I
2
Jacques Lacans Structuralist Criticism of Karl Jaspers
Phenomenological Psychiatry: Concerning the Comprehensibility and
Treatment of Delusional Disorders
Abstract
The validity of psychiatric diagnostic constructs remains
suspect, a problem compounded in the case of differential diagnoses
(DDx), which imply multiple and concurrent disorders. Can one have
more than one mental disorder? Can such a supposed coexisting
differentiation be real? Whereas disorders vary by context, kind,
and manifest symptomsKarl Jaspers, in his General Psychopathology,
usefully called attention to a necessary penetrative discernment
into the reducible qualities of a disordered state. Though,
according to Jacques Lacan, Jaspers argued comprehensibility to a
fault. Deciphering the problem of psychiatric comprehension, this
essay will focus in on Lacans medical thesis commentary on Jaspers
phenomenological psychopathology.. Here we highlight important
differences between phenomenological and structural theories of
understanding. Where Jasperian phenomenology suffers by only being
able to study theories, in acknowledging that beliefs and delusions
cannot be clearly distinguished, Lacan will propose a restorative
method of listening to delusions psychoanalytically.
[footnoteRef:1] [1: A version of this paper was introduced to the
Karl Jaspers Society of North America at the December 15, 2014
joint meeting with the Eastern Division of the American
Philosophical Association in Philadelphia, PA, and was delivered by
the author on March 20, 2015 at the 19th Congress of the
International Society for the Psychological and Social Treatments
of Psychosis (ISPS) at the Cooper Union in New York, NY. Special
thank you to Professor Marc De Kesel for his assistance with this
manuscript. ]
Keywords: Karl Jaspers, Jacques Lacan, General Psychopathology,
Thesis, Phenomenology, Structuralism, Psychosis, Delusions,
Understanding, Meaningful Connections
Introduction
All conferences are organized around a dialogue, for instance,
seeking to merge biological and psychological conceptions of the
treatment of psychosis. All cases that we hear about at such
conferences deal with the work that goes on between the clinician
and the patient, tracing the methodological approach which should
be taken to provide suffering individuals, those who suffer in
states of madness, with some corrective solution. In doing so the
participants at such a conference will have been contrasting on the
one hand, biological treatments which aim to provide therapies
which target neuronal and nervous system functioning, and on the
other, dialogical a approaches which address the subject in their
symptomology. Now, adopting a thesis which states that biological
change should come secondary to the primary social experience of
psychosis disorders, of making sense in dialogue, this discussion
paper will elaborate upon an important change which took place in
theorizing about the psychotic experience in the works of Karl
Jaspers and Jacques Lacanand thus directing new questions at our
philosophical enterprise of reasoning.
This discussion paper will draw your attention to the meeting
between therapist and patient, and how this interaction should
address and work with the hallucinations and verbal
disorganizations associated with a psychotic break and later
reconstitution of a functional subjectivity in a social milieu. The
most difficult aspect of presenting a thesis like this is that my
understanding of Jaspers and Lacans system of psychopathology
cannot have come through any formal psychological or psychiatric
training program in the English speaking world, and quite possibly
any other. My research has come to me from my work in political
organization, as an advocate in legal disputes on worker rights,
and in my pursuit of answers to questions on the seemingly
irreconcilable nature of people to do exactly that which is most
harmful to their interests, and to deny their obvious blunders
right through to the graveI had to understand, and so my insights
come to me through anthropology, a clinical psychoanalytic
practice, and budding study of philosophy. Rather than provide a
properly critical investigation of power, politics, and culture,
today, most research conducted in the name of psychotherapy or
psychology is conducted in a narrow bio-medical, or in the best of
cases, the bio-psycho-social conception of mental illness, and so
for the most part there is no credible attempt being made at
hearing the individual patient in their suffering outside of
psychoanalytic circles. So we come to the matter of psychopathology
in similar circumstances which Jaspers must have come to the issue,
where responding to Emil Kreplian style biological conceptions of
mental illness identification, specification, and classification,
we too are located in a somewhat obtuse situation, where for the
most part, more knowledge available to researchers of any
discipline interested in the subject of human psychology, and
trouble with subjectivity, are faced with an avalanche of
information about the truth, but no reasonable way in which to make
sense of comprehend the overload of information.
