Ordinary Psychosis and The Body: A Contemporary Lacanian Approach PDF
Preview Ordinary Psychosis and The Body: A Contemporary Lacanian Approach
Ordinary Psychosis and The Body This page intentionally left blank Ordinary Psychosis and The Body A Contemporary Lacanian Approach Jonathan D. Redmond AustralianCollegeofAppliedPsychology,Melbourne,Australia ©JonathanD.Redmond2014 Softcover reprint of the hardcover 1st edition 2014 978-1-137-34530-1 Allrightsreserved.Noreproduction,copyortransmissionofthis publicationmaybemadewithoutwrittenpermission. Noportionofthispublicationmaybereproduced,copiedortransmitted savewithwrittenpermissionorinaccordancewiththeprovisionsofthe Copyright,DesignsandPatentsAct1988,orunderthetermsofanylicence permittinglimitedcopyingissuedbytheCopyrightLicensingAgency, SaffronHouse,6–10KirbyStreet,LondonEC1N8TS. Anypersonwhodoesanyunauthorizedactinrelationtothispublication maybeliabletocriminalprosecutionandcivilclaimsfordamages. Theauthorhasassertedhisrighttobeidentifiedastheauthorofthisworkinaccordance withtheCopyright,DesignsandPatentsAct1988. Firstpublished2014by PALGRAVEMACMILLAN PalgraveMacmillanintheUKisanimprintofMacmillanPublishersLimited, registeredinEngland,companynumber785998,ofHoundmills,Basingstoke, HampshireRG216XS. PalgraveMacmillanintheUSisadivisionofStMartin’sPressLLC, 175FifthAvenue,NewYork,NY10010. PalgraveMacmillanistheglobalacademicimprintoftheabovecompanies andhascompaniesandrepresentativesthroughouttheworld. Palgrave®andMacmillan®areregisteredtrademarksintheUnitedStates, theUnitedKingdom,Europeandothercountries. ISBN 978-1-349-46639-9 ISBN 978-1-137-34531-8 (eBook) DOI 10.1057/9781137345318 Thisbookisprintedonpapersuitableforrecyclingandmadefromfully managedandsustainedforestsources.Logging,pulpingandmanufacturing processesareexpectedtoconformtotheenvironmentalregulationsofthe countryoforigin. AcataloguerecordforthisbookisavailablefromtheBritishLibrary. LibraryofCongressCataloging-in-PublicationData Redmond,Jonathan,1977– Ordinarypsychosisandthebody:acontemporaryLacanianapproach/ JonathanD.Redmond. pagescm Summary:“Whatispsychosis?Howdowerecogniseit?Isittreatable? Thesedeceptivelysimplequestionspointtocomplexproblemsthathave occupiedcliniciansforcenturies.Intoday’sconsultingrooms–perhaps morethaneverbefore–cliniciansarefacedwithabroadarrayofdifficult todiagnosepatientswithdemandingtreatmentchallenges.Oneresponse totheproblemofdiagnosticuncertaintyistorevisittherichpsychiatric andpsychoanalyticliteratureonmilderpsychosis,acategorymarginalised intoday’spsychiatry.Thisbookdrawsoncontemporarytheoriesof psychosisdevelopedbyLacaniantheoristsintheWorldAssociation ofPsychoanalysistoexaminebodydisturbancesinmilderformsof psychosis.Byfocussingonbodyphenomenainconjunctionwiththree practicalelementsoftreatment–theonsetofpsychosis,psychotic states,andstabilisation–JonathanD.Redmondshowsthattheproblem ofembodimentmadeevidentbypsychosisshouldbecentraltoclinical assessmentandtreatmentpossibilities”—Providedbypublisher. ISBN 978-1-349-46639-9 1. Psychoses. I. Lacan,Jacques,1901–1981. II. Title. RC512.R4352014 616.89—dc23 2014018852 Contents Acknowledgements vii Introduction 1 1 MildPsychosis,theBodyandOrdinaryPsychosis 6 1.1 Thedeclineofmildpsychosisincontemporary psychiatry 6 1.2 Themarginalstatusofbodydisturbances inmildpsychosis 12 1.3 Areturntomildpsychosis:Theneurosis/psychosis distinctionandordinarypsychosis 20 1.4 Ordinarypsychosisandthebody 28 1.5 Conclusion 29 2 CaseStudiesonOrdinaryPsychosisandtheBody 31 2.1 Thetreatmentofpsychosisandtheconstruction ofasymptom 31 2.2 Onset,triggeringeventsandbodydisturbances inordinarypsychosis 34 2.3 Clinicalvignettes:Ordinarypsychosisandthe problemofembodiment 35 2.4 Conclusion 51 3 ModernPsychiatryandLacan’sTheoryofPsychosis 53 3.1 ModernpsychiatryanddeClérambault’stheory ofautomatisms 53 3.2 Lacan’sclassicaltheoryofpsychosis,elementary phenomenaandparanoia 60 3.3 Ordinarypsychosis,elementaryphenomena andthesuppletion 67 3.4 Conclusion 71 4 CompetingLacanianViewsofPsychosisandtheBody 72 4.1 Freud’stheoryoftheactualneuroses andpsychoneurosis 74 4.2 TheactualneurosesandVerhaeghe’stheory ofactualpathology 80 v vi Contents 4.3 Actualpathology,bodyphenomenaandthefieldof ordinarypsychosis 90 4.4 Conclusion 92 5 RevisitingtheBodyintheOnsetofPsychosis 94 5.1 Imaginaryidentification,ordinarypsychosis anduntriggeredpsychosis 95 5.2 Themechanismoftriggeringanddisturbances tophallicsignification 100 5.3 Theonsetofpsychosis,triggeringeventsandthe Name-of-the-Father 110 5.4 Conclusion 113 6 OrdinaryPsychosis,StabilisationandtheBody 115 6.1 Generalisedforeclosureandtheneurosis/psychosis distinction 116 6.2 ThefunctionsoftheName-of-the-Fatherandthe compensatorymake-believeName-of-the-Father 119 6.3 TheholeintheOther:Elementaryphenomena andthesinthome 129 6.4 Bodyeventsandbodyphenomenainpsychosis 135 6.5 Conclusion 142 Afterword 144 Notes 147 References 155 Index 165 Acknowledgements I would like to thank Lesley Sefcik for her excellent editorial work. Thanks to Russell Grigg for supporting this project, and to my col- leagues at the Lacan Circle of Melbourne for