‌‌‌‌　　英：psychosis; 法：psychose; 德：Psychose

‌‌‌‌　　“精神病”这一术语作为一种通常命名心理疾病的方式在19世纪出现于精神病学。弗洛伊德在世期间，精神病与神经症 (NEUROSIS)之间的一个基本区分便渐渐得到了人们的普遍接受，根据此种区分，精神病指代那些极端形式的心理疾病，而神经症则表示那些较不严重的心理紊乱（或心理障碍）。弗洛伊德自己就曾在多篇文章里吸收并发展了神经症与精神病之间的这一基本区分 (例如：Freud, 1924b与1924e).

‌‌‌‌　　拉康对于精神病的兴趣在时间上先于他对精神分析的兴趣。实际上，拉康的博士论文研究便涉及他将其称作“爱美”(Aimée)的一位女性精神病患者，正是这项研究把拉康最初带向了精神分析的理论 (Lacan, 1932)。经常有人评论说，拉康对于这位病人的债务会令人联想到弗洛伊德对于自己最早那批神经症患者（她们也是女性）的“债务”。换句话说，弗洛伊德最初研究无意识的取径是通过神经症，而拉康最初的研究取径则是经由精神病。此外，拉康的那种扭曲缠结且有时几乎费解的写作与言说风格，也经常被人拿来比作精神病患者的话语。无论是谁做出了这样的比较，拉康对于精神病的探讨都显然是其著作中最具重要性且最具独创性的方面。

‌‌‌‌　　拉康有关精神病的最详尽讨论，出现在其1955一1956年度被简单冠以“精神病”这一标题的研讨班上。正是他在这期研讨班上详细阐述的内容，变成了日后拉康派研究疯癫 (MADNESS)取径的主要宗旨。精神病被定义为三大临床结构 (STRUCTURES)之一，这一结构是由排除 (FORECLOSURE)的运作来界定的。在此种运作中，父亲的名义 (NAME-OF. THE-FATHER)并未被整合进精神病人的象征世界 (这一能指遭到了“排除”)，其结果便导致在象征秩序中留下了一个空洞。谈及象征秩序中的一个空洞，并不是说精神病患者不具有无意识：恰恰相反，在精神病中“无意识是呈现的而非运作的”(S3,208)。精神病的结构因而便起因于俄狄浦斯情结中的某种故障，即父性功能中的某种缺失，更确切地讲，在精神病中，父亲的功能被化约为父亲的形象（即象征界被化约为想象界）。

‌‌‌‌　　在拉康派精神分析中，在作为临床结构的精神病与诸如妄想 (DELUSIONS)和幻觉 (HALLUCINATIONS)之类的精神病现象之间做出区分是十分重要的。这些精神病现象的出现需要具备两个条件：其一是主体必须具有一个精神病的结构，其二是父亲的名义必须“被召回至与主体的象征性对抗之中”(E, 217)。当缺乏第一种条件的时候，与父性能指的对抗便永远也不会导致精神病的现象，一位神经症患者永远也不会“变成精神病患者”（见：S3,15)。当缺乏第二种条件的时候，精神病的结构便始终是潜在的。因而，我们便可以设想一个主体可能具有一个精神病的结构，却从未发展出妄想或是体验过幻觉。当这两个条件都满足的时候，精神病便会被“触发”，潜在的精神病即会表现出明显的幻觉和/或妄想。

‌‌‌‌　　拉康把自己的论点建立在对于施瑞伯个案 (Freud, I911c)的详础。・保・施瑞 (Daniel Paul Schreber)是德累斯顿 (Dresden, 德国东部萨克森州首府)的一名上诉法院的法官，他曾把自己的那些偏执狂妄想以书写的方式记录了下来，有关这些记录的分析，构成了弗洛伊德对于精神病研究的最重要贡献。拉康指出，施瑞伯的精神病之所以会被触发，一则是因为他无法生育孩子；二则是因为他在司法部谋得了一个重要的职位，这两方面的经验皆使他在实在界中面对着父性的问题，并因而把父亲的名义召回到了与主体的象征性对抗之中。

‌‌‌‌　　在1970年代，拉康围绕着博洛米结 (BORROMEAN KNOT)的概念重新阐述了他研究精神病的取径。博洛米结中的三个圆环代表着三大秩序：实在界、象征界与想象界。在神经症中，这三个圆环是以一种特殊的方式被联系起来的，但在精神病中，它们被拆解了开来。然而，某种症状形成 (symptomatic formation)有的时候可以充当把其他三个圆环嵌套起来的第四个圆环，从而避免这一精神病性的解离 (见：圣状[SINTHOME]).