What the therapeutic establishment has increasingly resorted to
is various kinds of quantification formulae for using
bio-statistics to attempt to find meaningful statistical inferences
that can shed light on why it is that time and time again, the same
kinds of proofs are invalidated, and time and time again, the
treatment of mental disorders with one kind of treatment or another
prove ineffective[footnoteRef:2]. The bio-psycho-social model
attempts to correct to apparent lack of technical or overall
perspectival wherewithal in coming to an overall understanding of
the comprehension of the individual who suffersso to properly and
most effectively intervene. This is certainly the project of
Jaspers General Psychopathology[footnoteRef:3], and it is the
project being continued in psychiatric and psychological diagnostic
protocols which aim for greater complexity, greater sensitivity of
scales, and a more profoundly accurate characterization of the
details of some psychopathologyand the only way through, it seems,
is as Jaspers puts it, whereby practitioners should be so well
read, perhaps as well read as a world class philosopher, in the
humanities, physical and natural sciences, and the full range of
psychiatric literature from the 19th century on, to be able to make
the most effective and comprehensive characterization of, and thus
planning an intervention for, the treatment of a mental disorder.
[2: Hejazi, 2013, Determinate Signification and the Neurobiology of
Reality Processing
(http://www.sfu.ca/humanities-institute/?p=4021). Here I discuss
the problem of treatment resistance and neuroscientific knowledge
in greater detail.] [3: Jaspers, Karl. General Psychopathology.
Translated by J. Hoenig and L. Hamilton. Manchester: Manchester
University Press, 1963.]
However, let this survey of the problem not be read as a
rejection of the scientific project. No doubt, the scientific
method of doubt and hypothesis testing is our only way, within the
always modern enterprise of reason, through to the other side, but
we must avoid understanding too much (Lacan), and taking on the
delusions of modernity. We cannot at the same time loose sight of
the fact that religion and science are one in the same, that belief
and doubt work in tandem, and thus science is our modern
placeholder for a certain establishment of an ideal, so ever too
quickly science is confused with a kind of rejection of reason in
the first place. This will be Lacans project, taking up from
Jaspers own, to advance the most important and prime topic in
psychiatry, that of delusional disorders, or psychosis.
If we, like Jaspers and Lacan, take up the topic of delusions,
we must be clear with ourselves that we too are delusional, and
that the distinction between a mad person, and the sane, is purely
evaluative and contextual. As one can appreciate, irresponsible
capitalism, targeted killings for peace, feigning ignorance at
torture, in a so-called, free and democratic society, being on par
with childhood certainties like a belief in Santa Clause, will
leave us embarrassingly short of the target I wish for us to make
through the course of this discussion: that we are just as
superstitious, errant, and shortsighted as ever, with the only
exception being the knowledge we were able to come through by
virtue of testing of hypotheses, and being able to let go of ideas
which we proved to be inconsequential. Yet in psychiatry, and
modern psychology, this capacity of moving through indefensible
knowledge seems to be most impaired. It is in these disciplines
that deal exactly with an issue as vague and seemingly
indecipherable as problems with subjectivity, where few theses are
proven founded, and totally dubious assertions are almost never let
go ofunless some protest movement emerges to shame the treatment
establishment, that like pious Sigmund Freud, we will claim
privileged insight into a particular myth, without a hint of being
able to truly test our assumptions as such.
Moreover, in this presentation, as in all presentations where we
will attend to the function and field of language, we need little
in the way of observable statistics or diagrams. So often now, it
seems, in the fields of psychiatry and psychology, texts books make
reference to scans of brains, and certain demographics, as if the
truth were to be found in the statistical calculations of a
computer which determined certain blood flow passages to be
correlated with a certain function, as certain flows of factors
among people is indicative of what goes on for a suffering
individual. The scope and span of the psychiatric and psychological
subject has become profoundly vast in its breadth and scope,
whereas what we will find through the course of this text, is that
the elementary phenomena, what we are to distinguish through a
certain kind of listening, will be purely individual, and certainly
cannot be scanned other than by attention to the speech of
another.
