Throughout the covid lockdowns I read numerous contemporary books about psychoses and psychiatry. They were written by professionals, service users, academics, and campaigners of one sort and another. It was my intention to summarise this literature for you. Slowly I began to realise this task was not achievable in one short seminar without becoming trite, reductionist, or trivial.
I also became aware of my own limitations, misunderstandings, and presuppositions about the what used to be called "the psychoses”. Some of these “presuppositions” now seem more like prejudices, don’t knows, or uncertainties.
So here I offer you a redefined task. It is to introduce several propositions for debate about the nature of psychoanalysis including its traditional distinction between psychosis/neurosis. These are based upon a lifetime's involvement with psychoanalysis and psychosis which began in my very early teens, if not before.
Some Proposals for Debate
1.Psychoanalysis is not scientific, nor a science, nor a psychology, nor a manual for achieving practical health results.
2.The notion that “neurotic” is somehow normal, whilst “psychotic” is invariably abnormal may well conceal prejudicial notions. Why should neurotics be considered superior or better than psychotics?
3. A psychoanalytic subject may primarily be psychotic .
4. Any knowledge found in psychoanalysis tends to be illusionary, temporary, and unstable.
5. Psychoanalysis is unable to offer, guarantee, or gift people such rare commodities as health, wealth, success: as well as various other aspirational states and demands like happiness, unity, contentment, peace.
6. Psychoanalysis offers both punters and professionals social forums for discovering and swapping delusions. These social networks are like bubbles. They float around for a bit, then disappear sometimes without trace other times following an almost silent "pop". When these delusion-bubbles are objectified and retailed as supposed "trainings", they cease to be psychoanalytic. Instead they become consumer goods for packaging, retail, and creating demand.
7. Delusions are valuable and utterly necessary for living
8. The greatest gifts of psychoanalysis are first, the opportunity to talk freely, next, a temporary social link with a person who is supposed to listen. Last but not least, there are events grouped around analytical transference which may well become crucial for a being.
The following writing is chiefly concerned with number 2 and a little of 3.
Psychosis vv Neurosis
In order to learn psychoanalysis, it was deemed absolutely necessary to read Freud in detail, as well entering one’s own private analysis whilst attending seminars conducted by senior adepts. Particular emphasis was placed upon learning Freud’s case histories so as to familiarise oneself with the principal psychological styles -or in the more technical language of Lacan “structures”- of neurotic patients.
The main two styles of neurosis were hysteria and obsession. A third, phobia, was an oscillating affair involving an unstable balance between two other quirks: a sort of oscillation not dissimilar to the experience spoken of by some bisexuals. These psychological fashions, styles, quirks, eccentricities, or “neuroses” were ways of fantasising about oneself, as well as systems for interacting with what is registered as reality. They also were enacted (and repeated) for the benefit of the social world of others too. Dealing with these “clinical structures” became the bread and butter of jobbing analysts. The entire field of neuroses had a common factor in what was called repression. This was an unsuccessful trick. It fails to get rid of unwanted thoughts, actions, desires, and various other unpleasantries -whether personal, natural, or social. The first users of analysis came because "repression" was failing.
A completely different style of being, living, and presenting oneself to the world of objects and people was supposed to be light years away from the neuroses. It was absolutely different in quality, quantity, and presentation from neurotic styles of thinking, being, speaking, of behaving. This other style was called psychotic.
Freud was never a really good doctor with a reassuring bedside manner. He wisely disallowed “psychotics”, with whom he had very little patience, from becoming analysands; though admittedly some of his earliest trainees admitted them into treatment. Freud himself was well acquainted with contemporary psychiatry. He believed it would very soon advance so radically that it would quickly begin to find cures -surgical, physical, or pharmacological- for the successful treatment of the psychoses. He exchanged letters with the celebrity psychiatrist Ludwig Binswager (1881-1966), as well as the eminent Eugen Bleuler (1857-1939) who is still known for his pioneer work on a group of symptoms clustering around the title of “the schizophrenias”. Bleuer was one of the signatories recommending Freud for a Nobel prize. But whatever his personal or professional relations with psychiatrists, Freud never even dreamed of psychoanalysis becoming a cure -or even an accessory application- for the treatment of psychosis.
The one detailed work Freud wrote about a sectioned insane person dates from 1911. It was based upon a contemporary autobiography written by a senior high court judge containing a candid account of his struggles. This judge was wrestling with his beliefs about god, the world, and his own role in a divine tragedy -because it was definitely no Commedia like Dante’s. To put it simply, judge Schreber believed god was turning him into a woman so that he would eventually become God’s “Slut”. The medical diagnosis was paranoid dementia -a condition thought to be terminal for body, personality, as well as brain function.
