I am not going to be exhaustive here. The aim is to present a little exegesis and a little analogy.The above chart – taken from Lacan’s Seminar X, on anxiety – may help to illustrate a couple of things at the very least, concerning the entry into subjecthood, and the separation of neurosis and psychosis.
To begin with the top left-hand side, we have the Other(A for Autre) , the capital Other, as the symbolic register that precedes the subject’s arrival (and which will persist beyond the subject’s demise), and into which the subject is born. The subject, here, is marked as S, and is subsequent to the Other. One is dealing with alienation from the outset.
The entry into subjecthood proper is marked by the barred S, which is to say, the divided Subject, the subject of lack. Subjective division – and we can take this as correlated with a series of somewhat overlapping but not totally coextensive terms, such as repression, desire, lack and law – has its counterpart in a corresponding division in the Other. The Other, and not just the Subject, is lacking, incomplete. The small a below is objet petit a, the remainder of this process of division.
This is how things stand with neurosis, at least. In psychosis, in psychoanalytic terms, there has to be some problem in this process of division, and several such problems are possible. For instance, the subject could be excluded from the outset somehow, without any place in the symbolic configuration. Every clinician must have encountered melancholics (subjects with psychotic depression), for example, whose very being does not seem to correspond with any associated parental desire; who function as unwanted, entirely surplus to parental lack. Likewise, the child who fits all too perfectly with maternal lack (for instance), may be apt to lapse into a folie à deux. Alternatively, there could be a lack in the Other which is inadequately marked or symbolised. The nature of the marking may have subjective repercussions for years, perhaps even generations. To use a Winnicottian term, it must be ‘good enough’. I don’t believe that one should be too schematic about the aetiology of psychosis, given the vast multitude of different pathways, but we have here a very basic sketch.
With this in mind, we should have pause for reconsidering the so-called ‘negative’ symptoms of psychosis, since it is actually the neurotic who ends up in a position of deficit. (Some phenomenological psychiatrists – Josef Parnas and Julie Nordgard – seem to have some similar scepticism regarding psychotic ‘negativity. I may have occasion to discuss them at some other time).
We are left with two positions, then, that approximately resemble Gödel’s two theorems. In response to the philosophical project to establish rigorous, logical principles to undergird mathematical truth, Gödel demonstrated that no such system could be found. One is left with an incomplete set of axioms (such as in neurosis, where the inconsistent axioms/signifiers/desires are unconscious), or an inconsistent set of axioms (as in psychosis, in which the operation of repression has not functioned in a comprehensive manner).
There are at least two reasonably obvious implications for the treatment of psychosis that might follow from this analogy. First, a goal of treatment in psychosis, if we presume that the Other for a psychotic subject is unbarred, is to decomplete the Other, to show that the Other is lacking in some way. This can, in fortuitous circumstances, happen to some extent. A paranoid delusion may lose some of its rigid, brittle character, and permit of some flexibility and amendment to changing circumstances. This may not be a ‘cure’, precisely, but it may nonetheless be better than a subject clinging to a paranoid construction at the expense of all else. Second, if the aim is decompletion, then the clinician would entirely undermine his position by too earnestly playing the role of expert, of authority, of the one who issues imperatives (or homework), the one who surveys and disciplines, however subtly, or who denies his or her own lack, or who exhibits too keen an inquisitiveness, or who unwittingly enacts some form of exclusion. Such positions in treatment, irrespective of one’s precise disciplinary orientations, are likely to foster greater paranoia, and reinforce the notion of an Other without limits. This is one of the reasons for nomination to be given primacy over interpretation, since the introduction of new meanings could be one of many inadvertent causes of destabilisation. Here, more than ever, one must be very precise in handling any notion of ‘resistance’, and, to follow Lacan, situate this resistance strictly on the side of the analyst, not the analysand.