The Subject of Psychosis - On Psychoanalysis and with Lacan

Psy-Complex in Question: Critical Review In Psychology, Psychoanalysis And Social Theory - Ian Parker 2018

The Subject of Psychosis
On Psychoanalysis and with Lacan

Vanheule, S. (2011) The Subject of Psychosis: A Lacanian Perspective. London: Palgrave Macmillan.

Stijn Vanheule’s 2011 The Subject of Psychosis: A Lacanian Perspective (London: Palgrave) is an extraordinarily clear decomposition of Lacan’s trajectory from surrealist concerns with representations of madness to literary attempts to signifierise it. One might even say that it is excessively clear, and that we have opened up for us in the book a view of psychosis that is as ’open to the sky’ as it is for the psychotic who sees better than neurotics the unbearable nature of language and the place of the subject. At the same time it provides a viewpoint doomed to eventually loosen its ties with the ’scientific’ description Lacan at times promised, and arrives at a more ambiguous and enigmatic relation between reason and unreason, to something closer to the ’babbling practice’ that is psychoanalysis in Lacan’s characterisation of it in Seminar XXIV.

Vanheule organises his account around four ’eras’. Aimée’s self-punishment paranoia — the subject of Lacan’s 1932 doctoral thesis in psychiatry — is located in a first era in which the confusing, distressing doubling of positions of the ego and its other is grounded in imaginary identification, alienation in which ’self-knowledge is imported, and accidentally revealed at crucial moments in life’ (p. 26). The second era, and this takes up the bulk of the book, is ’the age of the signifier’ in which the foreclosure of the Name-of-the-Father operating as paternal metaphor means that the subject lacks ’an internalised compass of culturally and socially viable principles’ to comprehend the desire of the (m)other and relations with others (p. 61). The first era empties itself into this second most significant period of Lacan’s work, and the imaginary is now structured by the symbolic; the lack of ’internalised compass’ to navigate the symbolic and the forms of desire brought to life within it at times of crisis tempt retreat to the imaginary, and, better, the construction of a stabilising delusional metaphor. Delusion is a necessary space for this construction that is an attempt at cure, not a symptom of disorder. Vanheule explicates in detail the role of delusion in psychosis, of which those pertaining to the domain of the voice assume centre stage, and, in one of his almost unobtrusive interpretations of Lacan’s work, suggests that the result of ’an encounter with the black hole of foreclosure is that the Other goes mad’ (p. 114). An encounter with the prospect of paternity, for example, triggers a crisis of signification in which it is the Other of the subject that is indeed deranged, calling for a symbolic response that the subject is not in a position to provide.

In the 1960s there is a shift into what Vanheule calls the third era, one in which he needs to carefully reconstruct the scattered comments Lacan makes about psychosis to trace a logic which takes psychoanalysis to the limits of the symbolic and into the realm of jouissance, and into the realm of the real. It is here that the fate of the enunciating subject is tied to the success or failure of the extraction of the object of the jouissance of the Other from their own body. This deepening of Lacan’s analysis also entails a complication of the way in which the relation between inside — in which what Vanheule (p. 46) calls the ’emptity’ of the subject is a crucial motif carried forward from second era Lacan — and outside of the subject — the language they use — is understood (including the way that complication is managed by the psychotic subject); now, ’voice qua object a points to this immanence of the living being in speech’ (p. 135). We end up with the age of the knot, a fourth era in which Vanheule underscores the way that the more ’systemic’ (as he puts it) articulation of real, symbolic and imaginary in the Borromean rings — the knotting of them by the sinthome, in the writing of Joyce, for example — brings us to ’case-specific reflection on how R, S and I are organized’ (p. 165).

At some rare moments in the book an argument on which the transition from one era to the next is threaded is itself articulated, and this argument which leads us to take seriously the progressive re-knotting of Lacanian psychoanalysis is all the more compelling for being so understated. Not only does each era enable us to disentangle our practice from medical psychiatry — and Lacan’s reference to de Clérambault (cited by Vanheule early on in the book) as his ’only master in psychiatry’ can be read as sarcastic mock-deference and dismissal of that tradition — but also break with what Vanheule calls ’a deficit model of psychosis’ (p. 147), which eventually entails that ’the boundary between neurosis and psychosis should be thought of as fluid and not categorical’ (p. 164). In place of a pathologising life-sentence which psychiatry today constructs for those diagnosed as ’schizophrenic’, Vanheule invites us to treat Lacan’s work as providing ’parameters of reflection on how singular cases should be approached’ (p. 170).

If we are to treat the narrative of Vanheule’s book as a retroactively efficient account which loops its way around the history of psychiatry and psychoanalysis (and Lacanian psychoanalysis) and encourages us to question the solidity of historical categories that only temporarily (if usefully at times) anchored its practice, then we may also make use of these ’parameters of reflection’ to question how those categories operate today. The reinterpretation of all of this from within what may or may not be a fifth era which is also still Lacanian might take us to the point where we ask whether ’ordinary psychosis’ might come to function as an empty signifier which facilitates a more ’fluid’, less ’categorical’ way of working with each singular case (in which case the grip of psychiatry on psychoanalytic practice is finally loosened altogether) or whether it extends the grip of the signifier ’psychosis’ so that many more ’analysants’ (as Vanheule helpfully reminds us to call them) are effectively diagnosed by analysts unwittingly reproducing a normative psychiatrised symbolic mode of apprehension and subjection. There is a risk, for example, in treating the failure of symbolic elaboration by an analysant as a sign that they must therefore be ’psychotic’; then the old trope of lack of ’psychological-mindedness’ used in the British tradition of psychoanalytic psychotherapy to exclude patients from access to treatment becomes resignified such that the pathologisation of those who do not speak about their symptoms in the way we expect them to speak (so we are able to hear what they are saying as symbolically elaborated) is intensified.

When that happens we might indeed be right to say that the Other (us as Other to our analysants) has gone mad, and that there is, instead of the proliferation of forms of symbolic and variety of names-of-the-father that Vanheule describes as unfolding in the course of Lacan’s work, an enforcement of one kind of symbolic that the small community of Lacanian psychoanalysts share as their own peculiar delusory system. Different ’culturally and socially viable principles’ are today being elaborated in different subcultures that may serve as an ’internalised compass’ for their subjects (and we should here take note of Vanheule’s cautious respecification of the role of the paternal metaphor in more general non-familialist terms), and even if psychoanalysts find it difficult to comprehend how such a mechanism might suffice, they do at least need to acknowledge that there is much today that is spiralling outside the range of their own compass that guides them in a purely psychoanalytic mapping of all of the symbolic.

Different kinds of knotting, unknotting and re-knotting of the symbolic that we find in the later eras of our tradition of work bring us face to face with what Vanheule emphasises right at the beginning of his book, that we are concerned not so much with ’abstract ideas’ about psychosis but with ’how to orient oneself clinically with such patients’ (p. 13). This statement reframed by his argument by the end of the book allows us to see how our clinical orientation to those who are no longer viewed as always-already contained within one particular discrete psychiatric category as a kind of being takes place within quite contextually-specific domains of symbolic practice in which we inhabit particular symbolic positions constituting a space for those who come to us to speak, to speak.