Paranoias and Madnesses of Everyday Life
Today, paranoia barely has a place in international psychiatric classifications (ICD-10, WHO and DSM V).
Griesinger, in 1845, was the first to give an account of paranoia and, at the same time, he was also one of the most fervent advocates of the idea of converting mental diseases into brain disorders. Griesenger proposed a model of unitary psychosis which brings different aspects of disorder together: the affective, the ideational and the deficient.
Kraepellin at the end of the 19th century includes it in the group called “dementia praecox”. In this way, it was reduced to a minimum set of symptoms characterized by the insidious development of a permanent and immovable delusional system, arising from internal causes, while conserving clarity and order of thinking, willing and acting. This perspective on paranoia radically challenged his view that mental illness had to cause deterioration, disability and changes in behaviour.
This will lead Lacan to say that “[t]his definition, coming as it does from the hand of an eminent clinician, is remarkable in that point by point it contradicts all clinical material”.[i]
Following the publication, in the second decade of the last century, of Bleuler’s monograph on schizophrenia, the latest editions of Kraepelin’s Manual and the Jasper’s General Psychopathology, the notion of paranoia has been increasingly put into question by psychiatry. It dissolves, on the one hand, into the field of schizophrenia and, on the other, into that of manic depressive psychoses.
It is in this context that one must approach Lacan’s 1932 doctoral thesis on the case of Aimée, in which a woman’s delusions disappear following a passage to the act and her confinement in prison, which throws into question most of the underlying assumptions of German psychiatry and his own teachers in France.
Freud’s impasses
In “Neuro-Psychosis of Defence” (1894), Freud tries to find the psychological mechanisms underlying the two neuroses (hysteria and obsession) and psychosis and the link between them.
In the case of psychoses, he proposes a radical mode of defence against intolerable representations and will use the term Verwerfung, which Lacan takes up by translating it as foreclosure.
In 1896, Freud wrote the case of Mrs. P, a case of chronic paranoia. She had been married for three years and was the mother of a two- year old child. Her illness began six months after the birth of her child. She started to become reserved and distrustful, showing discourtesy in social relationships. She was certain that the inhabitants of the small town in which she lived had changed their behaviour and that everyone, including her relatives and friends, disregarded her and did everything possible to irritate her. A short time later, she began to think that she was being watched, that she was being spied upon at night while undressing, and that they knew what was going on inside her house. She was depressed and had almost stopped eating.
Freud approached the treatment as if it were a neurosis, assuming that there were unconscious thoughts and repressed memories that could be made conscious by overcoming resistance. Evidently, the analytical work resulted in the appearance of certain ideas that Freud considered to be unconscious, which made it possible to refer paranoid obsessions to repression as well.
During these years, we can observe Freud’s ambivalence regarding the mechanism at play in psychosis. On the one hand, he speaks of rejection and, on the other, of repression, thereby making it equivalent to the mechanism of neurosis.
It is clear that Freud strives to isolate the specificity of a psychotic mechanism, but he does not succeed. In this case we are confronted with the limits of psychoanalysis, at its inception, in treating psychosis.
Later Freud elaborates his main contribution to psychosis in “Psychoanalytic Notes on an Autobiographical Account of Paranoia” (1911). For Freud, psychosis has two moments: one of libidinal retraction in which the libido withdraws from the external world bringing the loss reality as its consequence and a second moment, the one marking the outbreak of the illness, which is the delusional and hallucinatory one.
For Freud, the formation of a delusion was in reality an attempt at cure and a reconstruction.
In the letter to Jung (no. 25) of May 23, 1907, Freud stresses that he considers paranoia to be a sound clinical type and dementia praecox, the actual schizophrenias, as a bad nosological term. For Freud, paranoia represents the most important theoretical model for psychotic structure, Schreber being the most paradigmatic case.
The Lacanian perspective
Let us not forget that Lacan, before designating hysteria as the fundamental state of the subject, had begun by saying that paranoia is the native state of the subject. In fact, Lacan makes a single reference to schizophrenia in his text, “L’étourdit” with the expression “the so-called schizophrenic”.
