History of the opposition between psychogenesis and organogenesis in classic psychiatry: Part 2

This paper is the second of two to explore historical concepts of causation in psychiatry. Psychogenesis (as opposed to organogenesis) is superficially attractive but ambiguous, as it can apply either to something that is produced by the psyche or alternatively to the effect on the psyche from external factors. The term endogenous may be contrasted to exogenous or reactive, but the meanings of each have become blurred and ambiguous. Difficulty also arises when contrasting the process versus comprehensibility of mental disorders, as the limits of what may be understood are imprecise. A fourth comparison is between temperament and constitution against types of reaction, and again there is a tendency to circularity. Finally, a way forward is suggested using the notion of psychosomatic brain diseases.

History of the opposition between psychogenesis and organogenesis in classic psychiatry: Part 1

The question of causation in psychiatry is one of the oldest and most difficult in this field. This paper is the first of two published in this journal. First, it traces the development of psychogenic and organogenic views of mental disorders from Pinel until the early twentieth century. This includes the debate as to how a disturbance of function might create a lesion even without a visible pathological trace. The second part of the paper discusses in detail the controversy between functional and organic causes of mental disease. These concepts evolved taking into account psychological factors and also the response of the uninjured parts of the nervous system to trauma of various kinds.

Schizophrenia as a psychosomatic illness: An interdisciplinary approach between Lacanian psychoanalysis and the neurosciences

According to Lacan's theory of schizophrenia (as well as other delirious forms of psychosis), under certain conditions the signifying function breaks down, thus turning the schizophrenic individual's world into one in which a number of events become enigmatic and signal him or her. The schizophrenic individual tries to deal with these signs that besiege him or her either by means of an interpretative attitude (a stable delusional mood) or by apathy. These two types of responses correspond with the stereotypical (and mood) processes by which the schizophrenic individual attempts to avoid the distress provoked by the enigmatic desire of the Other, while simultaneously corresponding with psychosomatic processes of the brain organ.

The Psychoanalytic Concept of Jouissance and the Kindling Hypothesis

This article aims to define the conceptual field of jouissance in Lacanian theory, and put forth the hypothesis of a relationship between certain neurophysiological mechanisms and specific clinical phenomena where jouissance is “kindled” and outside the control of the symbolic process. First, the author briefly introduces Lacan's notion of jouissance and the way it draws on Freud's theorization, and describes the preliminary stages of this conceptual field in Lacan's work. Then, the jouissance related to two other concepts: repetition, with its Freudian and Lacanian nuances, as well as the—exclusively—Lacanian concept of the object petit a. Lacan's later conceptualization of language as jouissance (the notion of lalangue) is then discussed in relation to Freud's early ideas (“Letter 52”) on the different kinds of inscriptions that help form the mental apparatus. Finally, the author tries to formulate a hypothesis regarding specific neurophysiological mechanisms, based on clinical situations where jouissance becomes “kindled” and escapes the control of the symbolic processes through the neurophysiological mechanisms of conditioning, “kindling-sensitization” and “excitotoxicity.” In these cases, jouissance can have a destructive effect on the body and can affect, among others organs, the brain—a process the author has previously described heuristically as the “psychosomatic diseases of the brain.” This would be a special mechanism of automatism that would be triggered under the specific conditions of the fragility of the signifying chain (foreclosure of the Name-of-the-Father or solidification of the signifying chain) in combination with biological factors, including genetic factors. In this process, signifiers are reduced to signals, which in turn may be reduced to stimuli, with a tendency toward self-perpetuation, while affects are reduced to emotions and moods. Thus, conditioning and kindling-sensitization could also be understood in terms of a “semiotic reduction.” Can we therefore consider that certain phenomena of automatism and certain deficits (delusional moods, schizophrenic apathy, etc.) could be seen as psychosomatic disorders of the brain? The phenomena in question might also serve—albeit at random—as a kind of shield to mitigate excessive jouissance.

Pesquisa psicanalítica sobre os fenômenos psicossomáticos

RESUMO Lacan abordou os fenômenos psicossomáticos através do conceito de significante congelado. Os autores que se inspiraram nele fizeram uso desse conceito de diversas maneiras. Existem diferenças entre esses autores quanto à possibilidade de uma determinação concreta de tais significantes congelados (holófrases) que seriam suscetíveis de serem enfatizados pelo analista. Segundo alguns desses autores, o enfatizar tais significantes poderia colocar fim aos fenômenos psicossomáticos. Outros autores lacanianos contestam o valor clínico desse tipo de intervenção. O autor questiona também o parentesco entre os fenômenos psicossomáticos e outros fenômenos clínicos como a alucinação, a emoção, o humor e a passagem ao ato.