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From Psychoanalytical Notebooks 4, 2000 : Psychiatry and Psychoanalysis ON THE
SPECIFICITY OF ELEMENTARY PHENOMENA Cultural differences and clinical definitions From Psychoanalytical Notebooks, Issue
4, Psychiatry and Psychoanalysis, Spring 2000. The expression
‘elementary phenomena’, as it is used in contemporary Frech
psychopathology and psychoanalysis, phénomènes
élémentaires, has been coined by J. Lacan1 in his
doctoral dissertation (1932) to designate minimal delusional phenomena,
which, at least for a certain time, the patient can conceal or ignore,
until they develop (if they ever do) into a full-blown delusional or
hallucinatory experience. According to Lacan, these phenomena include the
same structure as the delusional system which can develop out of them, and
this is why, of course, the study of elementary phenomena has developed so
strongly, as it became clear that they could express the core conflict the
patient was besieged with. As we shall see, the Lacanian concept of
‘foreclosure of the father’s name’ is very strongly related to this
clinical concept. Another noteworthy point is that this concept is strongly embedded in the continental psychiatric traditions, which can be opposed in this respect to the American or British psychiatric tradition, although Anglo-Saxon practitioners and researchers have made laudable efforts to integrate some French and German clinical research in the recent decades. An excellent
indicator of this is the way eponymy functions. To French clinicians, le
syndrome (d’automatisme mental) de Clérambault and le
syndrome de Sérieux et Capgras, are classical designations of two
sorts of elementary phenomena, respectively: 1.
Auditory (but also sensory, motor, ideational) hallucinations. 2.
Delusional misinterpretations that tend to be logically structured. According
to Clérambault himself, the syndrome to which he vowed to give his name,
had been previously described by Wernicke, a German psychiatrist from
Breslau (now Wroclaw in Poland) under the name of Halluzinose,
but he considered that his own description and etiological hypotheses were
much more appropriate. In Eastern Europe, Polish and Russian psychiatrists
traditionally refer to this syndrome as ‘Kandinsky-Clérambault
syndrome’, considering that the Russian psychiatrist Viktor
Chrysantevich Kandinsky (1849-1889) has been an important forerunner of Clérambault
in describing this syndrome. Likewise, le
syndrome de Sérieux et Capgras is a continental elaboration which was
first inspired by one of Wernicke’s followers, C. Neisser. Neisser
particularised the krankhafte Eigenbeziehung symptom, which he considered as
characteristic of paranoia (he called it the Kardinalsymptom der Paranoia), and in which the patient felt that he
was being designated, pointed at, etc. Sérieux & Capgras added to
this that the development of delusions, in this sort of case, followed
usually a logical course, as the patient produced coherent and even
rational interpretations about what he felt was happening to him, until he
constituted a huge system encompassing all the prominent issues he was
confronted with. Both
syndromes refer quite clearly to what Lacan has called ‘elementary
phenomena’: a clinical disorder of reduced dimensions that gradually
overcomes a huge part of the patient’s personality, and of which it is
the main symptom. Now,
if we ask what the names ‘Clérambault’ and ‘Capgras’ refer to in
the Anglo-Saxon linguistic area, we will find that Clérambault is famous
for having described the ‘erotomania syndrome’, better known as
‘stalking’, which happens to be one of the most fascinating plagues of
Hollywood, and Capgras is associated with what is presented as a
‘schizophrenic disorder’ consisting in the misrecognition of
relatives, a condition which allows local clinicians to develop cognitive
research programmes on perception disorders. Automatism
mental does not seem to have attracted the attention of Anglo-Saxon
clinicians, and the closest known syndrome is probably Kurt Schneider’s
(from Heidelberg) ‘First rank symptoms’, elaborated at the end of the
1930s, which provides empirical criteria to detect schizophrenic
conditions, and has been integrated in psychiatric manuals in Great
Britain in the 60s, and in the USA in the 80s.
