Issue 71 now available

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]

The Letter, Issue 40, Spring 2009, Pages 33 - 41 Was Bleuler Right? - or the Perils of Procrastination Eadbhard O’Callaghan and Nicolas Ramperti This article employs recent empirical data to confirm Eugen Bleuler’s view that delays between the appearance of psychotic symptoms and treatment are harmful. It also bears out Bleuler’s less ominous view of Kraepelin’s dementia praecox by demonstrating that when delays are reduced patients are less unwell. Keywords: Bleuler; first-episode psychosis; early intervention; treatment “The sooner the patients can be restored to an earlier life and the less they are allowed to withdraw into the world of their own ideas, the sooner do they become socially functional” (Eugen Bleuler, 1908). [1] Emil Kraepelin distinguished manic-depressive psychosis from dementia praecox on the basis that those with manic depression had a later onset, and that people usually recovered between episodes, whereas those with dementia praecox followed an essentially downhill course. Some years later, Eugen Bleuler renamed dementia praecox by introducing the concept of “the group of Schizophrenias”. This was noteworthy because Bleuler did not consider Kraepelin’s dementia praecox to be a single condition, but rather a group of disorders whose final common pathway was psychotic symptoms.

The Letter, Issue 40, Spring 2009, Pages 19 - 32 From Gleann na nGealt to Schizophrenia: A Structure of Refusal? [1] Helen Sheehan This paper examines some aspects of the history of mental illness in Ireland from a Freudian perspective. It draws on the work of Joseph Robins and of Michel Foucault and argues that the concept of Schizophrenia cannot be understood outside its social and political context. Keywords: Gleann na nGealt; trauma; fear; guilt; compromise; paying the price. 1908 was an important year in the history of psychoanalysis. The first psychoanalytic Congress was held in Salzburg in the spring of that year and Freud tells us that it “brought together friends of psychoanalysis from Vienna, Zürich and other places”.[ 2] One of the results of this Congress was the founding of a periodical called “The Yearbook for Psychoanalytic and Psychopathological Research” which appeared for five years under the editorship of Jung and the direction of Freud and Bleuler. This publication gave expression to an intimate cooperation between Vienna and Zürich. Freud continues: “Bleuler’s great work on Schizophrenia in which the psycho­ analytic point of view was placed on an equal footing with the clinical systematic one, completed this success - after this it was impossible for psychiatrists to ignore psychoanalysis any longer”. [3]

The Letter, Issue 40, Spring 2009, Pages 7 - 17 Schizophrenia in Freud and Lacan: No Return to pre-Kraepelinian Bewilderment Tom Dalzell This article argues that while Freud accepted Kraepelin’s nosological divisions, he reversed the order of late nineteenth century conceptions of psychosis, objective-biological and subjective-biographical, without returning to early nineteenth century Romantic psychiatry or obviating the claims o f biological psychiatry on heredity. It demonstrates that neither the conceptions of Freud nor Lacan represent a return to the early Griesinger’s " unitary psychosis”or to pre-Kraepelinian classificatory confusion. Keywords: Freud, Lacan, Kraepelin, Schizophrenia, Unitary Psychosis "Schizophrenia” is the new name Eugen Bleuler gave to Emil Kraepelin’s "dementia praecox” in 1908. In a lecture to German psychiatrists that year, Bleuler questioned Kraepelin’s ominous prognosis and early onset. He came up with the new name, with its suggestion of tearing or splitting, because he believed that “splitting” of psychical functions was one of the most salient characteristics of the illness. [1] And while he regularly used the term schizophrenia in the singular, he thought of it as a group of illnesses. As early as 1906, Bleuler had begun to apply to psychosis the mechanisms Freud had discovered in the field of neurosis, [2] and his 1911 schizophrenia book expressed his indebtedness to Freud by placing him on a par with Kraepelin, the originator of dementia praecox. [3] But Bleuler’s conception was less pessimistic than Kraepelin’s and, in terms of symptoms, his new conception offered patients hope, as Bleuler’s son, Manfred, used to put it, "hope of a cure”. Kraepelin, for his part, had managed to draw order and clarity out of the existing classificatory confusion by bringing various clinical pictures together into distinct illness unities. The fourth edition of his psychiatry text-book in 1893 grouped dementia praecox, catatonia and dementia paranoides together. And while Kraepelin had originally applied the term dementia praecox only to “hebephrenia”, the sixth edition of his text-book in 1899 united the whole group under the one name, dementia praecox. Back in 1878, Rinecker had helped Kraepelin obtain a position at the Bavarian district asylum of the brain-anatomist, Bernhard von Gudden, and his experience there was important for his project of classifying distinct illness unities such as dementia praecox. According to Kraepelin’s memoirs, his first impressions in the asylum were disheartening. He was not only unhappy with Gudden’s repeatedly answering questions about the nature of illnesses with “I don’t know”, but what he called the “bewildering horde” of countless mental patients, the helplessness of medical treatment and complete perplexity in the face of so many forms of illness bereft of scientific understanding, made his chosen career weigh heavily upon him. [4]