Though Freud postulated Judge Schreber’s persecutory beliefs centred around conflicts concerning homosexual desires; he resolutely rejected any attempt to try to “cure” such people with psychoanalysis. Why? Because all such sufferers were organically destined to die of a dementia which was as inevitable, lethal, and as cruel as any Alzheimer’s. He continued to hold this opinion for the rest of his life.
Two decades later, during the winter of 1930, Princess Alice of Battenberg was admitted to Kurhaus Schloß in Tegel with a diagnosis of schizophrenic paranoia. Maybe she reminded Freud of judge Schreber, for one of her delusions took a religious form. In this instance God wanted the princess to become his bride and received regular messages from Jesus and Bhudda.
Eventually she was moved from Tegel hospital to Binswanger’s famous asylum for international celebrities at Kreuzlingen in Switzerland. When Freud was consulted by both Ernst Simmel, Tegel’s Director, and Binswanger, lead of the celebrated Kreuzlingen Respite, Freud recommended that the best way forward treatment-wise was for the patient’s ovaries to be exposed to high-intensity X-rays. It is not all clear whether that procedure was supposed to rejuvenate her femininity or -contrariwise- initiate menopause. Danny Nobus has helped to untangle some practices and beliefs related to this radical but odd procedure.
Be that as it may, by recommending seemingly psychotic patients like Princess Alice should be treated with such weird physical interventions, Freud was sticking to his conviction that the clinical applications of psychoanalysis were absolutely confined to what he called the neuroses. A complete consideration of endocrinological, organic, or neurological factors for the causation and treatment of psychoses would, he continued to believe, be the most successful avenues for addressing treatment for this diagnostic category.
Princess Alice several times attempted escape from Kreuzlingen and after two years of incarceration, she went on to perform quiet acts of heroism during the 1940’s whilst living in near squalor. She later become a nun: a bride of Christ no less! Later still Alice eventually became mother in law to a reigning queen. She died in December 1969 well into her eighties at Buckingham Palace, the home of her son Philip and daughter in law Elizabeth II. In her final years Princess Alice was physically frail, but completely lucid. In 1988 her body was moved from Windsor for reburial at an orthodox convent in Jerusalem. Ten years later she was honoured at Yad Vashem for being “righteous among the nations” for having
sheltered Jewish people from persecution during the Nazi era. Her two surviving children attended the ceremony.
Freud, then, bequeathed his followers several seeming certainties:
1. First of all the majority of human beings seeking analysis were either neurotic or psychotic. Others may have adopted a perverse clinical structure, but it is not entirely clear to me what precisely this consisted of….. then or now. Anyway whoever they were then, and are now, rarely did they ask psychoanalysts for help
2. Though there were sub-categories of both psychoses and neuroses, these two principal categories were supposed to be absolute, meaning that once a neurotic or psychotic condition was evident, its clinical status lasted the entire course of life. Once psychotic, one is supposed to remain psychotic. Likewise people labouring with neurosis.
3. Neurotics, believed Freud, might find some relief in the “ordinary unhappiness” offered through psychoanalysis and reconfiguring their demands, desires, and expectations to social or communal purposes.
4. Psychotics by contrast had to await empirical cures from medical science : drugs, surgery, combinations, or some other therapy (like radiation)
I first began to study Freud, Bleuler, Kraepelin, and Jaspers on the topic of psychosis in my twenties when volunteering in an old fashioned psychiatric hospital. The long term outcome of what was once called dementia praecox seemed as inevitable, lethal, and as cruel as a more famous dementia in modern times -Alzheimers. Regularly I heard staff speaking off-hand about “burnt out schizophrenics”. These were inmates who had become elderly and demented.
The only therapies considered worthwhile for these people were continued pharmacology, restraint, and some form of occupational therapy -like community singing at Christmas. Many ended their days in massive "psycho-geriatric" wards heavily sedated. So from the early twentieth century the word “psychosis” was used it meant a dementia with an unfavourable prognosis.
Approximations & Similarities
Freud returns to one of his early hysteric patients, Elisabeth von R., who, at her sister’s deathbed, was horrified by the notion that her brother-in-law would now be free to marry her. The unacceptable idea was promptly forgotten – though Freud speaks of regression in addition to repression in this passage – and this forgetting sets Elisabeth’s hysterical agonies in motion. This, Freud tells us, is a neurotic path to illness. A psychotic in similar circumstances would, on the contrary, have responded to the sister’s death not through repression (or regression) but disavowal, (Verleugnung). The latter process sets off a two-step mechanism, in which the ego first turns away from reality, and in which reality is itself modified to accommodate the needs of the id, which in a neurosis, would merely be constricted. In short, ‘neurosis does not disavow the reality, it only ignores it; psychosis disavows it and tries to replace it’. It is ‘alloplastic’ rather than ‘autoplastic’ (p. 185).
