Where do we stand today on the question of the psychoanalytic treatment of psychosis and other extreme states? What does psychoanalysis still have to learn from the experience of psychosis? 

Dr Bret Fimiani’s presentation will address the gap (a void) that too often derails the analytic relationship between the clinician and the person experiencing psychosis. Dr Fimiani will suggest that current misunderstandings of psychosis stem from biological reductionism and, more fundamentally, from an underlying fear of psychosis. Operating from a place of fear leads to clinical approaches that stigmatize and punish those who have extreme experiences. 

Lacanian Psychoanalysis remains a vitally important approach to working with people who experience psychosis and other extreme states. Lacan, like Freud, had a deep respect for the experience of, and the specific knowledge inherent to, psychosis. However even the most current Lacanian approaches are lacking when it comes to the problematics of the transference in psychosis. Although Lacan made several definitive statements that indicated his hesitation regarding the treatment of psychosis, his essay “On a Question Preliminary to Any Possible Treatment of Psychosis” is devoted to keeping the question of the treatment of psychosis, in the most radical sense, open. The “question” that is preliminary, Lacan tells us, is the question of the “defect [i.e., foreclosure] that gives psychosis its essential condition.” 

It is certain that Lacan advanced the understanding of the structure and true stakes of the psychotic experience. However, on the question of initiating treatment, Lacan did not reach far beyond Freud’s conclusion, particularly regarding the problem of transference. Given the unique relation of the psychotic to knowledge, the transference, according to Freud and Lacan, inevitably reaches an ‘impasse’. At this point in Lacan’s thinking psychosis represented something radically outside the practice of psychoanalysis. 

More recent advances (e,g., see W. Apollon, et al., 2002), have provided us with a guide on how to listen to, and intervene in, psychosis in a way that can create the possibility of a (symbolic) treatment. However, there are shortcomings of current Lacanian approaches that need to be addressed in order for clinicians to make more effective and authentic connections with people experiencing psychosis. 

Dr Fimiani will emphasize the work of Davoine and Gaudilliere (2004) to discuss ways that we can traverse the void that often separates psychotic and non-psychotic experience—a void that, if left unaddressed, can lead to a ‘transference impasse’. The void is made of ‘zones of non-existence’ already well known to the person experiencing psychosis and that evoke horror in the clinician. When one experiences ‘horror’ in the face of psychosis this is not necessarily to be chalked up to so-called ‘counter-transference’. Rather, the experience of horror is the price one must pay to cross the threshold and to gain access to an other’s subjective world. The horror is universal, but one has to have a desire to know it. 

The bulk of Dr Fimiani’s presentation will involve a discussion of a clinical vignette that explores how the ‘dream-work’ is one way to pass through the horror and to limit the violence of certain images seen and felt in the body. 

The seminar will take place on Zoom at 8pm-9:30pm British Summer Time (BST)/GMT+1/UTC+1 on Thursday 28 October 2021 and will be followed by a virtual pub gathering on the platform ‘Wonder’. Please be aware that Eventbrite (and Facebook) usually automatically converts the event time for the time zone from which you view the page.

The event is open to everyone and free with Eventbrite registration. The Zoom link to join the seminar will be available for registrants on the ‘Online Event Page’ (found when accessing your ticket on Eventbrite) on the day of the seminar, which is where you can also find information about the virtual pub taking place afterwards.

Dr Bret Fimiani is faculty, board member and psychoanalyst of the San Francisco Bay Area Lacanian School of Psychoanalysis, USA, and a clinical psychologist. He works with people experiencing psychosis and extreme states in his private practice in Oakland, CA and at the Haight-Ashbury Integrated Care Center in San Francisco. His research interests include adapting the Lacanian analytic frame for the treatment of psychosis and extreme states.

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