Are we pathologizing yet? Lacan's structures of desire: Neurosis, Perversion, Psychosis

I know that this is going to be an issue I'll be forced to navigate, probably more than once, as I'm hoping I'll be able to argue the case that psychoanalysis, specifically Lacanian articulations of it, have something useful to offer for thinking about trans subjectivity and embodiment (and about human subjectivity and embodiment more generally). That larger argument is likely not to take on much shape for some months to come, and may take years.      Who knows? 

Talkin' about my d-d-d-dissertation. 

But, given the justifiable intensity of negative responses on the part of trans people to the pathologizing discourses of psychiatry, medicine, and yes, that highly suspect brand of "psychoanalysis" which has become part of the ideological psychiatric state apparatus,.. psychodiagnostics might well be a hard sell. My basic contentions in regard to the psychic situation of trans people feel to me like they ought be utterly noncontroversial, even banal. Here are two of them (maybe all of them, actually);

* There is absolutely nothing inherently "dysfunctional" or "pathological" about being a trans person. Which is not to say that a trans person can't be bat shit crazy, just as, in principle, anybody can be bat shit crazy (I'm thinking of a GSU prof in the music department for example). 

* Psychoanalysts who would wish to claim that all trans people conform to any specific structure of desire (neurosis, perversion, psychosis) are being very bad analysts. Just as not every person with bleach blond hair is going to be "conservative", nor is every person with a hairlip going to be "shy" nor is everyone who has had braces going to be "promiscuous". Every person's inhabitation of a structure of desire will be unique, even if those structures qua structures are of a somewhat limited number (neurosis, perversion, psychosis - with the subtypes; hysteria, obsession, paranoia…. sometimes phobia, sort of). I would argue that, if anyone, claiming to speak with analytic authority (already a dubious notion) insists that all of any possible demographic set of people are going to share a single configuration with regard to their desire, that this cannot be anything other than an imaginarization of that "analyst", an elaboration of their own fantasmatic investments in their object of study (those folks they are charged with helping). Certainly these same analysts would be up in arms about my failure to appreciate the uniqueness and specificity of each subject were I to suggest that all heterosexuals or all men were perverts, psychotics or any one structure. 

Weirdly though (sadly, depressingly) there is lot of both of these things going on in the psychoanalytic lit on trans, giving the banalities stated above something of a radical character. Weird, huh? (not that there are any psychoanalysts listening) The commonest reference points are psychosis and hysteria, but I have also seen perversion and phobia suggested. The very plurality of these claims ought to raise some suspicions even before evaluating them. Applied as such, this very much deserves the name of pathologization and it is against the spirit of psychoanalytic thought as I understand it, in that psychoanalysis is not an agent of normalization. If it is used as such, it becomes something else, something other than psychoanalysis (for me at least, we can argue it elsewhere).

But this is where it also gets complicated and fraught for a number of reasons and reasons which ought not be swept under the rug. 

Before thinking about what might be problematic about the following psychodiagnostic categories, I'm going to try to give a brief overview of what I take the Lacanian position about structures of desire to be.  I'll be speaking out of the bag here, not running about like a good grad student and looking for other people who have said similar things to convince you that I am not wrong. How bout you decide?

The different structures of desire are all responses to the impossibility, once we have become speaking beings, of signification ever equalling being. Or we might think of this as a response to language's inability to capture being. There are thus three basic responses to this impossibility and the discomfort/suffering, etc that it imposes. We can deny it and construct any number of fantasies which resituate it not as forever lost (as it is) but as having been stolen, or mislaid, or forbidden or whatever. That would be the neurotic response. Or we can disavow that this happened, a sort of "I know it is lost but it isn't really lost" claim which allows that the subject can be the object, or control the object. This is the perverse response. Or, finally, one can foreclose. That is, one can rule out in advance that there could ever be any signification or even recognition of the loss of being that language entails. The response, in essence, forecloses the Symbolic by means of reducing it to the Imaginary. This is the psychotic response. 