The Letter, Issue 40, Spring 2009, Pages 1 - 5 Schizophrenia and Psychoanalysis: Brief Observations from Contemporary American Psychiatric Literature Kevin Malone Based on opening remarks to the conference Schizophrenia 1908-2008: - Psychosis and Psychoanalysis, this article reflects on the current status of psychoanalysis within modern American psychiatry and the fact that it no longer occupies the privileged position it once enjoyed. While it recognises that psychoanalysis is no longer the dominant paradigm within organised psychiatry, it also suggests that the psychodynamic approach to psychopathology still has a valuable contribution to make. Keywords: Bleuler; schizophrenia; psychoanalysis; psychiatry; dialogue Ladies and Gentlemen, I would like to welcome you to St. Vincent’s University Hospital, Dublin for today’s seminar on Schizophrenia 1908 - 2008 ' Psychosis and Psychoanalysis. I would particularly like to thank the organisers for today’s event, especially Cormac Gallagher, Tom Dalzell and Fiona O'Brien-Lavin for their efforts. I think special congratulations are in order for their successful application to the Wellcome Trust to sponsor this event. I think this is a very important development for education and learning in Irish mental health.

The Letter, Issue 40, Spring 2009, Pages v - vi

The Letter, Issue 39, Autumn 2008, Pages 123 - 128 REPLY TO CHRISTIAN FIERENS Guy Le Gaufey Translated by Cormac Gallagher Paris, Sunday 17 August 2008 Dear Christian Fierens, So then I have read your text ‘The act of saying notall’ and I thank you sincerely for it. For if this book (contrary to the preceding ones) has met with some serious readers, I have not had the privilege up to now of a work as consistent as yours. True, your Lecture de l’étourdit opened up for you the path to this critique that you make. I recognize right away that it is quite justified. Naturally, when I wrote this book I re-read and re-re-read l’étourdit, but in the end I took the decision, after writing some pages, to leave this text to one side because I told myself that what I would have been able to bring forward from it would not fulfil the purpose in terms of quality/price relationship. I will explain myself. I wanted above all to produce a reading of the formulae, which presupposed something other than a continuation (suivi) of the Lacanian text. It was necessary to bring in largely external data (like Brunschwig or Blanché, or the Kantian nihil negativum, etc). From the start therefore I had problems of coherence and dimension. I also left to one side, for example, some important developments about the exception that I had made at a first public presentation of what was going to become this book (because I think the examples furnished by Lacan are misleading). At that time I spent a long time on Carl Schmitt and Walter Benjamin, pursuing a brilliant intuition of Agamben in L’état d’exception, which quite rightly opposed them on the very point of the nature and the localization of the exception in juridical systems. I did not keep any of all that because I told myself that I could only render coherent what interested me in these authors by devoting at least sixty pages to them and in that case my beloved formulae would disappear, or at the very least be put in the shade, while the book would take on the appearance of a summa. I wanted to be brief.