‌‌‌‌　　拉康遵循弗洛伊德的观点声称，尽管精神病引起了精神分析理论研究者的极大兴趣，然而它超出了经典精神分析治疗方法的领域之外，因为此种方法只适用于神经症：“在【弗洛伊德】建立的技术所适用的经验【即神经症】之外来使用这项技术，就如同当船尚在沙滩上时便费力地划桨那般愚蠢。”(E, 221)经典精神分析的治疗方法非但不适用于精神病主体，它甚至还会作为禁忌疗法而导致治疗的失当。例如，拉康指出，精神分析的技术涉及使用躺椅与自由联想，可能会轻易地触发潜在的精神病 (S3,15)。这就是为什么拉康派分析家们往往都会遵循弗洛伊德的建议，以一系列面对面的会谈来开始对于新病人的治疗 (Freud, 1913c:SEXⅡ，1234)。只有当分析家有理由确定病人不是精神病患者的时候，他才会要求病人到躺椅上躺下来并进行自由联想。

‌‌‌‌　　这并非意味着拉康派分析家们就不跟精神病患者工作。恰恰相反，精神病治疗方面的大量工作一直都是由拉康派分析家们来完成的。然而，此时的治疗方法与被用来治疗神经症患者和性倒错者的方法有着实质上的差别。拉康自己就曾跟很多精神病患者在一起工作，但是关于他所使用的技术，拉康只留下了很少的说明，相比于展示与精神病患者一起工作的技术性程序，拉康更愿意把自己限定在讨论任何此类工作的先决问题之上 (Lacan, 1957-8b).

‌‌‌‌　　拉康拒绝将精神病的分析局限于想象秩序的那些人的取径，“在想象界的层面上来探究精神病的方法是丝毫没有指望的，因为想象的机制恰恰给精神病的异化赋予了其形式，而非是其动力学”(S3,146)。只有通过聚焦于象征秩序，拉康才能够指出精神病的基本决定性元素，即由排除而导致的象征秩序之中的空洞，以及随之发生的精神病主体在想象界之中的“囚禁”。同样也是此种对于象征秩序的强调，导致拉康首先重视的是精神病中的语言现象：“把重要性赋予精神病中的语言现象，对我们而言是最有收获的一堂课。”(S3,144)

‌‌‌‌　　在精神病中最值得注意的语言现象，即是语言的“紊乱”(dsorders), 同时拉康指出，此种紊乱的存在对于精神病的诊断而言是一个必要的条件 (S3,92)。在精神病的众多语言紊乱之中，引起拉康关注的是表句词 (holophrase: 能单独表达一整句意思的词)以及新词 (neologism: 可能完全是由精神病患者创造的新词，或者是由精神病患者重新定义的已然存在的语词)的广泛使用 (Ec, 167)。在1956年，拉康将这些语言紊乱归因于精神病患者缺乏足够数量的结扣点 (POINT DE CAPITON)。缺乏足够的“结扣点”即意味着，精神病患者的经验是以所指在能指下面的持续滑动为特征的，这是对于意指而言的一场灾难，“能指的再造有如瀑布般不断倾泻，从而在想象界中产生越来越多的灾难，直至抵达某种水平，能指与所指才在妄想隐喻 (delusional metaphor)中得以稳定下来”(E, 217)。另一种对此进行描述的方式是“主体与能指（在其最形式化的维度上，即在其作为纯粹能指的维度上）的关系”（S3,250)。主体与能指在其纯粹形式化面向的此种关系，便构成了“精神病的核心”(S3,250)。“如果说神经症患者是居住于语言之中的话，那么精神病患者则是由语言所居住、所占有的。”(S3,250)

