Monday, 9 April 2012

What is Madness? 9
Paranoia versus Schizophrenia

In chapter 3 pp. 76-87 Leader provides a typology of psychoses into paranoid, schizophrenic and melancholic forms. All are - if I understand correctly - said to be alternative ways a patient may attempt a solution to the problem caused by a failure of the 'paternal metaphor'. The terms are not to be taken in any pre-understood sense; rather their meanings emerges from Leader's discussion. In what follows I try and begin to separate out these different strands and elucidate the relevant meanings. A brief summary is given on p. 87: 'Where, in neurosis, the Oedipus complex succeeds in naming the desire of the mother, through an appeal to a normative fiction, in the psychoses the subject has to invent: for the paranoiac, in naming what is wrong with the world; for the melancholic, in naming what is wrong with themselves; and for the schizophrenic, as a perpetual and unresolved activity.'

Paranoia

In paranoia 'a meaning crystallises: the person knows what is wrong with the world. There is a plot against them, they have a mission to accomplish, a message to disseminate.' 'Libido is localized outside: in the persecutor or in a fault in society or in the order of the world.' ... I don't yet understand what it means to say that this is where 'libido is localised', especially as the examples which follow in the text (p. 77) have to do with evil. (Later (p. 79) Leader talks about 'bad libido in the Other'.)

Paranoia involves the building of a system of ideas in response to an experience of collapse. There is a 'belief system centred around a fault or a persecutor, which has a high yield of explanatory power and which goes beyond simply assuming that one is being targeted or maligned by others.' 'The key is that the person wants to bring an order to [the world], to strike out some badness' (p. 79). Accordingly they may try and restore a lost order, scouring Biblical or other texts for hidden knowledge to restore reason, peace and order to the world. 'These efforts can attract a wide audience, as we see in the popular appetite for both secular and religious movements that claim to access a secret wisdom' (p. 79).

The 'absence of the inscription of a third term will make this an ever-present possibility: the person may feel threatened or persecuted or that some other is too close' (p. 78).

The split between self and other is fully maintained in paranoia (contrast schizophrenia).

We owe some of the best and worst social transformations to paranoiacs - who fight for their cause (which may well be a very good one). The key to whether they are suffering from paranoid delusion lies not in the truth of their claims but in the manner of their relating to these claims (i.e. do they need to be right in their argument?)

The paranoiac may suffer from being 'told exactly what his or her role is: for example, to be a replacement for a dead child or an ancestor. It is this very stagnation and impossibility of a dialectical tension between messages that may contribute to the choice of a paranoiac position' (p. 83). The persecutor is 'rigidly named' without tolerance of ambiguity (p. 84).

The paranoiac has not been able to symbolise his mother's comings and goings and to link these with the father. Yet they 'still try to come up with their own interpretation of the mother's desire' (p. 84), succeeding in naming it (the CIA, FBI etc). (I don't yet understand - Leader hasn't yet told us - what the link is supposed to be between the paranoiac's 'discovery' that the CIA are after them, this firmly and montonously held explanation, and the (failure to grasp the) mother's desire.)

Schizophrenia

Paranoid ideas may surface in schizophrenia too, but here they are 'often a defence against the terror of disintegration' (p. 78). I don't yet understand the difference between this and the properly delusional paranoid case of 'building a system of ideas in response to an experience of collapse' (p. 77).

In schizophrenia, unlike in paranoia, the boundary between self and other may be blurred. 'The Other is present within themselves, as if a total separation is not possible,' Whilst a paranoiac sees external forces as acting outside them against them, the schizophrenic may believe that their thoughts and feelings may belong to someone else, or have been put into their minds by someone else.

Leader cites with apparent approval Bateson's 'double bind' theory of schizophrenia: that schizophrenic subjects often receive mixed signals from significant others (e.g. parents): e.g. an explicit declaration of love accompanied by an implicit (e.g. gestural) withdrawal. (p. 83). Or they may be cared for in a rather anonymous, dutiful way.

In schizophrenia the patient does not manage to make sense of their mother's desire - her intentional comings and goings away from the child.

Leader considers that the schizophrenic patient's complaints about bizarre sensations is their concrete way of trying to 'communicate that something has changed. This change uses the body as its idiom' (p. 86). Of course another interpretation would be that the schizophrenic patient experiences genuine disturbances in their corporeal selfhood - in the integration of their sensori-motor-proprioceptive systems.

Melancholia

By contrast with the paranoiac, for whom others are always to blame, the melancholic believes with delusional conviction that it is they who have done wrong. This 'ultimately concerns their very being, the core of their existence ... the self is irredeemably guilty, and nothing can be done about this: the meaning is fixed' (p. 78).

Final thoughts

Leader does not provide much by way of a link between the three types of disturbance he describes and the allegedly underlying failure by the proto-psychotic subject to grasp the fact of the mother's desire. It is as if we are supposed to accept as obvious that the child's emotional grip on the meanings of their interpersonal world, their development of the capacity for sane thought, necessitated their successful negotiation of the Oedipus complex. But who would accept that without a lot of argument and detail? My own clinical experience takes me some of the way, but I still need a good deal more from Leader before his theories will convince me. In particular I need a longitudinal perspective - one which shows why such psychotic disorders which often only explicitly show their faces after late adolescence are nevertheless to be considered functions of this or that early developmental failure.

Leader presents the three alternatives as different conditions. It would, I am assuming, therefore not make much sense to assume that the same person could change from one to another overnight. Rather they represent different solutions to the Oedipus complex that originate early in life and go on to differently shape the structure of the person's developing self. What we now need, I believe, is research showing that patients do reliably (over time) fall into such clusters - that the paranoid schizophrenic does not oscillate into purely paranoid forms of psychosis, for example. That would start to provide some index of the construct validity for Leader's Lacanian categories.