Seminar III – The Psychoses

1955 – 1956

Chapter II – The Meaning of Delusion

(All quotations refer to The Psychoses, The Seminar of Jacques Lacan, Edited by Jacques-Alain Miller, translated  with notes by Russell Grigg, Routledge: 1993)

The first few remarks in this session recap one of the main points that Lacan made in the introductory session of this seminar. He critiques the contemporary psychiatric understandings of psychosis by reaffirming that psychosis should not be viewed as a series of behavioural abnormalities. Psychiatry at the time he was speaking had failed to take us beyond a common understanding of psychosis as ‘madness’, he claims. He notes that writers such as Erasmus and Pascal had referred to madness behaviourally, even if in an effort to demonstrate how close normal behaviour is to madness. Lacan’s problem here is not so much that psychiatry has failed to recognise the closeness of madness and normality, but more that this behavioural conceptualisation of madness was carried forward uncritically into early psychiatric definitions. “What was then said in the language of philosophers, between philosophers, eventually ended up being taken seriously and literally”, he states (p.16). Taken on its own terms however, the effort to understand psychosis by looking for traits and patterns in the behaviour of the psychotic has not been able to delimit it clinically from ‘normality’ (to employ that label loosely). How can we term a type of behaviour, whether it be an emotive response or what we might think of now as ‘anti-social’, psychotic? Is it simply a matter of degree, and by what standards do we measure that degree? For Lacan this is all too flimsy a criteria for a conceptual distinction:

“It might be said that until Freud madness had been reduced to a number of modes of behaviour, of patterns, while others thought of judging everybody’s behaviour in this way. In the end the difference, pattern for pattern, isn’t obvious. The emphasis has never been fully placed where it would enable an image to be formed of what normal, or even understandable, conduct is and how properly paranoid conduct may be distinguished from it” (p.16-17).

Lacan later in this session tells his audience that there are many such false turns and assumptions made on the part of the psychiatrists of his time about the nature of paranoia, and that “If many of these episodes in the history of psychiatry are instructive, it’s perhaps more by virtue of the errors they bring into focus than by the positive contributions that supposedly result from them” (p.24). But Lacan levels particular criticism in his opening remarks at Kraepelin who, as we saw in the last chapter, is perhaps the major figure in the study of paranoia pre-Freud, and whose distinction between paranoia involving, on the one hand, systematised delusions, and dementia praecox (premature dementia) on the other, formed the backdrop to Freud’s interventions in the Schreber case. (As a curious side note, Kraepelin was also a student of Prof Paul Flechsig, the man who was both to become Schreber’s doctor, and tormentor in his delusions).

Lacan here is completely critical of Kraepelin’s conception of  paranoia, and mounts a line-by-line rebuttal of Kraepelin’s definition, found in his book Clinical Psychiatry. Here is that definition, according to Lacan’s French translation:

“’Paranoia is distinguished from the others because it is characterised by the gradual development of internal causes and according to a progressive evolution of a stable delusional system that is impossible to disturb and establishes itself with total preservation of clarity and order in thought, will, and action’” (p.17).

Lacan has three particular problems with this definition which we will summarise here. Firstly, “Its development isn’t gradual, there are always surges and phases” (p.17). Instead of developing gradually, Lacan believes we can identify a “fertile moment” (p.17), or series of fertile moments, accompanying the onset of a paranoid delusion. It is not a ‘gradual development’ or ‘progressive evolution’ but “an emotional element in the subject’s life, a life crisis that in fact does involve his external relationships” (p.17-18).

Secondly, rather than exhibiting a ‘progressive evolution of a stable delusional system that is impossible to disturb’ Lacan believes there to be a plasticity, a variation of the delusional construction that takes account of, or incorporates into the delusion, the changes in the subject’s external life and relations that take place during the paranoia. Indeed, from this perspective we can add that this part of Kraepelin’s definition hedges its bets. How can a delusion be ‘impossible to disturb’ but also ‘evolve’? In and of itself there seems to be something self-contradictory about Kraepelin’s definition.

Thirdly, although Lacan agrees that the delusion exhibits ‘clarity and order in thought, will, and action’ he says that we need to be precise about what clarity and order mean, and whether thought, will and action in psychosis is the same as what goes by that name for non-psychosis.

