Following masterful work of José María Álvarez , Ramon Esteban and François Sauvagnat entitled Fundamentals of psychoanalytic psychopathology , we discuss the concept of clinical structure, in particular psychotic structure. This is another way to approach and understand the phenomenon and the phenomena of madness, or psychosis, as it developed and widely explained by psychoanalysis, especially its Lacanian orientation. Give us a broad outline below the quoted text .
As the authors note, the notion of "medical structure" is a Lacanian notion, being an original conception of psychopathology, both in nosological aspects as nosographic, which defines mental disorders as stable organizations, crystallized early thanks to the use by the subject of several mechanisms designed to deal with unconscious psychic castration. There is decisively involved the subject, so that this conception is separated openly the vast majority of theories of psychopathology, in which the disease occurs the patient and determines his future. Therefore, within this conception that elevates subjective responsibility, clinical aspects and ethics are absolutely inseparable twin.
have been many and varied areas of knowledge that incorporated throughout the twentieth century structuralist approach. It focuses on the notion of "structure" which at present and within the scope of the theory of knowledge, specifies an abstract model applied to a set of elements and their internal composition laws, or to the provision of different parts of a whole in terms of their dependence and solidarity . In general, all authors generally agree that a structure is composed of various members rather than parts and that is a whole rather than a sum. Hjelmslev, in language testing (1987) defines it as "an autonomous internal units." Piaget, Structuralism Le (1970), the concrete as "a transformation system, which has laws as a system (as opposed to the properties of the elements) and is preserved or enhanced by the game itself of its transformation, without which they will lead beyond their borders or attend to the elements. In a word, a structure and includes the three characteristics of all of transformation, and self . " In the late sixties and early seventies, the notion reached an unprecedented growth in the context of the "structuralist movement, which emerged as a critique of humanism and confidence in human ideals. This movement placed the language in the focus of his interests and tried to find universal underlying structure to be extrapolated later to other disciplines. To a large extent, all systems that provide a structure are linguistic systems, so that structure is mutatis mutandis structure of language. Can be considered structuralist Lévi-Strauss, Barthes, Althusser, Foucault, Deleuze and Derrida. Despite their heterogeneity, the structuralist movement agree that man is subject to the structures and not vice versa, it is therefore of finding the invariants or structural mechanisms, thereby transcending mere phenomenology or description of phenomena. This heuristic model is given dutifully the discovery of the apparently hidden among the elements or objects that make up a given domain and tends to reveal its constant and unchanging forms. To find a given structure is required to undertake an internal analysis of the whole, thus distinguishing its components and the system of relations present there. The structure is revealed by this procedure as the skeleton of the object under consideration, thus allowing to differentiate the essential from the accessory, identifying lines of force, their functions and, occasionally, the mechanisms involved in its operation. From diverse backgrounds from different positions, has been thanks to the model proposed by F. de Saussure in the field of linguistics ("requires solidarity from a whole to obtain, by means of analysis, the items inside") and has been able to grasp the structuralist roots of many projects aimed at knowledge, including those on quantum physics (Bohr), psychophysiology (Goldstein), history (Dumézil), the morphology of the tale (Propp), phenomenology (Merleau-Ponty), cybernetics (Wiener), communication theory (Shannon and Weaver) , semiology (Barthes) or psychoanalysis (Lacan). Psychoanalysis has been achieved by this procedure not only substantiate the essence of psychopathological concept, but dharma and develop all their theoretical and clinical contributions. In this sense, one might say that Freudian metapsychology is in itself a knowledge model consistently settled in the structuralist approach.
fairly widespread use of the concept of structure has helped to undermine their accuracy, so should, according to Alvarez, Esteban and Sauvagnat, hold it some constants and maintain some minimum, which can be summarized in four as follows: The tendency to find the forms, functions or laws of configuration invariants or constants within each system, organization or structure, the search beyond the phenomenology of these mechanisms structures that can serve as models to be extrapolated to other seemingly similar or different manifestations, the importance attached to the forms of relationship of the elements of a structure, rather than considering that these elements have an intrinsic value, the importance of language and power structuring of subjectivity, which enables an articulation of the structure function relationships and locations (topology). In this sense, it can be considered the structuralist roots of psychopathology developed by Freud. Its nosological conception tends to see mood disorders as relatively stable organizations that crystallize early in relation to employment by the subject of generic defensive. Moreover, such organizations are defined as final and unyielding as the metapsychological and clinical settings is becoming one of them is incompatible with the rest. Because it forms curds definitely defensive, this model is opposed not only psychopathology those who argue in favor of a continuum of mental illness, but also those who put the disease to the subject, ie they consider mental illness as facts of nature. Freud gives a central value to language center turn of the structural development, and all his analysis of the unconscious are linguistic. In this respect, Lacan says: "Freud had invented a new language before it was born." Likewise, Freud practiced in their analysis a structural reduction, defining constant and invariant to find a model generalizable to other cases of the same structure. Unlike psychiatric psychopathology, methodology Freud comes to elevate a case, carefully analyzed, the paradigm of a range of clinical structure in that sense, all subjects share hysterical Dora the substratum of hysterical structure, and the same happens with regard to psychotic Schreber, etc. . This isomorphism gives accurate account of structural analysis that characterizes their investigations. As Serres said The communication (1968): "In a given cultural content, be it God, table or basin, a structural analysis (and structural only if) when he emphasizes that content as a model."