To simplify: neurotics try to forget reality and opt to abide in a fantasised past where the items "forgotten" are not supposed to exist. Psychotics by contrast try to reconstruct reality or change it by creating delusions. Both however, dislike the reality in which they live.
II) A state of near psychosis might occur to neurotics when they fall deeply, desperately, in love. Correspondingly narcissism (self love) was considered close to psychosis from its earliest outing. To get a handle of what Freud meant by this love-insanity, it would be necessary to read one of the most unattractive publications in the entire Freudian opus. I refer to the horrible Brautebriefe; the voluminous letters exchanged with Martha Bernays from 1882-1886 during their engagement. Following Martha, his next infatuation is witnessed by an even more extensive set of letters; but this time to a male. His friend, collaborator, and confident was Fliess (1887-1902). This relationship was initially creative, but eventually became acrimonious concluding with mutual accusations of plagiarism.
III) Another psychotic-like situation may happen in pressurised social, political or religious situations, when one identified with a popular leader, state, or ideology. When identifying like this, one almost surrenders -or sacrifices- one's being, desires, and hopes to the Other/s totally.
IV) Interestingly Freud and some his immediate circle, including Ernest Jones his Welsh biographer and eventual world leader of psychoanalysis, claimed that even eminent analysts could become psychotic. This happened, it was felt, to Sandor Ferenzci. He was a pioneering Hungarian analyst and one of the earliest colleagues of Freud’s. He began neurotic and ended psychotic it was claimed. Maybe however, this judgement was also due to innuendo, rumour, suspicion, and feigned medical ignorance about the symptoms of pernicious anaemia.
V) Finally in the twentieth century
a) Melanie Klein began to relativize the differences between neuroses and psychoses by suggesting that infants undergo psychotic-like experiences.
b) French analysts relativized another tenet of the neurosis or psychosis binary. For example, It was once thought that psychotics suffered from delusions, whilst neurotics entertained phantasies. Well Lacan and some followers began to emphasise that delusions often work protectively by keeping more threatening scenarios at bay. To that extent, everyone might be mad with his/her idiosyncratic creative delusion.
d) Finally very important contributions came from organisations promoting dialogical treatments and peer support groups, like the hearing voices network. In this network: We focus on helping to create respectful and empowering spaces, whilst challenging the inequalities & oppressive practices that hold people back. https://www.hearing-voices.org
It seems to me that any human being can easily be pushed into a psychotic mode of being whenever the conditions -internal as well as external- are sufficiently dire. Nevertheless many people like Princess Alice live well for years after several years of profound suffering. She certainly found a vocation for herself no longer needing doctors, hospitalizations, nor therapists for the many remaining decades of her long amazing life.
c) Psychoanalysis is always adapting itself to what can be believed so during the late twentieth century it is not surprising that a group of analysts invented a new category of psychosis called “ordinary psychosis”. This diagnosis and its treatment was unique to psychoanalysis. It is still unrecognised by either psychiatry or psychologies. Since its introduction "ordinary psychosis" underwent a series of revisions: nevertheless it remains highly significant. Psychoanalysis invented a clinic which caters for those with ideas, emotions, and behaviours that cannot easily be described as either neurotic or psychotic. They are not candidates for long stay psychiatric wards, clinics, or heavy medications. Ordinary psychosis arose therefore as tentative diagnostic style for clients who would otherwise have acquired a bewildering array of disorders. It provided highly effective clinical setting became popular in France for both therapists and their customers. There "treatment centres" offered reduced fee sessions for psychoanalysis during specified period of time During decades of working in NHS inner city areas, the reality of non-standard psychoses became highly significant for my practice.
I conclude this section by quoting from the Hearing Voices website:
If you hear voices, see visions or have similar sensory experiences – you’re not alone. The statistics vary, but somewhere between 3 and 10% of the population have experiences like these (increasing to about 75% if you include one off experiences like hearing someone call your name out loud). Despite being relatively common, many people who hear voices, see visions or have similar experiences feel alone. Fear of prejudice, discrimination, and being dismissed as ‘crazy’ can keep people silent. At a time when we are told that it is ‘time to talk’, it is important that anyone courageous enough to speak out is met with respect and empathy. People of all ages and backgrounds can hear voices at some point in their life, for many different reasons. Whilst some are distressed by their experiences, people can – and do – find ways of living with them.
