Freud,Griesinger and Foville: the influence of the nineteenth-century psychiatric tradition in the Freudian concept of delusion as an ‘attempt at recovery’

Introduction

When Freud made his study of Dr Schreber’s (1903) Denkwürdigkeiten eines Nervenkranken, he proposed an understanding of psychosis as being a diachronic process. This was a process that had two consecutive stages: initially, a collapsing of the world, which was characteristic of the onset of psychosis; this was followed by a second phase, that of the ‘reconstruction of the world’ performed by delusion. Therefore, according to this view, the delusional construct did not result from an initial and deficient psychopathological phenomenon, but should on the contrary be assimilated to an ‘attempt at recovery’ produced by the subject in response to something that came before: ‘The delusional formation, which we take to be the pathological production, is in reality an attempt at recovery, a process of reconstruction’ (Freud, 1911/1958: 71).

This concept of a temporal evolution at work in the unfolding of psychopathology in psychosis can, in some respects, be seen as a continuation of the theories that were current in the classical psychiatry of the nineteenth century. In Germany, in 1865 Griesinger had, in his Traité des maladies mentales, theorized the existence of a chronological succession between two groups of symptoms, where the mental disorders were subsequent to a previous disorder of the affects (Griesinger, 1865: 246). In France, during the same period, Lasègue in 1852 proposed making a distinction between two phases: an initial phase of ‘undefinable malaise’, that would then be followed by the first elaborations of delusions of persecution. The move from the first to the second phase would operate, according to him, through a process of deductive reasoning: the strange impressions experienced by the patient, which were inexplicable from a rational point of view, would in a logical way be attributed to the intervention of ‘something external’ ¹ (Lasègue, 1852/1971: 13). Following Lasègue, Achille Foville (1871), in his Étude clinique de la folie avec prédominance des idées de grandeurs, applied to the study of delusions of grandeur a theory similar to that proposed by Lasègue in explaining the genesis of delusions of persecution. According to Foville, megalomania would come as a logical continuation from the delusion of persecution: delusions of grandeur were according to him ‘the only explanation that could account for previous persecutions, in the same way that the belief in persecutions was the logical explanation, according to the patients, for the hallucinations that they experienced’ (p. 347).

This theory of the existence of a rational logic at work in the process of delusion is, in reality, quite distinct from Freud’s definition of delusion as an ‘attempt at recovery’. Freud (1911/1958) had expressed his strong opposition to the logic of delusion advanced by classical psychiatry, by explicitly attacking Foville’s theory of logical deductions. Indeed, in the Freudian perspective it is not a mechanism of rational deduction that determines the move between the first and the second phase of psychosis: delusion cannot be seen as an operation of reason, since on the contrary it should be understood as a phenomenon regulated by drives and libidinal dynamics. Freud’s reflections on the temporal evolution of the psychotic process can in some ways appear to be a continuation of previous psychiatric work, such as Griesinger’s; but, in contrast, the theory of a libidinal aetiology for psychosis introduces a radical break from classical psychiatry. Furthermore, it could constitute the uniqueness of what psychoanalytical theory brings to the understanding of the psychopathology of psychosis.

We will now try to shed light on the influence of nineteenth-century work in the field of psychiatry on Freud’s ideas, as well as to pinpoint the particularities of the psychoanalytical understanding of delusion in comparison with psychiatric ideas in this domain. It is first necessary to go over the Freudian definition of the libidinal aetiology of psychosis, and the elaboration of the hypothesis for delusion as an ‘attempt at recovery’, within Freud’s corpus of work. After putting into context the theoretical framework within which Freud’s ideas on delusion emerged, we will discuss Griesinger’s theories relating to the temporal evolution of the psychotic process. This is in order to try and tease out their possible impact on Freud’s ideas. We will look at the emergence of the theory of logical deductions in French psychiatry, then go on to study the critique that Freud made of this theory in 1911.

