Lacanian Psychoanalysis & Psychosis – 2. Paranoia

Helen Koumidi

Psychologist – Psychotherapist

www.elenikoumidi.gr

«Lacanian Psychoanalysis & Psychosis – 2. Paranoia»

«You talkin’ to me?»: Actor Robert De Niro in the film “Taxi Driver” (1976) amazingly interprets the phrase “Are you talking to me?” signaling the onset of a paranoid delusion.

 1.Lacanian Interpretation of Paranoia

Note: For the description of Psychosis (definition, causes, onset of psychosis, management of the transference) according to the Lacanian psychoanalytic approach, the reader can read the text «Lacanian Psychoanalysis & Psychosis/1. Schizophrenia»[1].

In 1932 Lacan studied paranoia in his first major work, his doctoral thesis. It was the case of a psychotic woman, whom he called Aimée, introducing a new clinical diagnosis of his own, ‘paranoia of self-punishment’. For Lacan, paranoia is developing during the formation of the individual’s own ego. This thought, that paranoia has its roots from the beginning of the genesis of the personality, is already present in this first work of analysis in Aimée: «[…] for these fixations related to the stage of primary narcissism, we propose, given the weakness of personality functions at this stage, the title pre-personal emotional dysfunctions“» (Lacan J., 1932).

Paranoia belongs to the Psychotic structure. In addition to the general psychotic features that also apply in the case of Paranoia, we would add the following special features:

→ « ‘We are all delusional’  – The Paranoid Structure of the Ego»:

Lacan distinguishes imaginary knowledge, which is knowledge of the ego, from symbolic knowledge, which is knowledge of the subject. Imaginary knowledge is characterized by Lacan also as paranoid knowledge, as its structure is the same as that of paranoia: the fantasy of absolute self-control and unity.

→ «Paranoia and Aggression – Paranoia develops as a result of fixation during the narcissistic Mirror Stage»:

Aggression is seen by Lacan as an intrinsic, structural psychic phenomenon. Furthermore, aggression is distinguished from aggressive acts, which are an expression of aggression into practice.

It should be noted that the relationship between paranoia and aggression is underlined by Lacan already in his first writing: «[…] aggressive impulses, especially homicidal ones, which sometimes manifest themselves without delusional phenomena and ‘silently’, nevertheless reveal a special dysfunction, similar to psychosis and pose the problem of the subject’s responsibility in the same terms»(Lacan J., 1932). Later, Lacan concretizes it: «The aggressive tendency turns out to be fundamental in a series of important personality states, the so-called paranoid and paranoia psychosis» (Lacan J., 1948).

Lacan sought the psychic cause of aggression in the so-called ‘mirror stage’. The ‘mirror stage’ is the narcissistic stage during which the subject enters the Imaginary order of psychic reality and experiences the successful or unsuccessful Oedipal passage into the Symbolic order of psychic reality. It is the stage where the ego is formed, the individual is introduced into a structure (psychosis/ neurosis/ perversion), where his relationship with the world and others is also structured. It is also the stage where narcissism, aggression and ambivalence are born due to the alienating nature of the ego. Lacan distinguishes the ego from the subject. The ego is formed through identification with its mirror image and is captured by it as it constitutes the place where the subject is alienated from oneself.

In particular, Lacan spoke of the ‘mirror stage’ in 1936 after Henri Wallon’s ‘mirror test’ in 1931. This test involved an experiment in which a human baby (6 months old) was compared to a chimpanzee of the same age when looking at their reflection in a mirror. The human baby was fascinated by its reflection in the mirror and triumphantly adopted this image as its own, while the chimpanzee realized that the image was illusory and lost interest in it. The human baby is still immature in terms of motor coordination but can recognize itself in a mirror before gaining control of its body movements. So the baby in front of the mirror sees his image as a whole. The composition of this image produces a sense of contrast compared to the lack of coordination of his body as the baby experiences his body as fragmented. Thus, the totality of this image threatens the subject with fragmentation as it experiences this contrast as a contrast to its own image, which mobilizes primary identification with its counterpart. The moment of identification of the subject with its image is a moment of triumph as it leads to an imaginary sense of control.