In the first moment of his teaching, which Lacan calls “his antecedents”, he considers that, to make a body, a living organism plus an image is needed. Lacan attributes the feeling of the unity of the body to the unity of the image.
An Infans does not speak, although he is immersed in a bath of language, he doesn’t yet have speech at his disposal. Through the fact of his premature birth, he suffers from the experience of a fragmented body, a body that he cannot master. However, his relation to the visual field is highly developed. It is in such circumstances that the experience of the mirror stage takes place, to be understood as a libidinal dynamism. The fundamental feature of this libidinal dynamism is that he will identify with an image given to him by the other, a total image of the body. Thanks to the image, a relationship can be established between the organism, the fragmented body and the reality or perception of the unity of the body.
This means that the subject experiences himself as “I” in the place of the other, starting from the image of the other, his self-image being constitutively alienated in the other. The image is his but at the same time it is the other’s because he is lacking with respect to it. The other is the one in which I see myself and from which I constitute the imaginary and symbolic identifications. This is how the matrix of the imaginary is established.
This explains the relationship of imaginary aggression with the counterpart, that ambivalent aggressiveness, because the counterpart is always someone who replaces him, who is in his place. This also explains the initial paranoid relationship that man has with his object to the extent that the object interests him because there is always another ready to take it away.
At this time we must take into account the developments of the post-Freudians in the USA who take the second topography of 1920 as a central reference and refer to the ego (moi) as the central agency of the personality endowed with a function of synthesis and hence the psychoanalyst has to reinforce the ego to bring the patient to reality.
Addressing the question of the ego from the mirror stage leads to something very different, because the ego is not something unified but rather a disorder of imaginary identifications that reappear successively in the analytic experience. The I for Lacan is originally a trap and is established in a register that pushes the subject to rivalry and aggressiveness: either me or the other, aggressiveness is constitutive of the human being by the way it is produced from the beginning.
The text, “Aggressivity in Psychoanalysis” defines aggression as constitutive of the subject and goes as far as to say that, for the subject, psychoanalysis establishes itself as a ‘guided paranoia’.[ii]
Thus, the imaginary relationship is a disorder and it is in this disorder that the symbolic order will come to intervene.
At the beginning of his teaching, in the 1950s, Lacan will stress the need for the infans to have to pass through alienation in the Other of language so that he can become a subject. Yet, at the same time, the subject’s inscription within the symbolic order provides one of the keys to understanding the affinity between paranoia and the structure of the subject.
Jacques-Alain Miller tells us: “Maliciousness is a fundamental signification linked to the signifying chain as such. By the sole fact that one signifier is liked to another, there is an effect of signification, and if there is one, there may be others. In other words, things get implied; it is a general property of the signifying chain. It can always be interpreted differently and for this very reason there is misunderstanding. Now, why do we imply things rather than spell them out? Why should we decipher what is said secretly? Everything leads us to suppose that we cannot say it directly because it is malevolent. Therefore, the meaning of malevolence is associated with the simple fact that the supplementary signifier varies the truth of a statement … By the mere fact that his parents speak about him, a whole speech precedes his arrival in the world. They talk about him [à son sujet]. This is what constitutes a malevolent other [un autre malveillant], an other that does not have good intentions. This defines the primary status of the Other. From this perspective, we can attribute an evil jouissance to any Other whatsoever, because the enjoyment of the other is always unknown to us”.[iii]
In other words, the dimension of paranoia, of misunderstanding, is something that we find in the very structure of the subject, regardless of whether it is a question of neurosis or psychosis.
In the psychoanalytic clinic, we usually find how the neurotic fantasy locates the Other in a territory very close to that of malevolence and in the same way we find subjects in whom the paranoid delusional theme can go clearly unnoticed.
A patient with a hysterical presentation and melancholic features may only speak to me a year after beginning her analytical work of her delusion concerning the malevolence of the Other, of the demons and the angels that protect her, a delusion that can finally be lodged in the transference. Shortly after this she came to the clinic telling me that she had consulted the Internet and discovered that what was happening to her were paranoid ideas.