The Freudian theory of a libidinal aetiology of psychosis, and a description of the two phases that occur in the psychotic process

In his first articles on the neuropsychoses of defence, Freud had put forward the hypothesis that the onset of psychosis is the result of a defence mechanism by which the ego rejects (verwift) a representation that it finds intolerable (Freud, 1894/1962). At the same time, he proposed a definition of paranoia as being a ‘psychosis of defence’, governed by a mechanism that differs from that of neurotic repression (Freud, 1896b/1962). However, in 1911 Freud formulated his central hypothesis for a libidinal aetiology of psychosis, without which the description of delusion as an ‘attempt at recovery’ cannot be conceived. Freud based his hypothesis on the analysis of the case of Dr Schreber, through a careful reading of Schreber’s (1903) Denkwürdigkeiten eines Nervenkranken. The study of this case of dementia paranoides (Freud was at that time using the Kraepelinian nosography) led him to clarify his definition of libido in the context of his opposition to Jung’s ideas on schizophrenia. These reflections then led Freud to the publication of one of his most important texts: ‘On Narcissism: An Introduction’ (Freud, 1914/1957), in which the distinction between ego-libido and object-libido is clearly defined. It was the introduction of the idea of narcissism, after studying the Schreber case, that led Freud to propose a description of the psychotic process as being regulated by the succession of two phases, in a twofold libidinal movement. The first phase of psychosis is described as the result of a significant withdrawal of libidinal cathexis from objects of the external world, the libido being redirected exclusively towards the ego and the subject’s own body. The peak of this first phase would, according to Freud, culminate in the ‘end of the world’ impression that overcame Schreber at that time, an impression that was accompanied by the certainty of the proximity of his own death. Schreber went so far as to hallucinate about the announcement of his death in the obituary section of a newspaper. According to Freud, this notion of universal catastrophe would be the projection of an internal catastrophe, the whole subjective world of the subject having come to an end due to the withdrawal of libidinal cathexis:

A world-catastrophe of this kind is not infrequent during the agitated stage in other cases of paranoia. If we base ourselves on our theory of libidinal cathexis, and if we follow the hint given by Schreber’s view of other people as being ‘cursory improvized men’, we shall not find it difficult to explain these catastrophes. The patient has withdrawn from the people in his environment and from the external world generally the libidinal cathexis which he has hitherto directed on them. Thus everything has become indifferent and irrelevant to him, . . . . The end of the world is the projection of his internal catastrophe; his subjective world has come to an end since his withdrawal of his love from it. (Freud, 1911/1958: 69–70)

It is therefore primarily within an economic perspective that Freud formulates this libidinal aetiology of the first phase of psychosis. In his essay on narcissism, Freud (1914/1957) develops a financial metaphor to describe the allocation of libido, referring to the cathexis as though it were capital one could dispose of, either by investing it in external objects or withdrawing it to re-appropriate one’s capital. Furthermore, he describes the redirecting of the libidinal cathexis towards the ego ‒ characteristic of the first phase of psychosis ‒ as a process of ‘secondary narcissism’. The logical supposition would then be that a primary narcissism had preceded it, before the libido had taken as its object people in the external world. Indeed, from a developmental point of view, there would first exist a ‘normal primary narcissism’, consisting in the unifying of the partial drives onto the ego: in the early stages of life, the newborn satisfies himself in an auto-erotic manner by stimulating his different erogenous zones, for instance when sucking his thumb to satisfy the oral drive. When these partial drives unite, it is the ego as a whole that becomes an object of love for the child, that is to say the object of libidinal cathexis. According to Freud, this happens before the psychic sexual energy can, in a second phase, be invested in objects in the external world, which will become the first objects of love and interest.

Thus, at the onset of psychosis, the quantity of libido habitually invested in objects of the external world finds itself, in the wake of an event that precipitates this withdrawal, suddenly directed away from these objects to flow onto the ego and the physical body of the subject. This phenomenon is illustrated in the Freudian metaphor of the communicating vessels, where one vessel contains the object-libido, and the other the ego-libido. The quantities contained within each vessel can only increase or diminish in strictly inverse proportions. According to this principle of the communicating vessels, the two extreme states of the libido are: on the one hand, the paroxysm of object-libido in the form of amorous passion, manifesting itself ‘when the subject seems to give up his own personality in favour of an object-cathexis’ (Freud, 1914/1957: 76); and on the other hand, the complete opposite, the peak of ego-libido that is ‘the paranoiac’s phantasy (or self-perception) of the ‘end of the world’ (p. 76). In the case of Dr Schreber, the withdrawal of the libido onto the ego in the phase of ‘secondary narcissism’ was characterized by a falling apart of his subjective world, by the enormity of the kinaesthetic hallucinations, and the hypochondriac themes that led him to the certainty of his imminent death ‒ or even of being already dead.

