{"id":81273,"date":"2018-09-22T16:35:52","date_gmt":"2018-09-22T23:35:52","guid":{"rendered":"http:\/\/www.lankaweb.com\/news\/items\/?p=81273"},"modified":"2018-09-22T16:35:52","modified_gmt":"2018-09-22T23:35:52","slug":"lacanian-model-of-psychosis","status":"publish","type":"post","link":"https:\/\/www.lankaweb.com\/news\/items\/2018\/09\/22\/lacanian-model-of-psychosis\/","title":{"rendered":"Lacanian Model of Psychosis"},"content":{"rendered":"

Ruwan M Jayatunge M.D.<\/em><\/strong><\/span><\/h2>\n

The term psychosis was first introduced in the mid-19th century (Thomas, 2001) and this term was first used by the Austrian medical doctor Ernst von Feuchtersleben in 1845(Gaebel & Zielasek, 2015). The term psychosis was soon used by others and the\u00a0 German psychiatrist Emil Kraepelin differentiated between \u2018dementia praecox\u2019 and \u2018manic depression\u2019 as the two forms of psychosis (Ebert & B\u00e4r, 2010).\u00a0 In 1924 Freud wrote that in psychosis the ego is dragged away from reality.\u00a0 Freud argued that the ego\u2019s alienation from reality could cause psychosis. According to Freud psychotic episode happens when the individual is eclipsed; when, facing the frustration of the loss of an object (De Oliveira et al., 2015).<\/p>\n

Psychosis is a heterogeneous psychiatric condition (Radua et al., 2018) composed of several symptoms and delusions, hallucinations, and thought disorder may be regarded as core clinical features (Gaebel & Zielasek, 2015). Psychotic illnesses are distinct, complex, multifactorial categorical conditions (Rosen et al., 2012).\u00a0 The American Psychiatric Association and the World Health Organization emphasize the presence of hallucinations without insight or delusions in their current definitions of psychosis. (Arciniegas, 2015).<\/p>\n

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The French psychoanalyst and psychiatrist Jacques Lacan formulated an original theory of psychosis, focusing on the subject and on the structuring role of language (Ribolsi et al., 2015).\u00a0Lacanian studies on psychosis are based on psychoanalytic explanation. He used\u00a0\u00a0\u00a0linguistics, mathematics and structuralism to explain the psychotic process. Lacan’s thesis psychotic structure\u201d discussed the psychodynamics in psychiatric ailments.<\/p>\n

Lacanian psychoanalysis describes\u00a0psychosis with a hypothetical structure (Vanheule, 2017). In Lacanian psychoanalysis psychosis continues to be an important focal point for new theoretical developments driven by clinical experience and Lacanian nosology has strong links to modern psychiatry (Redmond, 2013).\u00a0\u00a0<\/strong><\/p>\n

Human subjectivity is defined by language (Laufer & Santos, 2017). \u00a0Lacan described the\u00a0language phenomena in psychosis.\u00a0Lacan refers to psychosis in terms of language based structures (Vanheule, 2011).\u00a0For Lacan, when the subject enters the realm of language something is gained, a more or less coherent sense of self and mastery over the chaotic nature of the drive and the enigmatic relation to others (Meganck, \u00a02017).\u00a0\u00a0<\/strong><\/p>\n

Lacan believed that the disturbance in language is central to psychosis. Especially the process of symbolization is affected in psychosis.\u00a0The schizophrenic disorders are mainly associated with dysfunctions of the linguistic elaboration (Yoshino et al., 1995).\u00a0An impairment of verbal communication is one of several diagnostic features of schizophrenia (Kuperberg, 2010).\u00a0\u00a0<\/strong>Schizophrenia is characterized by abnormal interpretation of verbal and non-verbal information (Ribolsi\u00a0et al., 2015).\u00a0\u00a0The schizophrenic patients show impairments in semantic-syntactic integration processes and have difficulty to access to the long-term semantic-lexical memory (Covington et al, 2005).<\/p>\n

In Lacanian perspective psychotic structure is characterized by a defense mechanism-rejection (Bazan, 2012).\u00a0As Lacan believed in psychosis, the foreclosure of the signifier entails that the subject may encounter a hole in the symbolic at pivotal junctures in subjective experience. The rupture in the signifying chain occurs when the subject is unable to signify aspects of their existence along the axes of metonymy and metaphor. Problems with metonymy underlie many of the language disturbances encountered in psychosis such as loose associations\u201d and a break down in syntax\u00a0(Redmond,\u00a02013).\u00a0\u00a0 As metaphor functions to designate the position of the subject in the signifying chain, which is intimately linked to the question of meaning and identity (Vanheule, 2011; Redmond,\u00a02013).\u00a0\u00a0For Lacan psychosis is marked by the absence of a crucial metaphorization process (Ribolsi et al., 2015).<\/p>\n

