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by Alphonse De Waelhens and Wilfried Ver Eecke
Leuven University Press, 2001
Review by Adrian Johnston, Ph.D. on Jul 24th 2002

Phenomology & Lacan on Schizophrenia, After the Decade of the Brain

            In 1972, while Lacan himself was still in the process of forging his large and complex conceptual apparatus, a book entitled La psychose appeared.  The author, Alphonse De Waelhens, set himself the challenging task not only of putting together a clear and coherent overview of Lacan’s difficult teachings on the psychoses—although the third seminar of 1955-1956 and the roughly contemporaneous écrit “On a question preliminary to any possible treatment of psychosis” are the best known Lacanian texts dealing with psychotic phenomena, various other remarks on psychosis are scattered throughout the Lacanian corpus—but also of demonstrating the ways in which a Freudo-Lacanian theory of madness furnishes the building blocks for a new sort of philosophical anthropology, for a reconsideration of the very nature of subjectivity per se.  Furthermore, De Waelhens’ project, at least at an implicit level, also attempts to wed, in certain interesting ways, two normally antagonistic frameworks, namely, structuralism and phenomenology (De Waelhens coming primarily out of a more phenomenological background).

            In 1978, La psychose was translated into English by Wilfried Ver Eecke and published by Duquesne University Press under the title Schizophrenia:  A Philosophical Reflection on Lacan’s Structuralist Interpretation.  This title is, in fact, more accurate than the original one in French, since De Waelhens chooses to focus specifically on schizophrenia as the type of psychotic disorder concerning him in his study.  Sadly, this classic piece of Lacanian literature lapsed out of print.  Fortunately, a revised version entitled Phenomenology and Lacan on Schizophrenia, after the Decade of the Brain, which includes an extensive introduction by Ver Eecke as well as a brand new chapter by him on recent developments in the treatment of schizophrenia (hence Ver Eecke being listed as a co-author), is now available from Leuven University Press.

            In the introduction, Ver Eecke begins by contextualizing De Waelhens’ work in relation to philosophy.  More specifically, he uses issues raised by Sartre and Wittgenstein to explain why, philosophically speaking, one would be interested in turning to psychoanalysis.  For both Ver Eecke and De Waelhens, following in the footsteps of Freud and Lacan, extreme psychical pathologies such as schizophrenia are not totally aberrant and anomalous afflictions marking off as different-in-kind a sick minority from the rest of the mentally healthy population.  Instead, these “maladies of the soul” are windows opening out onto a view of some of the key universal components involved in the functioning of the psyche; the psychoses negatively highlight, by virtue of the psychotic individual’s lack of integration into the shared space of human socio-linguistic experience qua “consensual reality,” certain essential mechanisms underlying and making possible the field of “normal,” “everyday” experience.  When these mechanisms malfunction or are non-existent (the latter case of non-existence being what’s at stake in the Lacanian concept of “foreclosure”), stable subjectivity and its experiential correlates cannot come into being.  The individual, stranded somewhere in an anxiety-ridden no-man’s land between the pre-subjective and the subjective, falls ill.

According to Ver Eecke, Sartre’s analyses isolate as a crucial existential topic the question of the self’s origins:  Where does the “I” come from?  How does one conceive of one’s origins (or one’s death, for that matter) without projecting oneself as a witnessing gaze into the moment of the self’s emergence, thus paradoxically always-already positing one’s own existence even at the very point of the ostensible advent of this same self?  The psychoanalytic theory of the “fundamental fantasy” (especially as outlined in a 1964 paper by Jean Laplanche and J.-B. Pontalis entitled “Fantasme originaire, fantasmes des origines, origines du fantasme”) directly grapples with this Sartrean theme.  The basic idea is that the subject creates (unconscious) fantasies that “fill in the gaps,” the necessary holes, of its ontogenetic, life historical experience as regards, for example, its birth and what transpired before this birth.  The fashion in which the individual thus embellishes the tableau of his/her selfhood has, in the psychoanalytic view, decisive consequences for later psychical developments.  One of De Waelhens’ claims is that human finitude, as the kernel around which fundamental fantasies wind themselves, is an especially troubling and perturbing problem for those destined to lapse into psychosis.  In short, the psychotic has difficulty answering, to his/her own satisfaction, queries regarding from where the “I” comes.  This leads then, in Ver Eecke’s introduction, to a brief discussion of Wittgenstein (particularly the later text On Certainty).

