1. In the posts on the analytic session so far, I have been following Fink’s account of the analysis of a typical neurotic. The analyst’s concern is to let the neurotic analysand wonder out loud about the significance of their unconscious formations. The analyst must create a space where this is possible, standing in as an opaque Other whose hears something in what the neurotic says that was not consciously intended.
In so doing, the analysand begins to understand that he or she is not always in charge of the meaning of what he or she says. In the psychotic, by contrast, this place is not available, since he or she has not progressed beyond the imaginary stage.
In the case of the neurotic, analysis will pass through imaginary to symbolic to real stages. In the first transition, the analyst’s desire can be understood as constituting a rupture in the symbolic order as it is constructed by the patient. But there has to be a symbolic to disrupt; in the psychotic, there is not.
What is lacking is a subject of meaning; the psychotic lacks a sense of self. In relation to the neurotic, the analyst must disrupt his or her meaning-making activity, which can often be conventional and impatient, opening him or her to the unconscious rather than focusing upon the ego; with the psychotic, however, the ego is what is lacking. If there is to be any chance of the analyst’s ‘hitting the real’ then there is a great deal of constructive work to be done in the analytic sessions.
The psychotic must be brought to that stage where the meaning-making activity of his or her psyche is engaged, and carefully steered away from the creation of that kind of delusional world as found in Schreber. The aim of analysis will be for the psychotic to find a place in a world where the questions as to who he or she is, and why his or her parents wanted a child at all – questions of origin and destination – can be addressed without prompting a ‘psychotic break’ of the sort Schreber underwent which saw him, comparatively late in life, construct a cosmology in which he could find his place.
2. For Lacan, there are three principal clinical structures of the psyche: neurosis, into which most ‘normal’ people fall, psychosis and perversion. This diagnostic schema is simple and absolute – there can be no borderline cases, but diagnosis itself can be a difficult affair: certain psychotic traits in an individual may not indicate he or she is a psychotic. The defining mechanisms of each structure are therefore crucial to identify, especially since their particularities will orientate the method of analysis.
In the case of the psychotic, something has gone wrong with what Lacan calls ‘The Name of the Father’, to which Fink prefers the expression ‘father function’ or ‘paternal function’. Here, Lacan is not referring to the function played by an individual’s flesh-and-blood father, but to a symbolic function. But what does this mean?
For Lacan, the child is aware of the mother’s desire as a threat; at the same time, wanting for the mother to occupy herself exclusively with him or her, obliterating the distinction between mother and child. The father keeps the child from this becoming one with its mother, protecting the child from the desire of the mother – understood as both the child’s desire for the mother and the mother’s desire.
In this sense, the father can be understood as protecting the child from a threat, but he does so through prohibition, as the one who lays down the law for both mother and child. The father does not need to be present in order to function as a father. ‘Just wait till your father gets home’, says the mother: here, the child is supposed to reflect upon what the father will do or say.
The paternal function can play a similar role even when the flesh-and-blood father has died. ‘What would your father have thought about that?’, says the mother to an errant child. Crucially, the paternal function works to appeal to another source of authority beyond the mother’s.
For Lacan, the paternal function can also fail, leading to a variety of observable consequences to the analyst. But evidence has to be carefully reflected upon and weighed up. Take hallucination, for example. For Freud, the child who wants satisfaction of some kind hallucinates an earlier experience of satisfaction – seeing (and tasting) food, for example, in wanting to assuage hunger. Such is what Freud calls primary-process thinking, and is present in other unconscious formations such as daydreaming and fantasising.
Hallucination also has a specific relationship to the psychotic, but it is also a feature of any of the forms of psychic organisation. Faced with what he or she may take to be an account of hallucination by the patient, the analyst must pause and consider the subjective nature of the experience.
Crucially, Fink underlines, even as he or she makes no claim as to the ‘reality’ of the hallucination, the psychotic is absolutely certain about the significance of what he or she sees. The psychotic may believe he or she was chosen to hear or see it – ‘God has chosen me as his messenger’; ‘They are trying to get me’. The neurotic, by contrast, doubts the significance of the hallucination. Fink:
The neurotic is unsure: maybe the person was there, maybe not; maybe the voices are coming from some outside source, maybe they are not; maybe what they say has some meaning, maybe not; the meaning seems to have something to do with the person, but perhaps he or she is misinterpreting it.
