Abstract
In this brief, tightly reasoned work, Stijn Vanheule, Associate Professor of Psychology at the University of Ghent, Belgium, undertakes to show the unfolding of Jacques Lacan’s conceptions of psychosis over a fifty-year period. Lacan wrote and commented a great deal on the subject of psychosis, so the material is abundant, but for the most part his diverse contributions are poorly integrated and famously difficult to interpret. Yet for anyone interested in understanding and treating psychotic patients, Lacan offers original ideas that diverge from conventional psychoanalytic approaches (perhaps more than is the case for neurosis). Vanheule does not attempt to compare or evaluate theories but focuses on what he sees as four distinct stages of Lacan’s thinking about psychosis and the theoretical contexts of their development. His clear expository style displays an impressive command of Lacanian theory that will be instructive for anyone who wishes to grasp the difficult logic of Lacan’s project.
As a young psychiatrist in training at the Sainte-Anne Hospital in 1931, Lacan encountered his patient Aimée, who had stabbed a well-known actress in a jealous rage. This case became the focus of his doctoral thesis, which was subsequently published. Lacan emphasized both organic factors and major life events as leading to her illness, not an unusual approach at the time, but he also attempted to construct a third factor using psychoanalytic theory, which he was beginning to study at the Paris Institute. Lacan sought an explanation specific to psychosis beyond conventional assumptions about altered brain function or psychological mechanisms and found it in the nature of the psychotic subject and the relationship between self and other, ideas that frame Vanheule’s study. His hypothesis of unconscious identification as central to Aimée’s psychosis was elaborated over the ensuing period, during which Lacan developed his notions about the mirror stage and what he termed the imaginary register in human development. Although Lacan advanced many ideas about these matters, he did not offer much in the way of a guide to treatment, and this omission is perhaps a failing of his work. Vanheule attempts to remedy this in several sections, although more elaboration of a clinical approach would be helpful.
In the second period of his work, Lacan began to highlight the function of language and the symbolic realm. One cannot appreciate this turn in Lacanian thinking without understanding his position that it is the signifier, the use of language, that creates the subject; it is not that an ineffable subject uses language to express its relation to the world. From this perspective, the position of the subject is determined by discourse, by the forms of language that construct its speech. Vanheule is particularly strong in presenting and illustrating this conception. The linguistic turn led Lacan to reanalyze the Schreber case and to elaborate Freud’s version of foreclosure as the basic mechanism of psychosis. In the famous case of Senatspresident Schreber, Freud (1911) held it “incorrect to say that the perception which is suppressed internally is projected outwards; the truth is rather, as we now see, that what was abolished internally returns from without” (p. 71). Vanheule underlines Lacan’s criticism of the concept of projection, but may miss this debt to Freud. In any event, Lacan took Freud’s notion of verwerfung (retranslated by him as foreclosure) much further than Freud, linking it to a developmental failure of internalization of what he called the paternal metaphor as the basis of the symbolic order (the “paternal” referring to a symbolic structure of language and culture outside the mother-infant dyad). The paternal metaphor provides the subject access to signifiers that can be used to answer questions of meaning and identity, superseding the subject’s earliest efforts to define itself by imaginary fantasies. With foreclosure, this access to speech is impeded, leaving a “hole” (blocking, gaps, neologisms) in what can be articulated by the subject. What cannot be spoken by the subject then appears “from without” as delusions and hallucinations.
In his third phase, with the new concepts of the objet a and jouissance, Lacan took up the limits of the symbolic order in representing the real, especially the real of the body. To greatly oversimplify this point, the infant’s evolution from an initial state of immersion in the real to participation in the symbolic world brings about a speaking subject who carries retrospective fantasies of a return to a primal nirvana and reunion with a lost part of itself—the objet a—where it can partake of an unmediated enjoyment of the drives—jouissance. For the neurotic, who has access to language, the fantasy objet a is experienced as something desirable that can be sought in the external world of symbols. Something meaningful is there to be found. For the psychotic subject, however, because of foreclosure, the process of self-definition by signifiers is not available; the subject cannot use language to define itself in the social order and to pursue its desire there. The objet a as a remnant of separation is not experienced as a loss to be recaptured, but as something disturbing within the subject.
The final stage of Lacan’s development, according to Vanheule, addressed the interactions between the three orders of imaginary, symbolic, and real, which he saw as bound together by language in a form portrayed by a logic of knots. In this version, language is not only a symbolic structure but also a carrier of the real or of jouissance, which knots the three orders together. With foreclosure, language cannot serve this function, with a resulting confusion between real and symbolic, for example, in the case of auditory hallucinations. However, some other means of binding the three orders can be found or created, for which process Lacan invented the term sinthome, to designate another way of making meaning for the psychotic. An idiosyncratic solution of this type can stabilize a psychotic subject, as Lacan proposed in his interpretation of James Joyce. He went further by suggesting that there may be numerous versions of sinthomes even in apparently neurotic subjects, now blurring his earlier distinction between the two forms of subjectivity. One wishes that Lacan had been able to develop this aspect of meaning-making more fully in his theory.
Having participated in preliminary discussions with the author, I found his explication of the different facets of Lacanian theory both interesting in themselves and extremely helpful in understanding the nature of psychosis. Beyond this primary goal, The Subject of Psychosis may be the clearest and most rigorous analysis of Lacanian theory in print. While not proposing an etiology, the completed book offers a reassessment of traditional psychiatric thinking about psychotic persons that raises many fundamental questions. Its great strength is Vanheule’s demonstration of how language works to sustain the subject and the mechanisms of its failure in psychosis.