Thus and moreover in the same way, we will strive to illustrate,
by a progressive movement of intellectual work, by three authors,
Emile Kreiplin, Karl Jaspers, and Jacques Lacan, how one proper
phenomenon, the phenomenon of a delusional disorder, can be worked
with and through in three different ways. Rather than
distinguishing between supposed kinds of psychosis, we will deal
with the project of speaking about assumed normality, for the issue
of content normality is exactly the cross-roads upon which the
subject matter of hand, of delusions, must take us toand to no
other. What this means is that no other arbitrary correlates, of
delusions and age, or delusions and race, or delusions and brain
scan identifiers, will suffice to locate ourselves on the primary
issue of shared and social reality, and thus on the same point of
focus, which Jaspers would have us attend, the issue of
comprehensibility. Our purpose will be to, like Jaspers and Lacan,
advance us through, down the historical tradjectory, from exorcisms
of possessions, to the bio-psycho-social construct method, to the
post-structuralfor a new way of dealing with social difficulties of
many kinds.
A Brief Genealogy of Delusional Disorders
While we know that Hipocritus in 400 BC and later Galen, in the
fourth century, among other classics identified a disorder of the
mind as a problem with the constitution of a subject with their
brain (Hysteria, as a movement of the uterus), and later medieval
authors found mental disorder at the level of bad fluids
(melancholia)[footnoteRef:4], the change from between Jaspers to
Lacan marks a much more radical alteration in our theory of
knowledge. This change marks the difference from the pre-modern
conception of the madness of a derivative of some good and evil
contest, where a shaman or spiritual leader would provide an
explanation to the confessions of the subject, to the modern
conception of the individual as a locus of control, being given
responsibility for the functioning of their personal biological and
psychological apparatus. This change is between psychiatric
knowledge about the treatment of a mental illness, between the
pathogen and the body and what the subject says and experiences
about their disorder, and the psychoanalytic conception, derived
from the works of Sigmund Freud, as a problem of responses, as a
human capacity to represent and be representedand thus Freud, and
later Lacan, mark an important turn in scienceto a new kind of
science, as a way of understanding the way that the actions in the
clinic will act upon an individual. [4: Taylor, Michael, and
Vaidya, Nutan Atre. Descriptive Psychopathology. The Signs and
Symptoms of Behavioral Disorders. Cambridge, Cambridge University
Press, 2009. Print. ]
We might trace this psychoanalytic intellectual trajectory in a
somewhat different manner, from Parmenides (Who spoke about a=a,
setting out the subject basis of some supposision), to Descartes
(Who set for the doubting I, who thinks, I think, therefore), to
Hegel (Locating all knowledge along a historical and contextual
axes), to Freud (Who locates the thinking and thus speaking being).
The links between Jaspers and Lacan are important to our conference
discussion for this will lead us to deal with the mechanical
factors which are derived from the underlying biological
distinctions which we can refer to psychosis, and more importantly
define the function which operations in communication and social
relating to one-another which will order our knowledge about the
causes and factors of the psychotic condition. In this paper I want
to introduce a problematic factor in our reasoning, as
professionals and researchers in the field of psychiatry, who are
working with issues that relate to the mental well being of
another, of a patient who has come to us with a problem with their
subjectivity, their mental health.
This problematic factor, which I will call prequation, is given
where in the construction of our ideas about what is going on with
another, between ourselves and our patients, we preliminarily
equate the event of a psychotic hallucination nor break, with the
psychosis, as though the label for the disorder, a formula for
identifying classes of disorders, leave us, very quickly to an all
to hasty status of knowing, of comfortably attributing signs to
some underlying pathogenic process, and thereby dismissing very
important factors which can be worked into a formulation and
treatment process. In the rest of this paper I will elaborate how a
hasty equation process takes place in our perception of our
patients, and through elaborating the distinction between Jaspers
and Lacan, between phenomenology and structuralism, point us
towards how our researches into the complexities and difficulties
associated with psychosis can be more readily supported, treated,
and essentially overcome.
