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Towards the Difference between Neurosis and Psychosis

The Letter, Issue 40, Spring 2009, Pages 43 - 57

Towards the Difference between Neurosis and Psychosis

Barry O’Donnell

This paper recommends that clinicians attempting to differentiate the structures of neurosis and psychosis take account of Freud’s thinking on the mental act of negation, based on his clinical practice, as well as Jacques Lacan’s development of Freud’s conception. The author argues that this is essential for any diagnosis which invokes the notion of a loss of a sense of reality.

Keywords: neurosis; psychosis; psychoanalysis; reality; negation

If in recent years, in other discourses, there has been a loss of confidence in the terms “neurosis” and “psychosis”, their differentiation remains crucial to psychoanalytic practice.[1] The term neurosis was dropped from the DSM III in 1980; and in the current DSM IV-TR the term “psychotic” is more apologised for than advocated: “The narrowest definition of psychotic is restricted to delusions or prominent hallucinations, with hallucinations occurring in the absence of insight into their pathological nature”.[2] There is reference to an alternative definition in terms of “a gross impairment in reality testing”. This last arguably just makes explicit what the previous one hides behind the words “delusion” and “hallucination”.[3] By this account psychosis is understood in terms of an aberration regarding what is taken to be, by “almost” everyone else, reality.[4]

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