If,
on the other hand, you ask French clinicians how they feel about l’érotomanie
de Clérambault, they will usually admit that it is a somewhat
ill-constructed description of an unquestionably preoccupying disorder. As
to the illusion des sosies de
Capgras et Reboul-Lachaux, which is the exact designation of what is
in English called ‘Capgras syndrome’, it is usually considered as a
quaint patient observation of limited interest, which, according to its
inventors, had nothing to do with schizophrenia as the patient was
actually diagnosed psychose hallucinatoire. As
it may prove useful to be aware of such historical determinations I shall:
1.
Produce a sketch of the historical developments that have lead to
the theory of elementary phenomena. 2.
Describe the main types of elementary phenomena. Defining
psychosis As elementary
phenomena are supposed to be pathognomonic of psychoses, we cannot avoid a
few reflections on the nature of the latter. The
term ‘psychosis’ was first used by a German physician, Feuchtersleben,2
in 1856, to describe an acute condition in which patients suffered from
intense delusions and hallucinations, a definition which is still
currently considered as the best possible by some clinicians.3
As such, the term was opposed to neurosis, that is, the irritation of
nerves. In the second half of the XIX century, psychosis was to be equated
with madness, but what
Feuchtersleben described would no longer be the only variety of it. On
the whole, Feuchtersleben’s predominantly acute concept of madness was
shared by most of the clinicians of the time. This was in particular the
case of the French, who under the influence of Pinel and Esquirol, tended
to consider that aliénation mentale
was generally caused by the disappointment of passions, and that the
disorder could manifest itself in several manners, such as mélancolie,
manie, démence and idiotie;
it was generally admitted that the same patient could show these
derangements either separately or one after the other, but not necessarily
in this order (that is, from the lightest to the more severe), this
uncertainty corresponding to the very nature of passions. Another crucial
point was that madness was thought to be curable through moral treatment,
a liberal procedure applied
under various names by that time throughout Europe and New England, which
combined consolation, discussions, healthy food, lukewarm baths
and more invigorating methods such as the administration of cold
showers and even in extreme cases, superficial branding.
Nevertheless,
by the same period, in France, there was a lively debate over a curious
phenomenon called monomania, defined as folie
partielle, that is, partial — or part-time — craziness, which
appeared to be much more frequent than the other mental disorders. This
was especially at issue when unlawful acts came before a court, as
psychiatric experts claimed that some of the culprits, although they
displayed few or even no apparent symptoms during the trial, had actually
suffered from delusions at the time they had committed their crimes. Of
course the right-wing prosecutors and the relatives of the victim held
that this was sheer nonsense: you could not be a madman just for a few
instants, they contended. Madness had to be obvious and constant,
otherwise the person should rather be considered as one of these
blood-thirsty monsters who heartily operated the guillotine during the
French revolution; no sensible being should pity them, and all they
deserved was a death penalty.4 Over
the decades, the concept of monomania was more and more criticised, not
only on forensic grounds, but also because it was dependent on the more
general assumption that madness was a substantially continuous disorder,
of which you could only sketch clinical pictures determined by the
delusional themes that came to the fore. Under the influence of Antoine
Bayle’s (1799-1858) ‘general paralysis’ model, the idea, inspired by
Sydenham’s theory of medical diseases, that there should exist several
separate mental conditions, and that they should have a specific course,
from the prodromes to a particular final state, began to gain ground. One
of its most prominent defenders was Jean-Pierre Falret, who, in his Leçons cliniques sur les maladies mentales (1850-1851), tried to
promote a scientific programme to define separate maladies mentales. This is for us an important moment as Lacan, one
century later, was to take the opposite view to Falret’s, as he wrote
that the analyst should ‘make himself the secretary of the insane’.5 Jean-Pierre
Falret and the prohibition to ‘make oneself the secretary of the
insane’ J.-P. Falret
began his investigation by criticising the current nosographic methods.
