The Subject of Psychosis: A Lacanian Perspective

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Synthesising ideas from Lacan's entire oeuvre, this book, now in paperback, sheds light on the evolution of his theory and provides a valuable tool for students and scholars. He is the author of multiple papers on Lacanian and Freudian psychoanalysis, psychoanalytic research into psychopathology, and clinical psychodiagnostics. Our customers have not yet reviewed this title. Be the first add your own review for this title.

The Subject of Psychosis: A Lacanian Perspective by Stijn Vanheule

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Jung and Analytical Psychology. Selected Fiction, Biography and Memoir. The Subject of Psychosis: Lacanian Psychoanalysis Catalogue No: Moreover, identity formation as such is hampered as well , p. He argues that actualpathology is characterized by anxiety equivalents, rather than formations of the unconscious, as the attachment figure has failed to produce sufficient signifiers for the subject to modulate body arousal Verhaeghe, Verhaeghe contends that a developmental paradigm is required to conceptualize the transformation of drive tensions into a representation psychical form.

He asserts that ideas about metallization, particularly those of Fonagy et al. Thus, the primary mechanism informing his theory of actualpathology, which aims to explain how endogenous drive arousal becomes excessive to the point of traumatism, is based on a failure in the mirroring relation between the subject and the Other. Verhaeghe's theory of actualpathology then is based on the idea of deviant mirroring styles identified by researchers in psychoanalytic attachment theory. He claims that the disturbances to the mirroring relation outlined by Fonagy et al. This claim is derived from Fonagy et al.

As he believes that deviant mirroring styles constitutes the mechanism underlying certain symptom constellations in psychosis then it will be useful to provide a brief outline of how these ideas inform his work. According to Fonagy et al. They claim that deficits in metallization correlate with affect regulation disturbances: Mentalisation refers to preconscious and conscious representation capacities utilised in negotiating inter-subjective relations and for the regulation of affect.

Mentalisation is linked with the development of a sense of self; the capacity to attribute intentional states, beliefs, goals, desires and emotions to the self and the other, is also a developmental achievement, and it is the emergence of these capacities that correlates with the capacity for affect regulation. Affect disregulation occurs when an individual is unable to modulate emotions through self-soothing: Bateman and Fonagy claim that there are at least two types of deviant mirroring styles and both have potentially traumatizing effects:.

Mirroring would be expected to fail if it is either too close to the infant's experience or too remote from it. If the mirroring is too accurate, the perception itself can become a source of fear, and loses its symbolic potential. If it is absent, not readily forthcoming, or contaminated with the mother's own preoccupation, the process of self-development is profoundly compromised , p. In the first example, where the parent's mirroring is analogous with the infant's affect, the mirroring is too realistic due to a high degree of similarity. There are several consequences to this. First, the infant may identify with the caregiver's emotional disregulation; consequently, the infant's consistent exposure to the caregiver's negative affect is both alienating and disorganizing.

Anchoring refers to the associational link between secondary representations and the primary affect; here, a deficiency of self-perception will emerge in conjunction with an affect regulation disturbance. Third, negative affect will be externalized onto the other. Finally, realistic mirroring in an unmarked form escalates the infant's negative affect leading to traumatism: In contrast, in the second form of deviant mirroring, where the mirroring is absent, there is a lack of category congruence between the affect and its secondary representation.

In this instance, the mirroring performed by the caregiver is too dissimilar from the infant's primary affect state. There is marked, but inaccurate, mirroring of infant's primary affective state. Mirroring is partially effective; the infant develops secondary representations anchored to the primary affect state. However, these representations are incongruent with the affect; therefore, a distorted sense of the affect states may ensue He claims that psychosis, particularly cases featuring body phenomena without hallucinations and delusions, is characterized as the Other's failure to modulate the subject's drive.

