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The Letter, Issue 55/56, Spring/Summer 2014, Pages 75 - 79 RETHINKING PSYCHOSIS IN THE 21ST CENTURY BRIEF REFLECTIONS FROM THE FRONT LINE Malcolm Garland [1] Based on published research, the views of service users, as well as clinical experience, this paper critiques the concept of schizophrenia. It will highlight: the failure of the emergence of a biological explanation for schizophrenia; the ‘myth’ of antipsychotics; the heterogeneity of ‘psychosis’ in the real world; psychosis as just another form of psychological stress. Our summary view is that schizophrenia is too broad a term to be useful and that there are many patients with this diagnosis being treated with a pharmacological approach rather than a psychological one. We propose an aetiological/narrative based model of psychosis ‘What happened to you?’ replacing a phenomenological one ‘What is wrong with you?’ Keywords: limit of medical model in psychosis treatment; anti-psychotics misnomer?; trauma-related aetiology; service user movement

The Letter, Issue 55/56, Spring/Summer 2014, Pages 65 - 73 THE REAL OF LACAN IN THE TREATMENT OF PSYCHOSIS Christian Fierens [1] The concept of lack in Lacanian theory leads to the Lacanian Real. How can the Real take the place of a conception of psychosis as a lack in the Symbolic, thought of as foreclosure of the Name-of-the-father? Reality appears in connection with the possible. The Real is in connection with the impossible. The psychoanalytic discourse is the science of the Real in so far as it is touched in the meeting with the impossible. It is possible to focus on this Real in the approach to psychosis. Keywords: lack; logic of the truth; logic of the way to err; borromean knot; the groove of the real; lack of resources; resilience In 1908, Bleuler said ‘for the sake of further discussion I wish to emphasise that in Kraepelin’s dementia praecox it is neither a question of an essential dementia nor of necessary precociousness…’. For these two reasons, he introduced the word ‘schizophrenia’, the first of which consists in not taking the problem as a lack of an essential human element. The second reason consists in not placing the problem in a genetical conception. The question is, how to approach psychosis? First of all, to not think of it in terms of deficiency. And then not in terms of genetics, neither physical nor psychological genetics.

The Letter, Issue 55/56, Spring/Summer 2014, Pages 53 - 64 REFLECTIONS ON GUIDELINES FOR SUPPORTIVE PSYCHODYNAMIC PSYCHOTHERAPY WITH PERSONS EXPERIENCING THEIR FIRST EPISODE OF SCHIZO- PHRENIA-SPECTRUM PSYCHOSIS Bent Rosenbaum [1] The Danish National Schizophrenia Project [2] , [3] is used as a background for presenting some phenomenological characteristics of persons in psychotic states of mind, some psychoanalytic concepts grounded in the phenomenology of the psychotic self, and some elements in the supporting psychoanalytic approach. Finally, the concept of cure will be presented as an increased capacity for symbolisation. Keywords: Danish National Schizophrenia project (DNS); phenomenology of first episode psychosis; supportive psychodynamic psychotherapy; guidelines Some phenomenological characteristics of psychotic states of mind In the last 20 years, an increased interest among psychiatrists and psychologists in the revival of phenomenological psychiatry has taken place. The focus of this interest has mainly been in the field of diagnostics, and this approach has, to some extent counteracted the objectifying, reductionistic, symptomfocused mode of diagnosing psychopathological disorders in the DSM- and ICD-dominated mainstream psychiatry. In Denmark, the psychiatrist, Josef Parnas, has worked with the philosopher, Dan Zahavi, and the American psychologist, Louis Sass, to investigate the phenomenological aspects of schizophrenia. The disturbances in the self-experience of psychotic persons draw on observations of some German psychiatrists, e.g. Karl Jaspers, Klaus Conrad and Wolfgang Blankenburg

The Letter, Issue 55/56, Spring/Summer 2014, Pages 41 - 52 REFLECTIONS ON THE CHALLENGES OF PSYCHOSIS Sarah Clarke, Elizabeth Lawlor and Mary Clarke [1] Recent research does not support the pessimistic view of recovery outcomes in those receiving early intervention for psychosis. However the effectiveness of any intervention depends on the willingness of the patient to engage with intervention in a sustained manner. Engaging people with a psychotic illness can prove challenging. Understanding the role of individual appraisal may contribute to the engagement and management of the illness and lead to improved recovery. Keywords: psychosis, recovery, engagement, cognitive processes ‘Science cannot solve the ultimate mystery of nature and that is because in the last analysis we ourselves are part of the mystery we are trying to solve’ (Max Planck 1858 - 1947).