The first method in use, which was especially characteristic of the
founders of modern psychiatry, Philippe Pinel or Etienne Esquirol, was a
‘literary’ one, that is, it aimed at describing cases without much
consideration for the actual circumstances of the disease, focusing mainly
on the content of the delusions, and the result, he claimed, had only been
the multiplication of unnecessary entities, like the dozen of monoamines
described by Esquirol or his followers. Another method, trying to focus on
different ‘types of diseases’, had not proved to be fruitful, for lack
of clear principles on which it could rest. In Germany, two antagonist
schools were confronted to each other, the Psychiker
(contending that all mental diseases had an exclusively moral cause) and
the Organiker (who elaborated exclusively physiological theories of
mental conditions in spite of the paucity of actual knowledge in this
domain), doing little more than adding to the reigning confusion.
Obviously
instructed by the debate over monomania, Falret proposed to envisage
mental diseases as long-lasting processes, which could remain hidden for
years, until diverse symptoms came to the fore — but even then, he
contended, the symptoms were not necessarily a faithful image of the
nature of this morbid process. The role of the clinician, he insisted,
should not only be to portray faithfully what was before his eyes, but to
trace out the nature of this inner process, no matter what its outer
results could be. “We therefore declare, he wrote, that if you wish to
discover the general states on which delusional ideas thrive and develop;
if you want to know the tendencies, the directions of mind, the
dispositions of feelings which are the source of all manifestations, do
not reduce your duty of observers to the passive role of the insane’s
secretary, of the stenographer of their speeches, or narrator of their
actions: be convinced that if you do not intervene actively, if you write
your observations under the dictation of the insane (aliénés),
the inner state of these patients will be distorted as it passes through
the prism of their illusions and delusions
(délire)”. What
Falret insists on is that ordinarily mental patients are deceiving
themselves and deceiving others, in a manner that is not very different
from the narcissistic misrecognition that can be observed in normal
persons: ‘man never knows oneself’, he wrote. Falret proposes the
example of the melancholic who, overwhelmed with sadness because he
believes that he has committed the most heinous crimes or lost all his
fortune, believes that his sadness is determined by these imaginary
disasters. “Instead of subordinating these painful preoccupations to the
general feeling of sadness which pre-existed under a vague form”.6 Hence, three major principles are to be followed, according to Falret: 1.
The clinician should pass from the role of observer to an active
role, allowing the patient to manifest what he would not spontaneously
express. 2.
The clinician should study and characterise the individuality of
the disease, so as to “subtract oneself from dangerous influences and
arbitrary classifications”.7 3.
The clinician should never separate a fact from its setting, from
the conditions in which it has arisen, for “disease is nothing else than
a series of more or less complex events, which the observer must present
under their true colour, in their natural order of succession and
filiation, and surrounded with all the circumstances in the middle of
which they have occurred”.8 This
led Falret to privilege the study of what he called ‘general states’
or ‘inner states’, which, alone, can permit a ‘scientific study’
of madness, in so much as they have been separated from the prism of
subjectivity, and are ‘independent from the delusional ideas’. The
result of this is that 1) the patient’s testimony should be taken as
strongly biased, and 2) there is no regular relationship between what the
patient actually utters and the underlying process. One
of the main benefits of J.-P. Falret’s positions was the delineation, in
the next decade, of two different disorders, folie
des persécutions and folie
maniaco-dépressive, which could readily be viewed as having a
specific course of their own. Nevertheless,
what Falret could not foresee was the rapid evolution of neurology, and
especially the research on aphasias, which allowed to relate, in the 1870s
and 1880s, motor and sensory aphasias to specific neurological lesions. It
was rapidly assumed that whereas lesions could provoke obvious deficits in
speech performances, local irritations of the brain were likely to cause
delusional disorders. This paved the way for the study of what was rapidly
coined mecanismes de formation du délire,
as it became clear that discrete mechanisms, like hallucinations, could be
the motor cause for the constitution of a delusional world. The
mental hallucinations and Séglas’ syndrome The first type of
‘mechanism’ that was described was the verbal hallucinatory mechanism.