Ver Eecke contends, in connection with a brief examination of Wittgenstein’s musings on personal pronouns and proper names, that an essential part of the process in becoming human (i.e., the quasi-mythical moments theorized to exist in the passage from immediate asubjectivity to mediated subjectivity) is the assumption and interiorization of the symbolico-linguistic mediators of one’s identity/selfhood.  This identification effectuated in and through language is a prerequisite for entry into human social reality.  Not only does the psychotic have severe difficulties with his/her psychical relation to the enigmas of the self’s origins, but he/she also never fully comes to terms with the representational emblems of selfhood normally taken for granted in those with comparatively normal egos.  In this light, Lacan’s teachings on psychotic pathological structures can be broadly taken to be inquiries into the psychical repercussions of the failure of the individual to be assimilated into the “symbolic order” of language.  The remainder of Ver Eecke’s introduction summarizes the crucial contributions of De Waelhens’ work as regards a Lacanian theory of psychosis and its philosophical consequences.

            Before proceeding to a synopsis of the book, a few remarks about how De Waelhens’ phenomenological background impacts his approach to Lacan’s “structuralist” account of the psychoses are in order.  Although far from forced or blatant—De Waelhens doesn’t openly drag figures like Husserl, Heidegger, or Merleau-Ponty into the fray of psychoanalytic debates here—two of De Waelhens’ emphases reveal his underlying philosophical leanings.  First, his additions to Lacan’s battery of concepts dealing with psychosis derive from the attention paid to the experiential qualities of the hallucinations and delusions endured by those suffering from this class of pathological phenomena.  De Waelhens, employing the Lacanian registers, speaks of these illusions as an “imaginary real” (more will be said about this phrase subsequently).  Second, in line with themes from existential phenomenology, De Waelhens productively maintains that human finitude (issues surrounding the matter of birth as well as something like Heideggerian Sein zum Tod), rather than simply sexuality as per classical Freudianism, is perhaps the central focal point in the psychical economy, the nucleus of the formations of the unconscious.  And, apart from these issues, De Waelhens’ entire analysis is deeply and profoundly Hegelian at various decisive junctures, with Ver Eecke aptly drawing out these myriad connections between philosophy and psychoanalysis in the copious footnotes to his translation.

            As already noted, De Waelhens is interested in showing how an inability to integrate oneself into language, as do other subjects, is complicit in generating psychosis.  And yet, it’s sometimes hard to tell whether linguistic shortcomings are causes or effects of a disorder like schizophrenia (in his supplementary chapter in the revised edition, Ver Eecke’s attempt to reconcile physiological and ideational etiologies in the diagnosis of schizophrenia via his “dual epistemology” speaks to this opacity in De Waelhens’ presentation—on this, see some of the concluding paragraphs below).  Does the “rejection/foreclosure of the signifier” trigger psychosis?  Or, alternatively, is the lack of capacity to unproblematically enter into the socio-symbolic order itself a symptom of psychosis, a symptom perhaps pre-determined by neurological defects?  In his treatment of hallucination, this ambiguity is especially pronounced, with disturbances in the individual’s relation to language and the hallucinations allegedly thereby resulting being simultaneously both visible manifestations of psychosis (i.e., symptoms qua effects or consequences) as well as underlying determinants or catalysts of psychosis (i.e., causes leading to psychotic disorders).

Introducing a biological level of explanation helps break the deadlock of this vacillation. However, De Waelhens rejects this option.  Employing a now all-too-familiar argumentative tactic, he observes that biologistic diagnoses are powerless to account for the particular content of the ideational disturbances characteristic of the psychoses.  At most, a neurologist can show that a patient hallucinates and possibly explain some of what is transpiring at the cerebral level when such symptoms are reported; a neurologist might even be able to predict that certain impairments or injuries to the gray matter of the brain will likely lead to an individual becoming schizophrenic.  But, De Waelhens contends, the genuine interest, the true explanatory task, lies in showing why specific individuals are plagued by specific delusional contents.  Different psychotic patients are trapped in different hallucinatory worlds, and a psychoanalytic-philosophical analysis sets itself the goal of revealing the reasons for the material of delirium taking on the contours that it does for each and every analysand (with this analysis requiring an investigation into the experiential, ideational elements of particular ontogenetic histories).  Nonetheless, even if De Waelhens is correct regarding the explanatory limits of physiological diagnosis, this shouldn’t be mistaken for a carte blanche to totally ignore the burgeoning field of neurological research into the physical underpinnings of psychosis.  Only a fool could today deny that the body plays a causal role in predisposing people to schizophrenia.  De Waelhens himself isn’t such a fool, although his deliberate and careful avoidance of treading onto the soil of biology might, in a contemporary context (as opposed to when this text was originally written), be seen now as an unjustifiable theoretical shortcoming given the progress that’s been made in the natural scientific study of schizophrenia.

