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Jacques Lacans Structuralist Criticism of Karl Jaspers Phenomenological Psychiatry: Concerning the Comprehensibility and Treatment of Delusional Disorders

Abstract

The validity of psychiatric diagnostic constructs remains suspect, a problem compounded in the case of differential diagnoses (DDx), which imply multiple and concurrent disorders. Can one have more than one mental disorder? Can such a supposed coexisting differentiation be real? Whereas disorders vary by context, kind, and manifest symptomsKarl Jaspers, in his General Psychopathology, usefully called attention to a necessary penetrative discernment into the reducible qualities of a disordered state. Though, according to Jacques Lacan, Jaspers argued comprehensibility to a fault. Deciphering the problem of psychiatric comprehension, this essay will focus in on Lacans medical thesis commentary on Jaspers phenomenological psychopathology.. Here we highlight important differences between phenomenological and structural theories of understanding. Where Jasperian phenomenology suffers by only being able to study theories, in acknowledging that beliefs and delusions cannot be clearly distinguished, Lacan will propose a restorative method of listening to delusions psychoanalytically. [footnoteRef:1] [1: A version of this paper was introduced to the Karl Jaspers Society of North America at the December 15, 2014 joint meeting with the Eastern Division of the American Philosophical Association in Philadelphia, PA, and was delivered by the author on March 20, 2015 at the 19th Congress of the International Society for the Psychological and Social Treatments of Psychosis (ISPS) at the Cooper Union in New York, NY. Special thank you to Professor Marc De Kesel for his assistance with this manuscript. ]

Keywords: Karl Jaspers, Jacques Lacan, General Psychopathology, Thesis, Phenomenology, Structuralism, Psychosis, Delusions, Understanding, Meaningful Connections

Introduction

All conferences are organized around a dialogue, for instance, seeking to merge biological and psychological conceptions of the treatment of psychosis. All cases that we hear about at such conferences deal with the work that goes on between the clinician and the patient, tracing the methodological approach which should be taken to provide suffering individuals, those who suffer in states of madness, with some corrective solution. In doing so the participants at such a conference will have been contrasting on the one hand, biological treatments which aim to provide therapies which target neuronal and nervous system functioning, and on the other, dialogical a approaches which address the subject in their symptomology. Now, adopting a thesis which states that biological change should come secondary to the primary social experience of psychosis disorders, of making sense in dialogue, this discussion paper will elaborate upon an important change which took place in theorizing about the psychotic experience in the works of Karl Jaspers and Jacques Lacanand thus directing new questions at our philosophical enterprise of reasoning.

This discussion paper will draw your attention to the meeting between therapist and patient, and how this interaction should address and work with the hallucinations and verbal disorganizations associated with a psychotic break and later reconstitution of a functional subjectivity in a social milieu. The most difficult aspect of presenting a thesis like this is that my understanding of Jaspers and Lacans system of psychopathology cannot have come through any formal psychological or psychiatric training program in the English speaking world, and quite possibly any other. My research has come to me from my work in political organization, as an advocate in legal disputes on worker rights, and in my pursuit of answers to questions on the seemingly irreconcilable nature of people to do exactly that which is most harmful to their interests, and to deny their obvious blunders right through to the graveI had to understand, and so my insights come to me through anthropology, a clinical psychoanalytic practice, and budding study of philosophy. Rather than provide a properly critical investigation of power, politics, and culture, today, most research conducted in the name of psychotherapy or psychology is conducted in a narrow bio-medical, or in the best of cases, the bio-psycho-social conception of mental illness, and so for the most part there is no credible attempt being made at hearing the individual patient in their suffering outside of psychoanalytic circles. So we come to the matter of psychopathology in similar circumstances which Jaspers must have come to the issue, where responding to Emil Kreplian style biological conceptions of mental illness identification, specification, and classification, we too are located in a somewhat obtuse situation, where for the most part, more knowledge available to researchers of any discipline interested in the subject of human psychology, and trouble with subjectivity, are faced with an avalanche of information about the truth, but no reasonable way in which to make sense of comprehend the overload of information.