Hallucinations had first been defined by Jean-Etienne Esquirol in 1938 as
‘perceptions without an object’: “A man who is thoroughly convinced
that one of his sensations corresponds to an actual perception, while no
object capable of triggering such sensation is within the reach of his
senses, is in a state of hallucination: he is a visionary”,9
and it was clear for Esquirol that this applied mostly to visual
hallucinations. But at the beginning of the 1850s, a discussion came to
the fore among Parisian psychiatrists as to whether this definition was
appropriate outside a rather limited range of pathological phenomena.
Baillarger reported several cases in which patients had the feeling of
being invaded by thoughts which at certain moments were described as
hallucinations without any sensory quality. This he called hallucinations
psychiques (mental hallucinations), and discussed whether they should
be entirely separated from delusional misinterpretations (interprétations délirantes). Even though the debates failed to
reach a satisfactory conclusion, hallucinations
psychiques became a classical issue, and as research on aphasia
progressed, Jules Séglas,10 at the beginning of the 1880s,
proposed to consider that this delusional experience, which was also
called ‘pseudohallucination’, to discriminate it from the official
Esquirolian ‘perception without an object’, should be understood as
‘motor hallucination’, that is, as the autonomisation of the
production of speech. Empirical
evidence was soon to corroborate the idea that verbal hallucinations were
generally not mere ‘sensory disorders’, but motor disorders, as it was
shown that in most cases patients were actually pronouncing in undertones
the hallucinations they claimed to be hearing. This led gradually to the
idea that in a significant number of cases, the ‘motor hallucinatory
mechanism’ was responsible for the formation of a psychotic syndrome,
which became extremely famous in France under the name of psychose hallucinatoire chronique. As the hopes to discover a
specific neurological lesion responsible for this gradually decreased, the
idea arose that it could be caused by some psychological determination,
and the debate between these two hypotheses continued as the
psychoanalytic movement gained ground in France. In the 1920s, G. G. de Clérambault
presented himself as a faithful follower of Séglas, and claimed that most
of the psychoses (not including schizophrenia and the ‘passional
psychoses’) were actually determined by what he termed automatisme
mental, which he suspected to be caused by a superficial
‘serpiginous lesion of the brain’; his theory was immediately
challenged by Henri Ey, who in his Traité
des hallucinations advocated that the explanation could not be that
simple, as according to him the syndrome showed the double neurological
modification described by Hughlings Jackson (liberation and deficit), but
also the influence of ‘psychological complexes’ described by Eugen
Bleuler. A
few decades later,11 Lacan will present himself as another
follower of Séglas, especially when commenting on the patient who
hallucinated the insult ‘swine’ as she thought to herself “I have
just been to the porkbutcher’s”, or on Schreber’s interrupted
hallucinations. But of course his point of view was entirely distinct from
that of Clérambault or Henri Ey, as he considered that this phenomenon
was the manifestation of a ‘signifier in the real’, determined by the
absence of a fundamental signifier allowing the subject to formulate a
call and justifying his own separate existence.
As a result, the basic Lacanian model of psychosis was not so much
the Freudian concept of ‘loss of reality’ than the Schreberian Brüllenwunder,
a phenomenon in which D. P. Schreber, when he refused to respond to the
unceasing questions coming from God, felt that an unbearable yelling was
coming out of his own throat, as he felt that the deity was abandoning
him. Clemens
Neisser, the ‘personal signification’ and its therapeutic applications Another sort of
‘mechanism’ was described by Clemens Neisser (from Leubus, Silesia) in 1892, at a time when German
psychiatrists were attempting to reduce paranoia, and all-pervading
category which was supposed to account for no less than 70% of the
psychopathology, to more reasonable proportions — this dilemma was about
to be solved by borrowing from the French their délire
des persécutions and identifying paranoia to this sole syndrome.