In this way, the dual imaginary relationship of the ego with the other (a – a’) is structured. At this stage, narcissism, aggression and ambivalence are born, three interdependent terms of our mental reality. The identification during the mirror stage is the identification of the self as another, that is, it is an alienating, imaginary identification. Thus, the relationship of alienation “I am you” can lead to the conflict relationship of exclusion “you or me”, where the possibility of an aggressive act increases.

In more detail, the narcissistic relationship characterizes the imaginary dimension of human relationships. Narcissism is considered the love attraction of the mirror image and can range from extreme self-love to so-called ‘narcissistic suicidal aggression’. The person is therefore ‘captured’ by the mirror image, the mirror game, as on the one hand, the image seduces, has an erotic character, on the other hand it leads to a fixation, has an aggressive character, not letting the person move forward. Lacan underlines the relation of narcissistic libido to aggression: «Aggression is a tendency connected with a type of identification, which I call narcissistic, which determines the formative structure of the human ego and the status of the essential features of its world» (Lacan J., 1948). Aggression is therefore of an imaginary type, is a characteristic of narcissism and is placed in the dual relationship of the ego with its counterpart. Furthermore, identification with the mirror image implies an ambivalent relationship with its counterpart. The ambivalence as stated by Lacan is structural and involves both eroticism and aggression: «A child who hits another child says that he himself has been hit; a child who sees another child fall, cries. Similarly, he identifies with the other who experiences the full range of reactions – whose structural ambivalence is clearly revealed in his behaviors» (Lacan J., 1948).

During the Mirror Stage, if the person has ‘passed the danger’ of the structural genesis of Schizophrenia (where the person will remain captive in the experience of the fragmented body, without the possibility of entering the Mirror Stage), but at the same time fixated on this, then opens up either the possibility of a paranoid psychotic structure or that of a manic-depressive psychosis.

The fixation of the paranoid person in the narcissistic stage of the mirror, where the ego is constructed on the model of the imaginary-dual relationship (a-a’), determines the type of relationships he will enter into in his later life. The paranoid person thus remains captive in the mirror games, with the result that specular fascination and rivalry determine his relations with the world.

→ «Paranoia as a ‘pathology of identity’»:

In the paranoid subject we see a hypertrophy of the ego’s imaginary identity, fixed in the narcissistic stage, which it defends and reinforces, through a defensive projection, at all costs. Recalcati describes these two important aspects of the individual’s paranoid state, namely the narcissistic fixation and the defensive projection: «Precisely to the extent that he remains a prisoner of his ‘ego’, the paranoid subject does not operate through the symbolic filter of repression but through fixed forms of projection. This means that what we are not able to accept for ourselves – that is, what conflicts with the ideal image of the ego, with our megalomaniacal self-admiration – does not manifest itself through a pathway coded with the linguistic formations of the unconscious (symptom, slip of the tongue, dream, parapraxes) but is expelled, projected outwards, potentially returning to the subject only as a direct and persecutory reaction of the real» (Recalcati, 2013).

«The Other that makes possible the formation of identity comes from outside and drags the subject into a vortex of identifications. This other is narcissistically loved as an ideal, but to the extent that its nature remains external, inaccessible, always necessary other, it also emerges as an invincible enemy. The nature of paranoia indeed consists in setting the closest Other as the enemy. His internalized ideal-ego as persecutor» (Recalcati, 2013).

The paranoid defense thus leads the subject into a vicious circle of perpetual paranoid defense of identity: «The paranoid defense implies that anything that exceeds the solid imaginary horizon of the Ego becomes the site of a repulsive impurity. The political type of paranoia is therefore a type pathology of identity; more precisely, a pathology of identity which is unleashed by an extreme strengthening of the defense of identity. Indeed, the paranoid cycle develops between these two poles: a pathological defense of identity and a reinforcement of identity as the extreme end of this defense» (Recalcati, 2013). But it should not escape us that the identity of the ego is imaginary, it cannot be fixed in an eternal concrete image: «[…] as Lacan repeatedly reminds us, the real madness is not to lose the identity of the Ego but to believe really into an Ego, to posit it as one undivided identity» (Recalcati, 2013).

→ «The Beginning of a delusional belief – The Paranoid Subject is persecuted by the significance of the Other»:

Delusion as an elementary phenomenon begins when the paranoid person begins to believe that the Other is targeting him to exploit him. That is, the Other is supposed to get satisfaction by exploiting the paranoid subject, by making him a ‘victim’. « […] the delusion began the moment the initiative came from the Other, with a capital O, when the initiative was founded on a subjective activity. The Other wants this, and above all he wants this to be known, he wants to signify it» (Lacan J., 1955, p.193).