What the therapeutic establishment has increasingly resorted to is various kinds of quantification formulae for using bio-statistics to attempt to find meaningful statistical inferences that can shed light on why it is that time and time again, the same kinds of proofs are invalidated, and time and time again, the treatment of mental disorders with one kind of treatment or another prove ineffective[footnoteRef:2]. The bio-psycho-social model attempts to correct to apparent lack of technical or overall perspectival wherewithal in coming to an overall understanding of the comprehension of the individual who suffersso to properly and most effectively intervene. This is certainly the project of Jaspers General Psychopathology[footnoteRef:3], and it is the project being continued in psychiatric and psychological diagnostic protocols which aim for greater complexity, greater sensitivity of scales, and a more profoundly accurate characterization of the details of some psychopathologyand the only way through, it seems, is as Jaspers puts it, whereby practitioners should be so well read, perhaps as well read as a world class philosopher, in the humanities, physical and natural sciences, and the full range of psychiatric literature from the 19th century on, to be able to make the most effective and comprehensive characterization of, and thus planning an intervention for, the treatment of a mental disorder. [2: Hejazi, 2013, Determinate Signification and the Neurobiology of Reality Processing (http://www.sfu.ca/humanities-institute/?p=4021). Here I discuss the problem of treatment resistance and neuroscientific knowledge in greater detail.] [3: Jaspers, Karl. General Psychopathology. Translated by J. Hoenig and L. Hamilton. Manchester: Manchester University Press, 1963.]

However, let this survey of the problem not be read as a rejection of the scientific project. No doubt, the scientific method of doubt and hypothesis testing is our only way, within the always modern enterprise of reason, through to the other side, but we must avoid understanding too much (Lacan), and taking on the delusions of modernity. We cannot at the same time loose sight of the fact that religion and science are one in the same, that belief and doubt work in tandem, and thus science is our modern placeholder for a certain establishment of an ideal, so ever too quickly science is confused with a kind of rejection of reason in the first place. This will be Lacans project, taking up from Jaspers own, to advance the most important and prime topic in psychiatry, that of delusional disorders, or psychosis.

If we, like Jaspers and Lacan, take up the topic of delusions, we must be clear with ourselves that we too are delusional, and that the distinction between a mad person, and the sane, is purely evaluative and contextual. As one can appreciate, irresponsible capitalism, targeted killings for peace, feigning ignorance at torture, in a so-called, free and democratic society, being on par with childhood certainties like a belief in Santa Clause, will leave us embarrassingly short of the target I wish for us to make through the course of this discussion: that we are just as superstitious, errant, and shortsighted as ever, with the only exception being the knowledge we were able to come through by virtue of testing of hypotheses, and being able to let go of ideas which we proved to be inconsequential. Yet in psychiatry, and modern psychology, this capacity of moving through indefensible knowledge seems to be most impaired. It is in these disciplines that deal exactly with an issue as vague and seemingly indecipherable as problems with subjectivity, where few theses are proven founded, and totally dubious assertions are almost never let go ofunless some protest movement emerges to shame the treatment establishment, that like pious Sigmund Freud, we will claim privileged insight into a particular myth, without a hint of being able to truly test our assumptions as such.

Moreover, in this presentation, as in all presentations where we will attend to the function and field of language, we need little in the way of observable statistics or diagrams. So often now, it seems, in the fields of psychiatry and psychology, texts books make reference to scans of brains, and certain demographics, as if the truth were to be found in the statistical calculations of a computer which determined certain blood flow passages to be correlated with a certain function, as certain flows of factors among people is indicative of what goes on for a suffering individual. The scope and span of the psychiatric and psychological subject has become profoundly vast in its breadth and scope, whereas what we will find through the course of this text, is that the elementary phenomena, what we are to distinguish through a certain kind of listening, will be purely individual, and certainly cannot be scanned other than by attention to the speech of another.