Contemporary Attempts at Understanding Delusional Disorders
The American Psychiatric Association, since the first edition of
their Diagnostic and Statistical Manual of Mental Disorders
(DSM)[footnoteRef:5], has allowed for the identification and
designation of both specified and unspecified disorder types, as
well as multiple differential diagnoses. Can one be mentally ill in
more than one way? Does pathology not need to be verified with a
qualified yes or no? The authors of diagnostic manuals will evoke
the notion of necessary openness to allow for changes to be made to
their categories, to ease the communication of what cannot be found
within any already compiled manual, and to leave the door open to
new possible applications of formulae. Paul E. Mullen writes in A
Modest Proposal for Another Phenomenological Approach to
Psychopathology[footnoteRef:6] , We have been left with
classificatory systems which impose reified categories increasingly
at variance with clinical reality and increasingly divorced from
the data generated by scientific enquiry. (113). In todays
psychologized social world one can readily hear people talk about
having a mental illness, having two or more mental illnesses, or,
undergoing recovery. A November 27th, 2014, article in The
Guardian[footnoteRef:7] suggests that people need to be treating
their delusions and hallucinations, as though delusions and
hallucinations were not a part of normal perception. Karl Jaspers
writes in his General Psychopathology, that, Delusion is a primary
phenomenon and the first thing we have to do is to get it into a
proper focus. The experience within which delusion takes place is
that of experiencing and thinking that something is real. (1963,
93). Jacques Lacan, following on Jaspers, will later write that the
structure of scientific truth is that of paranoia (2006, 724).
There can be no clear Archimedean point of view outside of a fixed
system of belief and understandingwhat for Lacan is a point of
impossibility. No matter what efforts are made, all clinicians and
researchers, are bound to the same infrastructure of made-up
thinking. [5: American Psychiatric Association. Diagnostic and
statistical manual of mental disorders. First edition. Washington:
American Psychiatric Publishing, 1952.] [6: Mullen, Paul E. (2007).
A Modest Proposal for Another Phenomenological Approach to
Psychopathology. Schizophrenia Bulletin, 33(1): 113-121. ] [7:
Freeman, Daniel. And Freeman, Jason. Delusions and hallucinations
may be the keys that unlock psychosis The Guardian, November 27,
2014:
http://www.theguardian.com/science/blog/2014/nov/27/delusions-hallucinations-psychosis-schizophrenia
]
Paranoia and psychotic paranoia have a prevalent position in
psychiatry and psychological research. We normally have a narrow
conception of the mad person as someone who exudes obvious
delusional phenomena and other atypical bodily symptoms.
Commentators on this norm, Sarah Troub, Thomas Lepourtre, and
Benjamin Levy, writing in Jaspers, Freud, Lacan: la question de la
comprehhension en psychpathologie[footnoteRef:8][footnoteRef:9],
state that the delusional character of any idea is its appearance
in a higher order of truth, an order of delusions, which
necessarily places understanding within the limits of the human
capacity for knowledge (9). The problem of understanding and the
search for the specific features of understandability is a common
theme in the study of psychopathology. The problem of understanding
has been addressed by psychiatry; the issue of comprehensibility
marks the significant role of psychiatry in the process of the
determination of truth for the society as a wholegiven in the
historical transition of psychiatry from the church to the
government hospital[footnoteRef:10], and predictably, on to the
private clinic. [8: Translated as: the question of comprehension in
psychopathology] [9: Troub, Sarah, Lepourte, Thomas, and Levy,
Benjamin. Jaspers, Freud, Lacan: la question de la comprehhension
en psychpathologie. PSN 3(2): 7-31 (2013). ] [10: Foucault, Michel.
The Birth of Biopolitics. Lectures at the College de France,
1978-79. Edited by Michel Senellart. Translated by Graham Burchell.
New York: Palgrave Macmillan. Print. ]
For Troub, Lepourttre, and Levey, the primary delusional
experience is the source of radical incomprehensibility (12).
According to Jaspers there can be an emotional interpenetration
(13) that can be undergone to investigate the nature of a given
encounter that the subject makes due to their delusional core.
Jaspers will state that what makes psychosis delusions important,
though not altogether understandable, nor consequentially linked to
an inner causal factor, is the manner in which, as Matthias
Bormuth[footnoteRef:11] writes that for Jaspers, no science could
fully fathom in either psychopathological or existential terms (5)
of what is really going on within a psychotic process. Jacques
Lacans scholarly career interestingly takes from Jaspers works on
the way in which meaningful life events underlie the formation of
symptomology. Lacan later departs from Jaspers with respect to the
knowability of the formative substrate, as he develops his
theorizing about the nature of understandability in general.
Substantiating the totalizing approach, Stijn Vanheule
[footnoteRef:12] discusses how Lacan contests Jaspers assertion
that whereas most mental phenomena are rationally and empathically
understandable for psychologists, delusions are not (2011,
98)rather, Lacan will demonstrate how an analysis challenges
mainstream capacities of knowledge as a process of reaching a point
of verifiable certainty, but that certainty is a factor in all
systems of knowledge. [11: Bormuth, Mathias. Life Conduct in Modern
Times, Carl Jaspers and Psychoanalysis. Philosophy and Medicine,
Volume 89 Co-Editor, Stuart F. Spicker. Doredrecht: Springer, 2006.
