The term psychosis was first introduced in the mid-19th century (Thomas, 2001) and this term was first used by the Austrian medical doctor Ernst von Feuchtersleben in 1845(Gaebel & Zielasek, 2015). The term “psychosis“ was soon used by others and the German psychiatrist Emil Kraepelin differentiated between ‘dementia praecox’ and ‘manic depression’ as the two forms of psychosis (Ebert & Bär, 2010). In 1924 Freud wrote that in psychosis the ego is dragged away from reality. Freud argued that the ego’s alienation from reality could cause psychosis. According to Freud psychotic episode happens when the individual is eclipsed; when, facing the frustration of the loss of an object (De Oliveira et al., 2015).
Psychosis is a heterogeneous psychiatric condition (Radua et al., 2018) composed of several symptoms and delusions, hallucinations, and thought disorder may be regarded as core clinical features (Gaebel & Zielasek, 2015). Psychotic illnesses are distinct, complex, multifactorial categorical conditions (Rosen et al., 2012). The American Psychiatric Association and the World Health Organization emphasize the presence of hallucinations without insight or delusions in their current definitions of psychosis. (Arciniegas, 2015).
The French psychoanalyst and psychiatrist Jacques Lacan formulated an original theory of psychosis, focusing on the subject and on the structuring role of language (Ribolsi et al., 2015). Lacanian studies on psychosis are based on psychoanalytic explanation. He used linguistics, mathematics and structuralism to explain the psychotic process. Lacan’s thesis “psychotic structure” discussed the psychodynamics in psychiatric ailments.
Lacanian psychoanalysis describes psychosis with a hypothetical structure (Vanheule, 2017). In Lacanian psychoanalysis psychosis continues to be an important focal point for new theoretical developments driven by clinical experience and Lacanian nosology has strong links to modern psychiatry (Redmond, 2013).
Human subjectivity is defined by language (Laufer & Santos, 2017). Lacan described the language phenomena in psychosis. Lacan refers to psychosis in terms of language based structures (Vanheule, 2011). For Lacan, when the subject enters the realm of language something is gained, a more or less coherent sense of self and mastery over the chaotic nature of the drive and the enigmatic relation to others (Meganck, 2017).
Lacan believed that the disturbance in language is central to psychosis. Especially the process of symbolization is affected in psychosis. The schizophrenic disorders are mainly associated with dysfunctions of the linguistic elaboration (Yoshino et al., 1995). An impairment of verbal communication is one of several diagnostic features of schizophrenia (Kuperberg, 2010). Schizophrenia is characterized by abnormal interpretation of verbal and non-verbal information (Ribolsi et al., 2015). The schizophrenic patients show impairments in semantic-syntactic integration processes and have difficulty to access to the long-term semantic-lexical memory (Covington et al, 2005).
In Lacanian perspective psychotic structure is characterized by a defense mechanism-rejection (Bazan, 2012). As Lacan believed in psychosis, the foreclosure of the signifier entails that the subject may encounter a hole in the symbolic at pivotal junctures in subjective experience. The rupture in the signifying chain occurs when the subject is unable to signify aspects of their existence along the axes of metonymy and metaphor. Problems with metonymy underlie many of the language disturbances encountered in psychosis such as “loose associations” and a break down in syntax (Redmond, 2013). As metaphor functions to designate the position of the subject in the signifying chain, which is intimately linked to the question of meaning and identity (Vanheule, 2011; Redmond, 2013). For Lacan psychosis is marked by the absence of a crucial metaphorization process (Ribolsi et al., 2015).
Lacan emphasized the Name-of-the-Father (nom du père) entail absence and repression. The Name-of-the-Father is associated with an array of functions linking the subject with the other; these include castration, symbolic identifications, desire, and the installation of the proper name (Redmond, 2013). According to Lacan the exact opposite of nom du père represents psychosis. In psychosis Name-of-the-Father is radically missing (Vanheule, 2017). Lacan believed that psychotics have not been properly separated from their mother. In addition distorted paternal metaphor signified psychosis.
Lacan elucidate that the failure of the paternal metaphor serves as the essential condition of psychosis. The paternal metaphor is what enables the child to understand the mother’s (or mothering figure’s) absence as an Oedipal separation (Razon et al., 2017). In psychosis the absence of the paternal metaphor implies that the subject is not named in relation to maternal desire (Vanheule , 2011). Hence the psycho navigational system is disrupted.
The concept of desire is central to Lacan’s theory and practice. As described by Lacan the desire of the mother is the founding desire of the whole structure and in the psychotic subject it is outside of the symbolization introduced by the paternal metaphor, therefore the knotting of records does not occur in an Oedipal way (De Battista, 2017). However Lacan considered Oedipus complex is important for characterizing the structure of psychopathology (Ribolsi et al., 2015). Furthermore Lacan, in his “return to Freud,” identifies language as essential to the dynamics of the Oedipus complex (De Waelhens & Ver Eecke, 2001). For Lacan psychosis was a drive-related problem creating a psychical reality (Vanheule, 2017).
Lacan further states that the position on the desire differs in neuroses, psychosis, and perversion. In the case of psychotic desire, Lacan has affirmed a fundamental relationship with the body (De Battista, 2017).
Lacan highlighted the concept of unitary psychosis. ‘Unitary psychosis’ is the collective name for a set of disparate doctrines whose common denominator is the view that there is only one form of psychosis and that its diverse clinical presentations can be explained in terms of endogenous and exogenous factors and it is characterized by the claim that there is only one fundamental mechanism underlying all non-organic psychosis (Berrios & Beer, 1994).
Lacan viewed paranoia as a major category of “functional psychosis” and indicated that paranoia was a qualitatively different disorder than schizophrenia (Lepoutre, et al., 2017). For Lacan paternal function paranoia continued to be the resistant nucleus” of psychosis. Lacanian model of psychosis underscore that in psychosis the unconscious is at the surface, conscious. In schizophrenia the unconscious has become conscious (Bazan, 2012).
According to Lacan’s theory of schizophrenia under certain conditions the signifying function breaks down, thus turning the schizophrenic individual’s world into one in which a number of events become enigmatic and signal him or her and the schizophrenic individual tries to deal with these signs that besiege him or her either by means of an interpretative attitude (a stable delusional mood) or by apathy(Dimitriadis, 2018). Consequently schizophrenia becomes a disorder of consciousness and self-experience.
Jacques Lacan proposed a conceptual framework for psychosis. Lacan’s ideas have profound impact on psychiatry. His extraordinary work on psychotic phenomena provides great insight to clinicians.
Ruwan M Jayatunge M.D.
Professor Stijn Vanheule – Ghent University-Belgium
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