‌‌‌‌　　在精神病的所有不同形式当中，拉康最感兴趣的是偏执狂 (PARANOIA),而对精神分裂症 (schizophrenia)与躁狂-抑郁型精神病 (manic-depressive psychosis)则鲜有讨论 (见：S3,3-4)。拉康遵循弗洛伊德的观点声称，在偏执狂与精神分裂症之间有一个结构性的区分。

‌‌‌‌　　(psychose)The term psychosis arose in psychiatry in the nineteenth century as a way ofdesignating mental illness in general.During Freud's life,a basic distinction betweenpsychosis and NEUROSIS came to be generally accepted,according to which psychosisdesignated extreme forms of mental illness and neurosis denoted less serious disorders.This basic distinction between neurosis and psychosis was taken up and developed by Freud himself in several papers(e.g.Freud,1924b and 1924e).

‌‌‌‌　　Lacan's interest in psychosis predates his interest in psychoanalysis. Indeed it was hisdoctoral research, which concerned a psychotic woman whom Lacan calls 'Aimee', thatfirst led Lacan to psychoanalytic theory (see Lacan, 1932). It has often been remarkedthat Lacan's debt to this patient is reminiscent of Freud's debt to his first neurotic patients (who were also female). In other words, whereas Freud's first approach to theunconscious is by way of neurosis, Lacan's first approach is via psychosis. It has alsobeen common to compare Lacan's tortured and at times almost incomprehensible style ofwriting and speaking to the discourse of psychotic patients. Whatever one makes of suchcomparisons, it is clear that Lacan's discussions of psychosis are among the mostsignificant and original aspects of his work.

‌‌‌‌　　Lacan's most detailed discussion of psychosis appears in his seminar of 1955-6, entitled simply The Pychoses. It is here that he expounds what come to be the main tenetsof the Lacanian approach to MADNESS. Psychosis is defined as one of the three clinicalSTRUCTURES, one of which is defined by the operation of FORECLOSURE. In thisoperation, the NAME-OF-THE-FATHER is not integrated in the symbolic universe ofthe psychotic (it is 'foreclosed'), with the result that a hole is left in the symbolic order. To speak of a hole in the symbolic order is not to say that the psychotic does not have anunconscious: on the contrary, in psychosis 'the unconscious is present but notfunctioning' (S3,208). The psychotic structure thus results from a certain malfunction ofthe Oedipus complex, a lack in the paternal function; more specifically, in psychosis thepaternal function is reduced to the image of the father (the symbolic is reduced to theimaginary).

‌‌‌‌　　In Lacanian psychoanalysis it is important to distinguish between psychosis, which isaclinical structure, and psychotic phenomena such as DELUSIONS andHALLUCINATIONS. Two conditions are required for psychotic phenomena to emerge: the subject must have a psychotic structure, and the Name-of-the-Father must be'calledinto symbolic opposition to the subject' (E, 217). In the absence of the first condition, noconfrontation with the paternal signifier will ever lead to psychotic phenomena; aneurotic can never 'become psychotic' (see S3,15). In the absence of the secondcondition, the psychotic structure will remain latent. It is thus conceivable that a subjectmay have a psychotic structure and yet never develop delusions or experiencehallucinations. When both conditions are fulfilled, the psychosis is 'triggered off, thelatent psychosis becomes manifest in hallucinations and/or delusions.

‌‌‌‌　　Lacan bases his arguments on a detailed reading of the Schreber case (Freud, 1911c) Daniel Paul Schreber was an Appeal Court judge in Dresden who wrote an account of hisparanoid delusions; an analysis of these writings constitutes Freud's most importantcontribution to the study of psychosis. Lacan argues that Schreber's psychosis wastriggered off by both his failure to produce a child and his election to an importantposition in the judiciary; both of these experiences confronted him with the question ofpaternity in the real, and thus called the Name-of-the-Father into symbolic oppositionwith the subject.