Neisser considered that krankhafte
Eigenbeziehung was a constant phenomenon during the acute and stable
phases of paranoia.12 Patients with this symptom were certain
that they were being pointed at, designated, etc. but claimed that they
had no idea why this was done nor what it meant. By the same period,
Meynert (Vienna) described what he called Beobachtungswahn,
delusion of being observed, and most of the contemporary clinicians
considered both syndromes as identical.13 Neisser
set up a sort of a therapeutic programme in which incoming patients were
to stay in bed for several days (Bettbehandlung)
— a rather uncommon practice in mental institutions of that time — so
that the ‘clinical picture’ should simmer down, as exterior
solicitations were reduced to a minimum. Then in most cases, Neisser
wrote, krankhafte Eigenbeziehung
came to the fore, and it appeared that most of the patient’s agitation
had been nothing but an uncoordinated attempt to protect himself from it.
As soon as the Cardinalsymptome
had been confessed, the psychiatrist could get into therapeutic action,
that is, show the patient that all his disorders could be reduced to the
same symptom, and that it was some sort of an illusion. Although Neisser
gives no indication as to the results, this method has become extremely
popular in Germany at the beginning of the XX century, to such a point
that when the promoter of activere
Therapie, Hermann Simon, who was to become one of the main models of
the French psychothérapie
institutionnelle, tried to conceptualise his practice and find
examples of what one should not do, all he could think of was the
Neisserian Bettbehandlung, which
he criticised for not being invigorating enough. When
Eigenbeziehung was incorporated
into French psychiatry, it underwent a curious change: while Neisser said
little of the delusional elaborations what were facilitated by the
phenomenon, Sérieux et Capgras, in their book Les folies raisonnantes, considered that as a rule, Eigenbeziehung,
which they translated by signification
personnelle, was the core phenomenon of interprétation
délirante (delusional misinterpretation), a mechanism in which the
laws of logic were duly respected while the premise was false, and the
rigorous construction through which the patient tried to explain why he
was being designated led to an all-pervasive delusional system, taking
much of the patient’s time and preventing him to become dangerous before
long. A
third type of mechanism, the mécanisme imaginatif, was proposed by Dupré, as the main way to
constitute a délire d’imagination
— what continental clinicians were to call paraphrenia after Kraepelin
proposed this term in 1913. But it soon appeared that this mechanism was
in fact a compound one, that could not be presented as a ‘primary’
elementary phenomenon. In fact the only elementary phenomena which can be
claimed to have been sorted out later on are those of manic-depressive
psychosis, schizophrenia and autism, as we shall see. What
can we expect from elementary phenomena? Lacan has given
to the expression ‘elementary phenomenon’ at least four sorts of
meanings: 1.
The possibility to isolate discrete pathognomonic symptoms. 2.
The possibility to sort out in non-triggered psychotic cases
minimal symptoms which can sum up most of the following delusional
developments, in a way quite similar to the ‘fundamental fantasy’ in
the neurotic cases. 3.
The possibility to find hints of the modes of stabilisation’s
that can be foreseen in a
given patient. 4.
Most of the elementary phenomena imply some sort of a ‘subject
supposed to know’, which characterise the structure of the Other. These
phenomena can be dissimulated for a certain time, masked behind acting-out
behaviours, personality traits, reluctance, etc. What
is at stake in the enquiry about elementary phenomena is to find out what
is the implicit structure of the Other, and how the subject tries to
calculate his own existence; it is also clear that elementary phenomena
are predominantly linguistic phenomena. Two
sides can be differentiated: 1.
Elementary phenomena as questions: this is evidenced by a
perplexity, the feeling that one is confronted by an enigma, in a direct
confrontation with the foreclosure of the Name-of-the-father. 2.
