In this article, we’re going to talk about ordinary psychosis. It’s a concept that doesn’t appear in the DSM V or ICD but is frequently used in psychoanalytic practice. The distinction between psychosis and neurosis is well known. The process of psychoanalysis has also helped identify certain intermediate categories. The most well-known is the borderline structure of personality. These intermediate categories are far more interesting at the clinical level. That’s because they use a dimensional and less structural model to explain human behavior.
Ordinary psychosis was defined by Jacques-Alain Miller. He pointed out that when there are no obvious signs of neurosis, a hidden psychosis can occur, a veiled psychosis. It designates a mode of functioning typical of individuals with a psychotic structure who don’t present overt clinical signs of psychosis, so they retain the ability to socially adapt.
In many patients, there’s an ‘attenuated form of psychosis’. It remains within the range of psychotic spectrum disorders. In fact, ordinary psychosis doesn’t present the classic signs of psychosis (delusions or hallucinations) but the psychotic aspect is apparent in other manifestations.
The concept of ordinary psychosis forces us to abandon the usual nosological categories, classified into large syndromes that indicate an ‘all or nothing’ logic. Instead, it focuses on dimensions of behavior. It seems that many cases of psychosis have remained dormant yet tend to appear in psychological consultation. Indeed, a sufferer can live with a basic psychotic structure without their symptoms being particularly noticeable.
According to the psychoanalyst and writer Gustavo Dessal, this type of psychosis presents different phenomenologies. It can range from an excess of normality to the appearance of serious characteropathic neuroses. However, the encapsulated delusional nucleus is always present. Nevertheless, the patient only surreptitiously confesses to it or keeps it hidden by means of circumlocutions or ellipses of speech.
How it manifests
Ordinary psychosis manifests itself through rather subtle symptoms. For instance, extravagances, particular use of language, disturbances of thought, or attacks of anguish.
The sufferer may also find themselves socially dislocated. That’s because the condition presents obstacles in relationships. For example, they might suddenly reject others for no apparent reason. In ordinary psychosis, the symptoms aren’t spectacular, they’re discreet. For this reason, it may be referred to as normalized madness.
Symptoms of ordinary psychosis
Gustavo Dessal details different clinical phenomena that point to the existence of ordinary psychosis:
- Sufferers don’t usually discuss their history, and there’s an absence of subjective implication.
- Their sexual life is often non-existent or they show signs of a labile relationship with regard to their sexual identity.
- Frequently, the social bond is permeated to varying degrees by signs of aggressiveness and paranoid distrust. As a rule, they’re discreet, but they do exhibit unequivocal points of foreclosure.
- Sufferers tend to spontaneously manifest an extraordinary tendency to recreate in their speech an ‘oedipal’ type discourse, little filtered by censorship.
- They experience incomprehensible difficulty in carrying out activities that should be well within their capabilities. The fact that there are certain activities that they used to be able to carry out normally in the past, yet are no longer able to do could be a sign of a psychotic incident. For example, a teen sufferer may no longer be able to attend class.
- Their relationship to language is altered. They often speak in proverbs or odd language to cover up their inability to express themselves in a regular way. Eric Laurent pointed out that they exhibit an “almost neological use of common words”.
Ordinary psychotics camouflage their condition in the everyday landscape, while extraordinary psychotics, by contrast, have far more disabling limitations. Therefore, to the casual observer, the ordinary psychotic will appear to be quite outgoing.
The origin of ordinary psychosis
The interest in new forms of psychosis free of delusions and hallucinations is increasing. There are increasingly more cases presented in consultation. Sufferers possess a kind of social functioning that’s seen as acceptable. However, they have a completely unstructured system of symbolic representation of the world.
Marie-Hélène Brousse, in an article entitled Ordinary Psychosis in the Light of Lacanian Discourse Theory, argued that the field of psychosis seems to be changing today. She relates it to the decline of the paternal role and claims that the power of the Name-of-the-Father is accompanied by the pluralization of its function. With the father’s evaporation come social norms. In the face of the decline of law, norms and (ordinary) common sense proliferate. When we speak of ordinary psychosis, it involves absolute submission.
The symbolic precariousness that characterizes life today has certain effects. Information presentation algorithms based on likes are extraordinarily unifying (normalizing). But what if this normalcy ends up being empty? Indeed, if there’s nothing for an individual to oppose, their personality is unable to finish forming. It reaches ‘ordinariness. Mixed with loneliness, this can become unbearable.
When talking about a ‘normal’ person, there’s always a kind of emptiness present. Similarly, there’s a void present in these ordinary forms of madness, the kind that isn’t triggered publicly but is hidden in the sufferer’s thoughts and way of behaving.It might interest you...
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- Dessal, G. “Continuidad y discontinuidad en las psicosis ordinarias. Tres preguntas a Gustavo Dessal” en Nodus. L’Aperiòdic Virtual de la Secció Clínica de Barcelona, accesible en http://www.scb-icf.net/nodus/contingut/article.php?art=274&rev=37&pub=1.
- Laurent, E. (2007). La psicosis ordinaria. Virtualia, 6(16), 2-6.
- Lippi, S. (2015). La psicosis ordinaria:¿ cómo pensar los casos inclasificables en la clínica contemporánea?. Desde el jardín de Freud, (15), 21-36.
- Manuel Fernández Blanco, El tiempo de la psicosis ordinaria, Asociación Mundial de Psicoanálisis. XI Congreso. https://congresoamp2018.com/textos-del-tema/tiempo-la-psicosis-ordinaria/