Luc Fouché, Delusions in Psychiatry and Psychoanalysis Lecture 4
Lecture notes for the course “Delusions in Psychiatry and Psychoanalysis”, one of the special topics of the EPS Psychoanalytic Action School Seminar. This article is the fourth lecture. Therefore, I will attempt to outline Ms. Blanche’s spiritual and artistic journey from writing her first book to the end of her treatment. 1. The journey of literature, art, and spirituality Mrs. Blanche is a 78 year old writer and artist who became particularly famous in the 1980s. Mrs. Blanche was awarded the French Medal of Arts and Literature, and she has published over 30 books in the past forty years, many of which have been adapted into plays and radio dramas. Although her paintings and graphic works are not well-known to the public, she has still held multiple individual and collective exhibitions. Ms. Blanche suddenly began to delve into literature at the age of 35. As a PhD and professor in geography, Ms. Blanche has previously worked as a teacher. When a famous fortune teller told her, “Now, you will become a writer. You will write 14 books and marry a film artist.” Her psychoanalyst encouraged her to listen to her true wishes, so she obediently followed the fortune teller’s instructions without resistance. Although she had no literary ambitions before, she immediately gave up her career at the Ministry of Education and did not even go back to the office to retrieve her personal belongings, so she went straight home to write her first book. While writing her first book, Ms. Blanche also became a fortune teller. In fact, due to discovering that Ms. Blanche had a rare talent for spiritual media, the fortune teller taught her how to use tarot cards and would refer her divination consultation to Ms. Blanche during her vacation. In the next decade, Ms. Blanche continued her practice of divination while writing. She has no doubt about her exceptional divination talent: “To write, one must have this talent.” During the talks, Mrs. Blanche even showed me her psychic skills by predicting my future. It was at the end of her first book that Mrs. Blanche suddenly began her painting activities, aided by a phenomenon of hallucinatory revelation. Mrs. Blanche was invited by her diviner colleagues to attend Augustine Le Sage’s exhibition, and she was completely impressed by the artist’s amazing journey. In fact, the legendary fate of Augustine Le Sarge seems to reflect the fate of Lady Blanche in every aspect. Just like Mrs. Blanche, who started writing at the age of 35 without any literary training, this humble miner, without any artistic training, heard a voice from deep in the mine say to him at the age of 35, “One day, you will become a painter!” and then he began painting. Therefore, it was through this mirror recognition of Augustine Le Sarge that, without any knowledge of painting, Mrs. Blanche began her practice of sketching and watercolor painting. Whenever writing encountered difficulties, painting replaced her writing. In fact, after watching the exhibition, Mrs. Blanche immediately returned home and began creating her first painting. The title she gave for her first work is very informative: “The Way Comes”, taken from a line by Victor Hugo. She not only paints, but also creates unique writing works. These peculiar manuscripts were created once when she felt lost in writing, and Mrs. Blanche referred to them as “writing notes.”. These are strip strips of paper, on which Mrs. Blanche unfolds a long uninterrupted string of words in tiny font, all squeezed together without any spaces, line spacing, or punctuation. And Mrs. Blanche’s writing notes, such a pile of condensed and difficult to recognize words, have entered the ranks of artworks. It was during the first exhibition of writing notes that Mrs. Blanche met the then President of the Republic, who came to admire the strange works mentioned to him by his advisor. At the end of their conversation, Madame Blanche suddenly boldly invited this outstanding man to pose, just like a model in front of a painter, while she silently remembered the portrait of the president through writing. The President agreed to this initial request and held a total of seven “presidential posture talks” for two and a half years, ultimately publishing a new book. This honor from the President will open all the doors for Ms. Blanche in the coming years, not only ensuring her lasting reputation, but also greatly ensuring the restoration of her narcissism. 