One of the biggest questions for Lacanian psychoanalysis in the 21st Century – perhaps the biggest – is the question of psychosis. The classical formulation of clinical structures largely divides them into two (and then to subsequent sub-types). These two structures are, of course, neurosis, and psychosis, which correspond to the operations of repression (Verdrängung) and foreclosure (Verwerfung) respectively. One question is whether these two categories are adequate to capture contemporary clinical phenomena and, if not, what alternative formulations may look like, especially with respect to ‘borderline’ symptoms. (It is not the patient, but only ever the clinician who is on the ‘borderline’, hovering between a diagnosis of neurosis or psychosis). The later work of Lacan points to this (the theory of the Sinthome), as does Jacques-Alain Miller’s notion of ‘ordinary psychosis’, and Paul Verhaege’s theory of ‘actualpathology’. These are still early and contested formulations; I’m yet to see much of Verhaege’s work applied in the Anglophone world (though happy to stand corrected if such work exists), and much of what is said or ordinary psychosis could, on closer inspection, apply equally to regular, extraordinary psychosis.
There is a third clinical category of perversion, which corresponds to the operation of disavowal (Verleugnung). This is a much-neglected category within the Lacanian paradigm, though Miller has published some work on it, and Stephanie Swales has recently published a fine book on the topic. This third category, broadly conceived, could be put to work in conceptualising some of the more elusive contemporary symptoms and presentations – after all, it seems a kind of madness, but of a more organised and delimited kind compared to schizophrenia, for instance. In order to look at disavowal, I think it valuable to revisit Freud’s original conception of psychosis, which is where the concept first arises. Freud discussed psychosis relatively infrequently, his practice being outside of hospital settings. His lengthiest discussions take place in his examination of Judge Schreber’s memoirs, and in two short papers from the mid-1920s. The Schreber case is sufficiently well-known for me to move directly to the two late papers for Freud’s positions on psychosis and disavowal.
Let us begin with ‘Neurosis and psychosis’. Freud is clear about the ‘most important genetic difference between a neurosis and a psychosis’, namely, neurosis is the result of a conflict between the ego and id, whilst in psychosis, the conflict is situated between ego and external world (p. 149). Freud’s second topography was of course, not operative in his reading of Schreber, but this formulation does not contradict Freud’s conclusions from that paper.
In neurosis, the id generates a ‘powerful instinctual impulse’, and by means of repression, the impulse is ‘fended off’. Nonetheless, the repressed impulse returns, as it were, like an intruder, and by way of a ‘substitutive representation’, the ego compromises with the id by producing a symptom. The super-ego, formed initially by commands and imperatives from the external world, compels the ego to undertake the repression. Those familiar with the work of Lacan will recognise that ‘substitutive representation’ is the Freudian basis for notions of metaphor and metonymy.
How, then, do things stand with psychosis? In the first instance, the aetiology is much the same. The id generates its impulse, but rather than repressing this impulse, as it would in neurosis, the ego invents a ‘new world’, one that is ‘constructed in accordance with the id’s wishful impulses’ (p. 151). For this reason, Freud believes that psychosis shares a ‘close affinity’ with dreams, which for him, find their origins in wish-fulfillment. The delusion is an attempt at a recovery, a ‘patch’ applied to the rent between ego and external world. Thus, despite the different aetiological pathways, both neurosis and psychosis are borne of ‘frustration’ (or renunciation, as Bruce Fink’s translation in the Écrits would have it).
What determines the choice of pathway between neurosis and psychosis? Freud is circumspect in his remarks in this paper. He calls for a ‘new field of research’ on the matter, but ventures forth with two hypotheses. First, he thinks that ‘economic considerations’ may determine the outcome, that is, the relative magnitude and intensity of the initial impulse, and subsequent frustration. This is a quantitative, rather than structural distinction. Secondly, he thinks that the ego may be able to retain its unity, paradoxically, through a split. In any case, Freud believes that psychosis must be caused by a ‘mechanism’ which is ‘analagous to repression’ (p. 153), but in this paper, at least, he does not suggest what that mechanism might be.
A few months later, Freud published ‘The Loss of Reality in Neurosis and Psychosis’. Here, Freud reiterates his contention that in psychosis, the id alters its relations with reality. Freud realises, however, that this explanation is insufficient, since neurotics too withdraw from and distort their ‘reality’; fantasy is perhaps an example of this, and needs to be more rigorously distinguished from psychotic delusion.
To explore this problematic, Freud returns to one of his early hysteric patients, Elisabeth von R., who, at her sister’s deathbed, was horrified by the notion that her brother-in-law would now be free to marry her. The unacceptable idea was promptly forgotten – though Freud speaks of regression in addition to repression in this passage – and this forgetting sets Elisabeth’s hysterical agonies in motion. This, Freud tells us, is a neurotic path to illness. A psychotic in similar circumstances would, on the contrary, have responded to the sister’s death not through repression (or regression) but disavowal, (Verleugnung). The latter process sets off a two-step mechanism, in which the ego first turns away from reality, and in which reality is itself modified to accommodate the needs of the id, which in a neurosis, would merely be constricted. In short, ‘neurosis does not disavow the reality, it only ignores it; psychosis disavows it and tries to replace it’. It is ‘alloplastic’ rather than ‘autoplastic’ (p. 185).
Again, Freud stresses the similarities between neurosis and psychosis. ‘Probably in a psychosis the rejected piece of reality constantly forces itself upon the mind’, he says, ‘just as the repressed instinct does in a neurosis’ (p. 186). Again, Freud emphasises that the mechanisms underpinning the development of psychosis require further research. Both the neurotic and the psychotic have their fantasies and a loss of reality, and use the former to substitute for reality. Freud indicates that the piece of reality repressed by the neurotic (and returning qua repressed) has a symbolic character, and this, it seems, is one of the few categorical distinctions between neurosis and psychosis.