In Verhaeghe's description of this failure, it is clear that Fonagy et al. This is significant for his approach to the treatment of psychosis because Verhaeghe believes the failure of Other to adequately modulate the subject's drive will be repeated in the transference; in actualpathology the transference will likely be characterized by rejection, guilt, appeal and refusal in the subject's relation with the Other , For Verhaeghe, the failure of the Other to adequately mirror and hence modulate the subject's drive tension produces a structural trauma in the formation of the psyche.

Actualpathology has been characterized as that group of disorders where the subject remains stuck in primary development: As a result, the initial un pleasure and anxiety, together with their somatic anxiety equivalents, persist in an unelaborated form. The resulting disorders center on somatization and anxiety, accompanied by reactive avoidance behavior. No processing occurs in the representational order, hence the absence of a fundamental fantasy and symptoms , pp. When discussing actualpathology in psychosis, Verhaeghe claims that endogenous drive tensions make a demand on the subject and the only way to respond is through anxious preoccupation.

However, in his synthesis of actualpathology and psychosis, anxiety equivalents are the focal point of his discussion of body phenomena. In actualpathology in psychosis, the clinical presentation is often characterized by hypochondriacal phenomena and panic disorder; secondary symptoms such as hallucinations and delusions may be altogether absent. For Verhaeghe, hypochondriacal complaints and intrusive body phenomena indicate that drive arousal has not been psychically represented.

He claims that hypochondriasis emerges from the impossibility of psychically representing somatic drive arousal; in a psychotic structure, the failure of the Other to adequately modulate the subject's drive tension governs the emergence of body phenomena such as hypochondriacal symptoms. In actualpathology, there is no substitution by signifiers and no symbolization; thus, the development of a symptom articulated via a chain of signifiers is not evident and the disturbance remains in the form of an anxiety equivalent.

He then advances the idea that the stabilization of disorganizing body phenomenon in schizophrenia is best achieved via the construction of a delusion; this engenders a level of psychical organization that uses secondary defenses and a network of signifiers to bind drive tensions in the form of a delusional construction. In actualpathologies, the primary aim of the treatment is the restoration or even the installation of the primary relation between the subject and the Other through the therapeutic relation.

It is this that will enable the subject to build up a secondary elaboration and, through the transferential relation, embed the original body arousal into signifiers, enabling symptoms to be constructed. To put it correctly, one must begin with an exploration of the original relation between the subject and the Other with emphasis on separation anxiety and on the remaining signifiers that is, the minimal original inscriptions of the somatic in the Symbolic-Imaginary order.

Rather than subject analysis, the therapeutic goal here is subject amplification , p. He advocates that one treats anxiety equivalents encountered in actualpathology by the elaboration of a delusional construction in therapy. Disturbances encountered in actualpathology are anxiety equivalents not substitutive symptom formations; for Verhaeghe , to interpret actualpathological phenomena as meaningful, which supposes a metaphorical structure, is technically incorrect and is likely to induce guilt in the subject.

Here, the treatment aim of developing secondary representational processes requires specific techniques irreducible to interpretations. He claims that the first step is the installation of a primary relation between the subject and the Other in the context of a secure relation with the Other; the therapeutic relationship becomes the foundation for building the secondary representational processes required to manage drive arousal that was hitherto experienced as overwhelming.

The provision of a secure relation with the Other in transference relation is the first logical step in the movement toward secondary processing of the drive. However, as the subject's relation to the Other in the actualpathological position is characterized by a failure to modulate drive tensions, the therapist's intervention will likely be experienced as failure, as never being good enough; in essence, a testimony to the historical rejection from the Other that will be necessarily repeated in the transference.

According to Verhaeghe , therapeutic engagement with psychosis in the actualpathological position necessitates alterations to classical analytic technique. The recapitulation of developmental history has important consequences for the role that constructions have in the direction of the treatment; constructions emerge through the mirroring and naming function that the therapist assumes due to the subject's experience of developmental failure with the Other. This recapitulates Fonagy's idea of attuned mirroring linking affect with signifiers evident in the secure attachment system between parent and infant.