The Letter, Issue 39, Autumn 2008, Pages 103 - 122 THE ACT OF SAYING NOTALL WITH REFERENCE TO LE GAUFEY’S WORK: LACAN’S NOTALL, LOGICAL CONSISTENCY, CLINICAL CONSEQUENCES Christian Fierens Translated by Cormac Gallagher Christian Fierens pays Guy Le Gaufey the tribute of critically reading Notall in a positive way. As author of Lecture de L’Étourdit, h e proposes that this later work of Lacan throws new light on Le Gaufey’s theoretical and clinical conclusions. Some texts of Lacanian psychoanalysis, notall (pastous), leave us with too strong an impression of mixing an inconsequential clinical practice without consequences with an uncritical reading of Lacan and an author’s libido that is apparently illogical. There remains then to the reader three possible tracks; either he will capitulate unconditionally and join the good cause presented by the author (which can be called an introjection), or indeed he will rebel without considering the reasons adduced and will heap on the work the facile abuse of being incomprehensible and detestable (which one can call a projection), or indeed finally he will set to work without delay to make good as well as he can for the flagrant lack that the work gives proof of (which one could call an interjection). Far from being inscribed in this category of works, the books of Guy Le Gaufey [1] do not fail to challenge and to make one work not as a way of trying to make good what may appear to be inconsequential, pre-critical or illogical, but on the contrary in the logical continuation of the obvious desire of the author to read Lacan with a critical eye and to draw out its clinical consequences. The three parts of Le Gaufey’s last work are called: The logic of the sexual fault, towards a critical reading of the formulae of sexuation, some clinical consequences o f the logical difference between the sexes.

The Letter, Issue 39, Autumn 2008, Pages 97 - 102 KANT’S NOTHINGS AND LACAN’S EMPTY OBJECT Tom Dalzell Guy Le Gaufey’s critical reading of Lacan’s formulae of sexuation has traced the historical course of the invention of Lacan’s object. Lacan’s objet a is not the specular object corresponding to his early concentration on the Imaginary, not the unary traitfrom his transition to the Symbolic, but "an object without a concept” or an object in the Real. It is to make sense of this new object that Lacan draws on Immanuel Kant’s “four nothings ” and, in particular, his nihil negativum or negative nothing which is a nothing without a concept. The relevance of this to theformulae ofsexuation and the “not-all” is that Lacan’s interpretation of this negative nothing will allow for an object free from a concept, a concept which would relate it to a whole, a class or an “all”. This paper will examine Lacan’s use of Kant’s nothings and attempt to raise some questions about Le Gaufey’s reading.

The Letter, Issue 39, Autumn 2008, Pages 91 - 96 PLATO’S SYMPOSIUM AS BACKDROP TO A CONSIDERATION OF THE OBJECT DESCRIBED AS ‘PARTIAL’ Irene M. Sweeney The author argues that a consideration of the subjective economy crucially calls for reflection on an object described as “partial Plato’s Symposium (or more evocatively Le Banquet) which forms a backdrop to major sections of Lacan’s Seminar VIII on Transference, leads her to the notion of agalma, which, she explains, suggests an object which lacks the full and steady presence expected of an object, a partial that is not part of any whole. The essential linkage between the birth of desire and a state of lack is also elaborated. Jacques Lacan, in the early 1960’s, defines the subject as that which is represented by a signifier for another signifier. From now on the subject can no longer be regarded as substantial, but rather as an effect of language. [1] This formulation crucially calls out for a re-examination also of the object. In pursuit of this task, ‘a path was opened up to think of the existence of a thing crucial in the subjective economy which, in Freud’s own expression in the Project, escapedfrom the unity presented by any object worthy of the name’. [2] Another register is indeed entered upon in coming to a consideration of an object such as this, described as ‘partial’. The deadening, constraining dualities of subject-object, man-woman are now being shed. It is from the realm of such a something, a not-all, a ‘pas-tout ’, that a track opens up whose direction is away from the flat-earth of either /or totalisations.