Let’s apply this theory of Freud’s to the case of Schreber. (Freud’s account of Schreber in 1911 does not refer to later notions of disavowal, but instead, makes use of repression). Nonetheless, for Freud, the ‘instinct’ that Schreber is attempting to curb is his homosexuality. His mode of doing this is through paranoiac projection – rather than loving another men, the other man hates him, persecutes him. This is the construction in which Freud pinpoints Schreber’s delusions, which are themselves an attempt at restoration of the ‘reality’ which was abolished during the apocalypse of Schreber’s ‘subjective world’ (Freud, 1911, p. 70). Notwithstanding the reliance on the notion of repression, (which Freud modifies with the concept of projection), Freud’s account of paranoia in Schreber is generally consistent with his later accounts of psychosis from the 1920s, ordered through the later topography.
Yet we have reasons for questioning Freud’s formulation, and Freud himself is aware of this when he calls for ‘further investigation’. Why should the neurotic repress what the psychotic disavows? Why should Schreber’s alleged homosexual wishes have resulted in such a catastrophic breakdown, when such wishes are common enough, and equally compatible with a mere neurosis? Freud seems to give a quantitative answer to these questions; that is, the problem is the intensity of the wishes. This makes psychosis (and disavowal) a matter of economy, and raises the further question of why some impulses should be more ‘intense’ than others in the first place. There is a sense that something is missing in this account of psychosis.
This leads us to a consideration of disavowal – Verleugnung – which appears (for the first time) in several of Freud’s writings around the mid-1920s. Its first usage arises in the paper ‘The Infantile Genital Organisation’, where it relates to castration and sexual difference. Freud tells us: ‘We know how children react to their first impressions of the absence of a penis. They disavow the fact and they believe they do see a penis, all the same.’ (p. 143-144). This point on disavowal is reiterated in the short paper on sexual difference and children that Freud published a few months later in 1925. The psychotic disavows a piece of reality. Freud believes that in cases of perversion – for instance, masochism – that disavowal is specifically a disavowal of the fact of castration (see p. 165, ‘On the economic problem of masochism’). In the paper on fetishism (1927), for instance, Freud takes the fetish to be a substitute for the penis of the woman, or mother, the absence of which has been disavowed. We are left in a curious situation, then, in which both psychosis and perversion fall under the banner of Verleugnung. Yet this is not all. The case of Little Hans, for instance, does not make any reference to disavowal, published as it was in 1909. Nonetheless, Hans’ phobia is arguably a by-product of his disavowal of the castration of the mother. Psychosis, perversion, and possibly even phobia all come to be understood by Freud in connection with disavowal in some sense. It is around this period that Freud writes his paper on negation (1925), however, he does not ascribe the same kind of aetiological efficacy to this mechanism as to repression or disavowal. It would seem, then, that another mechanism is called for in order to more rigorously distinguish these various clinical entities.
If these issues were the focus of Freud’s attention in the mid-1920s, they came to be explicated by Lacan in the mid to late-1950s. In Seminar III, foreclosure of the Name-of-the-Father, comes to stand in for Freud’s other mechanism, Verwerfung. Appropriately enough, Seminar IV deals with perversion and the case of Little Hans, and the paper on psychosis in the Écrits condenses and crystallises much of this work. Freud does not succeed in a thorough accounting of psychosis, but nonetheless, the shortcomings of his approach are instructive, and point to the sorts of difficulties that Lacan is attempted to resolve in the 1950s. In part, this explains Lacan’s interest in the notion of Bejahung, which he takes up in Seminar I, and in the paper on psychosis in the Écrits. Bejahung, to be understood as affirmation, is introduced by Freud in his paper on negation. Affirmation belongs to Eros, and a symbol (or signifier), once affirmed, can be subsequently repressed, negated, or possibly disavowed. If it is not affirmed in the first place, however, we can understand it to be foreclosed.
According to Freud, disavowal relates to perversion, but not only perversion. It is as if here are two madnesses: outright psychosis (Verwerfung) and more limited madnesses derived from disavowal. It is speculative, but these latter may account, partially, for borderline phenomena, or for sociopathy, which was described by Pinel as manie sans délire, and by Prichard as a kind of ‘moral insanity’. After all, in these diagnoses, the subject (arguably) positions him/herself as an instrument of the Other’s anxiety or jouissance. But a more detailed examination of this will have to wait for another occasion.
Freud, S. (1923). The infantile genital organisation. (An interpolation into the theory of sexuality). (Trans J. Strachey). SE, 19.
Freud, S. (1924). Neurosis and psychosis. (Trans. J. Strachey). SE, 19.
Freud, S. (1924). The loss of reality in neurosis and psychosis. (Trans. J. Strachey). SE, 19.
Freud, S. (1925). Negation. (Trans. J. Strachey). SE, 19.
Freud, S. (1927). Fetishism. (Trans. J. Strachey). SE, 21.
Lacan, J. (2006). Écrits. (Trans. B. Fink). New York, NY: Norton.
Miller, J-A. (1996). On perversion. In Reading Seminars I and II: Lacan’s Return to Freud. New York, NY: SUNY.
Swales, S. (2012). Perversion: A Lacanian Psychoanalytic Approach to the Subject. New York, NY: Routledge.
Verhaege, P. (2004). On Being Normal and Other Disorders: A Manual for Clinical Psychodiagnostics. (Trans S. Jottkandt). New York, NY: The Other Press.