Part of what distinguishes a psychotic from an ordinary, run-of-the-mill neurotic is the presence of delusions and hallucinations.  Whereas the neurotic maintains a connection with the consensus reality of the socio-linguistic order by repressing that which runs counter to the dictates of this order, the psychotic lives out these normally unconscious aspects of ideational life on the surface of his/her conscious perceptions.  Taking his lead from Lacan, De Waelhens insists that the individual’s relation to the Symbolic qua language is absolutely decisive in the genesis and subsequent unfolding of those symptoms most characteristic of psychosis.  The “big Other” of the symbolic order introduces a measure of mediation into the pre-linguistic immediacy of the infant-child’s chaotic soup of libidinal bonds.  Although it has become a commonplace of Lacanian theory nowadays, De Waelhens deserves credit for being one of the first interpreters to recognize that, in Lacan’s structural account of the Oedipal family unit, the paternal function (i.e., the Nom-du-Père as the emblem of Symbolic intervention in the libidinal economy) isn’t simply a negative factor, namely, the mark of a prohibition introducing an unpleasant, resented loss into the infant’s existence.  De Waelhens rightly stresses that, for Lacan, the paternal function is that which makes possible an exit from a potentially psychosis-inducing state of perturbing dyadic dependency upon an unpredictable and seemingly capricious maternal desire.  He also foreshadows later developments in psychoanalytic theory by pointing out that the mother’s own psychical processes (for example, her unconscious libidinal investments) are major factors determining whether or not the child will become psychotic.  The Symbolic Nom-du-Père serves as the child as a sort of lever or fulcrum enabling him/her to pry loose from the situation of primordial helplessness in which all human beings find themselves initially; in his more Hegelian moments, De Waelhens likes to speak of this pre-Symbolic state in terms of an “immediacy” to be contrasted with the “mediation” establishing subjectivity proper.  The stabilization of affect and cognition resulting from the intervention of the paternal pole of the Oedipal triangle is necessary for the construction of a non-psychotic self-identity.

This is not the place to rehearse the arguments explaining why Lacan, in his “return to Freud,” identifies language as essential to the dynamics of the Oedipus complex and the type of subjectivity produced therein.  Suffice it to say that, in De Waelhens’ view, failures to be integrated into a language-structured world are decisive for the emergence of psychotic symptoms.  So, what about the category of the “imaginary real” employed in this study to describe schizophrenic experience?  Freud speaks of psychosis as involving a massive “dis-investment” in the Umwelt of external objects and persons; De Waelhens proceeds to hypothesize that a correlative “reinvestment” of this thus-withdrawn libidinal cathexis is placed upon language by the psychotic.  But, hasn’t it already be claimed that the psychotic remains, in a manner of speaking, outside of language?  A greater degree of precision is required in response to this question:  De Waelhens stipulates that the psychotic has problems specifically with that dimension of language consisting of intersubjectively-recognized significance, this being what disintegrates with the collapse of the Symbolic for the psychotic.  The hallucinations and delusions of the imaginary real, in this model, result from an excessive reinvestment in language not as a matrix of socially shared meaning, but as a series of signifiers construed in such a hyper-literal fashion by the psychotic that they lose all anchoring in a set of stable signifieds (this “unmooring of signifiers” being what Lacan describes in terms of the unraveling of the “quilting point” [point de capiton] established through the Name-of-the-Father).  For instance, a metaphorical idiom or turn of phrase might be understood by the psychotic in such a literal way that this idiosyncratic interpretation generates corresponding hallucinations or somatic disturbances (the favored example used by De Waelhens is of a German-speaking patient whose symptomatic eye trouble is the effect of a German phrase describing a deceitful person as a “twister of eyes”).  The hyper-literal misunderstanding is the “imaginary” moment, and the return of this misunderstanding under a delusional-perceptual guise is the “real” aspect.

De Waelhens maintains that hallucinations cannot simply be explained as nothing more than false perceptions.  In fact, careful questioning of hallucinating patients reveals that they themselves are aware of the experiential qualities distinguishing hallucinations from genuine perceptions.  Combining Lacanian theory with phenomenological sensitivity to the task of accurately describing the sensory world of the individual, De Waelhens adamantly insists that the illusions associated with psychotic delirium are already attempts at recovery spontaneously undertaken by the afflicted person.  The often intricate and highly developed delusional systems of psychotics represent a struggle to reestablish a firm foundation of meaning in the wake of the Symbolic’s collapse.  The psychotic tries, however inadequately, to reintegrate him/her-self back into the domain of trans-individual significance.  Unfortunately, a by-product of this furious activity at self-recovery is the disorienting kaleidoscope of the imaginary real.  In a more recent study from 1997 entitled A Clinical Introduction to Lacanian Psychoanalysis, Bruce Fink articulately develops this line of analysis presented by De Waelhens.  Fink contends that, in the Lacanian clinic, the analyst tries to help the psychotic not by trying in vain to permanently banish the “false perceptions” haunting the analysand—this assumes, of course, that full-blown psychosis is, to a large extent, incurable—but by assisting the psychotic in constructing a stable delusional system, a set of metaphors that, although perhaps not in line with consensus reality, nonetheless enable the sufferer to cling to meanings that help him/her have a bearable existence.  Again, on this point too, De Waelhens stands out as a pioneer in Lacanian exegesis.