The psychotic person thus feels the target of the “bad Other”. The paranoid person has the delusional certainty that the “bad Other” is targeting him with the importance he attaches to him. In other words, this meaning concerns him. «Paranoid fantasy involves the identification of jouissance in the place of the Other» (Miller J-A., 2008).

→ «There are different ‘types of delusion’»:

Regardless of the different type of delusion we can distinguish the persecutory dimension in each delusion, which lies in the meaning imposed by the ‘bad Other’. The individual thus experiences himself as an object, as a ‘victim’ of the other. At this point lies the suspicion that often governs the person’s relationships with others. So, in persecutory delusion the paranoid subject has the delusional certainty that the other is watching him, controlling him, in the jealous type, the other cheats him, in the erotomanic type, the other loves him, in the delusion of grandeur, the world assigns him a ‘mission’, in the hypochondriac type, his physical pain remains unexplained with all the doctors ‘not helping at all’ and in the ‘folie à deux’ delusion, where the second member of the imaginary relationship is identified with the delusion of the first. Furthermore, the persecutory dimension of paranoia here also involves psychotic anxiety.

→ «The role of delusion in the life of the paranoid subject»:

In neurosis, Fantasy (the subject’s relationship with libido – jouissance – object a) functions as a defense against the Real of jouissance but also as an answer, through the Symbolic , both to the question of gender difference (‘am I a man?’, ‘am I a woman’? ‘what should a man do?’, ‘what should a woman do?’) as well as to the question of the Other’s desire (‘what am I for the other ?’). In the unconscious, there is no written answer of ‘what is a man’, ‘what is a woman’. However, the subject needs to give an answer himself with a story that will indicate to him how to stand in the world, otherwise he will be faced with the void of non-answer to the question of what he is towards the other.

In paranoia, the delusional construction functions like fantasy for the neurotic, that is, as a defense and response to this symbolic void. Thus the paranoid person with this construction he will try to ‘cure’ himself, to reconstitute the Other and to give meaning to his world. This construction therefore stabilizes the individual constructing at the same time a ‘worldview’ with which he can stand in the world.

→ «Dominance of Imaginary relationships»: The relationship that the paranoid person has with the other is modeled on the imaginary relationship. This means that he sees his imaginary self in the other. Through this relationship he can find the place where he will support his image. The other becomes the duplicate of his ego, his mirror. This point is important as it determines what image the paranoid has of oneself and how this image may collapse the moment this other person changes position.

So the people surrounding the paranoid subject have a double, without realizing it, imaginary role in his mirror game: when they support the imaginary identity, the ideal image of himself, then the individual’s reaction is positive, friendly, while when this image is obstructed in some way and the obstruction is experienced as a bad intrusion, then the reaction is aggressive, hostile.

→ «The attack of the Other»: The paranoid person starts to feel the defensive need to protect himself from the moment the other becomes a persecutor, who threatens his image, who invades his life. At this point the need to preserve his imaginary identity at all costs is born. This fact can lead to an aggressive act, either towards oneself (suicide/self-harm), or towards others/groups/society (hate that can be expressed on social media/racist violence towards ‘the different from me’/ individual or mass murder).

• «Homicide – Suicide – ‘Crimes of Passion’»

Imaginary identification with the other can have painful consequences. Specifically, if there is the fortuitous moment where a symbolic element intervenes between the two members of the imaginary relationship – people who may be lovers, relatives, friends, co-workers, etc. – and the structural gap opens, then the imaginary order dissolves, the imaginary identification that had a supporting function for the psychotic person no longer works, resulting in the release of psychosis accompanied by elementary phenomena (delusions or hallucinations). These elementary phenomena can lead the psychotic person to extreme acts, to destructive «passage à l’ acte», as in cases of homicide and suicide due to the elementary phenomenon of delusion.