Elementary phenomena as attempts to answer to the foreclosure of
the Name-of-the-father (‘personal signification’, hallucinations,
etc.). Most
of the therapeutic manoeuvres that have been proposed are actually using
these two sides, for instance in showing that the certainty about a
delusional idea is in fact an attempt to respond to the perception of an
enigma. Four
main types of elementary phenomena have been described, which seem to be
characteristic of paranoia, schizophrenia, manic-depressive psychosis and
autism. Paranoia As we have seen,
the elementary phenomenon of paranoia was the first to be described. It
can be characterised as an essai de
rigueur, as Lacan put it, or, if we use Frege’s (1892)
differentiation between Sinn
(meaning) and Bedeutung
(denoting, designation), as an attempt to propose a hypothesis allowing to
harmonise the discrepancy between the total lack of meaning experience by
the psychotic confronted with perplexity (not only in his relationship to
the outside world, as it can also manifest itself in bodily feelings in
the case of hypochondriasis), and the unbearable designation he feels
submitted to. S1....................S2
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Subject
S1=Bedeutung, S2=Sinn Paranoia
can be seen as a monstrous instance of Lacan’s definition of signifiers,
i.e., “a signifier is what represents the subject for another
signifier” — which in its turn represents the persecutor. These
patients have usually a particular talent to articulate a relatively
systematised problematic, that can go as far as the ‘loss of
contingency’ (E. Minkowski, P. Berner). The articulation between S1
and S2 allows a certain localisation of the jouissance of the Other (in a persecutor for instance), which makes
paranoid delusions sound ‘understandable’ in a number of cases, and
this in turn is susceptible to generate a so-called folie
à deux. As we have shown, the analyst’s position should be one that
allows to show the relativity of the link between S1 and S2,
in order to allow the patient some doubt about his ideas of reference; a
classical manoeuvre consists in showing that the analyst does not know
anything about the persecution, even if he is personally interested in the
patient’s fate. Schizophrenia While in the
German and in the Anglo-Saxon linguistic domains, the term schizophrenia
tends to encompass several sorts of psychoses, in the French tradition, it
only designates cases in which the delusional experience includes a
notable degree of disorganisation and inadequateness. The RSI problematic,
proposed by Lacan in the 1970s, was an attempt to elucidate this clinical
issue. In his RSI seminar, Lacan
considers the possibility that the real, the symbolic and the imaginary
should not be articulated to each other; this is obviously an attempt to
address the issue of ‘discordance’, such as it was described by
Philippe Chaslin (1857-1923),14 a Parisian logician and
psychiatrist. In
this case, the question is not that of the articulation and separation of
S1 and S2, but the point is that the subject is not
submitted to a S1 that allows him to be identified, and the S2
lacks a sufficient consistency to localise the jouissance
of the Other. The lack of articulation between R (the real), S (the
symbolic) and I (the imaginary) has several consequences: 1.
Lack of articulation between S and I, especially the incapacity to
articulate the mirror image with the ego-ideal, and, as a result, the
feeling of ‘identity’ will be artificial (‘as if personalities’ in
the best cases, or various types of disorganisation of the body-image). 2.
Lack of articulation between I and R, and the impossibility to
localise the jouissance of the Other. We would be inclined to think that the
so-called ‘paraphrenic’ phenomena (délire
d’imagination in Dupré’s terminology, or psychotic mythomania,
such as in the illusion des Sosies
or illusion de Frégoli) are,
above all, attempts to designate this lack of articulation. 3.