Thus and moreover in the same way, we will strive to illustrate, by a progressive movement of intellectual work, by three authors, Emile Kreiplin, Karl Jaspers, and Jacques Lacan, how one proper phenomenon, the phenomenon of a delusional disorder, can be worked with and through in three different ways. Rather than distinguishing between supposed kinds of psychosis, we will deal with the project of speaking about assumed normality, for the issue of content normality is exactly the cross-roads upon which the subject matter of hand, of delusions, must take us toand to no other. What this means is that no other arbitrary correlates, of delusions and age, or delusions and race, or delusions and brain scan identifiers, will suffice to locate ourselves on the primary issue of shared and social reality, and thus on the same point of focus, which Jaspers would have us attend, the issue of comprehensibility. Our purpose will be to, like Jaspers and Lacan, advance us through, down the historical tradjectory, from exorcisms of possessions, to the bio-psycho-social construct method, to the post-structuralfor a new way of dealing with social difficulties of many kinds.

A Brief Genealogy of Delusional Disorders

While we know that Hipocritus in 400 BC and later Galen, in the fourth century, among other classics identified a disorder of the mind as a problem with the constitution of a subject with their brain (Hysteria, as a movement of the uterus), and later medieval authors found mental disorder at the level of bad fluids (melancholia)[footnoteRef:4], the change from between Jaspers to Lacan marks a much more radical alteration in our theory of knowledge. This change marks the difference from the pre-modern conception of the madness of a derivative of some good and evil contest, where a shaman or spiritual leader would provide an explanation to the confessions of the subject, to the modern conception of the individual as a locus of control, being given responsibility for the functioning of their personal biological and psychological apparatus. This change is between psychiatric knowledge about the treatment of a mental illness, between the pathogen and the body and what the subject says and experiences about their disorder, and the psychoanalytic conception, derived from the works of Sigmund Freud, as a problem of responses, as a human capacity to represent and be representedand thus Freud, and later Lacan, mark an important turn in scienceto a new kind of science, as a way of understanding the way that the actions in the clinic will act upon an individual. [4: Taylor, Michael, and Vaidya, Nutan Atre. Descriptive Psychopathology. The Signs and Symptoms of Behavioral Disorders. Cambridge, Cambridge University Press, 2009. Print. ]

We might trace this psychoanalytic intellectual trajectory in a somewhat different manner, from Parmenides (Who spoke about a=a, setting out the subject basis of some supposision), to Descartes (Who set for the doubting I, who thinks, I think, therefore), to Hegel (Locating all knowledge along a historical and contextual axes), to Freud (Who locates the thinking and thus speaking being). The links between Jaspers and Lacan are important to our conference discussion for this will lead us to deal with the mechanical factors which are derived from the underlying biological distinctions which we can refer to psychosis, and more importantly define the function which operations in communication and social relating to one-another which will order our knowledge about the causes and factors of the psychotic condition. In this paper I want to introduce a problematic factor in our reasoning, as professionals and researchers in the field of psychiatry, who are working with issues that relate to the mental well being of another, of a patient who has come to us with a problem with their subjectivity, their mental health.

This problematic factor, which I will call prequation, is given where in the construction of our ideas about what is going on with another, between ourselves and our patients, we preliminarily equate the event of a psychotic hallucination nor break, with the psychosis, as though the label for the disorder, a formula for identifying classes of disorders, leave us, very quickly to an all to hasty status of knowing, of comfortably attributing signs to some underlying pathogenic process, and thereby dismissing very important factors which can be worked into a formulation and treatment process. In the rest of this paper I will elaborate how a hasty equation process takes place in our perception of our patients, and through elaborating the distinction between Jaspers and Lacan, between phenomenology and structuralism, point us towards how our researches into the complexities and difficulties associated with psychosis can be more readily supported, treated, and essentially overcome.