III) Another psychotic-like situation may happen in pressurised social, political or religious situations, when one identified with a popular leader, state, or ideology. When identifying like this, one almost surrenders -or sacrifices- one's being, desires, and hopes to the Other/s totally.
IV) Interestingly Freud and some his immediate circle, including Ernest Jones his Welsh biographer and eventual world leader of psychoanalysis, claimed that even eminent analysts could become psychotic. This happened, it was felt, to Sandor Ferenzci. He was a pioneering Hungarian analyst and one of the earliest colleagues of Freud’s. He began neurotic and ended psychotic it was claimed. Maybe however, this judgement was also due to innuendo, rumour, suspicion, and feigned medical ignorance about the symptoms of pernicious anaemia.
V) Finally in the twentieth century
a) Melanie Klein began to relativize the differences between neuroses and psychoses by suggesting that infants undergo psychotic-like experiences.
b) French analysts relativized another tenet of the neurosis or psychosis binary. For example, It was once thought that psychotics suffered from delusions, whilst neurotics entertained phantasies. Well Lacan and some followers began to emphasise that delusions often work protectively by keeping more threatening scenarios at bay. To that extent, everyone might be mad with his/her idiosyncratic creative delusion.
d) Finally very important contributions came from organisations promoting dialogical treatments and peer support groups, like the hearing voices network. In this network: We focus on helping to create respectful and empowering spaces, whilst challenging the inequalities & oppressive practices that hold people back. https://www.hearing-voices.org
It seems to me that any human being can easily be pushed into a psychotic mode of being whenever the conditions -internal as well as external- are sufficiently dire. Nevertheless many people like Princess Alice live well for years after several years of profound suffering. She certainly found a vocation for herself no longer needing doctors, hospitalizations, nor therapists for the many remaining decades of her long amazing life.
Carlo Bonomi Jones's allegation of Ferenczi's mental deterioration: a reassessment International Forum of Psychoanalysis 1998
S. Ferenzci Bleulers Kritik der Freudschen Theorien in Ferenczi: Bausteine zur Psychoanalyse IV copy of first edition of1938 published by Huber Verlag 1964
David Ferraro Ordinary Psychosis 2015 Archives of a Divided Subject https://melbournelacanian.wordpress.com/2015/01/04/ordinary-psychosis/
ibid Disavowal and its Vicissitudes 2013 see blog above
S Freud The Loss of Reality in Psychosis and Neurosis. See Standard Edition
S Freud and L Binswanger The Freud-Binswanger Letters Open Gate Press 2002.
S Freud and E Bleuler Ich Bin Zuversichtlich, Wir Erobern Bald. Die Psychiatrie Briefwechsel 1904 - 1937 Schwabe 2012
Karl Jaspers General Psychopathology John Hopkins new edition 1997
K G Jung The Psychology of Dementia Praecox New York 1909
Jacques Lacan The Sinthome - The Seminar of Jacques Lacan, Book XXIII Polity 2016
Danny Nobus The Madness of Princess Alice: Sigmund Freud, Ernst Simmel and Alice of Battenberg at Kurhaus Schloß Tegel History of Psychiatry, 31(2), pp. 147–162.
J.-A. Miller et al La Psychose ordinaire, La Convention d’Antibes, Agalma-Seuil, 1999.
ibid. Irony: A Contribution of Schizophrenia to the Analytic Clinic (Re)-turn: Volume 1, Winter 2003
ibid Ordinary Psychosis Revisited Psychoanalytical Notebooks, 26 (2013), p. 36.
N Putman & B Martindale Open Dialogue for Psychosis: Organising Mental Health Services to Prioritise Dialogue, Relationship and Meaning (The International Society for ... Social Approaches to Psychosis Book Series) Paperback July 2021.
François Sauvagnat Ordinary psychosis: what it adds to the previous understandings of Lacan’s theory of psychosis PsychoanalysisLacan Vol. V 2022
Thomas Svolos: Ordinary Psychosis 2007 and Ordinary Psychosis in the era of sinthome and semblant 2008 both published in Svolos Twenty-first Century Psychoanalysis Routledge 2017
S Vanheule The Subject of Psychosis: A Lacanian Perspective Palgrave Mcmillan 2011
Robert Whitaker The Rising non-Pharmaceutical Paradigm for the Psychoses. Whitaker is a journalist and author who has written and travelled internationally, reporting on changes in therapeutic practice. See this talk at https://recoveryfromschizophrenia.org/2021/04/robert-whitaker-the-rising-non-pharmaceutical-paradigm-for-psychosis/