Lack of articulation between R and S, determining an absence of
articulation of the phallic jouissance
and the capacity of separation. What is
particularly striking in these cases is the variety of results of these
lacks in articulation; while some patients will be able to stick to
artificial ‘false selves’, others will tend to ‘let themselves
go’, showing a predominantly ‘negative’ or ‘deficitary’ clinical
picture. In other cases, the patient will manifest what has been termed
‘schizophrenic irony’, manifesting or acting out what he feels to be
the total inconsistency of the Other. Among the reliable therapeutic
manoeuvres that have been proposed for this lack of articulation, it seems
that attempts to give the Other some sort of structure through a specific
‘knotting’ can be recommended. Manic-depressive
psychosis There have been
major variations within the psychiatric literature on whether specific
mechanisms of manic-depressive psychosis are to be found; it seems clear
that the predominantly ‘affective’ approach which has been advocated
by a number of clinicians, as well as most of contemporary biological
approaches, rule out the very possibility to find any. We
have shown that it might be useful, as German psychiatric phenomenology
advocates, to consider the question from the viewpoint of the ‘flight of
ideas’ (Ideenflucht), and
consider that melancholia (psychotic depression) is nothing else than a
reversal of the flight of ideas, that is, the patient finds no sort of
limitation to his guilt-feelings. In
this case, the most obvious elementary phenomenon is an impossibility that
the real should interrupt the chain of signifiers (R/S), and this is
probably what Lacan means when he speaks about the ‘touch of the real’
in Television, or what he
alludes to in the seminar on Anxiety,
where he presents the flight of ideas as resulting from the fact that the
subject is not ballasted any more by the object a. This would explain why, in the case of the mathematician Georg
Cantor, who has been diagnosed manic-depressive, his main preoccupation
was to construct several types of infinite, each of which is the limit of
the previous one. In a recent book, I have shown that a Swiss writer, C.
F. Meyer, who was hospitalised twice for melancholia, presented in his
youth some elementary phenomena exhibiting the impossibility to give some
limits to the chains of signifiers he was confronted by; later in his
life, he invented a special style of historical narratives (récits
encadrés, i.e., ‘framed narratives’) which limited the expansion
of the signifiers, and his psychosis was triggered again when he gave this
method up.15 Autism It might seem
surprising to envisage autistic elementary phenomena, since the
obviousness of the disorders, in most cases, seems to leave little
interest to the research of hidden elementary phenomena. However, the
evolution of autistic children towards less pathological presentations is
not seldom, and one should remember that Leo Kanner himself described
cases in which patients, after years of evolution, could be presented as
‘pseudoneurotic’; besides, there has been a growing interest in the
last decades for ‘Asperger’ cases, in which the Kannerian symptoms
were not always easy to retrieve. The
impossibility to bear designation — be it by calling the person’s
name, by touching his shoulders, or by eye-contact — is certainly a good
candidate to be an elementary phenomenon of autism. But we must also
remember that this impossible designation also refers to a second
signifier, whose effects of meaning are usually experienced as totally
disorganising, and autistics usually try to respond to it through
stereotypes, in an infinite series of S1 which are designed to
avoid an unpredictable S2. In fact, two sides of the
symptomatology are often to be observed: on one side, the subject
attempts, through his stereotypes, to stop the hole of the Other, in a
parody of ‘transitional object’; on the other side, he arranges a
series of objects in an immutable order, in which he is in no way
involved. This refusal to be involved is also manifested by the refusal to
use properly personal pronouns of the first person. What is at stake is
not the ‘absence of a theory of mind’ — as many autistic persons
show that they accept indirect contact, and even use echolalia to ensure
some sort of communication — but the structure of the Other, an Other
which seems to be experienced as extremely threatening. It seems that in
the case of autism, some ameliorations can be expected if the subject
manages to elaborate differently the hole in the Other (i.e., the jouissance
of the Other), by building up trajectories or objects that allow him to
have a different relationship to this perplexing lack.16 Conclusion We have seen that the first attempt to consider psychosis beyond its obvious pathological manifestations had led J.-P. Falret to advise his colleagues ‘not to be the secretary of the insane’. We have tried to show that the consideration of elementary phenomena could help us to go one step farther, in so much as discrete elementary phenomena can give us hints on the structure of the Other by which psychotic patients are confronted. This leads us to a concept of ‘elementary phenomena’ which is quite different from what is usually suspected. While it has been upheld that the Lacanian concept of elementary phenomena derived directly from Clérambault’s theory of phénomènes basaux (indicative of a brain lesion), we have seen that this could not be the case. Lacan’s concept of elementary phenomena is mainly based on the assumption that the subject acquires a sense of being through his representation, or his supposition, in language; a direct consequence of this is that elementary phenomena always have some sort of relationship to transference — even if it is a heavily delusional one — and this is not without consequences as to the position we should hold with these patients. 1.