] [12: Vanheule, Stijn. The Subject of Psychosis: A Lacanian
Perspective. London: Palgrave Macmillan, 2011.]
French historian, Elisabeth Roudinesco writes, in her biography
of Jacques Lacan[footnoteRef:13], that in General Psychopathology
Jaspers highlights the clinical differentiation within psychiatric
thought between "practices of meaning and sciences of causation".
In this conception, the comprehensible followed on events via
underlying factors and in the explicable there is an element of the
incomprehensible, so "one must resort to a logic different from
that of reaction to facts. The voices heard by someone suffering
from hallucinations, the persecutions imagined by a paranoid
person, belong to the realm of the explicable because of a causal
concatenation." Roudinesco notes "how helpful Lacan found such a
notion in constructing a science of personality. The idea allowed
him to assign more importance to a formal logic of causality than
to a mere comprehension of meaning" (46). [13: Roudinesco,
Elisabeth. "Jacques Lacan". New York: Columbia University Press,
1994. ]
Karl Jaspers
Mathias Bormuth writes in Life Conduct in Modern Times, Karl
Jaspers and Psychoanalysis, 2006, that Jaspers epoch-making
methodological systematics in General Psychopathology challenges
what Bormuth says Jaspers referred to as a reprehensible philosophy
(2), namely Freuds deterministic psychoanalytic formulations, on
the basis of an important mindset difference which he endeavored to
promote through his philosophy. According to Bormuth, Jaspers was
endeavoring to establish the life conduct of the individual as an
appeal against mass psychology. Jaspers assumed a three-step
psychopathological method. The first step involved rational and
static understanding of isolated psychic phenomena; the second,
constituted genetically associative understanding; and the third,
the classification of symptoms according to ideotypical disease
entities. (14). Observation includes exploration of the patient,
and having the patient draw up written material. Jaspers adopts
Webers methodological concept of the ideotype but does not exhaust
its epistemological substance; for Jaspers, the construct merely
acts as a relative paradigm used to recognize and classify
symptomatic and motivational connections in the case of mental
disorders. (15). Thus differentiating between understanding and
valid science. There are layers and there are dispositions that
relate to the psychopathological core. In postulating an infinite
horizon of causal connections, Jaspers contends that explaining
causality principally forms the core of pathogenesis whereas the
understandable connections merely constitute a peripheral asset
with no decisive effect. (16)
In his essay, The Phenomenological Approach in
Psychopathology[footnoteRef:14], first published in 1912, Jaspers
states that it is normal to distinguish between the subjective and
the objective. Included in the subjective, for Jaspers, is anything
that cannot be observed as coming from the subject other than
through their words, inclusive of mental processes and how any
subject organizes themselves. Jaspers argues that, According to
this, only the objective symptoms offer certainty; they alone form
a basis for scientific study, whereas subjective symptoms, though
we cannot easily do without them for our preliminary assessments,
are considered to be quite unreliable for making final judgments
and unfruitful for the purpose of any further scientific
investigation (1313). Jaspers continues: [14: Jaspers, Karl. The
Phenomenological Approach in Psychopathology. British Journal of
Psychiatry 114, 1313-1323 (1968). ]
There is no doubt that objective psychology produces results
which are more obvious, more convincing, and easier for everyone to
grasp than does subjective psychology the difference in degree of
certainty is simply quantitative, when it comes to the kind of
certainty, the difference is qualitative and fundamental. This is
so because subjective psychology always aims at the final
realization of the concepts and ideas which form the inner
representation of psychic processes, whereas objective psychology
finds its ultimate aim in observation in undisputed fields such as
sense-perception and the rational concepts of thought and by such
means as graphs and statistics. (1314).
Jaspers says of the qualitative research activity above, that it
is the preliminary work of representing, defining, and classifying
psychic phenomena, pursued as an independent activity, which
constitutes phenomenology an end in itself. This end, Jaspers
writes, is a search for irreducible phenomena, through the others
self description as a means, not the object where by means of
analogies one can identify, observe, and reach the completely
empathically inaccessible (1318). For Jaspers, what his method will
be able to reach is that which is completely objectively
unverifiable, though functionally affective.
