new book from Stijn Vanheule: The Subject of Psychosis

published by Palgrave Macmillan

extract from the introduction below

Jacques Lacan’s oeuvre covers a period of more than 50 years, during which time he developed a theory that innovated psychoanalytic practice and introduced a new method of reflecting on human subjectivity. His work continues to be read today and is well known for being powerful, intriguing, baroque and complicated, all at the same time. The theory he formulated represents a work in progress of a restless inquiring mind and needs to be studied with appreciation for how his concepts and ideas evolved over time. The purpose of this book is to clarify his particular approach to the clinic of psychosis. The principal themes running through his work concern the ways in which psychotic experiences are structured and how psychoanalysis can provide a useful framework for the treatment of psychosis.

During the nineteenth and early twentieth centuries psychosis was largely understood in terms of organic mechanisms: its symptomatology was seen as a surface phenomenon of presumed underlying disturbances in the brain. While Lacan was interested in the strict neurobiological work of his forbearers, particularly because of its detailed observation of the functioning of psychotic patients, he felt nonetheless that these theories neglected the complexity of psychotic experience. The main factor left out of consideration was the question as to how psychosis affects subjectivity. One of the central aspects of Lacan’s work is his exploration of how the experience of self and other is organized in psychosis and how stability can be achieved despite the disruption that characterizes it. At first Lacan addressed these questions by focusing on identification, suggesting that identification with a specific type of image marks the turning point in psychosis. Later he put this view aside, contending that what matters in psychoanalysis is the materiality of speech. He argued that language makes up the experience of subjectivity and that psychosis is marked by the absence of a crucial signifier. This absence implies a specific type of subject-Other experience, one in which mechanisms of identification play only a secondary role. As his seminar progressed, however, Lacan revised these ideas twice: First, he stressed that in psychosis the subject-Other relation entails a different experience of corporeality and a different relation to the drive; second, he began to focus on the systemic interplay between the registers that he places at the basis of human functioning: the Real, the Symbolic and the Imaginary (Miller, 1999).

I propose that Lacan’s work on psychosis can best be framed in terms of four eras or four broad periods. In each period a different set of key concepts can be discerned together with a number of crucial texts containing references to psychosis. In this book I present a close reading of these texts. The central ideas are explained and contextualized in terms of Lacan’s broader oeuvre. Related texts, such as those of Freud, de Clérambault and Merleau-Ponty are discussed. I argue that the empirical field of psychoanalysis should include detailed case studies, and to this end I discuss one case study from each period of Lacan’s work. These case studies were central to Lacan’s explanation of his ideas. I have not included case studies from my own clinical practice nor that of other psychoanalysts, nor do I address other theories of other authors working with Lacanian psychoanalysis. In this respect I have limited myself to examining the logic articulated within Lacan’s oeuvre. My guiding principles were that Lacan’s ideas on psychosis should be presented as clearly as possible and that shifts in his conception of psychosis should be framed in the context of his broader work. Through this approach, I hope to contribute to the academic and clinical study of Lacanian theory.

The first era I discern in Lacan’s work covers the nineteen thirties and forties, and focuses on identificatory mechanisms, which I discuss in Chapter One, Lacan brings psychoanalytic concepts into dialogue with psychiatric theory, and gradually emancipates the psychoanalytic thesis from the psychiatric one. He stresses that psychosis is involves an imaginary mode of relating to the world. At the basis of this relation he proposes that an identificatory structure can be found in which the ego is captured by an ideal image. What is typical of psychosis is the inability to recognize that one is captured by the images one actually imposes upon the world, rendering it deeply threatening. Key texts in this period include Lacan’s doctoral thesis (1932), which has not yet been translated into English, and his article Presentation on Psychical Causality (Lacan, 1947). The case of Aimée, a paranoid patient Lacan worked with during an internship and discussed in his doctoral thesis, is pivotal for this era.

The second era I distinguish covers the nineteen fifties, when Lacan refers to psychosis in terms of language-based structures. Central to this period is his year-long seminar on psychosis (Seminar III; Lacan, 1955-56), which gave rise to the text On a Question Prior to Any Possible Treatment of Psychosis (Lacan, 1959). During this time Lacan provided his most extensive discussion of the topic of psychosis, proving himself a truly innovative thinker. His re-interpretation, or ‘structural analysis’ (Lacan, 1959, p. 449), of Daniel Paul Schreber’s (1903) autobiography is crucial in this phase of his work. I devote four chapters of my book to this era.