• Example 1 – Case of homicide of a partner (‘crime of passion’) followed by suicide:

In ‘crimes of passion’, as they are often called, the type of imaginary relationship that is characterized by imaginary-mirror fascination and rivalry emerges. The type of this relationship is written by Lacan as follows: (a-a’), where a is the alienated – paranoid ego of the subject and the other of the relationship is in a’, who occupies the position of the counterpart of the subject. That is, the other person becomes the mirror of the subject’s ego (alter ego), who owns his image – identity. The other of the relationship thus becomes vital to the psychotic person.

Through possessive behavior the jealous paranoid partner projects [here ‘projection’ as a paranoid defense] to the other his own need to maintain his imaginary identity (for example: telling the other: ‘if you leave you will be unhappy away from me’, ‘no one will ever love you’ etc.). If the other does not respond as usual to the subject’s demands, it ceases to be a support for his identity – in which the psychotic person is a captive – resulting in the collapse of his ego with the disastrous consequence of the transition to the aggressive act. Scenes of jealousy, possessiveness and aggression arise from the person’s delusional belief that the other person in the relationship is deceiving him, cheating on him. He thus feels himself the target of the other’s bad jouissance resulting in the gradual orchestration of the attack.

So when, for example, a man with delusions of jealousy, who has the imaginary identity of ‘I am your husband’ and ‘you are my wife’, is confronted with the declaration of the woman with whom he maintains a relationship that she will leave the relationship, then it is the moment of the collapse of the subject’s identity and ego image. That is, the psychotic person feels that the woman leaving at that moment is taking with her his sustainable image. Unfortunately, however, it is also the moment of the psychotic person’s act, who commits the murder of this woman. For example, a threatening phrase we often hear is: ‘if I fall I will take you with me’. A phrase that needs to be taken literally, as the moment he collapses – falls – the psychotic person literally needs to take the other with him. Then, he himself may commit suicide, as the rupture of their imaginary bond concerns both sides (a-a’), that is, he himself kills and follows this woman to death, not out of love, not out of passion, but because of the dependence of his ego image on her own image of him.

 Jealous behavior thus, is not a sign of love, but it’s a sign of danger for the other person in the relationship. The ‘crime of passion’ therefore does not concern the other person in the relationship but the subject of the homicide and suicide itself.

So, let’s keep in mind that delusional jealousy is not a sign of love but a sign of a relationship of captivity: imaginary captivity for the psychotic person and real captivity with disastrous consequences for the victim.

•  Example 2 – Case of infanticide by a paranoid mother:

 If the subject of delusional jealousy is a psychotic mother, we may be faced with the most pernicious consequences of this circumstance, namely the murder of her own children. In this case, if the paranoid mother has as a viable imaginary identity the identity of the wife (‘I am his wife’), when at some point she is faced with the fact of a separation or bereavement or distance (for various reasons) from the husband, then she herself will feel that she is losing her precious ego identity.

The children for this mother are the objects that reflect the imaginary relationship of the couple, the imaginary crutches that support the image of the individual, who are united to the father by an imaginary narcissistic thread, which if cut on the husband’s side (either intentionally – in the case of separation – or unintentionally – in the case of death or distance), then his identity as a father should also be cut off. That is, ‘if you are lost as my husband and I lose my precious identity as a wife, then your identity as a father is lost’. Here, we see the invalidation of the maternal fantasy, in which a mother would feel she is losing herself if she were to lose her child. In the case of the paranoid mother, the imaginary story is different: she does not experience herself as a mother but only as a woman who satisfies her husband’s paternal demand, but at the same time ‘playing the role’ of the mother. In this scene, the role of the mother is played out while the husband-father watches. If the husband-father’s gaze ‘turns away’ (as we mentioned above either intentionally or unintentionally), the maternal story collapses. The maternal role becomes a ‘burden’ without the father’s gaze.

As we see in both examples of homicide by a paranoid subject, the murderous act is not a matter of love or affection. The murderous act is a matter of life and death for the paranoid subject to maintain his imaginary identity at all costs.

 Note: Let us mention here that, the aforementioned examples of homicide by a paranoid subject do not fall under the cases of the ‘unaccountable’, even though we are talking about a psychotic structure. ‘Unaccountable’ would apply in the case of schizophrenia, where auditory hallucinations play a dominant role in a homicide (see related text on schizophrenia[2]). The psychotic structure in the Lacanian theory differs from the DSM-5 diagnostic criteria. Personality Disorders are not a separate medical category in Lacanian theory. If we were to approach these clinical examples according to the diagnostic criteria of DSM-5 we would refer to Personality Disorders, in which ‘unaccountable’ does not apply either.