Freud argues that, when he attempted to test his theory of libido against the psychopathology of schizophrenia, the first thing that had caught his attention was the constancy of the presence of ‘delusions of grandeur’ among those patients, along with the fact that they ‘[divert] their interest from the external world – from people and things’ (p. 74). The megalomania, which Freud perceived as being quasi universal both in paranoia and in schizophrenia, could thus be the result of the ebb of libido onto the subject’s ego, which would then be ‘inflated’, and would create megalomaniacal ideas. Megalomania could thus become an initial way for the psychotic subject to give form to the massive quantity of libido that has suddenly emerged within the ego, in the wake of the collapse of the world. Aside from delusions of grandeur, Freud had also imagined another possible outcome for this libido. Certainly, the person with schizophrenia ‘seems really to have withdrawn his libido from people and things in the external world, without replacing them by others in phantasy’ (p. 74). However, there would still exist a possible outcome for this disinvestment, one that could operate in a second phase, and would consist in the substitution of a new objective reality for the one that had been disinvested: ‘When he does so replace them, the process seems to be a secondary one and to be part of an attempt at recovery, designed to lead the libido back to objects’ (p. 74, original italics).

The emergence of the hypothesis of delusion as an ‘attempt at recovery’

The definition of the initial phase of the psychotic process in ‘secondary narcissism’, in relation to a withdrawal of the object-libido cathexis, becomes an essential heuristic point for the understanding of the logic for the theory of delusion as an ‘attempt at recovery’. In the case of Dr Schreber, the moment of libidinal withdrawal culminated in an end-of-world phantasy, in which the universe would be completely devasted and depopulated, other humans being reduced to no more than ‘miracled up, cursorily improvized men’ (Freud, 1911/1958: 70). Freud argued that in a similar way, after having experienced this ‘end of world’ that consists of ‘this internal catastrophe; his subjective world has come to an end since his withdrawal of his love from it’ (p. 70) – that is to say, since he had withdrawn his libidinal cathexis from objects of the external world – Dr Schreber had performed a ‘reconstruction’ of the world through the process of delusional construct. So the function of delusion would be the second stage of the psychotic process, and would present a form of mending in relation to the former: having withdrawn his libidinal cathexis from the objects of the external world at the stage of secondary narcissistic withdrawal, the psychotic would then attempt to reinvest objects by means of his delusion. It is, in effect, a delusional external reality that he rebuilds, but from a purely libidinal point of view this does constitute an attempt at reinvesting in an objective world. Thus, it was through the commentary of this phase of reconstruction performed by Dr Schreber’s delusion, that Freud introduced for the first time his theory of delusion as an ‘attempt at recovery’:

… [the] paranoic builds it again, not more splendid, it is true, but at least so that he can once more live in it. He builds it up by the world of his delusions. The delusional formation, which we take to be the pathological product, is in reality an attempt at recovery, a process of reconstruction. (pp. 70–1)

After the withdrawal of investment from objects in the external world, delusion constitutes an attempt at rekindling a connection with others, to ‘recapture a relation, . . ., to the people and things in the world’ (p. 71). With delusions of persecution ‒ as is the case with Schreber in the initial phases of the delusional construct, where the fear of persecution is mainly focused on the person of Fleschig ‒ the relationship with the other is expressed through feelings of hostility, where previously, according to Freud, the feelings could be of sympathy and affection. If, during the first phase of the psychotic process, the withdrawal of object-libido is total, the second phase of delusional reconstruction makes it possible to re-find a connection with external objects, even if it is precarious and marked by hostility: ‘When he does so replace them, the process seems to be a secondary one and to be part of an attempt at recovery, designed to lead the libido back to objects’ (Freud, 1914/1957: 74).