The Letter, Issue 39, Autumn 2008, Pages 71 - 89 IN PRAISE OF INCOMPLETENESS Patricia McCarthy In Todd Haynes 2007 movie on the life of Bob Dylan I’m Not There, one of the many Dylan semblances states ‘I’m not there but the song goes on As parletres, we are subject to lalangue, expressed equally as, we are subject to the phallic function (p. Lacan’s unwavering stance is that the phallic function calls the shots and how it is ‘variabilised’ decides our existence and our sexuality. We exist as semblances which doesn’t allow a complementarity or ratio between a couple - man and woman being the exemplars. Making the phallic function its keystone, Lacan built his formulae of sexuation - a version of Aristotle’s logical square - with the mathematical bricks of function and variable as fashioned by Frege (1848- 1925). Hisformulae show the limitation ofa logic, cf. Aristotle’s, that masks rather than handles thefault or faille that structures us. Beginning with a detailed examination of the relationship between function and variable, this commentary recasts the concept of the Primal Father, the at-least-one who is not subject to the phallic function as a necessary inexistent, by revisiting the paradigmatic case of Little Hans. It concludes with a comment on the fault in knowledge systems - recognised by Peirce and Godel in science and mathematics and by Lacan in his not all - as ultimately residing in S(Ø). I’m going to start by telling you what I have not been able to achieve in this paper. When our reading group began to meet last September, I thought, a little over-ambitiously, I might get to tackle Aristotle’s Prior Analytics, study the text - in English, I might add! - and work through his proofs of inconclusiveness and the indeterminacy of the particular. Inconclusiveness and indeterminacy, these terms suggest that something is not whole and complete. They suggest equivocation, and this, Jacques Brunschwig in his article The Particular Proposition and the Proofs of Inconclusiveness according to Aristotle [1] argues, was sacrificed, not only by Aristotle in favour of a logic that might not be equivocal, but by those who, in the succeeding centuries, translated, interpreted and revised his work. And the fact of this sacrifice, why might it be of importance to us? For Lacan, it is quite simply symptomatic of the attempt in logical systems to maintain that there is a consistency at the heart of language and of knowledge. And he is going to go a whole lot further than that and claim

The Letter, Issue 39, Autumn 2008, Pages 11 - 18 AN INTRODUCTION TO A CRITICAL READING OF LACAN’S FORMULAE OF SEXUATION Guy Le Gaufey This paper is based on an address in 2007 at the first study-day of the Irish School for Lacanian Psychoanalysis. The author introduces his essay on Lacan’s formulae of sexuation which appears here for the first time in English translation. He reveals what led him to make a critical reading of the formulae and he relates their development to another trajectory, Lacan’s gradual invention of his “o object”. I want first to tell you how touched and honoured I am to be invited to the first meeting of the Irish School of Lacanian Psychoanalysis because I was also present, 13 years ago, the day, the very day when the APPI was founded. It was a sunny Sunday of October and I could understand at that rime that this Association for Psychoanalysis and Psychotherapy in Ireland was kicked off with a title which was not a very happy one. I explained, that lay. that I had nothing against psychotherapy, that I practiced it every day, rut that was not a good idea to join these two practices under the same title. I was no longer green in psychoanalysis, and I knew things about schools and associations, especially that to mix in the same title Psychoanalysis and psychotherapy would lead to a mess. A title has to point to an aim, and you cannot have two different aims like that, even if you practice both. So I am very glad to hear - for first time; I had not been warned of anything of the -and! - of this “ISLIP”, about which this morning we won’t say any more.