‌‌‌‌　　In the 1970s Lacan reformulates his approach to psychosis around the notion of theBORROMEAN KNOT. The three rings in the knot represent the three orders: the real, the symbolic and the imaginary. While in neurosis these three rings are linked together ina particular way, in psychosis they become disentangled. This psychotic dissociation may sometimes however be avoided by a symptomatic formation which acts as a fourth ringholding the other three together (see SINTHOME).

‌‌‌‌　　Lacan follows Freud in arguing that while psychosis is of great interest forpsychoanalytic theory, it is outside the field of the classical method of psychoanalytictreatment, which is only appropriate for neurosis;'to use the technique that [Freud]established outside the experience to which it was applied [i.e.neurosis]is as stupid as totoil at the oars when the ship is on the sand' (E, 221). Not only is the classical method ofpsychoanalytic treatment inappropriate for psychotic subjects, but it is evencontraindicated. For example Lacan points out that the technique of psychoanalysis, which involves the use of the couch and free association, can easily trigger off a latentpsychosis (S3,15). This is the reason why Lacanian analysts usually follow Freud'srecommendation to begin the treatment of a new patient with a series of face-to-faceinterviews (Freud, 1913c: SE XII, 123-4). Only when the analyst is reasonably sure thatthe patient is not psychotic will the patient be asked to lie down on the couch and freeassociate.

‌‌‌‌　　This does not mean that Lacanian analysts do not work with psychotic patients. On thecontrary, much work has been done by Lacanian analysts in the treatment of psychosis. However, the method of treatment differs substantially from that used with neurotic andperverse patients. Lacan himself worked with psychotic patients but left very fewcomments on the technique he employed; rather than setting out a technical procedure forworking with psychosis, he limited himself to discussing the questions preliminary to anysuch work (Lacan, 1957-8b).

‌‌‌‌　　Lacan rejects the approach of those who limit their analysis of psychosis to theimaginary order;'nothing is to be expected from the way psychosis is explored at thelevel of the imaginary, since the imaginary mechanism is what gives psychotic alienationits form, but not its dynamics' (S3,146). It is only by focusing on the symbolic order that Lacan is able to point to the fundamental determining element of psychosis, namely, thehole in the symbolic order caused by foreclosure and the consequent 'imprisonment'ofthe psychotic subject in the imaginary. It is also this emphasis on the symbolic orderwhich leads Lacan to value above all the linguistic phenomena in psychosis: 'theimportance given to language phenomena in psychosis is for us the most fruitful lesson ofall' (S3,144).

‌‌‌‌　　The language phenomena most notable in psychosis are disorders of language, and Lacan argues that the presence of such disorders is a necessary condition for a diagnosisof psychosis (S3,92). Among the psychotic language disorders which Lacan drawsattention to are holophrases and the extensive use of neologisms (which may becompletely new words coined by the psychotic, or already existing words which thepsychotic redefines)(Ec, 167). In 1956, Lacan attributes these language disorders to thepsychotic's lack of a sufficient number of POINTS DE CAPITON. The lack of sufficientpoints de capiton means that the psychotic experience is characterised by a constantslippage of the signified under the signifier, which is a disaster for signification; there is acontinual 'cascade of reshapings of the signifier from which the increasing disaster of theimaginary proceeds, until the level is reached at which signifier and signified arestabilized in the delusional metaphor' (E, 217). Another way of describing this is as 'arelationship between the subject and the signifier in its most formal dimension, in itsdimension as a pure signifier' (S3,250). This relationship of the subject to the signifier in its purely formal aspect constitutes 'the nucleus of psychosis' (S3,250).'If the neuroticinhabits language, the psychotic is inhabited, possessed, by language' (S3,250).

‌‌‌‌　　Of all the various forms of psychosis, it is PARANOIA that most interests Lacan, while schizophrenia and manic-depressive psychosis are rarely discussed (see S3,3-4). Lacan follows Freud in maintaining a structural distinction between paranoia andschizophrenia.