While Freud and certain other analysts have speculated or even insisted that analysis is irrelevant to those with a perverse or psychotic structure, Lacan disagrees. At issue is simply that 99% of what we think of as analytic technique is actually more accurately described as "the technique of the clinic of neurosis". I saw it suggested that to proceed with a psychotic's analysis as if they were a neurotic could in fact be actively detrimental to them. 

Now, a few more points to remember when thinking about psychodiagnostics and lacanian nosological categories.

1. For Lacan there is no "normal" space to occupy. In fact normality as a concept, reference point or standard is absent from Lacan's theory.

2. To be a subject of desire is not a "pathology" because there is no normal against which one would have to judge to say that this or that sort of desiring structure was a deviation and hence, pathological.

3. To be a neurotic does not require that incessant and endless doubts a la Woody Allen (but without the humor) be manifested at the level of someone's everyday behavior. To be a pervert does not require that this subject have anything at all to do with fetishism or any of the sexual practices that we mark as perverse in the vernacular. To be a psychotic does not require that this subject is a raving looney, speaking in nothing but inscrutable babble and unable to make use of logic or reasoning, ever. 

No, the donut is not a fetish.

i. Neurosis is said to be the most common structure. It's central anxiety, that which it doubts most, appears in the form of a question and this question is said to vary whether one is hysteric or obsessional. The hysteric wonders "am I a man or a woman?" and desires to know just what being this or that means (thus we see the denial I mentioned above, the neurotic persists in denying that being can be captured in words). The obsessional asks "am I alive or am I dead?" which is again a question which demands that life (read: being) be given a definitive meaning (i.e., made dead, like the letter). 

ii. Perversion is marked by a kind of certainty (of course it isn't, but IT IS nonetheless) and this certainty is about the object. The pervert knows that they are the object of the Other's jouissance. Cops, judges, military - these are prime perverse life paths as they afford endless opportunities to be the instrument of the big Other's (largely painfully exacted) enjoyment. "Of course I know that I am not the agent of the Other's jouissance, but feel how much the Other enjoys when I punish the lawbreakers!"

Hi, I'm feeling both ordinary
& a wee bit psychotic

iii. Psychosis too has a sort of certainty involved, though it is different in character I think. To play it out in an impossible monologue, we might imagine it like this; "No object can be lost." But when we speak of psychosis as well as the word "psychotic," in the popular mind, this means raving psychopath or serial killer or some such thing. This is not what it means to Lacan. I've long wondered about the psychic state of the psychotic who has not had a dramatic "psychotic break". I understand that J-A.Miller and perhaps others have written some about this under the heading "ordinary psychosis" but I have not read any of this work. Suffice to say that most psychotic subjects are not in a psychotic break at all times, rather contingent factors in their may lives provoke such an event by undermining the master signifiers that allow psychotic subjects to operate in the social world. I see no way to sustain an argument about whether or not most psychotic subjects will or will not ever have a psychotic break during their lifetimes, but my ungrounded hunch is that a great many never do and probably have as good a chance as any other sort of subject of being a "productive member of society"  (or whatever)

4. No structure is immune to being shaken. The psychotic break is surely dramatic (at least in one's imagination, if not always in "reality") but neurotics have break-downs and perverts undoubtedly as well. Likewise the implicit or explicit valuations that one now and then hears applied to one or another structure - hysteria, perversion and, via Deleuze and Guatarri "schizophrenia" (as a brand of psychosis) - which then get championed as somehow exceptional and radical and the path toward the future. I call bunk on all that. It's divisive, potentially abjecting, and simply wrong. It is not unlike the reverse image of the blanket claim that all trans people are ______…. just as ill-founded and just as un-psychoanalytic. A psychotic break is serious business, no doubt, and that it has such marked effects on language is fascinating as well. I do not know as much about psychosis as I would like, but I strongly suspect that the world has known serial killers and sociopaths who were neurotic or perverse.

