Bye Bye Ordinary Clinic, Hello Singularity
For a long time I resisted the concept of ordinary psychosis because I had long considered myself an expert in diagnosis. It was ordinary for me – ordinary in the banal sense – to diagnose psychosis in cases where for others it was extraordinary. Obviously I was mistaken… Nonetheless, given its frequency, the observation of the absence of a neurotic or perverse structure is an absolutely ordinary occurrence.
For years I thus made a provocative use of the diagnosis of psychosis, with interlocutors who I accordingly used to leave struck dumb. I certainly wished to go against the grain, not simply to impress or to destabilise the other but above all to provoke them. Because for those without a Lacanian formation, or for the common discourse, this diagnosis still has frightening resonances of madness. But for us, psychotic structure is not a madness. There are confused neuroses: incomprehensible phobias, invasive obsessions, unlimited hysterias.
If one does not wish to discomfort or to scare one’s interlocutor, the addition of the adjective ordinary introduced by Jacques-Alain Miller has the merit of bringing a certain clarification to the sulphurous term psychosis, not dramatising its use in a broader context with less informed interlocutors. This is the signified of the term ‘ordinary’ in its moderated sense: a moderated psychosis, one that does not disturb the social bond, and especially public order, too much.
But if one were thus to consider that the presence of a delusion or hallucinations would allow one to speak of an extraordinary psychosis, one would then have to take account of the fact that the presence of these symptoms, symptoms in the psychiatric sense of the term, is frequent. It is frequent when one considers a non-dialectisable certainty as a delusion. It is common when one pays attention to the presence of hallucinations. Because these hallucinations can be discreet, at times discreet to the point of being intra-psychic, which is a term that exists in the psychiatric clinic itself: that is to say, for example, the presence of a thought or even a word or an image experienced by the subject as alien to him yet present “in his head” as intrusive or simply imposed.
In both conditions, one can frequently make a diagnosis of extraordinary psychosis. In these cases, the discreet signs of extraordinary psychosis are thus called paranoia or chronic delusional psychosis in the classical nosology when there are no hallucinations or alternatively chronic hallucinatory psychosis when there are hallucinations. In these cases we can follow Jacques-Alain Miller in speaking of “Illnesses of the Other”, which is to say that what is in question is a disturbance in the place where speech is articulated for a subject, the place of the Other, essentially a disturbance in the relation between enunciation and statement, according to Jacques-Alain Miller. Given the frequency of these discreet cases in the clinic, we could say that extraordinary psychosis is in fact ordinary.
On the other hand there is a clinic of these other cases that are not structured as chronic psychosis, neurosis or perversion, even though they can at times look like it close up on account of certain traits that appear in the foreground. In certain nosological schemas one thus spoke of cold schizophrenias, white psychoses, pseudo-neuroses, borderline states, ‘as if’ personalities, etc. One enters here into the no-man’s land of very different discreet signs that compose a number of infinitely variable clinical pictures, modulated, mitigated, refracted variations of the knotting of the registers of the real, the symbolic and the imaginary where the term ordinary psychosis has meaning. But these clinical pictures where the relation with the Other at times seems so fragile that the body has no consistency can only be described case by case. In these cases, we could follow Jacques-Alain Miller in speaking of “Illnesses of Mentality”. But these clinical pictures are phenomenologically so unique that one could say that these ordinary psychoses are truly unique, one of a kind: extraordinary. These cases, therefore, can only be approached beyond the clinic, a clinic that appears ordinary with respect to the infinite enchantments of singularity.
Translated by Roger Litten