The Letter, Issue 39, Autumn 2008, Pages 1 - 9

The Letter, Issue 39, Autumn 2008, Pages vii - viii

The Letter, Issue 38, Autumn 2006, Pages 91 - 104 DISCOVERING TRANSFERENCE Barry O'Donnell Today we are marking the one hundred and fiftieth anniversary of the birth of Sigmund Freud. Why? Because he founded a new clinical practice, named psychoanalysis. His radical step, which he himself described, retrospectively, as arising from "an insight such as... falls to one's lot but once in a lifetime", involved taking up a new clinical position in the treatment of his patients. [1] So radical was his step that one has to ask how a young medical doctor in the 1880's and 1890's found himself able to make it. What distinctions did Freud have to make to realise an innovative clinical position which could respond to his fundamental redefinition of hysteria? Central to his founding of a new clinical practice was his recognition of the phenomena of transference. In my paper I would like to present to you some details and some remarks on what I gather to be a key moment in his taking this step, namely his case history, Fragment of an analysis of a case of hysteria, otherwise known as the 'Dora' case. [2] Before looking at this case history it is useful to consider a little bit of history. Freud's birth in 1856, even with the error in the date recorded by the Registrar, is easier to pinpoint than a moment when he recognised the transference and decided to respond to it in a new way. The dominant theories of hysteria in the 1880' s were those of Jean Martin Charcot, Hippolyte Bernheim and Paul Briquet. Charcot had proposed a theory of hysteria as hereditary and due to mental degeneracy. This renowned French physician was less interested in treating or curing hysteria than in reproducing it by means of hypnosis for scientific study, which is an interesting approach to take. Although highly regarded by Freud, Charcot did not consider hysteria from a psychological point of view at all. Bernheim, for his part, was occupied more with treatment, which he based on suggestion facilitated by hypnosis and the trappings of charismatic healing. Paul Briquet wrote Traite de l'Hysterie in 1859 having carried out 'a comprehensive clinical and epidemiological study of 430 patients with hysteria' Briquet situated hysteria in the brain and therefore marks the beginning of the approach to hysteria as a neurological phenomenon. The young doctor Freud found himself amid these different theories and practices in the 1880's and engaged enthusiastically in their implementation. Along with his colleagues he had at his disposal a heterogeneous collection of forms of therapeutic intervention - hypnosis, pressure technique, electrotherapy, suggestion, medication.

The Letter, Issue 38, Autumn 2006, Pages 81 - 90 PSYCHOANALYSIS AND PSYCHIATRY Aisling Campbell When I was twelve or thirteen I became interested in Freud when a friend came across the Penguin paperback edition of The Psychopathology of Everyday Life. The discovery that the omissions, lapses and slips that are part of everyday life are actually evidence of an everyday psychopathology was astonishing to me. The fact that my friend and I were quite ignorant of life did not get in the way of our enjoyment of the story of the various slips of the tongue and bungled actions which betrayed the obscure motives of their subjects. Indeed, I suspect that it was the discovery that there was a whole other side to life, right under my nose as it were, that made the book so fascinating. However, as I had never studied German and no-one in my family spoke it, I had no point of reference and am most embarrassed to tell you that I used to mispronounce his name as "Frood"! I suspect that my mispronunciation was unconsciously motivated - no doubt I could easily have discovered the correct pronunciation. But each of us has to discover Freud in his/her own way, to discover the theory in his own way and to reinvent it (although not perhaps to the extent of such mispronunciation). Furthermore, we each have to come upon the discovery of the unconscious for ourselves; it has to strike us with surprise, rather than being taught. The discovery of it can be a way out of hysteria, and hysteria is the hallmark of adolescence; the ignorance or supposed innocence, the not-seeing or not-knowing, the meconnaissance that is consolidated during the so-called latency period leads commonly to the taking up of a master discourse as a solution. There is no-one surer of things than the adolescent. For me, this early discovery of Freud was condensed with other identifications and led me to psychiatry as my chosen profession. I - incorrectly, of course - assumed that Freud was a psychiatrist. I really had no idea what I was letting myself in for. Just as The Psychopathology of Everyday Life might suggest to the novice that there is some easy way to know the mind, so I thought that psychiatry would involve the divination of unconscious motivations and possibly talking to the odd serial killer. Freud, for me, held the possibility of a master discourse which would inform this enterprise. No doubt the stern photograph of Freud on the front cover of Die Psychopathology of Everyday Life contributed to this as well. As is the case in analysis, I started off with what I thought was a guarantee, a master discourse, a primal father and ended up discovering the real limits of this discourse.