The Analyst as a Jester:
A Psychoanalytic Treatment for Psychosis

Traditionally, psychoanalysis is a treatment based around free association, that is, the patient speaks whatever comes to their mind. No censure, no regards of logic or worry about following what they were saying before.
The supposition of a structured unconscious is paramount for this method to make sense; Freud believed there was logic behind our unconscious processes, akin to a psychic determinism, where things come to mind not randomly but always determined by another stimulus. Thus, whatever comes to mind is never accidental.
Lacan takes this idea and expands it in his famous statement: “the unconscious is structured like a language.” This hidden logic is a system, a network of elements that are defined by their position in the same network and its relation to the other elements.
Freud believed that there are certain elements in that network that we may prefer not to acknowledge as our own, and thus we cover them with a veil in a process called repression (Verdrängung). The way it is veiled will determine the kind of symptom that will appear as an effect of this repressed content.
However, he believed that in psychosis there is an element that didn’t suffer a repression, but a rejection (Verwerfung). Something that happened is taken out of our unconscious, not only by covering it with a veil, but that piece itself is gnawed out of our minds. Sometimes the description is even more radical, and a piece of the network itself is sacrificed to prevent the inscription of that element on it.
What happens when that network is ruptured? When an element had to be taken out? When a lived experience is so traumatic that it was never inscribed there as such?
If every element is defined by its relation to the other elements in the network, taking one out actually impacts the whole structure. This explains why the symptoms in neurosis and psychosis are so different. Since what psychotics rejects remains outside their unconscious, it’s something from the outside that haunts them, for instance as voices that don’t belong to them, or as the French writer Dandelion — who lives with schizophrenia — says, they may feel like “falling out the edge of the world.” After all, our world is a not the planet itself, but the world of shared symbols with which we make sense of it all.
A traditional treatment rooted in this structured network of symbols, this symbolic register, won’t be fruitful, since that register was pierced in the psychotic by trauma, by what couldn’t be said or thought at the time, and thus was rejected. If the psychoanalytic treatment in neurosis could be considered in Freud words as making the unconscious conscious, what can we do when what we have to make conscious is not a repressed unconscious content, but a rejected one and not even inscribed?
There have been many post Freudians that have given their ideas about this. Recently I read ‘History Beyond Trauma’ by Françoise Davoine and Jean-Max Gaudillière, and today I want to share their proposal.
The authors show there through different cases a particular way to handle transference and counter-transference, in which the analyst express themselves — their feelings, their dreams — to the patient, even at the risk of being “a jester”, with the goal of reintroducing a rejected fragment of their unconscious.
Thus, the goal to recover something from the non-symbolized and exterior Real to the Symbolic structure will be started by the analyst, through an interexchange at the level of the Imaginary, where identifications between analyst and patient may not be an impasse as it is in the treatment of neurotics, but a pass that allows the treatment.
The analyst will share in certain occasions — sometimes hinted by their own patients — what images arise in their mind, and they will loan it verbally to their patient trying to restore a structure that, as every unconscious, is also built socially in the first place. What was rejected may, in a way, come back symbolized by the analyst, that is, with words and representations and not as the pure pre-verbal experience lived and rejected previously by the patient.
Is the way proposed by Davoine and Gaudillière the only one to face that which was rejected from the unconscious? No, but if you read the book you will find it respectful to their patients and logically sound.
It is, after all, a way that focuses in the pain and suffering that had to exist to reject something as radically as it was, something as traumatic as war — in most of the cases told there — or as childhood abuse, instead of focusing just in the neurochemicals involved in the process.
It is a way to maintain the respect we have as psychoanalysts to our patients, neurotics or psychotics, as subjects and equals, and not objects and inferiors.