The logic of delusion as being an ‘attempt at recovery’ should thus be understood within the framework of the libidinal dynamic which Freud had described as underlying the psychopathology of psychosis, and which involves a diachronic process governed by the succession of two phases. This formulation places the emphasis on the eminently temporal character of psychosis. The delusional construct unfolds in a progressive way, as Schreber’s memoirs bear witness, and can sometimes spread over an entire lifetime. Freud was therefore – in a gesture that was radically subversive in the eyes of classical psychiatry – breaking away from any concept of delusion as a deficiency. Indeed, the theory of delusion as an ‘attempt at recovery’ represents a major epistemological change, in that it proposes that the most blatant phenomenon of psychosis, the most manifest, the one that represents in the collective imagination the peak of unreason, is precisely the means by which the psychotic attempts to rekindle a connection with the external world and reality. Thus, as Paul-Laurent Assoun (2002: 13) writes, ‘where we believe we see the ultimate chasm of madness’, delusion would, on the contrary, be the last-ditch attempt to plug the breach that has torn the psychotic away from the external world. However, if this theory does condense all the singularity, subversiveness and originality of what Freudian theory brings to the clinical understanding of psychosis, it should be pointed out that the distinction made between the different phases within the psychotic process had already been described by previous psychiatrists. As Maleval (2011) points out, there did exist in French and German psychiatry of the second half of the nineteenth century a theory of the ‘evolutive logic’ of delusion, at a time when the interest of clinicians was mainly focused on the chronic and systematic forms of delusion.

A description of the temporal unfolding of the psychotic process in Griesinger’s nosography, and its influence on Freudian theory

In Germany, Wilhelm Griesinger was the first to theorize the existence of an evolutive logic in psychotic delusion. The idea of ‘unitary psychosis’ (Einheitspsychose) is generally attributed to Griesinger – although, as Géraud (2015) rightly points out, the term does not appear in Griesinger’s Die Pathologie und Therapie der psychischen Krankheiten (Griesinger, 1845; 1865: 246). Based on an essentially descriptive approach, Griesinger (1865) proposed making a distinction between two different categories of symptoms, creating a separation between ‘cognitive disorders’ and other disorders ‘of the affects’. Consequently, according to him, the clinical observation of the insane had enabled him to note that psychopathological phenomena could be divided into these ‘two large groups of fundamental states of psychic anomaly, which represent the two most essential differences of insanity’ (p. 246). In this way, he distinguished symptoms that belong to the sphere of affects from those characterized by an alteration of cognitive capacity and motivation – the latter leading in most instances to a weakening of the mental faculties. According to Griesinger, the first group generally came chronologically before the second in their expression: ‘observation shows us moreover that the states that make up the first group precede, in the great majority of cases, the states of the second group, and that the latter are normally only the consequence of the termination of the first’ (p. 247). Griesinger thus established not only a temporal succession but also a causal one between a primary disorder of sensations and the secondary formation of pathological ideas such as delusional constructs. This idea, based only on clinical observation, would nevertheless have important theoretical consequences, and a whole new way of understanding madness would follow. Griesinger maintained that, in the great variety of mental illnesses, there were ‘different phases’ of a single ‘morbid process’, which ‘on the whole follows a constant progression’ (p. 247) that could ultimately end in the complete destruction of psychic life. It is precisely the temporal logic of this process that he attempted to describe in his treatise on nosography: if hypochondria belonged in the group of ‘primitive mental anomalies’, all cases of chronic delusion, systematic insanity or partial dementia would belong to the group of secondary symptoms consecutive to the first initial disorder.

These ideas influenced Freud’s work in many areas, as can be seen from the numerous references to Griesinger’s work in Freud’s ‘The Interpretation of Dreams’ (1900/1953). Indeed, Griesinger had postulated that the higher psychotic functions developed from the more primitive ones – thus suggesting the existence of a continuity between animal modes of functioning and human ones; this was an almost Darwinian perspective, just four years before On the Origin of Species was published. In his preliminary reflections on the psychotic mode of functioning, which make up the introductory remarks of his Die Pathologie und Therapie der psychischen Krankheiten (Griesinger, 1865) and precede the development of his nosology, he proposed that the inaugural motion of the psychic development results from the transformation of the external stimuli received by perception into a motor action:

Psychic life, in man as well as in animals, begins in the sensory organs: it is a constant current that goes from the outside to the inside in perception, and from the inside to the outside in the organs of movement. The transformation of sensorial impressions into movement constitutes the general form of reflex actions, with or without sensory perception. (p. 28)

Thus, Griesinger began to formulate an understanding of the development of our psychic life using the reflex arc model. It should also be emphasized that Freud (1900/1953) later took this same model as his reference when he presented his famous diagram of perception. It represents how, between the excitation caused by the perception and the release of this excitation by means of motor movement, the different levels of inscription within the psychic apparatus follow on from each other.