Contemporary Attempts at Understanding Delusional Disorders

The American Psychiatric Association, since the first edition of their Diagnostic and Statistical Manual of Mental Disorders (DSM)[footnoteRef:5], has allowed for the identification and designation of both specified and unspecified disorder types, as well as multiple differential diagnoses. Can one be mentally ill in more than one way? Does pathology not need to be verified with a qualified yes or no? The authors of diagnostic manuals will evoke the notion of necessary openness to allow for changes to be made to their categories, to ease the communication of what cannot be found within any already compiled manual, and to leave the door open to new possible applications of formulae. Paul E. Mullen writes in A Modest Proposal for Another Phenomenological Approach to Psychopathology[footnoteRef:6] , We have been left with classificatory systems which impose reified categories increasingly at variance with clinical reality and increasingly divorced from the data generated by scientific enquiry. (113). In todays psychologized social world one can readily hear people talk about having a mental illness, having two or more mental illnesses, or, undergoing recovery. A November 27th, 2014, article in The Guardian[footnoteRef:7] suggests that people need to be treating their delusions and hallucinations, as though delusions and hallucinations were not a part of normal perception. Karl Jaspers writes in his General Psychopathology, that, Delusion is a primary phenomenon and the first thing we have to do is to get it into a proper focus. The experience within which delusion takes place is that of experiencing and thinking that something is real. (1963, 93). Jacques Lacan, following on Jaspers, will later write that the structure of scientific truth is that of paranoia (2006, 724). There can be no clear Archimedean point of view outside of a fixed system of belief and understandingwhat for Lacan is a point of impossibility. No matter what efforts are made, all clinicians and researchers, are bound to the same infrastructure of made-up thinking. [5: American Psychiatric Association. Diagnostic and statistical manual of mental disorders. First edition. Washington: American Psychiatric Publishing, 1952.] [6: Mullen, Paul E. (2007). A Modest Proposal for Another Phenomenological Approach to Psychopathology. Schizophrenia Bulletin, 33(1): 113-121. ] [7: Freeman, Daniel. And Freeman, Jason. Delusions and hallucinations may be the keys that unlock psychosis The Guardian, November 27, 2014: http://www.theguardian.com/science/blog/2014/nov/27/delusions-hallucinations-psychosis-schizophrenia ]

Paranoia and psychotic paranoia have a prevalent position in psychiatry and psychological research. We normally have a narrow conception of the mad person as someone who exudes obvious delusional phenomena and other atypical bodily symptoms. Commentators on this norm, Sarah Troub, Thomas Lepourtre, and Benjamin Levy, writing in Jaspers, Freud, Lacan: la question de la comprehhension en psychpathologie[footnoteRef:8][footnoteRef:9], state that the delusional character of any idea is its appearance in a higher order of truth, an order of delusions, which necessarily places understanding within the limits of the human capacity for knowledge (9). The problem of understanding and the search for the specific features of understandability is a common theme in the study of psychopathology. The problem of understanding has been addressed by psychiatry; the issue of comprehensibility marks the significant role of psychiatry in the process of the determination of truth for the society as a wholegiven in the historical transition of psychiatry from the church to the government hospital[footnoteRef:10], and predictably, on to the private clinic. [8: Translated as: the question of comprehension in psychopathology] [9: Troub, Sarah, Lepourte, Thomas, and Levy, Benjamin. Jaspers, Freud, Lacan: la question de la comprehhension en psychpathologie. PSN 3(2): 7-31 (2013). ] [10: Foucault, Michel. The Birth of Biopolitics. Lectures at the College de France, 1978-79. Edited by Michel Senellart. Translated by Graham Burchell. New York: Palgrave Macmillan. Print. ]

For Troub, Lepourttre, and Levey, the primary delusional experience is the source of radical incomprehensibility (12). According to Jaspers there can be an emotional interpenetration (13) that can be undergone to investigate the nature of a given encounter that the subject makes due to their delusional core. Jaspers will state that what makes psychosis delusions important, though not altogether understandable, nor consequentially linked to an inner causal factor, is the manner in which, as Matthias Bormuth[footnoteRef:11] writes that for Jaspers, no science could fully fathom in either psychopathological or existential terms (5) of what is really going on within a psychotic process. Jacques Lacans scholarly career interestingly takes from Jaspers works on the way in which meaningful life events underlie the formation of symptomology. Lacan later departs from Jaspers with respect to the knowability of the formative substrate, as he develops his theorizing about the nature of understandability in general. Substantiating the totalizing approach, Stijn Vanheule [footnoteRef:12] discusses how Lacan contests Jaspers assertion that whereas most mental phenomena are rationally and empathically understandable for psychologists, delusions are not (2011, 98)rather, Lacan will demonstrate how an analysis challenges mainstream capacities of knowledge as a process of reaching a point of verifiable certainty, but that certainty is a factor in all systems of knowledge. [11: Bormuth, Mathias. Life Conduct in Modern Times, Carl Jaspers and Psychoanalysis. Philosophy and Medicine, Volume 89 Co-Editor, Stuart F. Spicker. Doredrecht: Springer, 2006. ] [12: Vanheule, Stijn. The Subject of Psychosis: A Lacanian Perspective. London: Palgrave Macmillan, 2011.]