In psychosis, the construction of a delusion entails a distinct shift in the processing of anxiety: Although delusional systems can be persecutory, over time the subject's active role in producing a delusional construction will have a stabilizing function For Verhaeghe, the delusion is not only a form of recovery, but also, an indication for the direction of treatment in cases of actualpathology and psychosis.

Moreover, once the delusional system has evolved to a point of relative stability, the invasive jouissance becomes contained and encapsulated in delusions that are discrete formations that do not dominate the subject's life entirely. The emergence of symptom formations from the actualpathological position entails the progressive development and stabilization of a delusional system. However, there are a series of problems with his account. In Verhaeghe's theory of psychosis there appear to be difficulties distinguishing between the effects of foreclosure from the Other's failure to modulate the subject's drive tension.

For example, in hypochondriasis where body phenomena are predominant, the impossibility of representing drive arousal with the signifier could be an effect of foreclosure, rather than the difficulty in modulating the drive. This is because in Lacan's theory of psychosis ; , the mechanism of foreclosure is linked to disturbances to phallic signification; although such disturbances have diverging manifestations, one important feature is the subject's inability to represent that is, to signify, fundamental elements of experience such as sexuality and embodiment Sauvagnat, ; Vanheule, Thus, although he correctly claims that as the psychotic subject does not have access to phallic signification, the psychotic has a significantly different experience of the body and jouissance when compared to the neurotic: Consequently, it is difficult to separate the mechanism of deviant mirroring from the foreclosure of the Name-of-the-Father in his explanation of the failure of the Other to modulate the subject's drive.

Hence, the inclusion of deviant mirroring styles to explain mild psychosis remains to be clarified due to the under-developed theorization of foreclosure and deviant mirroring styles. Following from this emphasis on the failure of the other to modulate the subject's drive, his description of endogenous drive arousal in psychosis focuses extensively on anxiety.

As a consequence, the effects of foreclosure on the subject are minimized. Thus, the central problem in psychosis as articulated in Lacanian theory—the difficulty in regulating jouissance due to foreclosure of the Name-of-the-Father—is in Verhaeghe's account, shifted primarily to anxiety. Although anxiety in psychosis is of importance Sauvagnat, , the primacy of symbolic foreclosure, and its clinical effects, should be paramount; that is to say, anxiety in psychosis should be oriented to foreclosure and difficulties in regulating jouissance. For example, in hypochondriasis, although anxiety is clearly evident, the more pertinent issue concerns the subject's inability to regulate invasive jouissance due to the absence of the signifier, the Name-of-the-Father.

Hence, the feeling of perplexity that so often accompanies hypochondriacal phenomena Sauvagnat, ; Porcheret et al. This is a significant issue because in Lacan's theory of psychosis a complex array of clinical phenomena may emerge as a consequence of the foreclosure of the Name-of-the-Father Miller, , and, in following Freud's thesis concerning loss and restitution in psychosis, psychotic phenomena need to be oriented to the question of onset and stabilization.

Verhaeghe does not adequately discuss in detail the three distinct theories of stabilization in Lacan's theory of psychosis. Stabilization in psychosis is pivotal to Lacan's work and he approaches this issue from at least three separate angles: Moreover, his claim that the theory of sinthome is virtually equivalent to the construction of a successful symptom in neurosis is also opaque: Finally, another problem in Verhaeghe's theory of actualpathology is that he adopts the position that the construction of a delusion is the only method to stabilize a subject after the onset of psychosis.

Thus, he privileges the construction of a delusion as the modus operandi of stabilization and doubts that other forms of stabilization in psychosis are possible post onset. He states that the aim of treatment in psychosis is the construction of a systematized delusion:. The psychotic subject doesn't have the luxury of a conventional language and hence of a conventional, shared solution for the real.

This is why the psychotic must create a private solution, namely, a delusion. That this delusion is the psychotic's solution—perhaps even the only possible one—has not been recognized in today's approaches Verhaeghe, , p. On the one hand, he is right to state that the delusion, as a form of recovery, has not been sufficiently recognized in contemporary psychiatric theories of psychosis.