Therefore, this diagram of perception is a continuation of the understanding of the psychical processes proposed by Griesinger, in so far as Freud thought that ‘Reflex processes remain the model of every psychical function’ (p. 538). Our psychic activity would originate from stimuli – internal or external excitations perceived by the sensory organs – to result finally in motor innervation. This proximity between developments found in Freud (1900/1953) and some of Griesinger’s concepts is far from fortuitous. As Lepoutre (2015) remarks, we can find, within the first chapter of ‘The Interpretation of Dreams’, ‘the Freudian avowal of a decisive indebtedness towards Griesinger’ (p. 21).

However, when Freud presented his theory of the two phases at work in the psychotic process, Griesinger’s theories were not mentioned. If the work of contemporary psychiatrists did influence Freud’s thinking, it is most likely that these influences were within the German psychiatric movement, and Griesinger remains a significant psychiatric reference within Freud’s corpus of work. Nevertheless, when Freud (1911/1958) raised the question of the evolution of delusions of persecution into megalomania, he appears to have taken French psychiatry as his reference. It seems appropriate therefore, to lay down some of the historical elements that relate to the emergence of the theory of logical deductions in the work of nineteenth-century French psychiatrists.

The emergence of the theory of logical deductions in the description of the evolution of systematized delusion in France

In France, Jean-Pierre Falret made the first attempts at distinguishing, along similar lines as Griesinger, three stages within the evolution of systematic delusion (Maleval, 2011: 30). In his treatise ‘Des maladies mentales et des asiles d’aliénés’, Falret (1864: 13) differentiated a period of incubation, a period of systematization, and a chronic period. Lasègue (1852) had singled out delusions of persecution as a distinct clinical entity. He described it as a two-phase process, with a first phase dominated by a sense of ‘undefinable malaise’, accompanied by the first interpretations and, occasionally, by the presence of auditory verbal hallucinations. In the second phase, the persecuted patient would attempt to implement deductive reasoning to try to understand the origin of his illness:

The transition is made through a reasoning that is always the same: the ailments I am experiencing are extraordinary; I have endured worse, but I could understand those, and I could more or less guess at their reason; here, I find myself in strange circumstances that pertain neither to my health nor to my position, that in no way relate to the environment in which I live: it must be that something external, something independent of myself is intervening; . . . only enemies can have any interest in causing me distress; I must therefore suspect hostile intentions in regard to these injurious sensations. (p. 13)

This is the first appearance in French psychiatry of the hypothesis of a rational deduction at work between the first and the second phases of psychosis. This rational deduction would be at the origin of the appearance of delusional ideas with a theme of persecution. To some extent, it would be a part of the insane person’s reason that had remained healthy and would lead him to conclude that the subjective distress experienced at the onset of psychosis could only be attributable to the intervention of an external force. Thus, with Lasègue’s ideas, there emerges in France the hypothesis of a purely logical deduction that would lead the insane patient to delusion. This theory, as we shall see, is far removed from Freud’s own position. According to Maleval (2011: 30), the description made by Lasègue of the two phases of delusions of persecution made a significant impact among the psychiatrists of the late nineteenth century, and was taken up, most notably, by Morel, Falret the younger, and Legrand de Saulle. However, in 1890 Valentin Magnan, by isolating a separate clinical entity under the designation of ‘chronic delusion with systematic evolution’, fully developed the theory of a universal uniformity in the progression of the delusional process. Magnan defined this new nosological entity in these words:

It is, for us, a clearly defined pathological type, whose evolution is remarkably systematic, which distinguishes itself as much by its onset as by the regularity of its progression, its invariable nature, which can be clearly differentiated from all other mental formations. Delusions of persecution, megalomania, are only stages, successive phases of the same illness. (1890/1998: 10)