providing me with the opportunity to present and discuss the ideas presented in this book at conferences and seminars. Finally, thanks to the editorial staff at PalgraveMacmillan—NicolaJonesandElizabethForrest—forsupporting this project and to my copyeditor, Jayne MacArthur, for her fine work. Parts of Chapter 2 and 4 appeared as Redmond, J.D. (2013) ‘Con- temporary Perspectives on Lacanian Theories of Psychosis’, Frontiers in Psychology,4,350. vii Introduction Whenimaginingwhatpsychosislookslike,bodydisturbancesprobably donotinitiallycometomind.Formanyofuspsychosisisequatedwith madness:themadarecrazypeople,whodoandsaycrazythings...theyare delusional...theyconversewithimaginaryinterlocutors.Andsoon. While these impressions about psychosis are not wrong per se, they do nevertheless represent a narrow and simplistic view. Unfortunately, this narrow understanding of psychosis is akin to contemporary psy- chiatric nosology as found in The Diagnostic and Statistical Manual of Mental Disorders (DSM). In the DSM, the nosological approach to the schizophrenias is oriented around obvious psychotic phenomena such asdelusions,hallucinationsanddisorganisedcognitiveandbehavioural states.1 Moreover, the DSM schizophrenias scarcely mention the body, apart from where it is discussed in the context of delusional content and in the symptomatology of catatonia. In contrast, throughout this bookIdeveloptheideathatbodydisturbancesarepivotalinapproach- ingtheproblemofpsychosisandthatthisfocusconstitutesre-engaging the centrality of body phenomena in psychiatric and psychoanalytic discourse. Thus, the first important focus of my book is affirming the exis- tence of a broad array of body phenomena in psychosis. This idea that the body can be fundamentally linked to psychotic disturbances isnotnew—aquickreviewofmodernpsychiatricliteratureshowsthat clinicians have long been aware of the fact that body phenomena in psychosis may be the only set of symptoms afflicting a specific indi- vidual. Unfortunately, contemporary DSM versions of psychosis have virtually excluded body phenomena. It is important to understand that psychosis cannot be reduced to only obvious phenomena such as delusions, hallucinations, and disorganised thought and behaviour. OutsideofthenarrowDSM approach,bothmodernandcontemporary 1 2 OrdinaryPsychosisandTheBody psychiatric literature on psychosis provides a rich, descriptive account of body phenomena in psychosis. Consequently, I illustrate how body phenomenainpsychosishavebeenmarginalisedfrommainstreampsy- chiatricnosologyinamannerthatrunscountertothelargerpsychiatric contributions made to the field of psychosis by re-engaging with this influential psychoanalytic literature. The reductionistic DSM view of psychosisisinaccurateandproblematicbecauseoverlookingtheimpor- tanceofbodyphenomenainpsychosisleadstoeffacementofthe‘mild psychosis’categoryfromclinicalthinking. The pairing of body phenomena with the idea of mild psychosis is an important clinical feature of psychosis that serves as a platform for developingcoreideasthroughoutthisbook.Althoughclinicianswillbe hard pressed to find the conjunction between body disturbances and mildpsychosisintheDSM,reviewingthepsychiatricarchivestellsadif- ferentstory.Bleuler’sideaoflatentschizophreniaistestimonytothefact thatacutepsychoticsymptomsareeithertransitoryoraltogetherabsent inmanyinstancesofpsychosis.However,tosaythattherearenoindi- cationsofpsychosiswouldbemisleading,especiallyifweconsiderbody disturbances. For example, cenesthesias, which are motor and sensory automatisms,arebodyphenomenainpsychosisthatmayemergewith- out other more obvious signs and symptoms of psychosis. Proponents of categories such as cenesthetic schizophrenia (Huber, 1992) indicate that this variant of psychosis should be included in Bleuler’s original category of latent schizophrenia. However, the DSM system of classifi- cation has omitted the category of latent schizophenia. It would seem improbable that one of the most prevalent forms of psychosis—latent schizophrenia—has been altogether lost from contemporary psychia- try. Latent schizophrenia has not been lost categorically; rather, it is, in fact, more accurate to describe, as Svolos (2008a) suggests, that the DSM classificationconstitutesaweakeningoftheideaofpsychosis. Hence,olderpsychiatriccategorieshavebeen‘displaced’intheDSM’s complex and convoluted nosological system rather than lost categori- cally.Thus,althoughtheDSM’sreferencetotheschizophreniasislargely compromised of ‘diseases’ that have their antecedents in modern psy- chiatry, in particular in the ideas of Kraepelin and Bleuler (Mullen, 2007), the nosological system differs substantially from their earlier modern counterparts. The relationship between latent schizophrenia andthe‘personalitydisorders’demonstratestheclearestexampleofthis. IntheDSM,theinclusionofpersonalitydisordershashadadirectbear- ing on the mild psychosis category. For example, personality disorders such as ‘schizoid’ and ‘schizotypal’ are largely synonymous with what
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