His theory of stabilization in psychosis aims to transform the body phenomena, often encountered in schizophrenia, into paranoia. Hence, his theory does not develop anything new in terms of understanding the different mechanisms of stabilization in psychosis. I now focus on the field of ordinary psychosis and show how this approach to psychosis addresses some of the limitations evident in Verhaeghe's theory of psychosis.

The term, coined by Miller, was first used during a series of conferences at Angers, Arcachon, and Antibes Laurent, Moreover, the mechanisms of repression and foreclosure underlying Lacan's theory of psychic structure in neurosis and psychosis were also difficult to deduce from the clinical picture Svolos, Taking psychosis as an example, cases were presented where the clinical picture did not match with the classical symptoms of schizophrenia cognitive and corporeal disorganization, hallucinations, and language disturbances or of paranoia delusions.

In addition, although some cases were suggestive of psychosis, the absence of a clear onset of symptoms—a phenomena described by Lacan and an idea that gained traction in the way clinicians think about psychosis—created additional uncertainty. As the meetings continued it became clear that these rare cases were more common than first thought; clinicians realized that difficult to classify cases were being seen on a regular basis.

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Miller's theorization of ordinary psychosis emerges from this context. Miller's comments on ordinary psychosis focuses on diagnostic uncertainty. His statements on the idea of ordinary psychosis can be viewed as an attempt to respond to diagnostic uncertainty in clinical practice.

Specifically, his answer to this problem is to make psychosis a default position and in doing so, it is clear that he aims to utilize a broad idea of psychosis—whether this moves beyond Lacan's classical theory of psychosis is a subject to debate and an issue I return to later. The trajectory of his argument is worth noting. First, he states that ordinary psychosis does not denote a new nosological category, but instead, provides an approach to theorizing psychosis.

A psychosis that is difficult to recognize as such, but which I infer from various small clues. It's more of an epistemic category than an objective category. It concerns our way of knowing it , p. Second, if the clinician does not recognize a neurotic structure then they may assume it is a psychotic structure, even if there are no obvious features of psychosis.

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This claim is based on the assumption that neurosis has a definite structure and that clinicians will be able to recognize it. He states that neurosis will be characterized by repetition, the clear evidence of castration, and the differentiation between the ego, id, and super-ego , and in the absence of these signs of a neurotic structure, then the analyst may assume he is dealing with a case of psychosis.

The logic of the excluded middle refers to cases of diagnostic uncertainty. Miller's response to this problem is that one should default to psychosis, given that clinicians will recognize neurosis if it is present. Thus, doubt over the diagnosis entails a diagnosis of psychosis. Two points need to be made here.

Second, although one might object to Miller on the grounds that it is not as easy to recognize neurosis as he suggests, the notion of ordinary psychosis also includes instances of psychosis that have stabilized post-onset. In debates concerning ordinary psychosis, the question of what triggers and what stabilizes psychosis is pertinent to cases ranging from mild to severe. And if we take a category like schizophrenia, do we understand the time between breaks as dormant or quiet or latent schizophrenia , or do we understand that as ordinary psychosis?

In other words … I think we have a specific, restricted notion of ordinary psychosis … the ordinary psychosis of the banal, where it's very stable and limited and so forth—but then ordinary psychosis opens up a more general theory of ordinary psychosis against which we can articulate the specific structure of say, schizophrenia or paranoia. The utility of the concept is the way that it's broadened our ability to conceptualize psychosis and think about issues of stabilization in ways that didn't exist in the literature before , p.

These remarks indicate that there are two approaches to ordinary psychosis regarding triggering and stabilization. The first concerns cases where stabilization occurs subsequent to an obvious psychotic break. Although severe psychotic features, such as delusions and hallucinations, may appear subsequent to the triggering of a psychosis for a certain group of psychotics, these symptoms will often attenuate to the point where no obvious evidence of psychosis remains.