The slow, but ‘methodical, regular and progressive’ (p. 29) unfolding that took place in the progression of delusion could, according to Magnan, spread over some 20, even 30, years; and the rate of this evolution could vary in different individuals. This is how he described the four stages of this process:

The first phase, or incubation phase, is characterized by delusions, delirious interpretations, and the constant and progressive anxiety of the patient. In the second phase, or persecution phase, the principal phenomena are represented by distressing hallucinations, especially auditory, generalized disturbances of the senses, and ideas of persecution. The third phase, or ambitious phase, presents hallucinations of an ambitious kind, generalized disturbances of the senses, and ambitious ideas. The fourth and final phase, is characterized by the decline of cognitive capacities: this is the dementia phase. (p. 29)

The hypothesis for an irreversible process, ultimately leading to a period of dementia, should be placed within the context of the theory of dementia, of which Magnan, in the wake of Morel, was one of the principal theoreticians. Within an evolutionist perspective strongly influenced by Darwin, Magnan considered that it was essentially heredity that determined mental illness, since it was attributable to the existence of a congenital defect, transmitted from generation to generation. From a phylogenetic point of view, the effects of degeneration worsen from one generation to the next, producing individuals whose physical and mental constitution is repeatedly reduced; this is also true from an ontogenetic perspective, at an individual level. Thus, at the end of the nineteenth century, the ideas of the French school on the evolutive logic of delusion developed from a standpoint far removed from the non-deficient concept of delusion introduced by Freud.

However, it should be pointed out that two years before the publication of Freud’s 1911 work on Schreber, Sérieux and Capgras (1909) in their book Les Folies raisonnantes picked up on the existence of the three first phases already identified by Falret, and then by Magnan; but they did not accept the theory of an evolution of delusion that would irrevocably tend towards a lessening of the intellect. Sérieux and Capgras identify a first ‘period of incubation’ or ‘elaboration’, a second phase of ‘systematization’ also called ‘period of state’; they argued that the evolution of the delusional interpretations ended with a ‘terminal period’ that would in no way equate with a period of dementia, but which should be understood as a stagnation of the delusional construct, where ‘the psychosis is attenuated, but does not disappear, under the influence of developing senility’ (1909/1982: 203). These authors observed the progressive appearance of ‘resignation’ among some delusional patients, and they thought that the final stage of Jean-Jacques Rousseau’s paranoia would be an example of the ‘resigned kind’ of delusion of interpretation (Capgras syndrome).

The Freudian critique of Foville’s theory of ‘logical deductions’

French psychiatry at the end of the nineteenth century was marked by a desire to understand the evolution of systematic forms of chronic delusion, as obeying an implacable and rigorous logic, and unfolding in a methodical and regular way. This also applied to delusions of persecution described by Lasègue, chronic delusion with systematic evolution, and Sérieux and Capgras’s delusion of interpretation. The theories proposed by the different psychiatrists we have mentioned can appear to be slightly rigid, in so far as the argument for a universal character, applicable to the succession of different phases of illness, would make the evolution of illness entirely predictable. Through this description of clinical pictures, classical psychiatry introduced, at the very heart of madness, the idea of the existence of a kind of rationality, like a Hegelian ‘ploy of reason’, at work even in the purest expression of unreason. However, this theory of a rational logic that would govern the delusional process was quite different from the definition of delusion as an ‘attempt at healing’, as understood by Freud. For, as we have seen, from the Freudian point of view the two phases of the psychotic process are to be understood first and foremost as belonging to a libidinal dynamic. Freud had himself explicitly stated his opposition to the logic of delusion supported by classical psychiatry, and attacked Foville’s theory of logical deductions, according to which megalomania would be a logical consequence of delusions of persecution. Foville’s theory was in some respects the continuation of that put forward by Lasègue. This theory argued that the move between the first phase of ‘undefined malaise’ and the elaboration of the first ideas of persecution would occur through an operation of deductive reasoning, which would ‘always be the same’; the strange impressions experienced by the patient, inexplicable from a rational point of view, would in a logical way be attributed to the intervention of ‘something external’ (Lasègue, 1852/1971: 13). Freud, in attacking Foville’s theory, seemed, to some extent, to be targeting all the rationalist perspective of a logical deduction at work in the progression of delusion. In his Étude Clinique de la folie avec prédominance des idées de grandeurs, which received the Académie de médecine prize in 1869, Foville (1871) had applied to the study of delusions of grandeur an understanding analogous to that which Lasègue had proposed for understanding the genesis of delusions of persecution. Megalomania was, according to Foville, the logical outcome deduced from delusions of persecution:

… these ideas of grandeur present themselves as being the only explanation that can make sense of previous persecutions, in the same way as the belief in persecutions had been the logical explanation, according to the patients, for the hallucinations they had experienced. (p. 347)

Foville, demonstrating a certain degree of clinical finesse, continued with a description of the reasoning that might lead the insane patient from the delusion of persecution to delusions of grandeur:

Having suffered for a more or less extended period of time from their hallucinations, after having attributed them to unknown enemies or having satisfied themselves by explaining them with a more or less obscure or marvellous word, some . . . tell themselves: phenomena of this kind cannot occur, in the society in which we live, without the intervention of the most powerful and high ranking personages; only they have at their disposal the necessary authority to provoke such effects; consequently, only they are the instigators of our torments. Others, on the contrary, observing that ultimately they never entirely succumb to the dangers that surround them, thus conclude that they have hidden, all powerful friends, who protect them . . . . Struck by how little correlation exists between their modest social position and the power their enemies must have at their disposal in order to reach them despite everything, and between the self-effacing role they play in the world and the imperious motivation that alone can explain the relentlessness with which they are pursued, some of these patients end up questioning if they really are as unimportant as they seem . . . . For them to be pursued as they are, there must, they tell themselves, be a reason; and if there is such a great reason for catching them, it is that they have offended some rich and powerful personage; it is that they themselves have a right to some wealth and power of which they have been fraudulently deprived; it is that they come from a higher rank from which more or less mysterious circumstances have pushed them aside; it is that the people they believed were their parents are not their true parents; it is that they themselves belong in reality to a noble family, most often of royal lineage. (pp. 345–6)

It is precisely this theory of logical deductions that Freud argued against when he became interested in the evolution of megalomania in his study of Dr Schreber. He levelled his criticism at the ‘rationalization’ operating in the psychiatrists’ considerations. As already discussed, the Freudian description of the psychotic process is based on a libidinal dynamic, pertaining to affects and not to reason. Freud laid down his argument against the classical theory in these terms:

In textbooks of psychiatry we frequently come across statements to the effect that megalomania can develop out of delusions of persecution. The process is supposed to be as follows: the patient is primarily the victim of a delusion that he is being persecuted by powers of the greatest might. He then feels a need to account to himself for this, and in that way hits on the idea that he himself is a very exalted personage and worthy of such persecution. The development of megalomania is thus attributed by the textbooks to a process which (borrowing a useful word from Ernest Jones) we may describe as ‘rationalization’. But to ascribe such important affective consequences to a rationalization is, as it seems to us, an entirely un-psychological processing; and we would consequently draw a sharp distinction between our opinion and the one which we have quoted from the textbooks. (Freud, 1911/1958: 48–9)

Thus, in the wake of the libido’s withdrawal onto the ego, the reinvestment in the object that takes place in the second phase of the delusional reconstruction could in no way be interpreted as conscious reasoning, operating through logical deductions, based on the premise of kinetic hallucinations, and other physical phenomena. Anything more than megalomania could not be deducible from delusions of persecution. With this critique, Freud emphasized that his ideas should not be grouped together with all the rationalist theories of the classical psychiatrists. What he proposed was to describe the process at work in the diachronic unfolding of psychosis in libidinal and economical terms, thus placing them at the level of affects, and not in the realm of the intellect. As Maleval (2011) points out, ‘Freud differentiated himself from the paucity of the psychiatrists’ psychology, which centred around the work of reason’ (p. 45), fundamentally disregarding all the phantasmatic dimension. If a certain ‘logic’ of delusion can exist according to Freudian thinking, it would not be a logic of reason but, on the contrary, a logic of the drive, stemming from an essentially libidinal dynamic. We can add that, if the case of Dr Schreber and the introduction of narcissism gave Freud the opportunity to complete his understanding of a libidinal aetiology for psychosis, the emphasis placed on the affect aspect of delusion was present in his first formulations of the neuropsychosis of defence. Thus, in ‘Draft K’, Freud had already argued that patients ‘love their delusions as they love themselves’ (Freud, 1896a/1966: 212) and, resting the foundations of the delusional belief on this affective impulse, the ‘resistance with which the patient clings to his disease’ (Freud, 1905/1953: 261) can thus appear proportionate to this investment of sexual energy.