Then the hallucination is something from which the neurotic feels a certain distance. ‘God revealed himself to be, but am I to be his messenger?’ ‘What do they want with me?’ Fink goes so far as to suggest what the neurotic senses cannot really be considered as hallucinations:
a bona fide hallucination requires a sense of subjective certainty on the patient’s part, an attribution of external agency, and is related to the return from the outside of something that has been foreclosed.
3. A second example of observable consequences in the clinic that must be carefully reflected upon. For Lacan, we are all of us alienated by language. Growing up, we are taught language by others, allowing our thoughts and experiences to be shaped. At the same time, we might be aware that we are unable to use language to say what we mean; that, speaking or writing, we are unable to find a place in language and make it our own.
There are many ways of addressing this alienation: we might assume a particular accent, identifying with the privileged; on the other hand, we may rebel against a standard language, preferring a slang full of swear words. We may leave behind our mother tongue altogether, abandoning it as it reflects a hated political system.
Alienation, however, can never be quite overcome. Whereas the neurotic is able to ‘subjectify’ language, having the sense that speech and writing do his or her bidding, the psychotic has a sense of being possessed by language, as though words were coming from outside him or her, rather than doing his or her bidding.
This phenomenon is well attested in artists’ experience of inspiration. Invocations of the Muse may seem a bland poetical formula, but perhaps are ways of naming the way in which a certain kind of inspired language arrives from without. Of course, inspiration is not a simple receptivity, but depends upon an answering desire to suspend reason or wilful deliberation – a willingness, that is, to allow an empowering spirit into creative work, to render it productive.
The artist must embrace dispossession, acknowledging the authority of a possessing voice, but it is also necessary to assume responsibility for the work, to shape and realise what has been received so that it may inspire others in turn. Inspiration allows the artist to discover an enhanced fluency, a deeper level of expression.
In the twentieth century, the experience of inspiration is recast by Blanchot in terms of the experience of the outside (as Foucault calls it, the thought from outside (the thought of the outside, the outside as thought)): here, language is no longer ordered in accordance with what the human being is able to achieve, indeed, with the very measure of its so to speak ability to be able.
Language is encountered as precisely what forbids subjectification – as an impersonal streaming that offers not repose but restlessness. Coming from outside the world to which language normally answers by way of its capacity to refer, this experience or thought cannot be contained by the interior realm of the speaker or writer.
For Blanchot, it is language as the outside with which a certain literature engages, and which is reflected in a certain practice of literary criticism. The writer is now linked to an experience of depersonalisation and possession. Here, then, is an experience akin to that of the psychotic. But there is a crucial difference. The inspired writer, even the Blanchotian one, might be understood (except by Deleuze and Guattari) to be highly creative of metaphor. The psychotic, says Lacan, cannot create metaphors at all.
Reading Blanchot’s The Last Man, we find the narrator comparing the relationship to the eponymous figure to the function of a lock on a river, which changes the level of water relative to one another. Here is an original use of metaphor (but Deleuze and Guattari, I think, would call it a metamorphosis) of which the psychotic would not be capable.
Like the creative writer, the psychotic experiences language as dispossessing, but unlike him or her, the psychotic’s speech is not creative of new meanings through metaphor. The psychotic can only use other people’s metaphors, imitating the way they speak, but there is something about the essential structure of language that eludes them.
Why is this the case? Lacan’s answer is stark: because of the failure of the essential metaphor – the paternal metaphor. Recall the discussion of the relationship between the father and mother. The father, says Lacan, as name (The-Name-of-the-Father) cancels out the Mother (the Mother’s desire and the desire for the Mother); the paternal function, regardless of any particular act by one’s biological parent, forces the child to give up its proximity to the mother.
Here, there is a clear overlap with the castration complex: the child has been forced to give up its jouissance, but the father’s prohibition is also creative of desire. With the refusal of the mother, I now understand that it is the mother I lack; my desire is constituted by that prohibition that separates me from the pleasure I feel in proximity to my mother – the attention she pays me, the smell of her body, etc.
For both boys and girls, joussiance is born with the father’s (the paternal function’s) prohibition, although it is typically stronger for male children, with whom the father, for Lacan, feels rivalry. Fink writes, in a passage that reminds me of Bataille’s discussion in Theory of Religion of the emergence of the human being from the ‘first immensity’ of animal life:
… the child’s relationship with its mother is first given meaning by the father’s prohibition; that meaning is, we might say, the ‘first meaning’, and it establishes a solid connection between a sternly enunciated interdiction and an indeterminate longing for closeness (which is transformed into desire for the mother as a result of the prohibition).