Lacan suggests that the problem we have in thinking about paranoia is perhaps due to “inadequate clinical sub-divisions” (p.18). He wants us to ask whether the work of dividing up and differentially cateogorising all the different phenomena we are met with as exhibited by paranoid subjects actually helps us understand the condition more. He gives as examples the sub-division made by psychiatrists Paul S érieux and Jean Capgras in their 1909 work Les Folies Raisonnantes: Le Délire d’Interprétation, between ‘litigious delusions’ (with an accusatory or argumentative character) and ‘interpretation delusions’. The latter are very close to the ‘meaning as such’ phenomenon that Lacan described in the previous chapter (p.9). In contrast to hallucinations, which for them are sensory delusions, interpretation delusions instead denote a process whereby the subject gives a personal significance to some minor or contingent event which then, in a whirlwind-like effect, draws other events or associations towards it to give them too this personal signification. Lacan also references de Clérambault, who makes a similar distinction between ‘interpretation delusions’ and what he calls ‘passional delusions’ in which jealousy and erotomania are prominent. Whilst Lacan does not challenge these sub-divisions themselves, he does seem to express his doubts that this method of sub-division is the right way to go about studying psychosis:

“Does this mean that the clinical types have to be distributed more widely, that we have in some way to break them up? I do not believe so. The problem that arises for us bears on the framework of paranoia as a whole…. Every time psychiatry has made a bit of progress, advanced slightly, it has also lost the ground it has won through its very manner of conceptualising what is immediately accessible to observation” (p.18-19).

Instead of making constant sub-divisions and reclassifications of psychoses into groups and sets, Lacan proposes an alternative route to conceptualisation by looking at what he labels ‘elementary phenomena’ of psychosis (a term he borrows from de Clérambault). These elementary phenomena can be thought of as the DNA of a delusional system in that they appear at the outset of a delusion but show us the structure the delusional formation will take as it develops over time. Therefore, if we look at these elementary phenomena it does not matter whether we are trying to study the whole of the delusion or one of its parts, because the same pattern will be reproduced throughout. As Lacan puts it, elementary phenomena are,

“… as elementary as a leaf is in relation to the plant, in which a certain detail can be seen of the way in which the veins overlap and insert into one another – there is something common to the whole plant that is reproduced in certain of the forms that make it up. Similarly, analogous structures can be found at the level of the composition, motivation and thematisation of a delusion and at the level of the elementary phenomenon. In other words, it’s always the same structuring force, as it were, at work in a delusion, whether it’s the whole or one of its parts that is under consideration” (p.19).

The delusion itself, he goes on to say, is an elementary phenomenon at a higher level, it “reproduces the same constitutive force”. The elementary phenomenon is coextensive with the structure of the delusion itself. The delusion is a spiraling outwards or upwards of the pattern drawn by the elementary phenomenon. Instead of looking to the behaviour of the paranoid subject in order to classify and correlate instances of psychosis, we should instead try to identify the phenomena that are elementary to it. However, despite his referring to “the source of this [delusional] structure” in this passage (p.19), it is not clear here whether he places the elementary phenomena at the onset of psychosis (incorporating signs that reveal early on a psychotic structure, such as the appearance of ‘meaning as such’); or rather as the kernel of the delusion, a kind of nucleus that the delusion crystallises around.

In any case, Lacan seems to conceive of the elementary phenomenon as something autonomous that is able to survive and reproduce itself independently of the rest of the delusion. If the delusion were to fail or be challenged in some way, even if it were to completely fall apart, the elementary phenomenon would survive to propagate a new delusion, perhaps with a different form, but in which would be displayed nevertheless the same core characteristics. As is sometimes the case with Lacan’s work, it is (perhaps deliberately so on his part) difficult to pin down a more precise meaning for what he is getting at in this section. But he does offer us an example of this effect that he finds in a 1908 paper by Abraham, ‘The Psycho-Sexual Differences between Hysteria and Dementia Praecox’, in which he appears to want to demonstrate this point about the survivability of the elementary phenomenon to propagate a new delusional system even in the case of the collapse of a subject’s affective universe, and the loss of all his object-attachments.