The biggest difference between the 1978 and 2001 editions of this translation of De Waelhens’ text is the supplementary chapter by Ver Eecke on recent advances in the diagnosis and treatment of schizophrenia.  The “decade of the brain” mentioned in the new title of the revised book presumably refers to the 1990s, and Ver Eecke puts De Waelhens’ ideas into dialogue with a past decade’s worth of research both in psychoanalysis and psychology as well as the natural sciences.  This is a welcome and refreshing approach.  Normally, those working with Lacanian theory, especially if they have a philosophical agenda to pursue, opt to ignore empirical data stemming from the clinical observation of various mental pathologies.  The standard, well-rehearsed arguments for the avoidance of “biological reductionism” are trotted out, and those faithful to the letter of the text are released from the annoying obligation to determine whether or not their conceptual acrobatics are relevant to the boring banality of human life.  On the other hand, it bears mentioning that a complementary-but-inverse risk is run by those who espouse a materialism that truly is reductionistic, that is to say, those who have always-already concluded that all facets of a human being can be explained away as results of physiology.  Ver Eecke pleads his case for a “dual epistemological” account of schizophrenia.  Although the missing link between the ideational and the neurological has yet to be pinned down—if one believes certain authors working on the philosophy of mind, one might assume that such a link cannot ever be located and/or conceptually delineated—Ver Eecke urges thinkers on both sides of the soma-versus-psyche debate to cooperate rather than bicker in seemingly endless intellectual turf battles.  Behind this urging is the conviction that schizophrenia is the outcome of a physiological predisposition combined with certain “immaterial” factors (i.e., early socialization, the processes of accession to language-use, environmental stimuli of various sorts, etc.) aggravating or even setting off the psychotic episodes associated with schizophrenia. 

Furthermore, Ver Eecke uses all kinds of research to buttress the Lacan-inspired contention that a dysfunctional body image often lies at the root of a malformed self-identity.  And, if it is indeed true that disturbances of the “I” are an inherent feature of psychosis as De Waelhens asserts, then it follows that investigating the formative dynamics of body image is an important part of the effort to understand psychosis.  What’s more, since both soma and psyche are at play in the body image as an ideational representation of a material, physical reality, both psychical and neurological levels of explanation are useful here.  The most general philosophical upshot of all this is that a human being is a much too complex entity to be exhaustively analyzed from a single discursive/epistemological perspective.  However, in this supplementary chapter, one encounters a tension between De Waelhens and Ver Eecke:  the latter argues against the former’s strict partitioning of psychoanalysis and biological inquiries.  Ver Eecke’s position, in which he incorporates the findings of the natural sciences into a Lacanian framework, is more plausible for two reasons.  First, as mentioned earlier, the sheer weight of the ever-increasing empirical evidence concerning the body’s role in schizophrenia makes it intellectually (as well as therapeutically) unpardonable to neglect this dimension of the illness.  Second, an exclusively ideational explanation of schizophrenia is in danger of falling into a vicious circle in which psychical phenomena are made to lead an untenable epistemological double life as simultaneously both causes and effects of mental pathologies (as argued above, De Waelhens occasionally courts this danger when discussing the rapport between language and psychosis).

Overall, Phenomenology and Lacan on Schizophrenia, after the Decade of the Brain offers a rich and interesting collection of insights into both schizophrenia as well as the fundaments constitutive of subjectivity.  For those dealing with Lacan’s theory of psychosis, this text is absolutely essential reading.  Both De Waelhens and Ver Eecke bring the much-needed light of clarity into some of the darker conceptual corners of psychoanalysis’ metapsychological edifice; such difficult topics as primal repression and foreclosure are productively illuminated here.  And, hopefully, this book’s subtle interweaving of psychoanalysis, clinical psychology, philosophy, and the natural sciences will encourage future investigators to similarly nuance what have previously been rather heavy-handed approaches to the psyche, approaches stemming from false dichotomies which are themselves consequences of a tacit-yet-flawed philosophical anthropology.

 

© 2002 Adrian Johnston

 

Adrian Johnston recently completed a Ph.D. in Philosophy at SUNY Stony Brook. His dissertation was Time Driven: Metapsychology and the Splitting of the Drive.  He currently lives in Tennessee.




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