5. Who is psychodiagnostics for? Seriously. How would you answer that? Here is who it is not for: the analysand. If in your analysis you and your analyst are going round and round about whether you are an hysteric or an obsessional you are not having an analysis, you are aiding in your own pathologization or you're engaged perhaps in some bassakward sort of analytic game. Psychodiagnostics is a guide for the analyst. But in principle, every analysis must have the potential to reconfigure what we understand of the theory. Psychodiagnostics in that perspective would then be a way for them to assess, as best they can, which structure this analysand might be and to adjust their clinical method accordingly, because, as noted above, simply applying the clinical methods of the clinic of neurosis to perverse or psychotic subjects would likely be ineffective (with the perverse) or even detrimental (for psychotics). Given this, when looking to psychoanalysis to help one think through one's dreams or to try to understand others or to provide a gloss on film, it pays to be much more circumspect that most (non-clinical?) Lacanians are wont to be. If a good analyst does not ever tell an analysand You Are This (hysteric, obsessional, perverse, psychotic)!  I would suggest that even if one is not an analyst that a similar restraint and attendance to the unique specifics of oneself, others, or cultural texts guided by, but never ruled through psychoanalytic theory, is actually more psychoanalytic than the reverse would be.

Now, I've kinda shot my wad already - but I promised to consider these nosological categories critically as well, so here goes…

Each of these terms is fraught with difficulties, some internal to psychoanalysis and many external. Hysteria evokes centuries of pathologizing of women and indeed is tied quite firmly - even in Lacan - to feminine subjects, even if those terms, for Lacan, do not denote the same things they do for others - but this is much of the problem! too many competeing claims on a term. Perversion is heavily overdetermined in a whips and chains direction in the popular mind, but from what I understand about the BDSM scene - specifically of ideas like the 'safe word' or the practice of having a contract about the activities to come (pun?) would incline me to suspect that the majority of the folks engaged in such activities are not perverts at all. If the perverse subject acts as the instrument of the big Other's enjoyment, no contract with a mere so-n-so sort of other, or 'safe word' will place a limit on the jouissance of the Other. In fact the very offering up of oneself for "punishment" might negate the potential of it taking place if the other subject is truly perverse. & as noted, psychosis collocates with sociopath and psychopath and serial killer and lunatic and it is nearly unimaginable that a notion like that of "ordinary psychosis" will counter the gravitational push and pull of the established social meanings.

At issue, perhaps, is whether one wishes to talk psychoanalysis only with insiders, or whether one might wish to be able to bring psychoanalysis to those who know none of the terminology and who thus are NOT going to hear these terms as meant by Lacan without an enormous amount of groundwork being laid. Groundwork that will need to be laid again and again with each new person. (& if you think these are thorny issues, wait until you ponder sexuation and Lacan's understanding of the words Man, Woman, Masculine, and Feminine - and prepare for a bit of mind fuck if they are new to you).

Is there any solution to this? 

One could simply foreclose psychoanalysis I guess.

One could attempt to clarify the structure, dynamics and functioning of these terms and propose other ways to name them. This looks like the best strategy to me, but it is not an easy road either. 

If this woman can get a snake to drink
milk out of a straw, surely I can convince
someone to give psychoanalysis
another hearing...

& here is another wrinkle, at a tangent from the above. Per Lacan, once we adopt a structure as the basic template for our desirous relations, we are stuck there. So, once a perv, always a perv. But I find myself wondering about that. That is, for some time I entertained the idea that the psychotic break might very well be visited on anyone, and that it would at that moment impose a psychotic structure upon what had been a neurotic or perverse subject. I say this due to personal experience to a degree, when something heavily invested falls, when that S1 is undermined and no longer ties anything down... these moments can be harrowing, the values of all things seem suspended. Then, what are to we to make of the claim - relevant to the clinic of neurosis - that the analysand must becomes hystericized? If, said of an hysteric analysand, what does this mean exactly? & if said of an obsessional, ditto. (I think that this refers not to structure but to discourse, per seminar xvii, but I might be wrong). & then what about perverse enjoyment, that is when we enjoy seeing someone being subjected to the law "they got what they deserved!"… does this implicate the subject in a perverse structure in any way or not, perhaps because it is not that enjoying subject who imposes the law upon the transgressor?  Or, more succinctly - how do we know that subjects are forever tied to one and only one structure? What havoc would it play with the theory if we proposed that subjects - in certain very specific situations - might move from one structure to another? Would this be a useful flexibility or a monkey wrench into the clinical theory?

Done.                   (dang, close to 2,500 words)