The Time of Ordinary Psychosis
Ordinary psychosis is a clinical definition proposed by Jacques-Alain Miller on the basis of research work developed over three successive meetings of the French-speaking clinical sections that are part of the Institute of the Freudian Field. This proposal had an immediate echo, at least among the psychoanalysts of the Freudian Field. Perhaps this success was what led Jacques-Alain Miller to add precision to this clinical contribution ten years after its initial formulation. Thus in July 2008 he gave a presentation published under the title: “Ordinary Psychosis Revisited”. At the beginning of this text we can read: “[…] ordinary psychosis does not have a strict definition. Everyone is encouraged to give their opinion and their definition of ordinary psychosis. I have not invented a concept with ordinary psychosis. I have invented a word, I have invented an expression, I have invented a signifier, by giving a definition mark to attract the different senses […]. I have bet that this signifier could provoke an echo in the clinician, the professional. What I have wanted is for it to become increasingly important and see how far this expression could go. […] If we try to give a definition, it’s the definition ex-post”.i
We have mentioned at the outset the chronological time involved in the production of the notion of ordinary psychosis in order to introduce other dimensions of time in the psychoses. One of these dimensions is that of time conceived according to the continuous or discontinuous perspective of psychopathological pictures. Another dimension is time in its most general sense: time understood as a period of civilization, the key elements of an epoch and their impact on psychopathology, which poses the question: is psychosis more frequent now? However, it is first necessary to situate the clinical phenomenology that characterizes ordinary psychosis in its nosological and structural specificity.
Formalization of the ordinary psychoses
When trying to determine what the category of ordinary psychosis might respond to, we have to start from the most basic of questions. For example, how are we to specify a subject’s status before the onset of a triggered psychosis? In a discontinuous perspective, such as that represented by the Freudian clinical structures, we would have no other option but to think of him as a psychotic, with any nuances that we may wish to add (for example, whether it was a case of an untriggered psychosis or a latent psychosis).
But what about those cases that never trigger? From a structural (Lacanian) perspective we could only consider that such subjects have had the good fortune not to have encountered any vital contingency that would have confronted them with the particular form that the foreclosure of the name of the father had taken for them. The fundamental reference for thinking in these terms is Lacan’s canonical text on psychosis published in 1959 under the title “On a Question Prior to Any Possible Treatment of Psychosis”. In this text, Lacan states the following: “Let us now try to conceive of a circumstance of the subjective position in which what responds to the appeal to the Name-of-the-father is not the absence of the real father, for this absence is more than compatible with the presence of the signifier, but the lack of the signifier itself. […] At the point at which the Name-of-the-Father is summoned – and we shall see how – a pure and simple hole may thus answer in the Other due to the lack of the metaphoric effect, this hole will give rise to a corresponding hole in the place of phallic signification. […] It is clear that what we are presented with here is a disturbance that occurred at the inmost juncture of the subject’s sense of life.”ii
Classifications based on discontinuity, on clinical structure, today pose problems for the clinician. We all encounter cases that are difficult to classify and that account for the success of categories such as borderline disorders. Lacan himself referred to what he called “fringe phenomena” and “pre-psychotic” states.
The clinic of the psychoses admits a temporality that is not simply that of synchrony (governed by the triggering and its particular conjuncture) which is present in cases of extraordinary psychoses. We must also consider a diachronic temporality in those cases where we do not find a clear moment of rupture. This leads us from a discontinuous clinic (which allows classes to be established) to another kind of clinic made possible by Lacan’s late teaching on the basis of the developments of his seminars R.S.I. and The Sinthome.
Many clinical cases, and their possibilities of treatment, are clarified when we ask what it is that allows the knotting of the registers of the real, the symbolic and the imaginary. This is a clinic based on locating what it is that serves as a means of hooking onto the Other as well as what causes it to come undone. At the same time, this allows one to focus the direction of the treatment towards a possible re-engagement.
As mentioned at the outset, ten years after formulating the notion of ordinary psychosis, Jacques-Alain Miller returned to it in his paper “Ordinary Psychosis Revisited”. This text, which I will now take up, resituates the coordinates of this clinical category. Miller locates the invention of this syntagm as an attempt to avoid the rigidity of the binary clinic (neurosis or psychosis). However, he clarifies that, while ordinary psychosis is a way of introducing the third excluded by binary rigidity, it must nevertheless be situated within the field of psychosis.