French historian, Elisabeth Roudinesco writes, in her biography of Jacques Lacan[footnoteRef:13], that in General Psychopathology Jaspers highlights the clinical differentiation within psychiatric thought between "practices of meaning and sciences of causation". In this conception, the comprehensible followed on events via underlying factors and in the explicable there is an element of the incomprehensible, so "one must resort to a logic different from that of reaction to facts. The voices heard by someone suffering from hallucinations, the persecutions imagined by a paranoid person, belong to the realm of the explicable because of a causal concatenation." Roudinesco notes "how helpful Lacan found such a notion in constructing a science of personality. The idea allowed him to assign more importance to a formal logic of causality than to a mere comprehension of meaning" (46). [13: Roudinesco, Elisabeth. "Jacques Lacan". New York: Columbia University Press, 1994. ]

Karl Jaspers

Mathias Bormuth writes in Life Conduct in Modern Times, Karl Jaspers and Psychoanalysis, 2006, that Jaspers epoch-making methodological systematics in General Psychopathology challenges what Bormuth says Jaspers referred to as a reprehensible philosophy (2), namely Freuds deterministic psychoanalytic formulations, on the basis of an important mindset difference which he endeavored to promote through his philosophy. According to Bormuth, Jaspers was endeavoring to establish the life conduct of the individual as an appeal against mass psychology. Jaspers assumed a three-step psychopathological method. The first step involved rational and static understanding of isolated psychic phenomena; the second, constituted genetically associative understanding; and the third, the classification of symptoms according to ideotypical disease entities. (14). Observation includes exploration of the patient, and having the patient draw up written material. Jaspers adopts Webers methodological concept of the ideotype but does not exhaust its epistemological substance; for Jaspers, the construct merely acts as a relative paradigm used to recognize and classify symptomatic and motivational connections in the case of mental disorders. (15). Thus differentiating between understanding and valid science. There are layers and there are dispositions that relate to the psychopathological core. In postulating an infinite horizon of causal connections, Jaspers contends that explaining causality principally forms the core of pathogenesis whereas the understandable connections merely constitute a peripheral asset with no decisive effect. (16)

In his essay, The Phenomenological Approach in Psychopathology[footnoteRef:14], first published in 1912, Jaspers states that it is normal to distinguish between the subjective and the objective. Included in the subjective, for Jaspers, is anything that cannot be observed as coming from the subject other than through their words, inclusive of mental processes and how any subject organizes themselves. Jaspers argues that, According to this, only the objective symptoms offer certainty; they alone form a basis for scientific study, whereas subjective symptoms, though we cannot easily do without them for our preliminary assessments, are considered to be quite unreliable for making final judgments and unfruitful for the purpose of any further scientific investigation (1313). Jaspers continues: [14: Jaspers, Karl. The Phenomenological Approach in Psychopathology. British Journal of Psychiatry 114, 1313-1323 (1968). ]

There is no doubt that objective psychology produces results which are more obvious, more convincing, and easier for everyone to grasp than does subjective psychology the difference in degree of certainty is simply quantitative, when it comes to the kind of certainty, the difference is qualitative and fundamental. This is so because subjective psychology always aims at the final realization of the concepts and ideas which form the inner representation of psychic processes, whereas objective psychology finds its ultimate aim in observation in undisputed fields such as sense-perception and the rational concepts of thought and by such means as graphs and statistics. (1314).

Jaspers says of the qualitative research activity above, that it is the preliminary work of representing, defining, and classifying psychic phenomena, pursued as an independent activity, which constitutes phenomenology an end in itself. This end, Jaspers writes, is a search for irreducible phenomena, through the others self description as a means, not the object where by means of analogies one can identify, observe, and reach the completely empathically inaccessible (1318). For Jaspers, what his method will be able to reach is that which is completely objectively unverifiable, though functionally affective.