Although the same expression has been used separately by Henri Ey
in his Traité des hallucinations (Paris, 1934) to designate sensory
phenomena related to localised lesions of the nervous system, as opposed
to primary delusional experiences, it is quite clear that Henri Ey and
Lacan are using the same phrase for entirely different phenomena; it is
also clear that Henri Ey’s notion of elementary phenomena is in fact
exclusive of psychotic cases. 2.
On Feuchtersleben, see Hofmann, W.: Einleitung, in Hofmann, W.
& Schmitt, W. Hrsgb.(1992): Phänomen,
Struktur, Psychose, S. Roderer Verlag, Regensburg, p. 3. 3.
The discussion on the ‘visibility’ of psychoses (psychosis
understood as an acute state vs. psychosis as a process or a
vulnerability) has been in constant debate since then. We shall see that
the hypothesis of the ‘foreclosure of the father’s name’ has the
advantage of being rooted in something else than the ambiguous notion of
‘loss of reality’ which is at the basis of the orthodox Freudian
concept of psychosis. 4.
In spite of what Ian Goldstein writes in her book Console
and classify, International University Press 1981, monomania was not
just an instrument used by alienists to acquire an official professional
position; it was also a real clinical issue! For more details on the
controversies over monomania, see F. Sauvagnat, Le
clinicien saisi par le passage à l’acte in
Revue Actualités psychiatriques, 18e année (Janvier 1988), No 1, p.
36-45. 5.
J. Lacan, Le séminaire III:
Les psychoses, Seuil, Paris 1981. 6.
J.-P. Falret, Leçons
cliniques de médecine mentale faites à la Salpêtrière par M. Falret.
Extract from La Gazette des Hôpitaux, 1850-1851. p. 21. 7.
J.-P. Falret, ibid. p.
22. 8.
Ibid. 9.
E. Esquirol, Des maladies
mentales, Paris, 1838, t. I, p. 159. 10.
J. Seglas, Leçons cliniques
sur les maladies mentales et nerveuses, Asselin et Houzeau, Paris
1895. 11.
J. Lacan, D’une question préliminaire
à tout traitement de la psychose in Ecrits,
Seuil, Paris 1966. 12.
For more details, see our article: Histoire
des phénomènes élémentaires in Ornicar,
No 44, 1988. 13.
This was constantly the case in Freud’s first papers on paranoia,
between 1894 and 1896. 14.
Chaslin (1912): Eléments de
sémiologie et clinique mentales, Asselin et Houzeau, Paris, p. 176. 15.
For more details, see our paper: Conrad
Ferdinand Meyer ou le dévoilement mélancolique, post-face to Conrad-Ferdinand
Meyer: Les souffrances d’un enfant, Editions
Anthropos, 1997, p. 55-110. 16.
For a comparison between current cognitivist views and Lacanian
approach of autism, see our paper L’autisme
à la lettre: quels types de changements sont-ils proposés aux sujets
autistes aujourd’hui? in Du
changement dans l’autisme, Actes de la Journée d’Etudes de
l’Association Cause Freudienne-VLB, et du CEREDA, Rennes 1999,
p.9-43. Copyright © Francois Sauvagnat 2003. This text from the website of the London Society of the NLS, at http://www.londonsociety-nls.org.uk. Permission to use material from this site must be sought from the LS-NLS. All rights reserved. Please include this portion of the text in any printed version of this paper. |
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