NLS Minute 8



- 8 -

Six extracts from the text

Who is Mad and Who is Not?
On Differential Diagnosis in Psychoanalysis
Pierre-Gilles Guéguen


(Read the full text here, Reprint from Culture and Clinic , Minnesota press, Issue N°1, 2013)


Extract 1

There is a cross fertilizing movement at play between two streams of thought all along thework of Lacan. On one hand, in the name of psychoanalysis, he discards any kind of segregation of our fellow humans (for example when he defines madness as the essence of human liberty in his first Écrits or when he proclaims in 1976 that “Everyone is mad”); this is the Lacan in favor of continuism. On the other hand he tries to build up very precise definitions of what the phenomena to be addressed through psychoanalysis might be: their logics, their minute description, their clear-cut differences.


Extract 2

When Lacan says, “We are all mad, that is to say, we are all delusional” one might take it as a strict equivalent of “we are all psychotics”. If it were so, the option would totally be in favor of the late Lacan and erase the first part of his teaching. It emerges as extremely important to stress the very subtle way in which J.-A. Miller comments on this sentence. His indications in this matter are fundamental since they have bearings on the very practice of analysis.

In his last lecture of the year 2008, he takes a very clear standpoint: “The madness at stake here, this generic madness, is general, or rather universal. It is not psychosis. Psychosis is a category from the clinic with which we try to capture something which anyway inscribes itself in this very universal.” And Miller indicates that the signifier “delusional” in this particular sentence of Lacan’s is to be understood as: “taken within the network of meaning” (which cannot be avoided since human beings are captured within the network of language).


Extract 3

Within the Freudian Field the debate on un-triggered psychosis turned out to be a widely shared concern in 1998 when the category of Ordinary Psychosis was created by Jacques-Alain Miller during a research program of the Sections Cliniques du Champ freudien.

The concept of ordinary psychosis was at first of restrictive extension but became rapidly in vogue. In the beginning it was presumed to concern only some rare cases in which the foreclosure of the Name of the Father remained un-decidable. A consensus soon turned up that it was not rare to have to deal with an indetermination in the diagnosis of a case even after lengthy preliminary interviews. As a matter of fact there were already hints of it in Lacan’s first teachings when he mentioned un-triggered psychosis. And sometimes, even though psychosis is technically onset, it takes very discreet forms (an isolated elementary phenomenon for example).

However in some Schools of the AMP from 2004 to 2008, the vogue for the category of ordinary psychosis – and it is a fact that the increasing number of cases to be found is correlated with the ongoing decline of the Name of the Father in our civilization – and the emphasis put on rapid therapeutic effects in psychoanalytic treatment as developed in the French psychoanalytical free clinics created by the École de la Cause freudienne, produced an inflationist bubble of indecisive diagnosis and maybe some disarray for many clinicians who did not see the point of using clinical categories that were obsolete in modern psychiatry when the “new clinic in fashion” was the clinics of the knots.


Extract 4

Some precision and reflection about the overextension of “ordinary psychosis” was necessary. Miller presented these details in a lecture he gave in English under the title “Ordinary Psychosis Revisited”. This text of reorientation is to be read as a landmark and a turning point in our clinics.


Extract 5

In the same text Miller also indicates that in the differential diagnosis of ordinary psychosis the clinician has to look for a negative differential approach: if it is not a neurosis then it is a psychosis although it is not triggered. He mentions that the most solid reference to discriminate between ordinary psychosis and neurosis is Hysteria for which there is a very sturdy structural apparatus in the Freudian and Lacanian corpus.


Extract 6

The proposition: “We are all mad but we are not all psychotics” should also be examined in light of the theory of generalized foreclosure formulated by J.-A. Miller in 1986, since at first sight it seems to object to it.