2. Family and marital history The majestic yet affectionate father image embodied by the President of the Republic contrasts sharply with the silent and rigid father image portrayed in Mrs. Blanche’s works. Mrs. Blanche’s father was a great hero in the resistance movement, winning over a dozen medals for his bravery and fearlessness during World War II, as well as for joining the resistance organization Free France. Mrs. Blanche often describes her father as a distant, introverted, and silent person. When my father went to war, my mother was pregnant with her, and my father always stirred up some kind of fear in Mrs. Blanche. In her book, the gap that separates her from this distant father is often marked as an indefinite article placed before her father, in contrast to the adjective placed before her mother: “I come from my mother’s country, from her body, from her voice… I come from a country where my father went to war.” On the other hand, Ms. Blanche recalled the complete mutual penetration she experienced with her mother when her mother was nine months pregnant and her father was still on the front line: “For a year, I lived alone with my mother. We were the two of us, for a year. Can you imagine what love should be like?”. “There is an aunt, perhaps my grandmother, and so on, but my father is not here, and she must have liked me very much.” This intimate and passionate bond with my mother is recalled through the unforgettable main melody in every book: her mother listened to and played the piano humming and singing love songs during her pregnancy, which became a symbol of their original fusion throughout their lives. If the father returns from the war, it will somewhat break this symbiotic relationship, and he will not be able to fulfill his role as a third-party separator for mother and daughter. As Mrs. Blanche wrote, “Time in a mother’s womb can continue indefinitely.” Mrs. Blanche provided very little information about her childhood. She was surprised: “When people told me to talk about my childhood, I felt speechless.” Even if she wanted to know “where did the black veil that enveloped her childhood come from?” She still encountered an absolute taboo: “It’s hard to recall childhood or early childhood, I faced a prohibition.”. She only mentioned in one consultation that her parents often argue, and she inherited “painful karma” from them, especially from her mother. Blanche’s relationship with her two brothers and one sister seems to be equally conflicted. Like her childhood and adolescence, Mrs. Blanche never mentioned her adult life before becoming a writer, except for a brief mention of her joining and actively participating in the Women’s Liberation Movement (MLF), where she was once a prominent figure. She also revealed that although she had been pregnant twice, she had miscarriages on both occasions because she had not found a suitable person. She said that it was “too late” for her to meet her husband when she was 35 years old and they were “busy creating”. She said that her 20 year long psychoanalytic therapy was “completely successful” because it was this therapy that established a “stable and lasting relationship” with her husband. Shortly after she began writing her first book, she met her husband. If he is indeed a film artist as predicted by a fortune teller, what fascinates Mrs. Blanche is that her husband’s initials and “mother’s initials are the same”: “I married a man with my mother’s initials. I married my mother.” 3. Medical history When Mrs. Blanche was 54 years old, the death of her beloved mother plunged her into a deep abyss of sorrow: “Since her absence, my heart has been in turmoil and I often say the wrong thing.”. Without our mother, our appearance would look like it was torn apart. I was torn apart. One year after her mother’s death, a severe cerebral hemorrhage caused Mrs. Blanche to fall into a coma. When she woke up from her coma, she experienced episodes of bipolar disorder, characterized by multiple episodes of acute manic episodes and multiple episodes of depression accompanied by suicidal thoughts. She had to be hospitalized multiple times, during which she spoke many delusional words, with the theme revolving around the decay of internal organs, constantly complaining about her “blocked” and “dead” intestines, as if there was a hole in the middle of her stomach. Although the period of emotional stability is interspersed with mild manic stages, the melancholic side always exists to some extent, accompanied by strong anxiety, especially in moments without creativity. When she was 67 years old, her father passed away, which instead plunged Mrs. Blanche into a frenzy. During this time, she squandered her father’s inheritance and set up a luxurious property on a small island in the Mediterranean overlooking the sea/mother (mer (e)). After more than ten years of psychiatric follow-up at a hospital in Paris, during a manic episode ten years ago, Mrs. Blanche had a dispute with her psychiatrist. On the recommendation of her publisher, she came to the psychiatric inpatient department to see me. Year after year, she will experience a period of depression, some mild