The Letter, Issue 55/56, Spring/Summer 2014, Pages 27 - 39 TERMS AND CONDITIONS ‘PSYCHOSIS’ AND PSYCHOANALYTIC TREATMENT Barry O’Donnell[1] Psychoanalysis is a practice launched by a neurologist, Sigmund Freud [2] , based on the interpretation of dreams, products of every mental life which signify so madly that the normal and the pathological become indistinguishable. With the work of the psychoanalyst and psychiatrist, Jacques Lacan, psychoanalysis recognizes the human subject as a subject of the effects of the functioning of language. This requires that the practitioner in the field of the mental attend to the speech and language of a patient – one who is suffering a disturbance in their symbolization of their world. This requires a listening which refuses submission to the expectation to quickly fix a diagnosis with seeming certainty, a listening which resists the pressure to form an opinion on the basis of unreliable outward signs. This paper raises a number of points which support this contention, in in order to promote serious consideration of the consequences for practice for the position that psychosis is a disorder of the subject in language. Keywords: etymology; psychosis; paranoia; grammar and logic of language; subjective speech; delusion as solution; mental life; neurotic relation to treatment ‘Je te demande de refuser ce que t’offre parce que ce n’est pas ça.’ Jacques Lacan, ...ou pire : 9th February 1972; passim . [3] ‘It is in starting from the psychotic Schreber that Freud first articulated repression. And it is starting from the same Schreber that Lacan articulates the subject.’ Christian Fierens, The Psychoanalytic Discourse . [4]

The Letter, Issue 55/56, Spring/Summer 2014, Pages 13 - 25 RETHINKING THE DRUG TREATMENT OF PSYCHOSIS [1] Joanna Moncrieff [2] This talk challenges the current assumption that psychiatric drugs work by correcting an underlying ‘chemical imbalance,’ or any other brain-based abnormality. An alternative, ‘drug-centred’ model of drug action will be outlined that proposes that psychiatric drugs induce altered mental and physical states, and that these states may sometimes be ‘therapeutic’ by helping to suppress the manifestations of mental distress and disturbance. A drug-centred account of antipsychotic action will be presented that stresses the cognitive and emotional suppression produced by the drugs and how the desired and adverse effects of the drugs cannot be neatly distinguished. The impact of these effects on the symptoms of severe mental disorders will be discussed along with the practical and ethical implications of this sort of approach. Keywords: anti-psychotics; disease-centred versus drug-centred model of action; adverse effects; long-term effects

The Letter, Issue 55/56, Spring/Summer 2014, Pages 1 - 12

The Letter, Issue 55/56, Spring/Summer 2014, Pages iv - vi

The Letter, Issue 54, Autumn 2013, Pages 82 - 91 CAN I SAY WHO I AM Olivia Fox ‘That one might be saying this second, remains forgotten behind what is said’ is a phrase emphasised andrepeated in L’Etourdit. This paper suggests that, although the above quote is written in 1972 and late in Lacan’s career, he may have laid down the fundamentals for it in a much earlier paper ‘The Function and Field of Speech and Language’, written in 1953. Lacan’s writings tell us that the speaking subject who uses language to convey a meaning or sentiment, reveals itself as a subject not equivalent to the one speaking as I, but as a subject which can be detected in the very words or signifiers themselves. An examination of the intricacies of 'full speech' and ‘empty speech’ in Lacan’s 1953 paper was thought necessary by the author to establish if it is possible ‘to say who I am’. Keywords; L’Etourdit, subject, saying, said, full speech, empty speech The title of this paper Can I say who I am , is a question without a question mark and deliberately so. This was a question for me as a trainee psychotherapist, however the question mark is no longer there as my study of psychoanalysis has revealed to me that ‘to say’ anything has a dimension beyond what is said. This understanding was the reason for my engagement with the first turn of Lacan’s L’Etourdit [2] as part of a cartel group in 2013 for The Irish School for Lacanian Psychoanalysis , ISLP. As Christian Fierens says in his Reading L’Etourdit ‘L’Etourdit is the primary form that diverts us from our conscious semantics, it is the apparition of the unconscious in its dimension of non-sense, and it opens up a beyond of commonmeaning’ [3] . L’Etourdit is on the same level as the unconscious and that it may be a matter of recalling the implication of the subject inhis stating’. This question therefore ‘can only be turned saying again and again what you have already said’.