To fill in the details of this case where Lacan does not, Abraham relates the story of a child with an exceptionally (perhaps excessively) strong love for the mother and a corresponding affective dependence on her. However, Abraham notes that this turns into cold hostility the moment he is moved away from home at the age of thirteen. This he sees as a feature of dementia praecox – love reverses to hate very easily, and objects that once held great affective attachment are treated coldly. (Abraham’s paper can be found in his Selected Papers on Psychoanalysis, edited by Ernest Jones, Hogarth Press, 1948).

Far from challenging Abraham, Lacan elevates the case to axiomatic status, drawing our attention to the fact that when the subject experiences being torn from his mother he “… doesn’t pay the slightly bit of attention to what is going on, doesn’t raise the slightest protest before the general evacuation of the objects of his desires. He simply starts again, accumulating others. And that is dementia praecox” (p.20). However, in the next paragraph but one we find that Lacan referring to “These supposedly conclusive cases [which] are so completely ambiguous that one wonders how it’s possible to maintain the illusion for one second” (p.20), presumably referring to the case he has just cited. Because of this it remains unclear how Lacan wants us to view Abraham’s vignette.

From here however, Lacan reprises his warning against the dangers of understanding a case too readily, which we saw in the previous chapter (p.6, see commentary above). At this point in the seminar it may be a tactical move on Lacan’s part to encourage his audience to divest themselves of the psychiatric classifications with which he can justly assume they are familiar, and avoid inferring conclusions about psychosis generally from brief clinical vignettes like Abraham’s. Lacan tells his audience, a good number of which it can be expected would be trainees: “Start from the idea of a fundamental misunderstanding. This is an initial attitude, failing which there is really no reason why you should not understand anything and everything” (p.20). This echoes Freud’s advice to analysts in his 1912 paper on technique, ‘Recommendations to Physicians Practicing Psycho-Analysis’:

“… The most successful cases are those in which one proceeds, as it were, without any purpose in view, allows oneself to be taken by surprise by any new turn in them, and always meets them with an open mind, free from any presuppositions” (SE XXII, 114).

For Lacan, understanding (into which we can include the processes of dividing, classifying and describing that he inveighs against above) are at the root of the problems of conceptualising psychosis encountered by his psychiatric antecedents. “The difficulty of addressing the problem of paranoia arises precisely because it’s situated on the plane of understanding”, he says (p.20).

Returning to the example he employed in the previous session (p.10) of the psychotic subject’s reaction to a red car passing in the street, Lacan draws attention first to the enigmatic aspect that this experience presents for him, but also then the fact that the psychotic “symbolises what is happening in terms of meaning”, without regard to whether the meaning is good or bad (p.21). This is an example of the ‘meaning as such’ that emerges in the onset of psychosis. When Lacan says that “it’s precisely because it’s situated at the level of understanding as an incomprehensible phenomenon, as it were, that paranoia is so difficult for us to grasp and, also, of such great interest” (p.21) he is referring to the strangeness of the character of this delusion that will be apparent to anyone wanting to seek to understand it. Why the red car rather than some other element, we might ask. What meaning does the psychotic see in the red car? But the important point Lacan wants to impress on us is not what the psychotic sees sense in but the very attempt to make sense itself. A psychotic delusion is an attempt at sense-making. However, we must be very careful to not ourselves try to make sense of this making-sense! For the psychotic,

“It’s a question of things that in themselves already make themselves understood. And by virtue of this fact we ourselves feel that we are within reach of understanding. This is where the illusion starts to emerge –   since it’s a question of understanding, we understand. Well, no, precisely not” (p.21).

But Lacan does not stop there, and extends his exhortation against understanding to his students. His message here is simple: do not interpret by understanding. It is not necessary to understand – that is, to grasp or comprehend a sense or meaning – in order to proffer an interpretation. If your interpretation implies a ‘this is what the subject meant’  it has misfired.

“This is what the subject meant. How do you know? What is certain is that he didn’t say it. And in most cases, on hearing what he did say, it appears that at the very least a question mark could have been raised which alone would have been sufficient for the valid interpretation, or at least for the beginnings of it” (p.22).