manic moments, and recurrent migraines. She also developed a gradually worsening walking disorder, which seems to be related to multiple factors. If they are caused by the aftermath of stroke and the side effects of antipsychotic drugs, then they seem to fluctuate with mood. Sometimes, Mrs. Blanche can easily move around with the help of her husband’s arm or cane, while at other times, she needs a walker or wheelchair. Although related to her emotional changes, these walking disorders have recently worsened after a femoral neck fracture. As Ms. Blanche’s self-care ability becomes increasingly unstable, nurses now come to her home to help her wash, dress, and take care of her body. Returning to a dependency state in childhood did not bring secondary benefits to Mrs. Blanche, as she will admit with these words: “Showering is a huge happy time for me. She bathed me, and I really enjoyed it all.”. Mrs. Blanche could only lie in bed or armchairs, relying entirely on her husband’s help, who was also of advanced age. Mrs. Blanche’s husband is very dedicated to taking care of his wife, ensuring their daily lives with maternal care. He is responsible for preparing daily meals, accompanying her on outings and her medication treatment, and bathing her in the absence of a nurse. Mrs. Blanche’s favorite thing is “getting smaller again”, having her husband dress and undress herself, often confusing her husband and mother, “being with him is like being in a mother’s womb.”. In one of her books, she even wrote, “He is my mother,” sometimes without hesitation referring to him as “mother,” and we can see the fusion of the two. However, recently, Mrs. Blanche’s increasingly serious actions and complete dependence have been a severe test for her husband, especially as she often demands high and even difficult dishes, refusing the simple dishes her husband cooks for her and demanding vegetables that are difficult to buy or more exquisite dishes. Although she said she was fully aware that her actions could not be a daily enslavement for her husband, Mrs. Blanche did not stop her demands. As explained by her husband, when Mrs. Blanche is able to start writing or painting, she becomes completely immersed in her work. “At that time, you no longer exist!” On the other hand, when she fails to regain her passion for creation, Mrs. Blanche feels very anxious, so much so that she demands her husband’s attention every moment and doesn’t give him any breathing opportunities: “In ten minutes, I will call him. I don’t give him my own time. I’m killing him with a blunt knife.” Therefore, when he joined in the second part of the meeting as usual to inform us of his wife’s emotional fluctuations and adjust her medication treatment, Mrs. Blanche’s husband often allowed his wife to aggressively attack him, while he would speak in gentle or admirable words. Although he himself was a writer and film artist, Mrs. Blanche’s husband did indeed pour an unreserved admiration into his wife. Her literary and artistic influence seemed to greatly satisfy his narcissism, as he never missed any opportunity to emphasize the respect and reputation his wife enjoyed. As Mrs. Blanche told me one day, it’s not so much a great love story as a great admiration story. However, for a period of time, Mrs. Blanche’s husband struggled between exhaustion, irritability, and guilt. He often asked himself how much more family care for his wife would continue, and increasingly complained about the heavy burden of this dependence. However, he didn’t want to get rid of this dependence for anything else, as he admitted to me: “From the beginning, I always knew that I needed her more than she needed me. In short, I was a bit like her at first. If we live our lives the way we do, then we’re also a bit on the edge, right?” Her reputation and literary creativity weaken with illness, and as her therapist, I will unconditionally appreciate her works. I am the repository for her initial drafts of future works, fulfilling the role of a good and receptive environment. I not only did not refuse to be used as a storage place for this waiting spiritual part, but also encouraged her to regularly introduce these raw materials to me, allowing her to dare to write what came to her mind, and accompany her step by step in writing her last four books. In fact, it was in the area where her writing was not yet fully formed that I established a form of writing, which gradually emerged in Mrs. Blanche. As she gratefully admitted, saying that I am “the only, and also the first, person who loves her job” guided her “step by step towards what is suppressed in her place”, while “allowing her words to flow freely without extinguishing it, without forcing her to take another path”. She also said that I was the driving force for her to move forward and live on. Only in