Freud tried from the beginning to grasp the particular psychological mechanism that configures and establishes each of the pathological mental organizations. This is not just a spring mechanism that the nervous system starts to reorganize a very inaccurate or infirm (as the conceptions defend organodinámicas), nor the sensory or intellectual means by which we make a certain type of symptoms most imaginative, ideational , interpretive or hallucinatory (as advocated by some clinicians in the second French classicism with the mechanisms of delirium). It is, rather, a generic defense mechanism, that is generalizable to all cases comprometidos en una misma estructura, que el sujeto pone en marcha frente a aquello que le resulta más “irreconciliable” con su Yo y que determinará definitivamente su organización psíquica y su psicopatología. Todo el énfasis recae en una decisión subjetiva inconsciente. La concepción freudiana de la patología psíquica se articula con su doctrina general del psiquismo, pues a diferencia de la gran mayoría de los modelos psicopatológicos, el psicoanálisis propone una psicología patológica basada por entero en una psicología general. Freud reparó, a propósito de la histeria, en las diferencias entre la realidad objetiva y la realidad psíquica, formulando una concepción psychic apparatus separated into two interconnected bodies, the system unconscious and the preconscious-conscious system. Although he uses the word "structure" to refer to elements of the psyche, its sense seems to be limited to the topological and architectural layout. From the beginning, this structure has to Freud eminently functional is based on the concept of "representation" (Vorstellung ), which constitute the core of the formulation of economic and dynamic aspects of the first topic.
A profound change in this conception of the psychic apparatus when Freud was attributed to a new theoretical value I happened to be one of the forms of unity of the subject to become one of the instances of the psychic apparatus, which seeks precisely and regulates the relationship of the psychic apparatus with the world and is also the instance that provides the subject of a "self-image." As indicated Alvarez, Esteban and Sauvagnat, the Freudian concept gradually became a more sympathetic to the idea of \u200b\u200bsystem, especially with the enunciation of the three psychic instances (I, id and superego) that are redistributed the above functions in relation to the unconscious or preconscious-conscious. The concept of "representation" will remain unchanged. The description of the distribution "regional" of each of these instances underlines the comparison with the other two, it is well appreciated the extent to which Freud's conception is radically opposed to the psychological theories that advocate a harmony of the psyche, often argued by the notion of personality, a notion that was criticized by Freud. Based on the above, we rule out the possible existence of an ideal demonstration of the functioning of the psychic apparatus and any free operation type that could be assimilated to "normal" given by the medical clinic. By adding the word "clinic" to the term "structure" is cut a semantic for describing the various forms of events that takes the mental apparatus during its operation and, therefore, possible and acquire various relationships to each other the elements it up.
From his first contributions psychopathological Freud laid the different manifestations of the psychic apparatus descompletitud the idea, showing it, for example, the mismatch between the pleasure principle and reality principle. The central concept that served to define this mismatch is "castration." Core of the Oedipus complex, castration complex is the last time that the child, since it implies a renunciation of the Oedipal and incestuous sexuality to return, keep such a precious organ. In this logic that is established according to the maxim of "lose something in order to gain something else" is precisely the function standardization afforded by the castration complex. In girls, the castration complex development is different because instead of being its conclusion serves as a gateway to the Oedipus complex. Normalization function of the complex in the girl is in minimizing the possibility of penis envy ( Penisneid ), to find a symbolic equivalent and finalized by the desire to have a child of the father. Impossible to be completely accepted, castration (Freud say, "the greatest trauma in the child's life") is intimately involved in the formation of psychopathological structures. Freud made three modes specific that serve the self to face castration, three logical rules define three clinical structures with which psychoanalysis nosography orders and directs the practice: castration exists or not, ie displayed or not is. The device acknowledged the existence of psychic castration (or affirmation Bejahung primary) or the representation was rejected ( Verwerfung ) in the psychic apparatus, which determine the clinical structure of psychosis. If such a representation of castration is performed, two possibilities may happen: either it away conscious representations through the mechanism of repression ( Verdrängung ), as in the neurosis, or the subject denies its reality through the mechanism of disavowal ( Verleugnung ), as in the perverse structure.