The ‘first meaning’ in question is, for Lacan, brought into being all at once by the paternal metaphor. In the act of prohibition, ‘a link is established between language and meaning (reality as socially constructed), between signifier and signified, that will never break’.
This Lacan’s famous point de caption, variously translated as an ‘anchoring point’, a ‘quilting point’ or ‘button tie’, which refers to that stitch used to secure a button that stops the fabric moving round in the stuffing of a piece of furniture. The efficacy of this stitch in no way depends upon the rigid structure of a particular piece of furniture, and likewise, the paternal metaphor ties meaning to specific words without regard to reality considered in itself, that is, free from particular acts through which, for each individual, language and meaning are stitched together. Without this stitch, everything will come apart – language as a structure cannot be assimilated.
This is precisely the problem the psychotic faces. He or she cannot create new metaphors, to new meanings using the same old words because of the failure of the paternal metaphor. But he or she can resort to neologisms – these are one of the signatures of psychosis, according to Lacan.
Here is an example (although free from the neologisms that characterise psychotic speech) from Roger, the patient examined in the case study Fink includes in this chapter:
Words frighten me. I’ve always wanted to write, but couldn’t manage to put a word on a thing … It was as though the words slipped off things … So I thought that by studying the dictionary from A to Z and writing down the words I didn’t know, I would possess them all and could say whatever I wanted.
4. A third diagnostic sign of psychosis can be found in the predominance of imaginary relations in the psychotic. Analysis will typically carry the patient through the stages of the imaginary, the symbolic and the real. For the neurotic, it will quickly become clear that it is the symbolic Other that is their concern – the function of authority played by parents and authority figures. Feelings of inadequacy or guilt refer to a conflict at the level of what Freud would call the superego of the patient and Lacan the ego-ideal, that is, the way the patient is seen by others.
The psychotic, by contrast, remains at the stage of the imaginary, feeling a rivalrous relation to others not in terms of attempting to gain approval from an authority figure, but as they threaten to usurp his or her place. Persecution is one example of a rivalrous relations, and is the chief characteristic of paranoia (one of the psychoses).
This is because the patient has not acquired the Symbolic relation to language. Lacan: ‘It is insofar as [the patient] has not acquired … the [symbolic] Other [language with its underlying structure] that he encounters the purely imaginary other. This other negates him, literally kills him’. Words, for the psychotic, are literally things and have real power.
(Here once again there is a strong overlap between the experience of the psychotic, as described by Lacan, and the literary writer. For doesn’t poetry also involve an encounter with words as things – not, that is, as they fulfil the efficient functioning of the symbolic realm, allowing the circulation of language and meaning, but as they allow words to force themselves into our attention in terms of their rhythmical properties, their sonorousness?
Words, for the poet, are also things – even as, at the same time, the poet is obligated to allow words to mean, to signify. And we should also note the way in which Deleuze and Guattari’s account of language as performative, as interacting within larger assemblages, as accomplish incorporeal changes in the world, function as ‘mots de ordre’, as slogans or watchwords as incorporating features of the psychotic experience of language.)
5. For Lacan, the body, in neurosis (the state most of us occupy), is overwritten and codified by the symbolic. The ‘real’ of the body as biological organism is socialised and domesticated; jouissance is only at play in the erogenous zones. In Lacan’s terms, the codified body is dead, libido being alive or real in the zones in question.
Libido, jouissance is channelled in a manner entirely different to that of the psychotic, for whom only the imaginary structures and hierarchises its drives. As such, jouissance can return in a massive and unpredictable manner, the patient speaking like Judge Schreber of the ‘voluptuousness’ of the body, of indescribable ecstasy, or even of shooting pains with no discernible physical cause. This invasion of jouissance is the fourth sign that may lead the analyst to diagnose psychosis.
The paternal function not only determines the relationship to language in the subject, but also his or her relationship to morality, to conscience. Typically, the neurotic exhibits strong egoic and superegoic control over his or her drives. Lacking that function is the fifth sign of the psychotic, who feels little guilt about injuring others. For guilt is always linked to repression, and that to the paternal function.