In postulating an infinite horizon of causal connections, Jaspers in his General Psychopathology, 1963, writes that explaining causality principally forms the core of pathogenesis (16). For Jaspers there are:

Endogenous and exogenous causes-

The basic phenomenon of life is its self-realization in an environment which it molds from its own inner resources, on which it depends and by which it is in its own turn molded. In so far as we divide the whole unity of life into outer and inner world and both are broken down into factors, we attribute the phenomena of life either to causal factors of the outer world, which we call exogenous, or to those of the inner world, which we call endogenous; against the outer influences we set the inner disposition. As life always consists in the interplay of inner and outer, no phenomenon can be exclusively endogenous. Inversely, all exogenous influences unfold their characteristic effects within an organism, and the particular fashion of this will always appear as an essential factor. (454).

Jacques Lacan

In his published medical thesis[footnoteRef:15], De la psychoses paranoaque dans ses rapports avec le la personnalit[footnoteRef:16], 1932, Lacan drew upon Jaspers Phenomenology and the structure of psychic disorganization in psychoses. In this earlier period in his writing Lacan assumes that at the core psychotic outbreaks are constituted by relations of the subject to vital situations (77). Vanheule, in his The Subject of Psychosis: A Lacanian Perspective, 2011, writes that such vital situations, all psychogenic (11), relate to sexual and professional problems that go beyond a breaking point, touching the psychotic subject in a profound way(10), at an ethical level (11). At this point these events find their integration into the psychic makeup of the person and become comprehensible developments related to how the person regards himself or herself, leading to tensions that emerge from their situation and environment. Therefore, for Lacan, following on Jaspers, clinical analysis depends on the application of all ones capacity of sympathy (11, Vanheule citing Lacan, 224). [15: Lacan, Jacques. De la psychose paranoaque dans ses rapports avec la personnalit. De Doctorate ed Medicine de Jacques Lacan. Seuil, Franois a Paris, 1932.] [16: Translated as: Addressing Personality in Paranoid Psychosis.]

In his thesis Lacan writes that to understand the desire of jealousy for example, you must guard against imputing that it is a sickness, jealousy of another woman, a deductive or inductive construction more or less rational, but understand that its mental structure forces it to identify itself to its rival, when she evokes it, and to feel that this substitutes for her. In other words, the mental stereotypes are considered in this theory as compensation mechanisms, not of the affective order, but of the phenomenological order[footnoteRef:17]. Numerous clinical facts were in such a way interpreted in a brilliant way by Minkowski.[footnoteRef:18] Thus according to Lacan, there is something that is directed by jealousy, jealousy regarded as an emergent phenomenon, but the causal meaningful connections underlying this emergence cannot be logically followed to a particular causal factor as such. In this way Lacan both adopts and critiques Jaspers philosophy. [17: Husserl, Edmund. Phantasy, Images Consciousness, and Memory (1898-1925). Translated by John B. Brough. Dordrecht: Springer, 2005. ] [18: A quote from Lacan on Minkowski, Jalousie pathologiques sur on fond dautomatisme mental. A.M.P., June 1929, 24-48.]

Lacan goes on, We believe that all distinctions between the structures or forms of the mental life and the contents that fill it, rest on uncertain and fragile metaphysical hypotheses. This distinction resembles certain beings imposed by the organic psychoses and irrationalities, but these present a deep psychic disorganization with no psychogenic link to and indeed I say, like the very good remark by Jaspers, he [the psychotic subject] does not act from a true psychosis.[footnoteRef:19][footnoteRef:20] [19: Hence the emptiness of the objections to psychogenic research we hear everyday, the vanity of which is demonstrated by the isolation of an entity, like general paralisis, for example. These are lazy objections.] [20: I.e. not an actual derangement.]

In the psychoses, it is possible to settle the question of whether the structure of the symptom is not determined by the essential experience it appears to stem from; in other words, the content and form cannot be arbitrarily dissociated, such that essential trauma in psychoses will not be resolved. (132). Thus in this earlier text Lacan challenges Jaspers position on the irreconcilably arbitrary nature of the delusion, and states that in fact the delusion is both of consequence and is derivable from some contingent necessary underlying factor for the individual in their contexts and situationsthe self, the I.