the reassuring sense of security provided by this favorable environment can unfinished works be experienced as a fertile ground. To illustrate how to promote her return to writing work, I will describe this clinical clip to you: When Mrs. Blanche suggested that she should probably look for inspiration for her next book from the traditional Judaism of her family, I immediately supported her creative idea and proposed lending her a female rabbi, Delphine Horvilleur’s work “Women, Shame, and Judaism”, with the aim of helping her return to work and writing. Although lending her this book allowed her to engage in contemplation and calm down for a period of time, Mrs. Blanche did not find the creative surge she hoped for. She returned this book to me at the next meeting and insisted that I lend her another book. Therefore, the second book of the same author became the “object of communication”. As my representative by her side, the object of communication will enable the patient to maintain mental functioning while waiting for the next meeting, allowing her to maintain contact with me and maintain internal dialogue between the two meetings. In this way, after 40 years of career, despite increasingly severe physical and neurological disorders, she is about to publish a latest book. For Mrs. Blanche, writing is crucial, and she expresses this very clearly. What she is engaged in is the act of writing, “there is no need to search for anything else outside of this action, they are all the same”, “this action cannot be interrupted”, “it will not end, nor should it end”. Some explanations about this case: Although the driving force behind most works is to understand human existence or grasp the truth of the world, the only necessity of some writing practices seems to be to shape the author’s own confusion, dispersion, or unpredictability. It is a method of remedying mental and even physical breakdown during the process of mental illness. This patient is in this situation. She has been writing only in the form of autobiographical novels, basically talking about herself through her characters. Her first book was like this, quoting Antoine Alto’s words, attempting to “reshape the body with the bones of soul music.”. Morbidly delving into the inner world of a mediocre office worker, the first novel portrays the inevitable mental breakdown that occupies this woman every time night falls, presenting various delusions and illusions in front of her eyes, including nightmarish illusions. Alternatively, as Mrs. Blanche summed it up more mysteriously, the story revolves around one night when the woman is locked in her apartment. “She experiences what she imagines in front of her eyes and eventually collapses there.”. It is miraculous that this description ultimately became her experience, as she gradually became paralyzed and unable to move. Therefore, Lacan pointed out that it was at a critical moment when mental illness could develop that the author gained a deeper source of his work. Therefore, the key to Lacan’s approach to treating mental illness lies in the subject’s ability to invent one or more supplements, which may respond to actual return by limiting and positioning enjoyment that is not anchored by the signifier of the father’s name in specific places. Therefore, literary creation has the function of limiting pleasure by placing it on paper, marking it through the use of words or babbling, and emptying it through the publication of works (Maleval, 2000). By unloading the excessive pleasure of the body and discovering a new signifier that belongs only to the subject and has an identity function – he can identify with this signifier or be recognized by the other through it. The addition brought by literary creation not only introduces the subject into the symbolic order, but also places it in the realm of social reality. As far as it is concerned, image creation is a supplement that “does not use symbols, but rather operates on the reality of pleasure that is not captured by language” (Soler, 2002). Paintings do not use the subtleties of words, but instead create a new object in which pleasure is greatly transformed to the point where it is not only accepted but also praised by others. It can be affirmed that for the past twenty years, Mrs. Blanche’s literary and artistic creations have been a fortress against mental illness, while ensuring her social integration through the literary and artistic recognition she gained from them. Therefore, rooted in art and literature, it has structured value. However, if her writing and art allowed her to shape a body and a name, they did not prevent Mrs. Blanche from experiencing a mental breakdown. In this sense, Mrs. Blanche’s writing and art did not serve as a sacrament, but rather as a supplement. What is involved is the addition in the context