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Discreet Signs in Ordinary Psychoses

Maria Cristina Aguirre

New York

What should we look for?

What is discreet? Inconspicuous, subtle, unnoticeable…Ok, so I have to look for those small details, or maybe divine details?

Signs, what are signs? They can be from cyphers to symbols to secret code/language to emblems.

Can this be a tool of clinical orientation in the mental health clinic where I work in the most diverse ethnic neighborhood of the entire USA, where services are provided in more than 20 languages? ,

So diverse that we have to consider the particularities of each case in reference to their culture.

My wager is that this compass is an extremely valuable tool that can orient our practice and the direction of the treatment. While the diagnoses of the DSM give us global categories by checking off a list of symptoms, according to the time of onset, duration and severity, in a quantitative and statistical dimension, our Lacanian concepts may help us find our way in the modern towers of Babel.

Let’s take two basic categories of Depression and Anxiety. Are all depression the same? Are all anxieties the same? What are the discreet signs we should be looking for?

A symptom, or rather, a sensation commonly described by patients is  “blankness”, the feeling that their mind went blank, that their head is empty. This can produce a lot of anxiety and depression, fear of losing one’s mind, of having dementia or Alzheimer.

I think we can connect this to what Jacques-Alain Miller developed in the Conversation of Arcachon as an unplugging (débranchement). These episodes can have different time variations, last for a few minutes or longer but they are always lived as something strange, and also something the subject is afraid of and ashamed to talk about. In the Latino population of this mental health clinic it could be represented as a variation of what Almodovar described in that extraordinary film “Women on the Verge of a Nervous Breakdown”.

This “unplugging” is it a symptom or a sign? Even though the subject situates it in the mind, the head, can we speak of it as a body event? Is it an invasion of jouissance in the body or better still an emptying out of jouissance. My proposal is that it is the latter, as if the wall of language and images were like a sieve, incapable of containing jouissance as it leaks through its porous wall; therefore, the intense effort of the subject to hold onto something.

In Ordinary Psychosis Revisited, Jacques-Alain Miller situates this as a Subjective Externality: “its an experience in the ordinary psychotic of void, of emptiness and vagueness”. He says that we can encounter this in various cases of neurosis but in ordinary psychosis what we are looking for is “…a clue of a non-dialectisible quality of the void or of the vagueness. There is a special fixity of this element.” (Psychoanalytical Notebooks 19, p. 157)

The key words here are non-dialectisible and fixity. These are some discreet signs we may look for.

So in this non-dialectisible logic what is operative? Not the meaning which in itself can be delusional. But we need to invent, in each case, an apparatus, a prosthesis, that would allow the subject to reconnect, and that would stop or diminish the leakage, an artificial bond to re-appropriate his/her mind to itself.

Linda complains of symptoms of “depression” and “anxiety”. She wakes up crying every day, she doesn’t know why, she doesn’t ask herself why either. She just says she doesn’t know what is happening to her. This happening has been gone on since 9/11, when the Twin Towers collapsed in New York. Why? She doesn’t know, she saw it on T.V., she was not near that place, she doesn’t know anyone who died or suffered directly from the terrorist attack. Since then her world collapsed. She has no delusions, no hallucinations, only multiple physical illnesses that require medical services. Each session is like a new session, nothing is built from previous sessions. When she comes, she cries, complains, describes her suffering, calms down and leaves, week after week for years.

What function do I occupy? A safe space, where she can come and complain without being judged or rejected. The fixity and the repetition are the salient factors in this case. But the question remains how to make the surface less porous?