Neurosis is a very precise structure. If, for a long time, even years, we have not been able to find evident elements by which to recognize it clearly in a patient, we should then consider the possibility of a veiled psychosis, which we should be able to deduce from small clues, discreet signs. A neurosis is a stable formation, organized by means of constancy in repetition. If we do not find this, we must look for the discreet signs of a “disturbance that occurs at the most inmost juncture of a subject’s sense of life”. At this point Miller clarifies that: “The disturbance is in the way you feel the surrounding world, in the way you feel your own body, and in the way you relate to your own ideas. But what kind of disturbance, because neurotics too feel a profound disturbance? A hysterical subject feels a disturbance in her relation to her body, an obsessional subject feels a disturbance in relation to his ideas, so what is this ‘disturbance that occurs at the inmost juncture of the subject’s sense of life’?”iii
Miller proposes that we recognize this disturbance on the basis of a threefold externality: a social externality, a bodily externality and a subjective externality.
With respect to the social externality, it is a question of the function of social identification that gives us a place, a support (for example, a professional identification). Miller points out that “The clearest clue is when you have a negative relation of the subject to social identification, when you have to admit that the subject is unable to conquer a place in the sun, is unable to assume a social function, when you have to observe a mysterious helplessness, a powerlessness in relation to this function, when he doesn’t fit in – not in the rebellious way of the hysteric, or in the autonomous way of the obsessional, but there is some kind of gap which mysteriously constitutes an invisible barrier – when you observe what I called débranchement, ‘disconnection’.”iv We frequently observe this invisible barrier, this ditch, in the clinic.
The difficulty with social identification may be a sign of ordinary psychosis, as can an overly intense identification with a social position, for example a profession. In such cases, its loss can trigger a psychosis, because that social position was serving for the missing Name-of-the-Father.
Miller’s second externality is the bodily externality. Lacan states that “[we] are not a body, but [we] have a body”. This situates the body as Other for the subject. It is something that we perceive clearly in hysteria, where the body does what it wants. Also, in the masculine body, a part does not always obey. But unlike what happens in neuroses, Miller points out that: “In ordinary psychosis you have to have something else, a décalage. The inmost disturbance is a gap where the body is un-wedged and where the subject needs some tricks to re-appropriate his body, to tie his body to itself. To cast it in mechanical terminology, he needs a joint brace to connect with the body”.v In hysteria bodily phenomena are limited by castration and the limits imposed by neurosis, “whereas you feel the infinite in the gap present in the relation of the ordinary psychotic to his body.”vi
Miller’s third externality is subjective. When it comes to the dimension of the subjective Other: “Frequently it’s an experience in the ordinary psychotic of void, of emptiness and vagueness. This you may encounter in various cases of neurosis, but in ordinary psychosis you look for a clue of a non-dialectisible quality of the void or of the vagueness. There is a special fixity of this element. […] You may also look for the fixity of the identification with the object a as waste. The identification that is not symbolic but real because it is without metaphor. […] I say it’s a real identification because the subject goes in the direction of realizing the weight in his own person.”vii Another dimension of subjective externality is that in ordinary psychoses “identifications that are constructed with bits and pieces, with bric-a-brac, with flotsam and jetsam”,viii they are not identifications that have a solid and clear centre.