However, as Svolos notes, the periods of stability between triggering events need to be articulated in terms of stabilization, as opposed to mere phenomenological descriptions residual phase or the invention of new diagnostic categories schizotypal personality disorder For Svolos, combining these two perspectives on ordinary psychosis opens a general notion of psychosis that focuses on triggering and stabilization. If the idea of ordinary psychosis is oriented toward these two issues— untriggered psychosis and a post-onset stabilized psychosis —then triggering and stabilization emerge as key features to investigate in this field.

Milder forms of psychosis are devoid of clinical phenomena such as hallucinations, delusions, mania, and disorganized thought Laurent, ; Svolos, In their place, a significant number of clinical phenomena remain Miller, , which are poorly understood by clinicians. Before discussing these issues it must be emphasized that ordinary psychosis has continuity with aspects of classical psychiatry. It's an invitation to go further than this term Miller, , pp.

For example, Svolos' discussion of ordinary psychosis explicitly engages Bleuler's idea of latent schizophrenia , a psychosis without obvious or severe positive and negative symptoms; the conjunction between the two is made as both focus on the idea of mild psychosis I return to these issues later in the paper. Another parallel between the field of ordinary psychosis and classical psychiatry coalesces around cenesthetic schizophrenia.

Contemporary perspectives on Lacanian theories of psychosis

Cenesthetic schizophrenia shows the primacy of body disturbances in certain forms of schizophrenia, in which typical symptoms of schizophrenia—hallucinations, delusions, and cognitive disorganization—are only transitory phenomena Huber, Cenesthetic schizophrenia is a good example of body phenomena in cases of mild psychosis—obvious psychotic phenomena are transitory, disorganized behavior is absent, and diagnosis is difficult due to the brevity of psychotic episodes and the predominance of the residual phase.

Interestingly, he echoes Bleuler's claim that latent schizophrenia is probably the most prevalent of all the forms of psychosis. However, the dominance of DSM focused psychiatry means that these nuanced ideas of psychosis are being ignored and lost in contemporary clinical practice. The classical psychiatric ideas about psychosis have lost traction for several reasons.

The success of the personality disorders, particularly Cluster A and B types, has meant a movement away from the category of mild psychosis. Changing classical psychiatric ideas on psychosis to create new nosology has created a reductive model of psychosis in contemporary psychiatry. This produces a simplistic picture of, and an impoverished clinical engagement with, psychosis.

Bleuler required 95 separate psychopathological phenomena to characterize the schizophrenias, Kraepelin in his final formulation used 75, but DSM-IV-TR employs only It is this truncated psychopathology which forms the basis of virtually all characterizations of schizophrenia in today's scholarly literature Mullen, , p. Importantly, a reductive model has practical consequence. He states that research surveying psychiatric diagnoses of schizophrenia, in terms of the total number of symptoms counted for each diagnosis of schizophrenia made, shows an average of symptoms used for diagnosis.

In this sense, ordinary psychosis provides an opportunity to broaden the category of psychosis, in part, through returning to the classical psychiatric ideas on psychosis. However, from a theoretical perspective ordinary psychosis is centered on Lacan's ideas on untriggered psychosis and the suppletion. In Lacan's classical theory of psychosis, the idea of an untriggered psychosis highlights the stabilizing function of the imaginary in psychotic structure. An untriggered psychosis, as the name suggests, refers to a psychotic structure without onset.

Lacan claimed that in certain cases, imaginary identification may prevent the onset of psychosis: He suggests that in certain cases of schizophrenia , imaginary identification functions to stave off psychotic decompensation and used the term, untriggered psychosis, in such cases An untriggered psychosis may be likened to a broken stool; although minus one leg, a three-legged stool may still function to support a person depending on their weight distribution.

However, once the person's weight is shifted above the missing leg, it will collapse, person in tow. In the field of ordinary psychosis, it has become clear that imaginary identification can stabilize psychotic structure subsequent to the onset of psychosis and triggering events. Differentiating the onset of psychosis from subsequent triggering events is another important issue in the field of ordinary psychosis. Clearly identifying the onset of psychosis, the first triggering event , calls into question the utility of retaining the idea of untriggered psychosis.

