Against the ‘understanding’ of psychosis…

I may say that in the last teaching, Lacan is very close to saying that all of the symbolic order is a delusion, including his own construction of the symbolic order. In fact, life doesn’t make sense. Making sense is already delusional. And that is a very deeply held conviction of Lacan’s. In practice, when you understand what the patient says, you’re captured by his delusion, by his way of making sense. Your work as a clinician is not to understand what he says. It’s not to participate in his delusion. Your work as a clinician is to understand the particular way, the peculiar way he makes sense of things, how he always makes the same sense of things, how he makes sense of the repetition in his life.

  • J-A Miller, ‘Ordinary Psychosis Revisited’, Psychoanalytical Notebooks, 19, 2009, Trans. A. Price.

7 thoughts on “Against the ‘understanding’ of psychosis…

    • Thanks for your comment, blahpolar. I put up this quote from Miller thinking of the position on psychosis offered by the BPS report, ‘Understanding Psychosis’. The latter explicitly tries to position psychotic symptoms as an ‘understandable reaction’ to trauma, or even adversity. It might help to draw from a famous case of psychosis that’s on the public record – Freud’s account of Judge Schreber – to illustrate the point. It is unclear as to the extent to which Schreber suffered trauma. Some have adamantly claimed his father traumatised him, though some recent scholarship has cast doubt on this. In any case, even allowing for trauma (in the form of severe prohibitions against masturbation and idleness, the use of barbaric physical restraints), it’s not at all clear how one can go from these traumas to a readily ‘understandable’ delusion of being a direct part of God’s divine communications. And, if your clinical approach to treatment is to regard this delusion as ‘understandable’, it would follow that any clinical interventions are derived from participation in the delusion. That’s what ’empathy’ is in a sense, and why, as important as it is, it cannot be the alpha and omega of psychological treatment. (Empathy in German is Einfühlung, that is, one feeling, two subjects). At least, that’s my view.

      • Oh right, that makes more sense. I asked my psychiatrist if she thought psychosis was sort of … psychological flotsam and jetsam and she agreed. I pay attention to the tone/duration/type of mine rather than its content. Btw do people in Australia experience the negative voices in psychosis to the extent the western developed word does?

      • To be honest, I don’t know, but there is a line of research suggesting that culture is a big influence on one’s hallucinations. Here is one example:

        Australia is geographically south, but culturally very developed and western, even if its neighbours are some of the poorest in the world. My understanding is that Aboriginal Australians can have ideas about hallucination which are significantly different to ‘western’ ones, and such experiences are by no means indicative of psychosis.

      • Thanks, I’ve read a few papers on the subject, but not that. This acronym made me laugh:

        “Hallucinations research, like most experimental work in psychology and neuroscience, is WEIRD.57 That is, a majority of participants and subjects in mainstream studies live in Western, Educated, Industrialized, Rich, Democratic societies, as do the researchers who study them.”

        I wish there was more research done on countries like yours, NZ, SA … where levels of westernisation are a little different.

  1. In my situation (I have heard voices (and still do! 🙂 ) for over a decade), I found play, art and ritual to help when ‘understanding’ sucked (that almost got me locked up in a hospital). I don’t like to abuse my rationality for the sake of ‘niceness’. I think of rationality as a weapon which all too often we misuse, alas. 😦

  2. I think it helped that I was brought up in a hybrid Australian-Chinese environment (I’m an Australian-born Chinese), which allowed me to play with the tensions of interpretation and values, though it has been quite hard to communicate to others, especially those in the psychiatry world. It also helped that I wasn’t formally trained in psychology/psychiatry–I would have tried to disavow my experiences with much painful consequences. Rather, I had an anthropologist-turned-poet friend with wyrd experiences (as the both of us like to call them) help me through a dark patch whilst I was at uni, which goes to show that a good friend can do wonders that a so-called ‘professional’ can fail at.

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