From what we know of Lacan’s own practice (for example, the anecdotes told in Jean Allouch’s Les Impromptus de Lacan) he practiced what he preaches here. Rather than finding Lacan spelling out to the subject a ‘secret meaning’ to what they are telling him, instead he engages in tactics such as questioning what the analysand believes Lacan to understand to be obvious, or repeating back to the analysand an ambiguous phrase he has just used, or ending the session abruptly at that point. Lacan’s own interpretations do not demonstrate to his patients an understanding of what he has been told by them: very often he shows them that he is questioning the very way in which he is expected to understand it.

In place of understanding, what Lacan says we do find at the heart of a psychosis is a core that he describes as “inaccessible, inert, and stagnant with respect to any dialectic” (p.22). In spite of the way that a delusion changes over time, there remains a core belief or conviction that is not susceptible to any argumentation, inert to reasoning or probing as to its truth and which remains as a keystone in the subject’s life. It might be a delusional refrain that constantly repeated throughout his life, which whether communicated or remains private, is “closed to all dialectical composition” (p.22). We might think, for example, of the singleness of purpose displayed by some people we meet, perhaps a repeated preoccupation with a single goal or idea, which constantly reappears in their speech and appears to order their life in such a way that we might wonder of what function this element has in their ‘psychical economy’. Lacan takes as an example litigious delusion, in which “Litigation moves into the foreground so much that sometimes it seems completely to dominate his interest in what is at stake. Here also the dialectic comes to a halt” (p.22).

Lacan stresses this “dialectical dimension in the phenomenology of pathological experience” (p.23), and despite his insistence on a “dialectical inertia” (p.22) in psychosis he talks immediately after about “the autonomy as such of the dialectical dimension” (p.23) which he confusingly appears to extrapolate to all subjects, psychotic or not. As he puts it,

“The ever-present possibility of bringing desire, attachment, or even the most enduring manning of human activity back into question, the constant possibility of a sign’s being reversed as a function of the dialectical totality of the individual’s position, is such a common experience that it’s stupefying to see this dimension forgotten” (p.23).

So are we to understand that, although a dialectic is constitutive to human subjectivity, in psychosis we see this dialectic arrested or perhaps fixated on a single point? Perhaps this is why, as Lacan’s earlier critique of Kraepelin asserts, a delusion can be ‘dialectised’ in the sense of being integrated into what Lacan calls “the dialectical changeability of actions, desires, and values… characteristic of human behaviour” (p.23) – thus psychosis is demonstrably not a functional disorder, of intellect or reason, for example; however, we nonetheless find a kernel of sense-making that the psychotic constructs, a tight signification by which they can order their life, which remains “inaccessible, inert, and stagnant with respect to any dialectic” (p.22).

Before he goes on to make his first remarks on the Schreber case, Lacan adds a few comments about verbal hallucinations. What he tells his audience here is that these are not sensory disturbances, and points to a feature noticed by Séglas that subjects reporting verbal hallucinations could themselves be seen to utter the words that they hear, even if they were unaware of it and nevertheless experienced the hallucination as coming from outside. Is it not better to refer to these as psycho-motor hallucinations, rather than verbal hallucinations, he suggests. After all, your own voice is something you hear when you speak (although you may not always pay attention to it), not simply something that is only heard by your interlocutor. The psychotic in this instance appears however to be unaware of this, and perhaps it is by way of this observation that we should approach these phenomena.

In his first comments on the Schreber case Lacan gives a brief review of the chronology of the case. Stratchey breaks down this chronology helpfully in the Editor’s Note to Freud’s work in the Standard Edition (SE XII, 6-7) so for now it is only necessary to bear in mind that Schreber is admitted to an asylum three times, the longest admission being the second, from 1894 to 1902, the start of which is preceded by his appointment to the position of Presiding Judge of the Dresden Appeal Court. This was a prestigious post and Lacan recognises that Schreber was a relatively young man of 51 when he got it. This promotion “unhinged him slightly”, according to Lacan. “He found himself among men far more experienced… and for a month he overworked, as he himself says, and began to become disturbed” (p.25). Schreber’s Memoirs of my Nervous Illness are themselves written between 1900 and 1902 and published in 1903, the year after he succeeded in discharging himself from the asylum at Sonnenstein. Freud begins studying the Memoirs in either 1909 or 1910 and publishes his notes on the case in 1911.