These three externalities (although Miller indicates that we would need to specify a fourth: sexual externality) allow us a framework within which to situate the particularities of ordinary psychosis. The clinical details are linked to a central disturbance. In contrast to the so-called borderline cases, there is no suggestion that such subjects are neither psychotic nor neurotic. Ordinary psychosis is a clinic of the subtle signs of foreclosure, it is therefore a clinic of psychosis. Nor is it reducible to the category of un-triggered psychosis, which is situated in the timeframe of a possible triggering, since “there are psychoses that do not lend themselves to triggering, psychoses with the inmost disturbance continuing without clash, without an explosion, but with this gap, or deviation or disconnection perpetuating itself.”ix
Clinical Phenomenology of Ordinary Psychoses
Many colleagues in the Freudian Field have contributed to clarifying the subtle, discreet signs that help us take into account the possibility that we are faced with a case of ordinary psychosis. This is the case, for example, by François Ansermet in his article “Paradoxes of Discreet Signs in Ordinary Psychosis”. The clinic of ordinary psychosis presents in the form of small clues that may go unnoticed. Ansermet points out the following: “They can be about oddness, a peculiar use of language, tenuous thought disturbances, unacknowledged surges of anxiety emerging as if coming from the body. The subject can also feel socially displaced, and have relational difficulties, entailing a sudden rejection of the other, without premise, without history, unplugged from the other’s time”. Ansermet makes it clear that we must distinguish the discreet sign from the solution that it generates precisely because: “The sign can become discreet as a result of being played out in the solution. In the same way that there are discreet signs that are undetected, and there could be discreet solutions that are unnoticed – they are some solutions that take hold and some that don’t”.x
I find the contribution made by Gustavo Dessal in an interview on “Continuity and Discontinuity in Ordinary Psychoses” especially enlightening with regard to the clinic of ordinary psychosis.xi Gustavo Dessal specifies different clinical phenomena that need to be taken into account when considering a possible diagnosis of ordinary psychosis. He lists the following: “[T]hese are subjects who tend to show a lack of any discursive elaboration when it comes to their history. When referring to their past and to relevant circumstances, they rely on a limited assortment of phrases that are more or less coagulated in their signification, and in which the absence of subjective involvement is often clearly highlighted. […] It is frequently a question of people whose sexual life is either non-existent or who show signs that are sometimes subtle and at others more marked of a labile relation to sexual identity. Difficulties in social relations are also evident, although we also find many exceptions in this area, especially in those subjects who are successful in some professional, artistic or commercial activity. But even in these cases we perceive that the social bond is often marked to varying degrees by signs of aggressiveness, paranoid mistrust, or passages to the act that are usually unobtrusive but show unequivocal points of foreclosure. Another interesting aspect is the fact that many subjects whom we consider ordinary psychotics often manifest in spontaneous form an extraordinary tendency to recreate an ‘Oedipal romance’ in discourse that is barely filtered by censorship.”
Gustavo Dessal adds: “Ordinary psychoses, like any other clinical entity, present very different phenomenologies. From an excess of normality to the appearance of a severe characteropathic neurosis. In any case, the delusional nucleus, evidently encapsulated, is never lacking, just a hint of ideation that the patient confesses surreptitiously, or that he maintains by means of circumlocution or ellipses of discourse. We can also add that sometimes there is a very particular fixity in signification, cases in which the patient is able to maintain a discourse constructed out of phrases that have been selected here and there, supplementing their inability to metaphorize the Real and serving as a form of nomination. We notice this in the constant use of clichés, refrains, sayings, rhetorical turns, quotes, and even jokes, that make up a kind of verbal ‘ideology’ that the patient repeats to frame the void of enunciation.”
We find in Gustavo Dessal’s description clear indications to orient us in the phenomenology of the ordinary psychoses. I find especially interesting the appreciation of how the literal reference to the Oedipus complex is usually a sign of its non-existence given that in the neurotic Oedipus is deduced, read between the lines, but is not enunciated as such.
Likewise, the incomprehensible difficulty in carrying out tasks or activities, supposedly within the capacity of the subject, and which were often performed normally in the past, may be the sign of an undeclared psychotic break. As an example, the absolute, non-dialectizable impossibility of attending a class for some adolescents and young people who previously had a normal school performance.
The relationship to language is also altered. Their speech is often composed of refrains or commonplaces that cover over the void of their own utterance. We can also observe, as Eric Laurent has pointed out, an “almost neological use of common words”.xii
It is possible that psychosis is more frequent than we think. I think we are talking about a clinic that, at least in its formal expression, we can all recognize, and whose manifestations do not respond to the logic of neurotic symptoms. At this point, a question poses itself: is psychosis more frequent in the present moment of civilization? And if so, what could be behind this increase of cases that we cannot fit into the neuroses, but also do not present the symptoms that classically define psychotic disorders, such as delusions or hallucinations?
Civilization, discourse and psychosis
As we have already highlighted, ordinary psychosis is a psychosis. We could thus think that it should be in some way reducible to the classical categories of psychosis. In the ordinary psychoses the signs are not spectacular, they are discreet. Nor are the deficits spectacular. For this reason in these cases we can speak of normalized madness, as José María Álvarez calls it. From his perspective, normalized madness describes a group of psychoses in which the manifestations are discreet, but should be considered as reduced, subclinical or attenuated forms of paranoia, schizophrenia or melancholia/mania. José María Álvarez points out that “the normalized psychoses shares with the crazy psychoses the genuine experiences that identify them as psychosis or madness and separate them from neurosis. These are experiences that are characterized, in relation to knowledge and truth, by certainty, revelation and rigour; as regards relations with others, by self-reference, strangeness, xenopathic intrusion, solitude par excellence, and prejudice; with regard to satisfaction, pleasure and enjoyment, by fullness, excess and unbearable intensity; with respect to the body, by fragmentation and disunity.”xiii For José María Álvarez it is neither the severity nor the degree of adaptation to common reality that plays a determining role in the diagnosis of psychosis, but rather genuine experiences such as those mentioned.