Lacan emphasized the\u00a0Name-of-the-Father\u00a0(nom du p\u00e8re) entail absence and repression.\u00a0The Name-of-the-Father is associated with an array of functions linking the subject with the other; these include castration, symbolic identifications, desire, and the installation of the proper name (Redmond, 2013). According to Lacan the exact opposite of\u00a0nom\u00a0du p\u00e8re represents psychosis. In psychosis Name-of-the-Father is radically missing\u00a0(<\/strong>Vanheule, 2017).\u00a0Lacan believed that\u00a0psychotics have not been properly separated from their mother. In addition\u00a0distorted paternal metaphor signified psychosis.<\/p>\n

Lacan\u00a0elucidate that the failure of the paternal metaphor serves as the essential condition of psychosis. The paternal metaphor is what enables the child to understand the mother’s (or mothering figure’s) absence as an Oedipal separation (Razon et al., 2017).\u00a0\u00a0In psychosis the absence of the paternal metaphor implies that the subject is not named in relation to maternal desire\u00a0(Vanheule , 2011).\u00a0\u00a0Hence the psycho navigational system is disrupted.<\/p>\n

The concept of desire is central to Lacan’s theory and practice. As described by Lacan the desire of the mother is the founding desire of the whole structure and in the psychotic subject it is outside of the symbolization introduced by the paternal metaphor, therefore the knotting of records does not occur in an Oedipal way (De Battista, 2017). However Lacan considered Oedipus complex is important for characterizing the structure of psychopathology (Ribolsi et al., 2015).\u00a0Furthermore Lacan, in his return to Freud,\u201d identifies language as essential to the dynamics of the Oedipus complex\u00a0(De Waelhens & Ver Eecke, 2001). For Lacan\u00a0psychosis was a drive-related problem creating a psychical reality (Vanheule, 2017).<\/p>\n

Lacan further states that the position on the desire differs in neuroses, psychosis, and perversion.\u00a0\u00a0In the case of psychotic desire, Lacan has affirmed a fundamental relationship with the body\u00a0(De Battista, 2017).<\/p>\n

Lacan highlighted the concept of unitary psychosis.\u00a0‘Unitary psychosis’ is the collective name for a set of disparate doctrines whose common denominator is the view that there is only one form of psychosis and that its diverse clinical presentations can be explained in terms of endogenous and exogenous factors and it is\u00a0characterized by the claim that there is only one fundamental mechanism underlying all non-organic psychosis (Berrios & Beer, 1994).<\/p>\n

Lacan viewed paranoia as a major category of functional psychosis\u201d and indicated that paranoia was a qualitatively different disorder than schizophrenia (Lepoutre, et al., 2017).\u00a0 For Lacan paternal function paranoia continued to be the resistant nucleus\u201d of psychosis.\u00a0\u00a0Lacanian model of psychosis underscore that in psychosis the unconscious is at the surface, conscious. In schizophrenia the unconscious has become conscious (Bazan, 2012).<\/p>\n

According to Lacan\u2019s theory of schizophrenia\u00a0under certain conditions the signifying function breaks down, thus turning the schizophrenic individual\u2019s world into one in which a number of events become enigmatic and signal him or her and the schizophrenic individual tries to deal with these signs that besiege him or her either by means of an interpretative attitude (a stable delusional mood) or by apathy(Dimitriadis, 2018).\u00a0\u00a0Consequently\u00a0schizophrenia\u00a0becomes a disorder of consciousness and self-experience.<\/p>\n

Jacques Lacan proposed a conceptual framework for psychosis.\u00a0 Lacan\u2019s ideas have profound impact on psychiatry. His extraordinary work on psychotic phenomena provides great insight to clinicians.<\/p>\n

\u00a0Acknowledgement<\/u><\/strong><\/p>\n

Professor Stijn Vanheule –\u00a0\u00a0 Ghent University-Belgium<\/p>\n

References<\/u><\/strong><\/p>\n

Arciniegas, D. B. (2015). Psychosis.\u00a0Continuum\u202f: Lifelong Learning in Neurology<\/em>,\u00a021<\/em>(3 Behavioral Neurology and Neuropsychiatry), 715\u2013736.<\/p>\n

Bazan, A. (2012). From Sensorimotor Inhibition to Freudian Repression: Insights from Psychosis Applied to Neurosis.\u00a0Frontiers in Psychology<\/em>,\u00a03<\/em>, 452.<\/p>\n

Berrios G., Beer D. (1994).\u00a0The notion of unitary psychosis: a conceptual history.\u00a0Hist. Psychiatry\u00a05, 13\u201336.<\/p>\n

Covington, M.A. et al. (2005), Schizophrenia and the structure of language: the linguist\u2019s view, Schizophrenia Research, 77, pp. 85-98.<\/p>\n

De Battista, J. (2017). Lacanian Concept of Desire in Analytic Clinic of Psychosis.\u00a0Frontiers in Psychology<\/em>,\u00a08<\/em>, 563.<\/p>\n

De Oliveira Moreira, J., & Drawin, C. R. (2015). Possible relation between psychosis and the unconscious: a review of The Unconscious,\u201d by Freud. Frontiers in Psychology, 6, 1001.<\/p>\n

