following the anti-psychiatrists, a romanticisation of madness itself, then the idea that ‘mental health’ equates with ‘salvation’ starts to look increasingly questionable. However, and as I pointed out in my previous post, Freud’s own position regarding ‘mental health’ is, broadly speaking, firmly within the ‘coping and surviving’ camp.

Just to complicate things even more, perhaps, we also need to remember what Lacan said in 1978 very near to the end of his life and after his final seminar, namely that ‘we are all mad’, although he was in fact paraphrasing Freud at this moment. Needless to say, this statement has been subject to endless analysis ever since but it does seem to suggest at the very least that perhaps we are all ‘damned’ in the sense that none of us can escape the embrace of madness.

It was also during this period of the (very) late Lacan that the distinction between neurosis and psychosis becomes increasingly fuzzy and problematic. And, I would argue, this is critical in the context of the present discussion. This is because, within psychoanalytic circles at least, neurosis has always tended to be equated with ‘normal’, which in turn equates, broadly speaking with ‘mental health’ and therefore with a form of (psycho)salvation. Psychosis, on the other hand, is the descent into (psychic) hell, or so it is often portrayed.   And to make matters worse, from a (‘classical’) Lacanian position, there is no escape from this damnation, because ‘once a psychotic always a psychotic’.  Ironically, this represents a psychoanalytic parodying of the biological psychiatric position regarding the genetic and/or neurophysiological basis for psychotic illnesses.  In other words, whether it’s a foreclosure of the Name-of-the-Father or a problem with genes or biochemistry,  the result is the same: eternal damnation which can only be alleviated by a lifetime of medication and/or psychotherapy.  The best that psychoanalysis can offer is to provide some form of sinthome or knotting together of the Real, Symbolic and Imaginary so the subject can function to some degree or other in their daily lives.  So much for self actualisation….

But what if the distinction between neurosis and psychosis is not as clear as many have argued?  What, in fact, if Lacan is right and we are all, in fact, mad?  At this point I need to point out that, as with all things Lacanian, it’s not quite that simple.  In his paper on differential diagnosis Pierre-Gilles Guéguen reminds us of Miller’s position (the quote is from Miller):

The madness at stake here, this generic madness is general or rather universal. It is not psychosis. Psychosis is a category from the clinic with which we try to capture something which somehow inscribes itself in this very universal.

In other words, as Guéguen points out, we are all mad but we are not all psychotic.  Rather, psychosis, or at least this is how I read it, is a way to try and describe, to articulate, a particular form of subjectivity (and, one might add, a particular way of ‘coping’) within a generalised madness, a generalised foreclosure.  But this also means that neurosis is simply another form of subjectivity, another way of ‘coping’ within the same generalised foreclosure, the same universal madness.  And this is where Lacan’s concept of the sinthome is so critical, because it operates both within psychosis and neurosis.  In fact, the signifier of the Name-of-the-Father can be seen as the sinthome of the neurotic subject, but is only one of many possible sinthomes, only one of many possible ‘knottings’ of the Real, Symbolic and Imaginary.

Of course, here I am grossly simplifying what is a very complex argument.  However, the point I want to emphasise is that the notion that somehow ‘neurotic’ equals ‘normal’ and ‘psychotic’ equals ‘abnormal’ is simply nonsense.  And leading on from this, the idea that there is something called ‘mental health’, which somehow equates to (psycho) ‘salvation’ as opposed to something called ‘mental illness’ which equates to ‘damnation’ is complete rubbish.

Furthermore, looking at things in this way one must begin to question the whole point of psychoanalysis and psychotherapy in the first place.  If, at the end of the day, it’s a question of how each individual can find their own particular sinthome, their own particular way of ‘anchoring’ themselves in the world, then why, for example, would one wish to ‘deconstruct’ the sinthome of the neurotic, which is what ‘classical’ analysis appears to be aiming at, anymore than one would wish to ‘deconstruct’ the sinthome of the psychotic.   Both are serving an important function for the individuals in question.

And this relates to an even more fundamental question: a sinthome, a knotting together of the Real, Symbolic and Imaginary, can take many different forms.  For example, it can be writing, painting, philosophy, politics, religion, various forms of human relationships, and so on.  It could also, of course, take the form of psychoanalysis itself, but as Lacan pointed out in his Joyce seminar, Joyce’s writing was essentially his sinthome, and therefore there would be little point in Joyce being in analysis.  Perhaps the best psychoanalysis can aim for is to bring the subject to the point of discovering what would function best for them as their own, unique sinthome.