of the exclusion of the father’s name, which is revealed by the fact that Mrs. Blanche’s first writing and painting works were generated by the guidance and inspiration of the fortune teller, and were not influenced by any fantasy construction. As long as Mrs. Blanche did not encounter any reality that would disrupt her stability, the supplements she constructed for herself would continue to work, keeping mental illness in a low-noise state. It was the death of her mother and the sudden cerebral hemorrhage that later triggered the “temptation of mental illness” (Abensour, 2008). If, in the first twenty years, Mrs. Blanche received support from her psychoanalyst and her fortune teller, and even occasionally from the president, to carry out her literary creations, and if she began her painting work by identifying with Augustine Lessac’s peculiar fate, then in the past decade, Mrs. Blanche pursued her creative activities based on her transfer to me as an analyst. In fact, it was through acknowledging the ideal signifier carried by her psychiatrist psychoanalyst that Blanchev was able to emerge from her melancholic state multiple times. Therefore, when her literary passion dried up, it was the support I received from the few words I wrote to her that Madame Blanche found her inspiration. For example, my brief comment on the necessity of taking a break in all creative work not only helped Mrs. Blanche “find words to express” her pauses in painting work, but also prompted her to rethink similar moments in the writing process. My unwavering support, I always respond, even on Sundays, to her painful messages and suicidal desires, as she feels fortunate to point out in her latest book, demonstrates the true presence of the Other, especially the therapist, which is indispensable for the subject of mental illness, as his words inevitably comment on and support the subject’s position in the mirror, just like a permanent realization of the mirror stage. My absence during the holiday period has a direct impact, and often depression relapses. Therefore, Mrs. Blanche’s art can be considered as a unique mode of supplementation she invented to prevent mental illness and stabilize her condition after episodes of bipolar disorder. In addition to the additions brought about by creation, there should also be occasional or continuous imaginative additions of the ideal other, reflected in the image of a psychiatrist and psychoanalyst, to make up for the short-term failure of her own additions. Finally, I will once again quote this sentence as a conclusion: “We are well aware that sometimes the veil covering words may be torn apart in order to develop another kind of knowledge, a non knowledge, an absolute knowledge.”. This is a sentence for psychoanalysts.
Speaker: Luc Fraser, psychiatrist, psychoanalyst, and director of the psychoanalysis department at Paris Saint Anna Hospital.
Delusions in psychiatry and psychoanalysis, Lesson 4
Translator: Xu Yajun
Hello everyone, last time we discussed the issue of supplementation and sacraments, and demonstrated through a clinical case what we as psychoanalysts can do in the process of transferring delusional subjects. Today, I invite everyone to think about another patient’s case, who will show us how to find ways to deal with their mental illness through her literary and artistic works. Rather than saying that all literary works are actions of fiction, construction, or narration, it is more accurate to say that they are a certificate of survival, dedicating themselves to the endless pursuit of writing at all costs, sometimes even completely disregarding the coherence, meaning, and readability of the text. However, it was through this writing that my patient, Ms. Blanche, not only became a writer and artist, but also invented a unique coping strategy that saved her from depression and collapse over the past twenty years. Even during this period, once her mental illness flared up, she still maintained a certain degree of stability through this writing style that was less like creative thinking but more like executing actions. Therefore, I will attempt to grasp the clinical points of this case through Ms. Blanche’s use of writing, which is closely related to her life and difficult to distinguish. What role did literature and painting play in Ms. Blanche’s creation? What is the mechanism through which this literary and artistic creation enabled Ms. Blanche to prevent and stabilize her bipolar disorder over a period of forty years? Does Ms. Blanche’s writing and art constitute a constantly evolving therapeutic attempt to address the excess and chaos brought about by unrestrained pleasure? Undoubtedly, Ms. Blanche’s writing falls within the scope of compensation, supplementation, and sometimes sacraments, concealing the exclusivity of the father’s name.