In Lacans later seminar on The Psychosis, 1955-1956, he writes that under a very clear meaning under the name of [a] relation of understanding, Jaspers has made the pivot of all so-called general psychopathology[footnoteRef:21]. For Lacan, It consists in thinking that some things are self-evident, that, for example, when someone is sad its because he doesnt have what his heart desires. Nothing could be more false says Lacan, there are people who have all their heart desires and are still sad. Sadness is a passion of quite another color. (6). In this, contrary to his assertion given in his medical thesis, as Vanheule notes, Lacan grew more critical of his dissertation, he criticized comprehension-based approaches (2011, 11). [21: See Karl Jaspers, "Meaningful Connections," "Verstandliche Zusammenhange,"chap. 5 of his General Psychopathology.]

In France, Lacan notes, a paranoiac was a nasty person, an intolerant one, a bad-humored type, proud, mistrustful, irritable, and who overestimated himself. (4). In this context, Lacan notes that Genil-Perrinss work on the perverse structure of character pointed to the fact that sometimes the paranoiac goes beyond the limits and falls into that frightful madness, the unbounded exaggeration of his unfortunate character All the formal references to an organic base, to temperament for example, don't change a thing - it's really a psychological genesis. Something is defined and assessed at a certain level, and its development follows uninterrupted with an autonomous coherence that is self-sufficient in its own field. (5). For Lacan it is false to assume that psychoanalysis restores meaning to the chain of phenomena, or to understand the patient. This, Lacan says, is a pure mirage.

Lacan uses the example of a child receiving a smack, however he notes, while the child might cry, its not at all obligatory that he should cry. He gives an example of a child who asks if the smack was a pat or a slap, if the latter response is given as a reply then the child would cry, following on the rules of convention, and if it was a pat he would be delighted (6). For Lacan, in Jaspers chapter on Meaningful Connections, in General Psychopathology understanding is evoked within its meaningful relational consequence. However, in understanding the underlying factors, as soon as one attempts to apprehend the source, it becomes elusive. Lacan, therefore, will hold that there is no psychogenesis in this meta-realm of understanding given by the field and function of psychoanalysis, and even if there is a psychogenesis of sorts, it is not one to which psychoanalysis can be beholden. He states, If that is what psychogenesis is, there is precisely nothing that could be further from psychoanalysis in its whole development, its entire inspiration and its mainspring, in everything it has contributed, everything it has been able to confirm for us in anything we have established. For Lacan a way of expressing things that goes much further is to say that the psychological is, if we try to grasp it as firmly as possible, the ethological, that is, the whole of the biological individuals behavior in relation to his natural environment. This he calls the order of real relations, an objectifiable thing, a field with quite adequately defined boundaries. (7).

Lacan posits that Everything that in human behavior belongs to the psychological order is subject to such profound anomalies and constantly presents such obvious paradoxes that the problem arises of knowing what needs to be introduced in order for a cat to find its kittens. For Lacan, the problem cannot be solved by a mere immediacy of experience, for this is no better placed to arrest or captivate us than to any other science. In no way is it the measure of the development that we must ultimately reach. For Lacan, Freud brings resources into play that are beyond immediate experience and cannot be grasped in any tangible fashion. (8)[footnoteRef:22]. [22: Here Lacan is referring to the psychoanalytic oeuvre, inclusive of free-associations, the frame, and an encounter with resistances and neurotic wish fulfillments (etc.). ]

Discussion

A number of authors have commented on how the DSM unspecified categorical and differential diagnostic approaches follow a phenomenological approach to research and reasoning. Jaspers, in The Phenomenological Approach in Psychopathology writes that, subjective psychology always aims at the final realization of the concepts and ideas which form the inner representation of psychic processes, whereas objective psychology finds its ultimate aim in observation in undisputed fields such as sense-perception and the rational contents of thought and by such means as graphs and statistics. (1314) Thus for Jaspers, Without doubt, the first step towards scientific comprehension must be the sorting out, defining, differentiating and describing of specific psychic phenomena, which are thereby actualized and are regularly described in specific terms. (1316). According to Jaspers, this is a search for an irreducible phenomenon, such as a colour, that is subtly differentiated, fitting contexts and experiences. The immediate grasp of these differences can be reached through an empathic process and route (1317).