The establishment of these three major defense mechanisms is itself transfenomenológica. However, its presence can be apprehended through its manifestations symptomatological or in general terms, the phenomenon that they determine. The effects caused by these generic mechanisms are presented to the observer in those critical moments after the psychic organization that is unbalanced, ie when it fails the defense mechanism comes generic and recurrence or return of the repressed elements or representations before, rejected or rogue. According to the structure in question, the return process is carried out through specific mechanisms (displacement, condensation, identification, conversion, projection, hallucination ...). For example, in the case of the psychotic subject, which constitutes the Verwerfung mechanism such radical effects, returning rejected representations from the Real (hallucination, delusion certain phenomena of mental automatism, etc..), In this case, the subject inevitably feel concerned by these representations that are presented, and they are just not symbolized their own representations. The scattered references in the work of Freud to the concept of rejection or Verwerfung were articulated by Lacan to converge in the notion of foreclosure.
The three major clinical structures, which as noted Alvarez, Esteban and Sauvagnat can also be distinguished from the theory of libido and present, each of them, different varieties or types reports: hysteria, obsessional neurosis and phobia as clinical forms of neurosis, paranoia, schizophrenia and psychosis in melancholic and manic psychosis, and finally, the perversion is often subdivided basis at the end and object. Each of these clinical forms share the same structure of the generic TDM (etiology), but differs in part in other specific mechanisms and, therefore, in the pathogenesis characteristic of each group of symptoms also match the type of return that what the subject is screened, as well as the subjective form of experience (xenopática in the case of psychosis and endofásica in neurosis and perversion).
The term "structure" is present in Lacan's work from beginning to end, and reaches in her routine treatment. For Lacan, preexisting language structure and determines the subject. It is in the fifties when Lacan deepens and elevates the symbolic register, displaying his particular reading of Freud and psychoanalysis to develop a doctrine that closely follows the model of Saussurean linguistics. In this context that the inherent association between structure and language, which will serve to Lacan to state one of its most famous peak: the unconscious is structured like a language. Thus the structure is defined primarily by the articulation of signifiers, joint conditional, in turn, by castration in significant. The seminar psychosis (1955-1956) we find the following definition: "The structure is first a group of elements which form a co-variant. said a whole, did not say a whole . Indeed, the notion of structure is analytical. The structure is always set by reference to something that is consistent with something, it is complementary. [...] Interested in the power structure is not significant neglect. [...] What we meet in a structural analysis is to clear the signifier of the most radical way possible. " Thus, as you say Alvarez, Esteban and Sauvagnat, as the structure of language and the speaking subject and the city council come together in an inseparable, since that subject which we are concerned, is inevitably captured by language that precedes and remains under the government of the logic of the signifier and the symbolic order. This structure is what allows us to explain also the catch of the living body by the Symbolic, the ultimate parent in the articulation of the subject, the Other and the object, the medium in which language and enjoyment gear which sits the knotting of the three registers of experience: Real, Imaginary and Symbolic.
The design of the structure of the subject from thesis, "the unconscious is structured like a language" allows for many developments. One is to consider the depths of the subject is outside himself, that is, "ex-centric," as Lacan often uses the neologism "ex-sistence" and even "extimity": "In the end if we start from what we describe as the central location, this intimate exteriority, this extimity [...]", as developed in The Ethics of Psychoanalysis (1959-1960). From these schematizations of the structure of the subject can be defined two "extimate" of the Other, which will determine the subject through the "master signifiers" and the very significant effect while outside the discourse with which the subject is said to himself as "ex-sister". Based on this notion of "extimity" Lacan argues that the vector that guides the entire structure is desire, which refers to the subject to the Real first experience of satisfaction. Permanently address the neurotic play in encounters with those objects that confers the ability to represent the primary object. In the psychotic, they become persecutors whenever the Real becomes present in bulk, because due to lack of representation of castration can not unless found in real life.
Just as the structure of language is not built but predates the subject, the clinical structures, by contrast, are construction or accommodation arrangements subject to the structure of language prior to birth, the place that the subject is before birth and while speaking of him, he is appointed and mobilizes certain individual parents. Like Freud and other psychoanalysts, Lacan sees three clinical structures perfectly differentiated: neurosis, psychosis and perversion, which correspond roughly , to which other orientations psychopathological categories are called nosographic. But the structures being considered introduces some differences: firstly, it is more than symptom clusters (syndromes) that are renewed as appropriate to the ideologies that underlie the psychopathological thinking, on the other hand, these structures are stable and mutually exclusive.