Although the ideas of an untriggered psychosis and ordinary psychosis both relate to cases of mild psychosis, there is a significant difference between these positions. The idea of untriggered psychosis assumes that the onset of psychosis has not occurred. In contrast, others claim Brousse, that in order to preserve the idea of untriggered psychosis, cases of ordinary psychosis need to be restricted to instances of post-onset stabilisation.

In doing so, the distinction between untriggered and post-onset psychosis is maintained.

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A problem with the idea of untriggered psychosis concerns the uncertainty in clearly identifying the onset. The investigation of the onset, particularly in milder forms of psychosis, supports the idea that the effects of foreclosure are subtle, difficult to detect, and will vary considerably between cases. As the case of Murielle demonstrated, psychosis can be discreet, without schizophrenic disorganization or a delusion. While the onset of psychosis is important clinically and attempts should be made to clarify the genesis of psychosis, the onset is often unverifiable.

For example, Stevens raises the issue of whether there has been a clear onset of psychosis in a case featuring a man with fibromyalgia Stevens claims that the man was psychotic and that the fibromyalgia constituted a symptom , as it had several important functions for the subject: This response provides a good example of the shift in emphasis evident in the approach to cases of psychosis.

Stevens response corresponds with an emphasis on stabilization and suppletion rather than on the idea of untriggered psychosis and the onset; the key difference is that clinicians are now more interested in identifying small effects of foreclosure indicative of a psychotic structure, as well as the symptomatic responses that may be stabilizing psychotic structure.

Miller's theory of ordinary psychosis is useful as both the onset of psychosis and triggering events are linked to the more general idea of stabilization and the suppletion. For the first time, from a CMB situation to the opening of a hole , and it goes on and on, you have a triggering. We don't say triggering. The CMB Name-of-the-Father is important as it emphasizes the continuity between triggering events and stabilization in psychosis. Although the CMB Name-of-the-Father is also applicable to the onset of psychosis and hence cases of untriggered psychosis, its application is broader because it encompasses triggering events and stabilization in psychosis, as well.

Moreover, as mild cases of psychosis may not exhibit an acute onset then other factors need to be considered. This phrase, derived from Lacan , can orient the clinician to at least three distinct areas of inquiry concerning the effects of foreclosure: Of these, body disturbances are particularly important, as they have been linked to a restitution attempt.

Theorists in the field of ordinary psychosis claim that certain body phenomena in psychosis may have an important stabilizing function. These body phenomena are different to conversion symptoms in hysterical neurosis Porcheret et al. They are particularly significant because theorists claim that in certain cases the onset of psychosis is followed by body phenomena that function to stabilize psychosis. While Lacan's theorization of paranoia is both highly instructive and indispensable to clinicians working with psychosis, theorists have over emphasized the classical theory of psychosis concerning the onset of psychosis and stabilization.

Theorists claim that for some individuals, a part of the body, experienced as painful, can become a symptom with a restitutive function. One issue central to the field of ordinary psychosis is the claim that body symptoms can have a restitutive function in psychosis. If one accepts the idea that certain body phenomena have a restitutive function then theorizing how the mechanisms of foreclosure and symptomatisation operate in these instances remains to be addressed.

Miller's explicit reference to catatonia supports the idea of a supplementary device in psychosis. Catatonia is considered to be the most severe manifestation of psychosis Cottet, ; Declerq, as it is characterized by radical social withdrawal, body disorganization, and the loss of cognitive functions: He states that if the psychotic subject is not in a state of complete catatonia, then we must assume the existence of a mechanism of suppletion that has a compensatory function.

This reasoning is fundamental to understanding cases of ordinary psychosis; the entire notion of stabilization in psychosis is, in a sense, premised on the kinds of catastrophic states evident in severe catatonia being possible in a psychotic structure, regardless of whether an individual ever experiences this kind of acute disturbance The absence of a supplementary device is catastrophic as the real remains unmediated by either the imaginary or the symbolic. The contrast between the severity of catatonic states and cases of ordinary psychosis highlights the variability of symptoms in psychotic structure: Miller's reference to symptom severity in catatonia constitutes a position from which the supplementary functions of the Name-of-the-Father may be developed.