In postulating an infinite horizon of causal connections,
Jaspers in his General Psychopathology, 1963, writes that
explaining causality principally forms the core of pathogenesis
(16). For Jaspers there are:
Endogenous and exogenous causes-
The basic phenomenon of life is its self-realization in an
environment which it molds from its own inner resources, on which
it depends and by which it is in its own turn molded. In so far as
we divide the whole unity of life into outer and inner world and
both are broken down into factors, we attribute the phenomena of
life either to causal factors of the outer world, which we call
exogenous, or to those of the inner world, which we call
endogenous; against the outer influences we set the inner
disposition. As life always consists in the interplay of inner and
outer, no phenomenon can be exclusively endogenous. Inversely, all
exogenous influences unfold their characteristic effects within an
organism, and the particular fashion of this will always appear as
an essential factor. (454).
Jacques Lacan
In his published medical thesis[footnoteRef:15], De la psychoses
paranoaque dans ses rapports avec le la
personnalit[footnoteRef:16], 1932, Lacan drew upon Jaspers
Phenomenology and the structure of psychic disorganization in
psychoses. In this earlier period in his writing Lacan assumes that
at the core psychotic outbreaks are constituted by relations of the
subject to vital situations (77). Vanheule, in his The Subject of
Psychosis: A Lacanian Perspective, 2011, writes that such vital
situations, all psychogenic (11), relate to sexual and professional
problems that go beyond a breaking point, touching the psychotic
subject in a profound way(10), at an ethical level (11). At this
point these events find their integration into the psychic makeup
of the person and become comprehensible developments related to how
the person regards himself or herself, leading to tensions that
emerge from their situation and environment. Therefore, for Lacan,
following on Jaspers, clinical analysis depends on the application
of all ones capacity of sympathy (11, Vanheule citing Lacan, 224).
[15: Lacan, Jacques. De la psychose paranoaque dans ses rapports
avec la personnalit. De Doctorate ed Medicine de Jacques Lacan.
Seuil, Franois a Paris, 1932.] [16: Translated as: Addressing
Personality in Paranoid Psychosis.]
In his thesis Lacan writes that to understand the desire of
jealousy for example, you must guard against imputing that it is a
sickness, jealousy of another woman, a deductive or inductive
construction more or less rational, but understand that its mental
structure forces it to identify itself to its rival, when she
evokes it, and to feel that this substitutes for her. In other
words, the mental stereotypes are considered in this theory as
compensation mechanisms, not of the affective order, but of the
phenomenological order[footnoteRef:17]. Numerous clinical facts
were in such a way interpreted in a brilliant way by
Minkowski.[footnoteRef:18] Thus according to Lacan, there is
something that is directed by jealousy, jealousy regarded as an
emergent phenomenon, but the causal meaningful connections
underlying this emergence cannot be logically followed to a
particular causal factor as such. In this way Lacan both adopts and
critiques Jaspers philosophy. [17: Husserl, Edmund. Phantasy,
Images Consciousness, and Memory (1898-1925). Translated by John B.
Brough. Dordrecht: Springer, 2005. ] [18: A quote from Lacan on
Minkowski, Jalousie pathologiques sur on fond dautomatisme mental.
A.M.P., June 1929, 24-48.]
Lacan goes on, We believe that all distinctions between the
structures or forms of the mental life and the contents that fill
it, rest on uncertain and fragile metaphysical hypotheses. This
distinction resembles certain beings imposed by the organic
psychoses and irrationalities, but these present a deep psychic
disorganization with no psychogenic link to and indeed I say, like
the very good remark by Jaspers, he [the psychotic subject] does
not act from a true psychosis.[footnoteRef:19][footnoteRef:20] [19:
Hence the emptiness of the objections to psychogenic research we
hear everyday, the vanity of which is demonstrated by the isolation
of an entity, like general paralisis, for example. These are lazy
objections.] [20: I.e. not an actual derangement.]
In the psychoses, it is possible to settle the question of
whether the structure of the symptom is not determined by the
essential experience it appears to stem from; in other words, the
content and form cannot be arbitrarily dissociated, such that
essential trauma in psychoses will not be resolved. (132). Thus in
this earlier text Lacan challenges Jaspers position on the
irreconcilably arbitrary nature of the delusion, and states that in
fact the delusion is both of consequence and is derivable from some
contingent necessary underlying factor for the individual in their
contexts and situationsthe self, the I.