A sixth sign in the male patient is a certain feminisation. Some fathers exhibit an ‘unbridled authoritarianism’, feeling rivalrous with their sons. ‘The imaginary is way, the symbolic peace’, writes Fink very nicely. The symbolic order depends upon a kind of pact – the paternal function decrees ‘your mother is taken, but you can have another woman’, or ‘spend the morning doing homework, and in the afternoon you can go out to play’.
By contrast, the unbridled father, stuck in the imaginary, does not curb what he demands of the son and can never be satisfied. The father is the monster in relation to whom the son can only feel rivalrous. The Oedipal triangle cannot form, and the child assumes a feminine position in relation to the imaginary father. It is this feminine position which emerges in what Lacan calls a ‘psychotic break’, in the collapse of the patient’s imaginary identifications.
Feminisation in psychosis [Fink writes] thus seems to be indicative not of a total absence of a real father in the child’s family, but of the (at least occasional) presence of a father who established only an imaginary relationship with his son, not a symbolic one. Interestingly enough, the psychotic may also describe himself in a feminine or passive relation to language itself, passively submitting to it, invaded by it, or possessed by it.
Thus Schreber’s account of the voluptuousness of his body will be couched in terms of a felt feminisation.
6. For Lacan, human desire is a question that is formed in language. Over the course of therapy, the psychoanalytic ‘talking cure’ sees changes in the neurotic, who discards ideas that seemed formerly to be intrinsic to their character, giving up prior ego identifications and so on. With the psychotic, such changes cannot be seen; there is no movement in his or thoughts. The same phrases are reiterated. As Fink writes, ‘There is no properly human desire in psychosis. Where the structure of language is missing, desire too is missing’. The psychotic does not know repression, and hence questioning and wondering are entirely absent. Unconscious formations, for the psychotic, indicate nothing.
Fink discusses a case study of a psychotic, Roger, who has been attending sessions for 2 years. He brings his analyst a huge quantity of meticulously kept accounts of his dreams, which he types up and memorises (such productivity, Fink notes, is very common in the psychotic).
Roger is allowed to recite his dreams for a long time, the therapist keeping his writings. But one day, the therapist offers an interpretation of what he hears: when Roger recites a dream in which he is in a gilded cage ‘strewn with roses, watched by the therapist’, the therapist suggests this may be an image of what is currently happening; as Fink writes, ‘perhaps he sees the world as if from within a gilded cage where everything is rosy and he is admired by his doctor’.
This interpretation triggers what Lacan call a psychotic break: the patient has become shockingly aware that there is more to his dreams than pretty images he can write down and remember. What has happened? The therapist has become the Other to the psychotic patient, thereby taking on a symbolic role for a patient who lacks a relationship to the symbolic.
Until this point, his relationship to Roger was merely dyadic; now it has become triadic, with the introduction of an ‘outside’. What happens next? With a psychotic patient like Roger, there is no subject who can respond to the Other – no button tie through which meaning is established by way of the paternal metaphor.
Roger begins to attribute a menacing meaning to all kinds of things that, prior to the therapist’s intervention, had no such meaning. A hammer inadvertently left in the therapist’s waiting room is suddenly understood by Roger to imply that the therapist thinks Roger has ‘a screw loose’. A question on the cover of a journal in the therapist’s waiting room, ‘Are students crazy?’ (announcing an article on discontent among college students), leads Roger to believe that that question is aimed directly at him, and that it is intended specifically for him.
Roger is becoming delusional which, if given its head will lead to the fully fledged construction of what Lacan calls a ‘delusional metaphor’ – a point from which the psychotic might remake the world. This is exactly what happened with Schreber, whose complex cosmology grants him a stable world of meanings in which he can give himself a place. Here, the capacity of meaning-making runs amok – Schreber creates a world of meanings, it is true, but it is one that intersects only partially with the world of others around him.
Fortunately, in Roger’s case, the analyst is at hand to prevent that fully fledged delusional process that follows a psychotic break, in which the psychotic attempts to explain why he or she is here, why they were wanted and so on. The psychotic needs to do so because he or she lacks that answers to these questions, however provisional and shaky they are, that issue from the experience of the desire of one’s parents or caregivers.
‘[A]s subjects, we are born of our parents’ desire, not of their bodies’, writes Fink. As such, the psychotic cannot be said to have quite be born. Then it is the analyst who must find a place in which the psychotic can fit as part of a world of meaning without giving way to delusional activity. The analyst must encourage the meaning-making that is part of the ego, producing a sense of self in a patient who otherwise lacks it.
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