As I indicated earlier, Lacan goes from the specific relation of the subject to language, and ends up isolating from Freud’s writings a concept that until then had gone unnoticed or had not attracted attention: Verwerfung.
In the text “On a Question Prior to Any Possible Treatment of Psychosis”, in 1958, he will emphasize what the psychotic lacks in order to be neurotic, he lacks the signifier of the Name of the Father that gives meaning to life and allows him to signify the jouissance of his body and the jouissance of the body of the Other.
In his introduction to the French translation of the Memoirs of President Schreber, Lacan gives us a very valuable indication of how to think about the paranoid dimension of psychosis: “Doesn’t this allow us to propose a more precise definition of paranoia as identifying jouissance in the place of the Other as such?”[iv]
In this way, the axiom that summarizes Lacan’s position regarding the subjective position of what psychiatry recognizes under the name of Paranoia is “the Other enjoys me”.
Jacques-Alain Miller will stress that: “Paranoia is a pathology, without any doubt, however Lacan also says that personality as such is paranoid … it is impossible to be someone without being paranoid. It is impossible to be someone who is spoken of, someone whose name circulates in the discourse of the Other, being for that reason vilified, defamed at the same time spoken of far and wide, it is impossible to be someone without the support of a paranoia. It is simply to say that the social Other is always another evil one, that wants to enjoy me, to use me, to make me serve his uses and his ends. “[v]
Lacan says at the end of his teaching, “Everyone is crazy, in other words, delusional” which questions us about the differential clinic between the quasi-delusional character of the neurotic fantasy and the reasoned delusion of the paranoiac. This raises many questions of a clinical nature in relation to transference and work with psychosis. These points will be clarified at the next Congress of the AMP in Barcelona.
Drifts of civilization
We could add that this coincides with the current state of civilization where every subject is a suspect, in which the place of the Other becomes persecutory and where the subject suffers the torments of the Other. This is Lacan’s perspective. The Other watches over him, pursues him, gains access to and knows his most intimate thoughts, language intervenes without being regulated by repression, there is no veil, nothing happens by chance, everything happens in a logic constituted by the maliciousness of the Other.
In today’s civilization, the development of science and technology placed at the service of the mechanisms of control and exploited by Big-Data can act as a push for that structure of the subject that has that same paranoid dimension. Science and technology develop a power and knowledge about our ways of life that do not cease to be disturbing for human beings.
In some cases, it can happen that the paranoiac himself, in his delusion of countering evil, can embody a figure of the saviour and embody a discourse in which the segregation of the Other can be a mode of response to the failure of his own structure.
It may happen that certain discourses that promote hatred and the rejection of what is different, find an echo in that same subjective structure, promoting identities that re-signify the hole of foreclosure.
We could propose the following hypothesis. If, in Europe and in the world at large, the segregative drive today acquires a strength and intensity that surprises us, it is not so purely by chance from the perspective of psychoanalysis. Hatred of the Other, difference presented as evil, this is one of the manifestations of the madness of civilization and everyday life.
Translated by Maria Lopez and Lorena Hojman, reviewed by Philip Dravers
Notes
[i] Lacan, J. The Seminar, Book III, The Psychoses, London, Routledge, 1993, p.17.
[ii] Lacan, J., “Aggressiveness in Psychoanalysis”, Écrits p. 89.
[iii] Miller, J.-A., L’Autre mechant. Six cas cliniques commentés, “La bibliothèque lacannien”, 4. Navarin, 2010.
[iv] Lacan, J., “Présentation de la traduction de Paul Duquenne des « Mémoires d’un névropathe » de D.P. Schreber”, en Cahiers pour l’analyse n° 5 p. 69-72.
[v] Miller, J.-A.,“La salvación por los desechos”, en El Psicoanálisis nº 16, Revista de la ELP. Novembre 2009, Barcelona, pp. 15-23.