In Lacans later seminar on The Psychosis, 1955-1956, he writes
that under a very clear meaning under the name of [a] relation of
understanding, Jaspers has made the pivot of all so-called general
psychopathology[footnoteRef:21]. For Lacan, It consists in thinking
that some things are self-evident, that, for example, when someone
is sad its because he doesnt have what his heart desires. Nothing
could be more false says Lacan, there are people who have all their
heart desires and are still sad. Sadness is a passion of quite
another color. (6). In this, contrary to his assertion given in his
medical thesis, as Vanheule notes, Lacan grew more critical of his
dissertation, he criticized comprehension-based approaches (2011,
11). [21: See Karl Jaspers, "Meaningful Connections,"
"Verstandliche Zusammenhange,"chap. 5 of his General
Psychopathology.]
In France, Lacan notes, a paranoiac was a nasty person, an
intolerant one, a bad-humored type, proud, mistrustful, irritable,
and who overestimated himself. (4). In this context, Lacan notes
that Genil-Perrinss work on the perverse structure of character
pointed to the fact that sometimes the paranoiac goes beyond the
limits and falls into that frightful madness, the unbounded
exaggeration of his unfortunate character All the formal references
to an organic base, to temperament for example, don't change a
thing - it's really a psychological genesis. Something is defined
and assessed at a certain level, and its development follows
uninterrupted with an autonomous coherence that is self-sufficient
in its own field. (5). For Lacan it is false to assume that
psychoanalysis restores meaning to the chain of phenomena, or to
understand the patient. This, Lacan says, is a pure mirage.
Lacan uses the example of a child receiving a smack, however he
notes, while the child might cry, its not at all obligatory that he
should cry. He gives an example of a child who asks if the smack
was a pat or a slap, if the latter response is given as a reply
then the child would cry, following on the rules of convention, and
if it was a pat he would be delighted (6). For Lacan, in Jaspers
chapter on Meaningful Connections, in General Psychopathology
understanding is evoked within its meaningful relational
consequence. However, in understanding the underlying factors, as
soon as one attempts to apprehend the source, it becomes elusive.
Lacan, therefore, will hold that there is no psychogenesis in this
meta-realm of understanding given by the field and function of
psychoanalysis, and even if there is a psychogenesis of sorts, it
is not one to which psychoanalysis can be beholden. He states, If
that is what psychogenesis is, there is precisely nothing that
could be further from psychoanalysis in its whole development, its
entire inspiration and its mainspring, in everything it has
contributed, everything it has been able to confirm for us in
anything we have established. For Lacan a way of expressing things
that goes much further is to say that the psychological is, if we
try to grasp it as firmly as possible, the ethological, that is,
the whole of the biological individuals behavior in relation to his
natural environment. This he calls the order of real relations, an
objectifiable thing, a field with quite adequately defined
boundaries. (7).
Lacan posits that Everything that in human behavior belongs to
the psychological order is subject to such profound anomalies and
constantly presents such obvious paradoxes that the problem arises
of knowing what needs to be introduced in order for a cat to find
its kittens. For Lacan, the problem cannot be solved by a mere
immediacy of experience, for this is no better placed to arrest or
captivate us than to any other science. In no way is it the measure
of the development that we must ultimately reach. For Lacan, Freud
brings resources into play that are beyond immediate experience and
cannot be grasped in any tangible fashion. (8)[footnoteRef:22].
[22: Here Lacan is referring to the psychoanalytic oeuvre,
inclusive of free-associations, the frame, and an encounter with
resistances and neurotic wish fulfillments (etc.). ]
Discussion
A number of authors have commented on how the DSM unspecified
categorical and differential diagnostic approaches follow a
phenomenological approach to research and reasoning. Jaspers, in
The Phenomenological Approach in Psychopathology writes that,
subjective psychology always aims at the final realization of the
concepts and ideas which form the inner representation of psychic
processes, whereas objective psychology finds its ultimate aim in
observation in undisputed fields such as sense-perception and the
rational contents of thought and by such means as graphs and
statistics. (1314) Thus for Jaspers, Without doubt, the first step
towards scientific comprehension must be the sorting out, defining,
differentiating and describing of specific psychic phenomena, which
are thereby actualized and are regularly described in specific
terms. (1316). According to Jaspers, this is a search for an
irreducible phenomenon, such as a colour, that is subtly
differentiated, fitting contexts and experiences. The immediate
grasp of these differences can be reached through an empathic
process and route (1317).