Conclusion

A number of nineteenth-century psychiatrists had already perceived the importance of the diachronic aspect of the psychotic process, and tried to highlight the temporal evolution at work in systematic forms of chronic delusion. In Germany, Griesinger had been the first to conceive of the existence of a chronological succession between two groups of symptoms, where cognitive disorders – such as delusional ideas – would be subsequent to the initial disorders of the affects. In France, some psychiatrists such as Foville, Magnan, Sérieux and Capgras sought – on the basis of the previous writings of Lasègue on delusions of persecution – to understand the evolution of systematic chronic delusion as obeying a rigorous and implacable logic. This logic would see a succession, over time, of different phases in the illness, following a methodical and regular progression.

In 1911, on the basis of his study of Dr Schreber’s (1903) memoirs, Freud proposed an understanding of psychosis as being a twofold process, where delusion would constitute and attempt at ‘rebuilding the world’ in response to the falling apart of the world that had taken place beforehand; he was thus positioning himself within a diachronic approach to the psychotic process by highlighting its eminently temporal character. On this point then, Freudian developments in the area of psychosis can appear to be a continuation of the theories of the nineteenth-century psychiatrists. However, the Freudian understanding of delusion as an ‘attempt at recovery’ cannot be understood independently of the theory of a libidinal aetiology of psychosis, and so it does signal a clear break from the concepts of the psychiatrists of his time. It is true that they had already observed the existence of a temporal evolution operating within the psychotic process. However, the psychiatric theory of a rational logic at work in psychosis introduced the idea of a rationality that governed the evolution of the psychotic process, making its progression methodical and regular, and thus, a fortiori, predictable. This was a theory of a rational logic that operated through deductive reasoning: megalomania would be logically deduced from persecution, which itself would have been deduced from a first phase of ‘undefinable malaise’.

Now, by explicitly attacking the psychiatric theory of a ‘rationale’ at work in delusional constructs, Freud (1911/1958) underlined that, on the contrary and in his opinion, they should be understood as being essentially determined by economic and libidinal dynamics; he was therefore placing them on the level of affects, and not of the intellect. Thus, Freud’s ‘logic of the drive’ was in opposition to the logic of reason defended by the psychiatrists, and he stressed that he was drawing ‘a sharp distinction between our opinion and the one which we have quoted from the textbooks’ (p. 49). Through this conception of the psychotic process as being governed by a dynamic of the libidinal drive, the psychoanalytic approach is differentiated from the position held by the nineteenth-century psychiatrists on the evolution of psychosis. Furthermore, the psychiatric theory of a rational deductive logic that would oversee the delusional construct entails accepting the existence of a ‘consecutive and constant progression’ (Griesinger, 1865: 247). This could confer on the psychotic process a universal, and thus predictable, evolution; logical deduction – which is dependent on the realms of reason, a faculty common to all humans – does imply understanding the evolution of psychosis as dependent on a progression that is ‘methodical, regular and gradual’ (Magnan, 1890/1998: 29). Now, the Freudian refusal of the rationalist perspective, in favour of the description of a libidinal drive at work in the delusional construct, means that there is no possibility of universalizing the progression of the psychotic process. If the theory of a deductive logic could guarantee a degree of universality in the evolution of psychosis, placing the delusional construct under the guidance of a mechanism belonging not to the realms of reason but to that of the affects gives the process a singular character – and is thus not open to generalization. The delusional construct then becomes, from the Freudian perspective, the locus of the psychotic patient’s subjective expression in all its singularity, something that confers on the delusional construct a character that is not open to generalization, thus rendering the evolution of psychosis absolutely unpredictable.