Ordinary psychotics are psychotics that are confused with what appears to be normal, while the extraordinary psychoses are always exceptional. This is something evident in the clinic: the subjects of persecution, of messianic delusion or of erotomania, do not think of themselves in the register of the common but rather in the order of the exception.
Marie-Hélène Brousse, in an article entitled “Ordinary Psychosis in the Light of Lacan’s Theory of Discourse”, argues that the field of psychosis seems currently to be developing and changing. She relates this to the fact that the decline of the paternal function, of the power of the Name-of-the-Father, is accompanied by the pluralization of its function. Thus, in the case of the extraordinary psychoses (of which the case of Schreber would be a paradigm), the subject has to incarnate the missing exception (Schreber has to incarnate the woman who God is lacking). “In ordinary psychosis, patients do not devote themselves to incarnating the exception function that is lacking in their symbolic organization. Therefore, ‘ordinary’ in ordinary psychosis, means banality, commonplace.”xiv
Social norms come in the place of the father’s disappearance. Norms, common sense, the ordinary, proliferate in response to the decline of the Law. This is why, as Marie-Hélène Brousse points out, When we speak about ordinary psychosis, it is super social behaviour. It’s an absolute submission, metonymical of course – and not metaphorical – to common uses, to the commonplace, as defined by the median of the bell curve. Statistics are no longer envisaged in the framework of probability, but take on the value of certitude.”xv Marie-Hélène Brousse takes up Lacan’s proposition, “Madness is no longer a privilege” in order to relate it to the function of the exception: “Ordinary psychosis seems to wring the neck of exception, and to be psychosis’s adaptation to a time when the Father, the exception, has been replaced by the number. Psychosis of the number and not of the name?”xvi
The symbolic precariousness that characterizes our time has effects in the clinic. It may be justifiable to think that in the era of number the tendency is toward the norm, toward the normal. But, as our colleague Vicente Palomera has expressed it, when speaking of the normal, for example of a normal person, there is something of the voidxvii. The clinic to come may be, to a large extent, a clinic of the void. A void already present in the ordinary forms of madness.
(Translated by Philip Dravers and Roger Litten)
i Miller, J.-A., “Ordinary Psychosis Revisited”, Psychoanalytical Notebooks, 26 (2013), p. 34-35.
ii Lacan, J., “On a Question Prior to Any Possible Treatment of Psychosis”, Écrits, trans. Bruce Fink, London & New York, W.W. Norton, 2006, p. 465-466.
iii Miller, J.-A., op. cit, p. 41.
iv Ibid. p. 42.
v Ibid. p. 43.
vii Ibid. p.44.
viii Ibid. p.45.
ix Ibid. p.47.
x Ansermet, F., “Paradoxes of Discreet Signs in Ordinary Psychosis”, available online at: http://psychoanalysislacan.com/wpcontent/uploads/2016/11/Translation_FAnsemet.pdf
xi Dessal, G., “Continuidad y discontinuidad en las psicosis ordinarias. Tres preguntas a Gustavo Dessal”, in Nodus. L’Aperiòdic Virtual de la Secció Clínica de Barcelona, accesible at http://www.scb-icf.net/nodus/contingut/article.php?art=274&rev=37&pub=1
xii Laurent, E., “Ordinary Interpretation” in The Psychoanalytical Notebooks of the London Society, Issue 19, 2009.
xiii Álvarez, J.M., “Sobre las formas normalizadas de la locura. Un apunte”, in Freudiana 76, 2016, pp. 83-84.
xiv Brousse, M.-H., “Ordinary Psychosis in the Light of Lacan’s Theory of Discourse”, The Psychoanalytical Notebooks of the London Society, 26 (2013), p. 27.
xv Ibid., p. 30.
xvi Ibid., p. 31.
xvii Palomera, V., Las psicosis ordinarias: sus orígenes, su presente y su futuro. Granada, Editorial Universidad de Granada, 2011, p. 43.