Miller , is adamant that in order to understand ordinary psychosis, the functions of the Name-of-the-Father, as elaborated in neurosis, remain an important reference point for theorizing stabilization in psychosis. The CMB Name-of-the-Father aims to show how the psychotic subject has access to certain functions of the Name-of-the-Father even if this signifier is foreclosed. Throughout Lacan's teachings, the theory of the Name-of-the-Father became increasingly complex as more functions were attributed to it. Stevens description of the functions of the Name-of-the-Father in a neurotic structure provides a useful starting point for exploring this issue:.

This is the father who enforces a prohibition. This is the symbolic dimension of the father. However, if the father limits himself to this capacity… then it is primarily the imaginary aspect of the father that is present. The primacy of the imaginary register yields a specific aspect of enjoyment. It is jouissance of the body. This is the father who makes it possible for the child to choose his own ideals. Finally, one also needs the inscription of a name, a unique name appropriate to the singularity of the subject.

Thus, the Name-of-the-Father is also the transmission of the name. It is the symbolic inscription of the generations p. These three functions of the Name-of-the-Father—castration, social identification, and naming—are associated with the reduction or tempering of jouissance. The neurotic subject's access to jouissance is limited by the cut of castration: In psychosis, however, this limit to jouissance is not achieved via castration due the foreclosure of the Name-of-the-Father.

Therefore, without these pacification effects of castration, jouissance may be invasive, delocalized and overwhelming. Yet, despite the psychotic subject not having access to castration, pacification effects that would otherwise be linked to the Name-of-the-Father can be observed.

The fact that pacifying effects are evident in cases of ordinary psychosis prompts the question of how stabilization occurs without the mechanism of castration. Consequently, mild forms of psychosis raises the question of how stabilization is possible.

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Miller's response is to ask: The CMB Name-of-the-Father is an extension of Lacan, — statement, made during the seminar on Joyce that one can do without the Name-of-the-Father provided it is put to use. On the one hand, the CMB Name-the-Father brings together the three distinct forms of suppletion in Lacan's theory of psychosis—imaginary identification, the delusion, and the sinthome; on the other, it is also emphasizes the importance of the sinthome in Lacan's later teachings.

When surveying the literature on ordinary psychosis, it is clear that the emphasis on stabilization centers on imaginary identification and the sinthome. The vignette featuring Murielle leans toward the sinthome. According to Deffieux, symptoms can be tracked via how the signifier, water , is displaced into other signifiers that extract and localize body jouissance.

The movement from water cleansing rituals through to the use of hydrating cream shows a mobility of jouissance and its gradual localization, which in turn, correlates with the disappearance of the invasive body pains. That is, it is possible to assume that there is not repressed signifier underlying the movement of signifiers Moreover, the displacement does not occur in a delusional system.

Deffieux's description highlights a decrease in painful body jouissance as a symptom coalesces around a series of signifiers linked to a bathing ritual that seems to reestablish corporeal unity. He also comments that her decision to join a group played an important social identification for her to create and maintain a group link.

This last point is significant as the psychotic subject's difficulty creating and sustaining social links is a well-known feature of psychosis i. From my perspective, this case is useful in highlighting important aspects of ordinary psychosis. First, the case foregrounds a series of issues central to ordinary psychosis—triggering, mild psychosis, body disturbances and stabilization. In contrast, as the vignette demonstrates the restitutive function of the sinthome in psychosis—without the delusional metaphor—then it requires a different response.

The case is instructive in foregrounding core debates in the field of ordinary psychosis. A central problem, namely, how a sinthome can emerge to localize jouissance, remains to be sufficiently elaborated. Two aspects of the sinthome - the localisation of jouissance and social identification - are the focal point of investigation.