A common debate among clinicians is trying to clear up the relationships between structure and clinical phenomena. Some authors make a discontinuity, based on the idea that the structure is deep and surface phenomena, others, however, consider their solidarity, ie the continuity of the structure and phenomena. Lacan wary of phenomenology and estimates that can not properly speak of directly observable phenomena, for they are always and inevitably filtered by a previous theory. Nevertheless, not inclined to separate the structure of phenomena, since both are rooted in the field of experience: "The structure appears in what may be called, in the true sense of the phenomenon. It would be surprising that some of the structure does not appear in the way that, for example, delirium occurs. But the confidence we have in the analysis of the phenomenon is completely different from granting the phenomenological point of view, which is dedicated to see in it what remains of reality itself. " An example of the continuity between the structure and phenomena in the so-called "elementary phenomena" of psychosis: a symbolic deficit (failure-Name of the Father), that is, an imbalance in the structure, causes disconnect the symbolic return of certain signifiers that the subject in the Real, therefore, are phenomena of intersection between the Symbolic and the Real without mediation of the Imaginary. Well you can see here the connection of the phenomenon and structure, as the symbolic deficit disorder necessarily involves an imaginary and a havoc of enjoyment, only through the phenomena that arise we can see the imbalances that affect the structure itself.
neurosis, psychosis and perversion define three positions subjective in relation to another, especially in relation to the Other's desire. Essence of man, the unconscious wish rather than an object related to it is with a lack: it is desire for desire. The desire of the subject is located and is first in the existence of the Other's desire, because beyond what the individual demand and beyond what the other claim to the subject, is always necessarily the presence and extent of what the other wants. Thus, "human desire is the desire of the Other." The relation of the subject (child) with the desire of the Other (the mother) is deployed and articulated in the Oedipus complex and castration complex, the effects of higher standards or less determine the registration of the subject in the corresponding clinical structure. Lacan proposes a thorough analysis of the Oedipus complex along three logical times: the first time characterized by the imaginary triangle of mother, children and the phallus, a second time that the imaginary father intervenes to enforce the law mother's desire, denying access and forbidding the phallic object access also subject to the mother a third time marked by the intervention of the real father, possessor of the phallus, which frees the child by the castration of the impossible task of be the phallus, and allow the deployment of identifications and superego formation. Thus understood, the Oedipus complex is a symbolic process structured as a metaphor ("paternal metaphor") or replacing the "Desire of the Mother" by the "name-the-Father", allowing access to the phallic significance for both sexes.
Lacan also highlights the effects of normalization of the Oedipus complex, and especially the assumption of symbolic castration by the subject, as it is the assumption of failure, such a waiver to the phallus, which creates the desire. However, the subject's relationship with his own castration and castration of the Other does not leave, or at best, be problematic and far from reaching an ideal of normality. It is at this critical point where they crystallize the three key positions that make clinical structures. Are all distinct defenses against castration, repression (refoulement ) representation of castration in neurosis, denied ( Denia dementia) or disavowal in perversion and foreclosure ( forclusion ) in psychosis. Research Lacan promotes a generic extension mechanisms for all varieties included in each structure nosographic clinic, also pointing out the different types of transfer that they print.
attention to psychopathological structures well organized nosographic spectrum sought by different taxonomies based on mere description and management of symptoms, especially when they are considered such only the observer, without the subject involved and beyond clinic under transfer. These differences are most evident in those forms of psychosis who do not have, perhaps for the moment, the clinical manifestations of them expect to descriptive psychopathology, although evidence of basic phenomena, or also in those other cases of psychosis that have managed to meet with some form of stabilizing the deficit is usually attributed to them. The basic phenomena indicate that behind them lies a psychotic structure, they contain in themselves the minimalist array of that structure. Is frequently seen in individuals who have not yet triggered a psychosis clinic, that is, the great folly with all the correlative of the most conspicuous (delirium, hallucination, stupor, flight of ideas, etc..). Can sometimes occur in episodic form over a lifetime without causing a crisis or discontinuity, but in others, warn of impending cataclysm. There are thus triggered forms of psychosis, potential forms of madness, for which descriptive psychopathology remains completely blind. It seems clear that the existence of a structure without psychotic symptoms creates striking diagnostic challenge traditional conceptions of disease in the medical sense. This is one of the aspects separate the psychoanalytic clinic of the psychiatric clinic, the first focusing on the subject and structure, and the second in the disease and its manifestations.