The Letter, Issue 54, Autumn 2013, Pages 74 - 81 CASE BY CASE: APPROACHING THE SUBJECT OF DRUG ABUSE IN TIMES OF OVER-CONSUMPTION Gustavo Cetlin The article argues that once nurtured by language, the human subject is removed from the condition of a natural existence where every instinct is matched to an external object; instead he is driven to pursue the lost object where satisfaction is rather a path than a fact Taking drug addiction as paradigmatic of modern illness, the author describes how the suffering and decay involving consumption pathologies are related tothe attempt to return to a natural state, non-dependent on language and desire, where objects of reality would be sufficient to silence the drive. However, by doing so it reinforces the constancy principle, later related in Freudian theory to the death drive, leading to the worst developments. In conclusion, basic directions for treating these patients are offered taken from the experience of the clinical practice of the ‘Centro Mineiro de Toxicomania’, a public health Centre in Brazil for patients with alcohol and drug abuseproblems and supported by a psychoanalytic orientation. Keywords: consumption, modern pathologies, psychoanalysis, drug addiction, treatment, Centro Mineiro de Toxicomania.

The Letter, Issue 54, Autumn 2013, Pages 63 - 72 DELUSIONAL IDEAS OF GOD AND THE DEVIL Tom Dalzell This paper demonstrates that both psychoanalysis and theology have understood God and the devil to be two sides of the one coin. Concentrating on Freud’s 1911 Schreber case and his 1923 case of devil-neurosis,it concludes that imagos of God and the devil are based on the infantile experience of the father and it argues that both the psychoanalyst and the minister of religion need to be what Lacan called a 'little other'[i(o)] for the psychotic patient, refraining from correcting non-threatening delusions, but rather providing a space where the patient can reconstruct his or her world of sense and develop an appropriate sinthome to hold his or her subjectivity together. Keywords: Freud, Lacan, psychosis, God, devil, nomination, sinthome Introduction The intention of this paper is to draw on psychoanalysis to make sense of delusions about God and the devil and to suggest appropriate pastoral responses to the psychotic patient. [2] Psychoanalysis understands a delusion as the patient’s own attempt at healing or reconstruction. It will be argued, therefore, that pastoral care needs to suspend its theological objections since, if it questions a psychotic patient’s image of God or belief in the existence of the devil, the patient has to begin the process of reconstruction all over again.

The Letter, Issue 54, Autumn 2013, Pages 46 - 62 CMJOYCIRENSFW THE WRITERSINGER Jacques Laberge From Chamber Music to Finnegans Wake through the Sirens’ episode in Ulysses, we have the revelation of aman who cannot really be a writer without being a singer. Joyce is a mixture of Henrik lbsen and Richard Wagner. At the end, he identifies himself to the tenor Sullivan considered by him better than any genius in literature, painting, or sculpture and defines his last book as ‘pure music’. Keywords: Ibsen, Wagner, Lévi-Strauss, Didier-Weill, Sullivan The works of William Shakespeare (1564-1616), Richard Wagner (1813- 1883), and Henrik Ibsen (1828-1906) made a special mark on the life and work of James Joyce. What do they have in common? Drama, theatre, and, especially, voices. On the basis of this drama, Joyce will invent a kind of writing that is meant to be heard. On Shakespeare, Joyce tells us in Drama and Life , written in 1900, that his art is, properly speaking, ‘literature in dialogue’, literature being ‘an inferior art-form’. It is in Henrik Ibsen that one finds, according to Joyce, a form of drama that 'transcends the critics: the artist forsakes his own self and sets himself up as a reverential mediator of truth before the veiled face of God. ….when the art of a dramatist is perfect, criticism is superfluous. Life is not be subjected to criticism, but to be confronted and lived’. [2] Forsaking the self cannot but suggest to a reader of Lacan the lack of a unifying image of the body associated with the lack of unification through meaning. We can, furthermore, understand this identification with the writer-god Ibsen as a kind of identification with the repairing sinthome . From being an heroic figure in Stephen Hero, Ibsen disappears in A Portrait of the Artist, this being one of the most striking differences between the two books. Ibsen’s death enables Joyce to write not The Portrait of an Artist , following in the footsteps of Henry James’ The Portrait of a Lady (1881) or Oscar Wilde’s The Portrait ofDorian Gray (1891), but, with the decisive switching of the definite and indefinite articles, to entitle the book A Portrait of THE Artist. The artist, a god-like one, is Joyce himself.