Mullen (2007) writes that the interest in phenomenology may be
undergoing a revival, with an approach among clinicians, as well as
researchers, which privileges the specific questions and the proper
categorization of the patients response. However, under the current
situation there seems to be a sacrifice of ambiguity for clarity,
where validity has been sacrificed on the alter of reliability,
where, the better you know a patient the better information about
them seems to fit (113). The escalating size of the disorder
manuals is rooted in phenomenology, as the authors welcome new and
added classification types. However, the disorder manuals also lead
to the creation of an authoritative structure that becomes the
source of an error. Such bowdlerization and concretization ends the
possibility of the scientific enquiries they were intended to usher
in. The right questions and answers are learned, and the disorder
types have reified certain conceptions of how a certain disorder is
(114), rather than the other way around, which would be
scientificthe struggle to grasp the nature of experiences prior to
their being lost in futile debates about the meanings and
definitions of the words used by others to describe those
experiences. (115).
John Mills in Lacan on Paranoiac Knowledge[footnoteRef:23],
writes that, Lost in its alienation, the Lacanian
subject[footnoteRef:24] discovers itself in the imaginary,
recovered through the mediation of the other, giving itself meaning
through the symbolic, struggling on the threshold of the real.
(36). Jacques-Alain Miller, in The invention of
delusion[footnoteRef:25], writes that Delusion and elementary
phenomenon constitute a binomial (1) between the elementary
starting point of an understanding and the consideration of an
outcome, a starting point, as in the case of a delusion. Miller
notes that a subject differentiates itself within a discourse,
whereby a delusion itself is an accentuation of what is carried
within (2). For Miller, delusion has a psychical cause because it
requires an intellectual effort to explain this curious, strange
and disturbing intrusion. (4) It is in Lacans medical thesis that,
for Miller, Lacan introduces the notion of an elementary phenomenon
emphasizing its causal quality rather than it being a specific part
of the personality. However, as we have seen, the personality
(taken as an ego) is not in the subject, but is arranged in the
symbolic order, outside of the subject, outward into the
intersubjective, emergent from a matter of course. This allows the
comparison of a structure given as long as there is a structure of
a subject in reality. [23: Mills, Jon. (2003). Lacan on paranoiac
knowledge. Psychoanalityc Psychology, 20(1), 30-51. ] [24: The
divided subject as conceived of by Jacques Lacan.] [25: Miller,
Jacques-Alan. (2009). The invention of delusion. Translated by G.S.
Marshall. International Lacanian Review, 5: 1-29. ]
Miller uses the example of an ability of a person to summarize
an extended story with a brief reference to its structure (8). This
is an elaboration of the delusion, given as a signifier, given for
another signifier, in a formation that is given through the
unconscious (given through differentiation of myself and what I am
not). For Miller there is an element given that structures the
experience of the subject in their reality (11). The delusion is an
articulation, the structure of which is that of a language. For
Lacan, there is an organization given by alterations in meaning.
This process is psychologically structural, always being identified
in a constitutive role as an appearance of unity. In both
instances, within a delusion and a neurosis, there is always a
return of a hallucination; and in all cases this manifestation is
an interpretation. The hallucination returns in neurosis in what
cannot be verbalized, and the hallucination returns in the form of
psychosis as a delusion within the speech of the subject, of
something they are certain of (13).
Conclusion
Where for Jaspers the psychosis can be dismissed as partially
unknowable, Lacan finds all aspects of a psychotics delusions to be
meaningful. This, Lacan will postulate as proof of some knowledge
that has no access to conscious awareness as suchsituating the ego
in a space, in a setting, which determines it within a discursive
environment, divided as such. This gap in knowledge is anchored in
a being, given in its topological spatial determination. The being,
in locating itself, believes in truths out of a paranoiac position
that needs to know, resolved by delusions constituted within
systems of magic, religion and science[footnoteRef:26]. In this
way, Lacan reintroduces the role of the name of the father, the
role of a master discourse, into science, into truth, for neurotics
only seem to doubt, and certainty is a sign of a delusion. [26:
Lacan, Jacques. Ecrits: a Selection. Translated by Bruce Fink. New
York: W.W. Norton & Company, Inc., 2006. (Page 724) ]