De Waelhens,, A., Ver Eecke,W.(2001). Phenomenology and Lacan on Schizophrenia After the Decade of the Brain.Leuven University Press.<\/p>\n

Dimitriadis,Y. (2018).\u00a0Schizophrenia as a psychosomatic illness: An interdisciplinary approach between Lacanian psychoanalysis and the neurosciences.\u00a0Bulletin of the Menninger Clinic: Vol.\u00a082, No.\u00a01, pp. 1-18.<\/p>\n

Ebert, A., & B\u00e4r, K.-J. (2010). Emil Kraepelin: A pioneer of scientific understanding of psychiatry and psychopharmacology.\u00a0Indian Journal of Psychiatry<\/em>,\u00a052<\/em>(2), 191\u2013192.<\/p>\n

Gaebel, W., & Zielasek, J. (2015). Focus on psychosis.\u00a0Dialogues in Clinical Neuroscience<\/em>,\u00a017<\/em>(1), 9\u201318.<\/p>\n

Kuperberg, G. R. (2010). Language in schizophrenia Part 1: an Introduction.\u00a0Language and Linguistics Compass<\/em>,\u00a04<\/em>(8), 576\u2013589.<\/p>\n

Laufer, L., & Santos, B. (2017). Language and Vulnerability\u2014A Lacanian Analysis of Respect. Frontiers in Psychology, 8, 2279.<\/p>\n

Lepoutre, T., Madeira, M. L., & Guerin, N. (2017). The Lacanian Concept of Paranoia: An Historical Perspective. Frontiers in Psychology, 8, 1564.<\/p>\n

Meganck, R. (2017). Beyond the Impasse \u2013 Reflections on Dissociative Identity Disorder from a Freudian\u2013Lacanian Perspective.\u00a0Frontiers in Psychology<\/em>,\u00a08<\/em>, 789.<\/p>\n

Radua, J., Ramella\u2010Cravaro, V., Ioannidis, J. P. A., Reichenberg, A., Phiphopthatsanee, N., Amir, T., \u2026 Fusar\u2010Poli, P. (2018). What causes psychosis? An umbrella review of risk and protective factors.\u00a0World Psychiatry<\/em>,\u00a017<\/em>(1), 49\u201366.<\/p>\n

Razon, L., Putois, O., & Vanier, A. (2017). The Lacanian Concept of Cut in Light of Lacan\u2019s Interactions with Maud Mannoni. Frontiers in Psychology, 8, 2177.<\/p>\n

Redmond, J. D. (2013). Contemporary perspectives on Lacanian theories of psychosis.\u00a0Frontiers in Psychology<\/em>,\u00a04<\/em>, 350.<\/p>\n

Ribolsi, M., Feyaerts, J., & Vanheule, S. (2015). Metaphor in psychosis: on the possible convergence of Lacanian theory and neuro-scientific research.\u00a0Frontiers in Psychology<\/em>,\u00a06<\/em>, 664.<\/p>\n

Rosen, C ., Marvin, R., Reilly, J.L., Deleon, O., Harris, M.S., Keedy, S.K., Solari H., Weiden, P., Sweeney, J.A.(2012).Phenomenology of first-episode psychosis in schizophrenia, bipolar disorder, and unipolar depression: a comparative analysis. Clin Schizophr Relat Psychoses.\u00a0 ;6(3):145-51.<\/p>\n

Thomas, A. B. (2001). Evolution of diagnostic criteria in psychoses.\u00a0Dialogues in Clinical Neuroscience<\/em>,\u00a03<\/em>(4), 257\u2013263.<\/p>\n

Vanheule S. (2011).\u00a0The Subject of Psychosis: A Lacanian Perspective. London: Palgrave Macmillan.<\/p>\n

Vanheule,V.(2017).Conceptualizing and Treating Psychosis: A Lacanian Perspective. British Journal of Psychotherapy 33, 3 (2017) 388\u2013398.<\/p>\n

Yoshino, M. et al., (1995), Relationship between the late positive component following N400 during a linguistic task and P300 during an oddball task in schizophrenia, Electroencephalography and Clinical Neurophysiology\/Electromyography and Motor Control, 97 (4), pp. 201-202.<\/p>\n","protected":false},"excerpt":{"rendered":"

Ruwan M Jayatunge M.D. The term psychosis was first introduced in the mid-19th century (Thomas, 2001) and this term was first used by the Austrian medical doctor Ernst von Feuchtersleben in 1845(Gaebel & Zielasek, 2015). The term psychosis was soon used by others and the\u00a0 German psychiatrist Emil Kraepelin differentiated between \u2018dementia praecox\u2019 and \u2018manic […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68],"tags":[],"class_list":["post-81273","post","type-post","status-publish","format-standard","hentry","category-dr-ruwan-m-jayatunge-m-d"],"_links":{"self":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts\/81273","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/comments?post=81273"}],"version-history":[{"count":0,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts\/81273\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/media?parent=81273"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/categories?post=81273"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/tags?post=81273"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}