The Letter, Issue 54, Autumn 2013, Pages 1 - 44 SOME CLINICAL CONSEQUENCES OF THE LOGICAL DIFFERENCE BETWEEN THE SEXES Guy Le Gaufey We have tried to follow as closely as possible the movements of the writing by which Lacan arrived at his formulae, in the hope of dissipating while doing so some stubborn obscurities, due in large measure to the interpretations that he was the first to make of them - among others, the one that sees in the exception, in, the logical writing of the totemic father, of him who is supposed by definition to escape the phallic law validfor all, except for him. Taken in an uncritical way, this interpretation confuses a singular (there are never xtotemic fathers per hoard) and a particular which, by definition, does not as such lay claim to singularity. Atleast in logic, where it is of overriding importance to distinguish between a particular proposition and a singular proposition which, for its part, implies one and only one individual, posing by this fact other problems a propos the existence of the element with respect to which it asserts something. Lacan, though giving the example of the totemic father, does not get involved in this confusion since he believes itappropriate to name this ‘theatleastoneman’ (‘ l’hommoinzun’ ), and therefore leaves open the possibility that there are several of them capable of supporting this exception. By reducing the particular affirmative to a singular proposition, one is exposed inversely to missing out on the difficult status of the exception that this particular encircles because by bringing its extension down to just one individual, we may as well let the narcissism of each do as it will to reduce this exception to a ‘self’ (momentarily projected into the exceptional other), and in this way play half the fish caught by Lacan.

The Letter, Issue 54, Autumn 2013, Pages v - ix

The Letter, Issue 53, Summer 2013, Pages 87 - 99 A CLINIC OF THE ‘NOT-ALL’ Karina Melvin This paper looks to Lacan’s formulae of sexuation in an effort to clarify the meaning of the ‘not-all’. It explores how Lacan interrogates logic to produce the ‘not-all’ and questions what is at stake clinically by means of this production. Greatly influenced by the work of Guy Le Gaufey , this paper looks to a slightly different reading of the formulae. It is hoped that this presentation of the theory opens up space for another way of looking at the ‘not-all’ which is not all about feminine sexuality. Keywords: enjoyment, speaking, ‘not-all’, maximal particular, exception, logic, Encore Many post-Freudians are preoccupied with the contentious and allusive notion of feminine sexuality. Indeed the Miller translation of Encore , On Feminine Sexuality, The Limits of Love and Knowledge [1] and Barnard and Fink’s accompanying Reading Seminar XX: Lacan’s Major Work on Love, Knowledge, and Feminine Sexuality , by their very titles, are caught up in this question of feminine sexuality which has been raging within psychoanalysis since at least the Great Debate. Yet this question is completely distracting and leads only to a cul-de-sac rooted in some notion of inequality erroneously attributed to Freud in his efforts to explore subjectivity. The formulae refuse any binary… The emphasis for both Freud and Lacan is on the becoming of the subject, a process which is uniquely particular, regardless of gender. Translation, which of necessity involves interpretation, has its part to play in the mis-cognition of this emphasis. There are, as is often the case with Lacan, differing interpretations of what exactly the quantified proposition, ∀x.Φx - ‘ not-all of x is subject to the phallic function ’ means. Some theorists in the English speaking world, most notably those who work with the Miller translation of Encore , rely on this text to provide the ‘last word’ on feminine jouissance . Others, influenced by Gallagher’s translation of the seminars and Le Gaufey’s direct engagement with the crucial seminars leading up to Encore , view the ‘notall’ as something more, an ab-sence which highlights the particularity of the subject.

The Letter, Issue 53, Summer 2013, Pages 57 - 85 THE KLEIN BOTTLE [1] Tony Hughes Some arguments about Lacan’s use of topology are explored in the light of the debate as to whether or not it adds anything beneficial to the clinic of psychoanalysis. This paper discusses the essential difference between sense and meaning and addresses Le Gaufey’s critique of the use of the Borromean knot to support Lacan’s formulae of sexuation. The issues raised by Lacan at the time of his first introduction of the Klein bottle are dealt with in some depth, in order to show the rigour of his endeavour. The addendum clarifies the use of the cut and the dimensions in Lacanian theory. Keywords: Lacan, topology, Nobus, Le Gaufey, the Klein bottle, the cut, the suture, the dimensions Lacan’s use of topology continued from the 1950s to the end of his life, and this project was facilitated by his friendship with the mathematician Georges-Th. Guilbaud. He put an enormous effort into developing this aspect of his work in order to make psychoanalysis an even more rigorous discourse. In 1951, Lacan, Levi-Strauss, Guilbaud, and Benveniste met to work on structures and establish bridges between the human sciences and mathematics. Each made use of the teaching of the other as one might a topological figure. On the basis of that collective effort, Lacan was not satisfied with empty talk or mere reflections on the history of mathematics. For thirty years, with or without Guilbaud, he engaged in daily mathematical exercises…Privately they [he and Guilbaud] shared a common taste for mathematical games: strings, inflatable buoys, miniature designs, children’s cubes, the art of braiding and cutting, Queneau-like exercises in style. The field of topology retained the whole of Lacan’s attention; he never hesitated to blacken reams of paper to teach his audience the elements of his doctrine as transcribed in topological figures. [2]