2.Lacanian Psychoanalysis for Paranoia… Why?

• Purpose: The delusional construction to function as a sinthome

Psychosis has always been considered a complex issue both theoretically and practically for the entire field of mental health. The combination of medication and psychotherapy now aims to improve the quality of life of the mentally ill. Lacanian Psychoanalysis has contributed both on a theoretical level – with the study for the causes and interpretations of mental illness – and on a practical level – with its own direction of treatment.

The sinthome is, according to Lacan, the fourth term that can reconnect the disconnected three orders of psychic reality (Imaginary – Symbolic – Real). The analyst aims to construct a sinthome for the psychotic person that will give him a new name, a new identity. The delusional construction of the paranoid subject functions as a metaphor, as a sinthome, enabling him to attach a new meaning to the world, thus replacing the lack of the paternal metaphor, that is, a lack in the Symbolic order of his psychic reality. So the repetition of the person’s words is important as it maintains an image of identity.

Lacanian Psychoanalysis is primarily concerned with the transference relationship that develops between analyst and analysand. The paranoid person therefore, through his relationship with the analyst, will try to find his “own place of speech”.

In psychoanalysis we aim at the symbolic self-knowledge of the individual (symbolic knowledge) by shrinking the imaginary illusory knowledge that dominates the ego. In clinical work dealing with a paranoid subject we will need to bear in mind that it is this illusory knowledge that sustains him. Its delusional construction is one that functions as a sinthome. Here, the speaking place constituted by the session needs the delicate management of what is said and the boundary so that the delusion continues to be sustainable for him and for others while reducing the risk of some aggressive transition into destructive ‘passage à l’ acte’.

So, in the surprise of hearing a delusion let us remember, just as Miller urged the practitioners to remember that: «In front of the crazy, in front of the delusional person, do not forget that you are, or were, analyzand, and that you too were talking about what doesn’t exist» (Miller J-A, 2008).

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Bibliography

 Dylan Evans (1996), «Εισαγωγικό λεξικό της Λακανικής Ψυχανάλυσης», μτφ. Γ. Σταυρακάκης, Ελληνικά Γράμματα, Αθήνα, 2005.

• Bruce Fink (1997), «Κλινική Εισαγωγή στη Λακανική Ψυχανάλυση: Θεωρία και Τεχνική», μτφ. Ν. Ηλιάδης, Πλέθρον, Αθήνα, 2006.
• Ελένη Κουμίδη «Ο μονισμός της ενόρμησης και η έννοια του θανάτου στο στάδιο του καθρέφτη» στο www.elenikoumidi.gr
• Ζακ Λακάν (1955-1956), «Οι ψυχώσεις», μτφ. Ρ. Χριστοπούλου, Β. Σκολίδης, Ψυχογιός, Αθήνα, 2005 & «The Psychoses», The Seminar of Jacques Lacan III (1955-1956), translated by Russell Grigg, Routledge (1993).
• Jacques Lacan (1932), «De la psychose paranoïaque dans ses rapports avec la personnalité», Έditions du Seuil, Paris, 1975.
• Jacques Lacan (1948), «L’ agressivité en psychanalyse», στο Έcrits, Έditions du Seuil, Paris, 1966
• Jacques – Alain Miller, «Λακανική κλινική των ψυχώσεων», μτφ. Γ. Αρχαύλης, Δ. Βεργέτης, Β. Γρηγοροπούλου, Ε. Lefeuvre, Ν. Περτέση, Γ. Φουντουλάκη, Πατάκη, Αθήνα, 2008.
• Jacques-Alain Miller (1984), «Τέσσερα σχόλια για το στάδιο του καθρέφτη», στο περιοδικό Fort-Da, τεύχος 2, Ψυχογιός, Αθήνα, 2012.
• Massimo Recalcati, «Το πολιτικό ύφος της παράνοιας. Ψυχαναλυτικές σημειώσεις σχετικά με το φθόνο της ζωής» (2013), μτφ. Άκης Γαβριηλίδης, στο https://nomadicuniversality.com

[1] https://www.elenikoumidi.gr/lacanian-psychoanalysis-psychosis-1-schizophrenia/

[2] Ibid.