Lacan begins his commentary on the case by looking at the open letter that Schreber writes to preface his Memoirs, addressed to Prof Paul Emil Flechsig, Professor of Psychiatry at the Leipzig asylum where Schreber is admitted in 1884 during his first illness, and to whom he returns to when he is remitted in 1893. Whilst the letter is not reproduced in the text of the seminar (and is too long to reproduce here) what is extraordinary about it, as Lacan notes, is the “courteous tone, the clarity and order” (p.26). In this particularly dense and striking letter Schreber is imploring Flechsig to read the Memoirs and substantiate Schreber’s account of his delusion, in which the figure of Flechsig holds the role of persecutor.

However, Schreber does not accuse Flechsig personally of being his tormentor – “In any case it is far from me to attack your honour, as indeed I do not harbour any personal grievance against any person”  – but rather that,

“…Certain nerves taken from your [Flechsig’s] nervous system became ‘tested souls’… and in this capacity achieved supernatural power by means of which they have for years exerted a damaging influence on me and still do to this day” (Schreber, Memoirs of my Nervous Illness, edited by Hunter and Macalpine, W.M Dawson & Sons, London: 1955, p.vii).

In Schreber’s delusion, the nerves of the body here are the seat of the human soul and contain impressions and memories made upon the body of the living individual, as Schreber describes in the opening page of the Memoirs. Without going over the details of this highly-developed and systematised delusion, we can just make the point that Schreber’s delusion does not consist of unreasoned ramblings. It is a clearly thought-out and carefully constructed theory which is internally consistent, and Lacan appreciates this fact, saying of it that, “All this is said with an air of likelihood that doesn’t render the theory unacceptable” (p.26).

Lacan also notes the fact that these nerves speak, utilising a particular language “akin to a highly vigorous German, with an extremely developed use of euphemism, that includes using the ambivalent power of words” (p.27). Language disturbances have been noted by many writers, not just Lacanians, as a key indicator of psychosis (perhaps even constitutive of it), with the prevalence of neologisms, stilted or precious language, fixed meanings and the ability to create or understand new metaphors all listed as features of the psychotic’s peculiar use of language. In Schreber’s case then, we can see these nerves (or more accurately Nervenanhang, nerve-contacts) as exhibiting just such linguistic disturbances, and perhaps indicating the particularity of the delusional structure. Lacan even (perhaps half-jokingly) notes the correspondence between the nature of the unconscious (as separate from the individual but speaking of him) and the function of Schreber’s nerves; and also the fact that Freud, at the end of the Schreber case, also draws a comparison to his libido theory of withdrawal of cathexes. This is probably not to be taken too seriously as these three theories – Lacan’s, Freud’s and Schreber’s – are very different from each other in their own rights, and Lacan’s choice of words when speaking about their similarities – “homogeneity”, “approximation” (p.27) – are rightfully cautious. It is nevertheless slightly amusing to find Freud asking his readers to bear in mind that he is not plaigiarising Schreber in psychoanalytic theory:

“I can nevertheless call a friend and fellow-specialist to witness that I had developed my theory of paranoia before I became acquainted with the content’s of Schreber’s book. It remains for the future to decide whether there is more delusion in my theory than I should like to admit, or whether there is more delusion in my theory than I should like to admit, or whether there is more truth in Schreber’s delusion than other people are as yet prepared to believe” (SE XII, 79).

A credit to the coherence and consistency of Schreber’s delusional productions, and a reminder that we should precisely not treat the Memoirs as the ramblings of a man not in control of his faculties. The value of an extended testimony by a psychotic of their delusion lies in the fact that, unlike the testimony of a neurotic, the truth is not hidden beneath a veil of repression but is “made well and truly explicit and virtually theorised” (p.28).  Indeed, Lacan wants to use Schreber’s writings and the commentary Freud provides on them “to extrapolate to all cases… a classification of paranoia to be recast on completely new foundations” (p.28).

By Owen Hewitson, LacanOnline.com

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