Pierre-Gilles Gueguen

No doubt in institutions these days it takes more than brandishing the psychoanalytical referent, all be it Lacanian, in order to be heard. The transference required to establish the conditions of the psychoanalytical act requires more than that. It requires, among other things, that the clinician make psychoanalysis desirable, and that he can therefore, attest to its efficiency, its pertinence and to the liveliness of the doctrine. As regards the treatment of psychosis, we have a substantial corpus to rely on whenever required. The title of this article joins the term of homeostasis with the adjective symptomatic. This choice requires clarification. "Homeostasis" substitutes for the more familiar or more frequently used nouns like "cure" or "suppletory device" [to the foreclosed Name-of-the-Father] for example. It is closer to the term of stabilization. Commonly, it is used to indicate the maintenance of a living organism's characteristics at a constant level. In applied psychoanalysis, the term serves to indicate the fact that psychosis is not "cured", but rather contained, reduced, that its disruptive manifestations are arrested by the treatment. The adjective symptomatic adds something that the term of stabilization does not render. That is, that homeostasis results from the symptomatic formation. In this sense, the expression "symptomatic homeostasis" replaces another frequently used, though poorly put expression, that of "the delusional metaphor". The idea that it is the formation of a symptom that allows for a veritable stabilization modulates what the term of homeostasis would tend to evoke as a simple abrading of the painful and destructive effects of psychosis. The research pursued for over the past twenty years now by the School of the Freudian Cause, founded as it is on a return to the clinical, has permitted great advancements in the clinical treatment of psychoses. We have gone from a doubtful and experimental approach in dealing with psychotic subjects, often combined with a diagnosis based only on language disorders or verbal hallucinations, to a keener and more pragmatic evaluation of psychotic states and of their treatment. We can certainly consider these advancements to be the result of a collective effort, one that has clearly demonstrated the necessity of a working School for psychoanalytical research. The role of J.-A. Miller's course, with his deciphering of Lacan's teachings, the importance of his DEA seminar, that of the Paris Clinical Section's Evenings (IRMA), as well as the Study days of the Clinical Sections to which he has lent his impetus, belong at the forefront of these advancements. The share of each has not been equal but on this theme whose role is essential to mental health, a work community has demonstrated its efficiency. Our praxis for the treatment of psychoses has been marked by a certain number of scansions that I may resume as chiefly the following: --1986: The thesis of "generalized foreclosure" which establishes the passage from a theory of discontinuity in the clinic of psychoses to a psychosis-specific, continuous one. --1993: Jacques-Alain Miller's article entitled "The Ironic Clinic", which asserts the thesis of "the universal clinic of delusion" in these terms: "I assert that all of our discourses are only a defense against the real." In this article he also develops the basis for a Lacanian treatment of schizophrenia. --1997-99: The collective works of The Conversation of Arcachon and Ordinary Psychosis where the theory of "ordinary psychosis", deduced from the third period of Lacan's teachings, is formulated for the first time. Following this path, many consequences of Lacan's teachings on the treatment of psychoses have been brought to light and put into practice. In this manner we can positively state that we have gone from "On a Question Preliminary to Any Possible Treatment of Psychosis" to a possible and logically guided treatment of psychosis. There still remains the task of giving detailed and classified accounts of these treatments in order to assert both the validity of our concepts and the results they permitted. At present, the publications of the School of the Freudian Cause and the Clinical Sections make available reports on a whole series of cases but which have not yet been the object of a systematic listing. I will insist strongly on two points concerning the therapeutic effects of the psychoanalytical treatment of psychoses: the limit of therapeutic effects and the nature of the symptom elaborated in the treatment. I will follow with three brief examples of therapeutic "successes".