Chapter Two comprises an overview of the basic tenets of Lacan’s structural approach to psychosis during the nineteen fifties. Two important sources of inspiration are reviewed: the work of linguists Ferdinand de Saussure and Roman Jakobson. I examine Lacan’s theory of the predominance of the signifier in the unconscious, and discuss his e concepts of “structure” and “subject,” which arguably receive a strongly materialist interpretation in his work. Compared to the other chapters of this book, here I concentrate my analysis less on psychosis but instead examine key concepts of Lacan’s work from that decade. The concepts of structure and subject are the cornerstones of what I call his second paradigm, in which psychosis is studied structurally in terms of how the Symbolic is organized. The next three chapters build on this analysis and attempt to shed light on how Lacan conceptualizes psychosis during this period.

Chapter Three examines the idea of foreclosure. Starting from the anthropological studies of Claude Lévi-Strauss, I explore Lacan’s idea that a foreclosure of the so-called signifier of the Name-of-the-Father lies at the basis of psychosis. I also investigate his suggestion that in psychosis a process of metaphorization does not take place. Four logical consequences of foreclosure are discussed: 1) the idea that in psychosis the subject threatens to remain undefined; 2) the suggestion that the other is perceived as fundamentally capricious; 3) the thesis that the unconscious obtains a status of externality; and 4) the proposal that imaginary identification might compensate for the negative effects of foreclosure.

In Chapters Four and Five I show how this paradigmatic shift towards a structural model of psychosis enabled Lacan to reconceptualize commonly accepted ideas about hallucinations and delusions respectively. In Chapter Four I demonstrate that in Lacan’s theory hallucinations are not thought of as perceptions without an object, but as perceptions that subvert the subject. Chapter Five discusses delusions demonstrating how ruptured metonymy can be found at their basis and how failing metaphorization can be compensated for through the creation of a delusional metaphor.

The third era proposed in this book comprises his tenth seminar onwards (1962-63) when Lacan begins to elaborate his theory of the so-called object a. Problems that were previously approached in terms of the logic of the signifier are now addressed in terms of the limits of the Symbolic. Lacan embraces the new idea that some aspects of Being are Real and cannot be grasped via language. The two key-concepts he used to address the domain of subjectivity that appears at the limit of the Symbolic are “jouissance” and the “object a.” The complex notion of jouissance denotes a mode of satisfaction or drive gratification beyond pleasure and the object a refers to what remains of the mythical partial object after the assumption of language. In this period of Lacan’s work, references to psychosis are spread across several seminars and texts (Lacan, 1965, 1966b, 1968). He argues that in psychosis the object a is not separated from the subject, whereas in neurosis such a separation has taken place. With the concept of jouissance he makes clear distinctions between paranoia and schizophrenia, and addresses the question of how problems with regard to jouissance might trigger acute delusional episodes. In Chapter Six this line of thinking is explored using thefictional case of Lola Valerie Stein from Marguerite Duras’s (1964) novel The Ravishing of Lol V. Stein.

The fourth era I discern in Lacan’s work on psychosis includes his twenty-third seminar (Lacan, 1975-76) where knot theory is used to operationalize the interrelations between the Real, the Symbolic and the Imaginary. The central question he is then working with concerns how a link can be made in the relation between the Real, the Symbolic and the Imaginary, the three registers that make up psychical reality. Lacan proposes the symptom as the systemic element that binds these registers, such that the link comprises a systemic whole that is more than the sum of its parts. In these years the Name-of-the-Father is redefined as the symptom of neurosis. In psychosis no use can be made of such symptoms, which implies that psychical reality is organized through tailor-made solutions he calls “sinthoms.” The main case Lacan uses to reflect on such singular inventions is that of James Joyce. In Chapter Seven I discuss these last developments in Lacan’s work on psychosis.

The attentive reader will observe that some of the ideas reviewed during my discussion of these four periods are complementary, while others are somewhat contradictory. For example in the nineteen fifties, Lacan strongly defended a categorical view of neurosis and psychosis, arguing that both are structured by clearly distinct Symbolic mechanisms called primal repression and foreclosure. In the nineteen seventies this is no longer the case. Neurosis and psychosis are then seen as modes of knotting the Real, the Symbolic and the Imaginary that have strong resemblances, despite independent characteristics. While writing this book I did not attempt either to resolve or conceal such contradictions. The more critical reader can decide how to proceed with them. Furthermore, it will become clear that as time progressed the level of abstraction in Lacan’s work increased considerably. Up until the nineteen sixties, Lacan’s discussion of psychosis frequently referred to the work of other authors, and largely aimed to connect theoretical ideas with clinical case material. From the nineteen sixties onwards, his ideas on psychosis were formulated in a more fragmented way, with a stronger focus on conceptual rather than clinical implications. This more abstract discussion of psychosis is evident in my last two chapters, which are more theoretical than the preceding five. Personally I strongly appreciate Lacan’s late work, but I believe that it is of utmost importance that his concepts and ideas be studied in terms of the different phases in his theoretical development. Furthermore, I believe that the clinical relevance of these ideas should be further examined, integrated with case studies, and brought into dialogue with other theories. I hope my book stimulates such research.