Mullen (2007) writes that the interest in phenomenology may be undergoing a revival, with an approach among clinicians, as well as researchers, which privileges the specific questions and the proper categorization of the patients response. However, under the current situation there seems to be a sacrifice of ambiguity for clarity, where validity has been sacrificed on the alter of reliability, where, the better you know a patient the better information about them seems to fit (113). The escalating size of the disorder manuals is rooted in phenomenology, as the authors welcome new and added classification types. However, the disorder manuals also lead to the creation of an authoritative structure that becomes the source of an error. Such bowdlerization and concretization ends the possibility of the scientific enquiries they were intended to usher in. The right questions and answers are learned, and the disorder types have reified certain conceptions of how a certain disorder is (114), rather than the other way around, which would be scientificthe struggle to grasp the nature of experiences prior to their being lost in futile debates about the meanings and definitions of the words used by others to describe those experiences. (115).

John Mills in Lacan on Paranoiac Knowledge[footnoteRef:23], writes that, Lost in its alienation, the Lacanian subject[footnoteRef:24] discovers itself in the imaginary, recovered through the mediation of the other, giving itself meaning through the symbolic, struggling on the threshold of the real. (36). Jacques-Alain Miller, in The invention of delusion[footnoteRef:25], writes that Delusion and elementary phenomenon constitute a binomial (1) between the elementary starting point of an understanding and the consideration of an outcome, a starting point, as in the case of a delusion. Miller notes that a subject differentiates itself within a discourse, whereby a delusion itself is an accentuation of what is carried within (2). For Miller, delusion has a psychical cause because it requires an intellectual effort to explain this curious, strange and disturbing intrusion. (4) It is in Lacans medical thesis that, for Miller, Lacan introduces the notion of an elementary phenomenon emphasizing its causal quality rather than it being a specific part of the personality. However, as we have seen, the personality (taken as an ego) is not in the subject, but is arranged in the symbolic order, outside of the subject, outward into the intersubjective, emergent from a matter of course. This allows the comparison of a structure given as long as there is a structure of a subject in reality. [23: Mills, Jon. (2003). Lacan on paranoiac knowledge. Psychoanalityc Psychology, 20(1), 30-51. ] [24: The divided subject as conceived of by Jacques Lacan.] [25: Miller, Jacques-Alan. (2009). The invention of delusion. Translated by G.S. Marshall. International Lacanian Review, 5: 1-29. ]

Miller uses the example of an ability of a person to summarize an extended story with a brief reference to its structure (8). This is an elaboration of the delusion, given as a signifier, given for another signifier, in a formation that is given through the unconscious (given through differentiation of myself and what I am not). For Miller there is an element given that structures the experience of the subject in their reality (11). The delusion is an articulation, the structure of which is that of a language. For Lacan, there is an organization given by alterations in meaning. This process is psychologically structural, always being identified in a constitutive role as an appearance of unity. In both instances, within a delusion and a neurosis, there is always a return of a hallucination; and in all cases this manifestation is an interpretation. The hallucination returns in neurosis in what cannot be verbalized, and the hallucination returns in the form of psychosis as a delusion within the speech of the subject, of something they are certain of (13).

Conclusion

Where for Jaspers the psychosis can be dismissed as partially unknowable, Lacan finds all aspects of a psychotics delusions to be meaningful. This, Lacan will postulate as proof of some knowledge that has no access to conscious awareness as suchsituating the ego in a space, in a setting, which determines it within a discursive environment, divided as such. This gap in knowledge is anchored in a being, given in its topological spatial determination. The being, in locating itself, believes in truths out of a paranoiac position that needs to know, resolved by delusions constituted within systems of magic, religion and science[footnoteRef:26]. In this way, Lacan reintroduces the role of the name of the father, the role of a master discourse, into science, into truth, for neurotics only seem to doubt, and certainty is a sign of a delusion. [26: Lacan, Jacques. Ecrits: a Selection. Translated by Bruce Fink. New York: W.W. Norton & Company, Inc., 2006. (Page 724) ]