Numéro 3 / avril 2012

On a clinical work in institution with a psychotic child

In this article, I present the elaboration of a clinical work realized at Courtil with a psychotic child. It is not an analytic cure but the result of an institutional practice underpinned by a reference to Lacanian psychoanalysis. I will account for three years of work in the daily living, workshop and leisure activities of the child. Damien was nine when he arrived at Courtil; he will be twelve at the first publication of this article. In the first part, I specify what bases a diagnosis of psychosis for this child. In the second, I develop the work carried out in the institution.

A case of psychosis

The foreclosure of the Name-of-the-father cannot be seen with the naked eye. It is deduced from the phenomena which are its effects. In this way one can locate for Damien a series of consequences of the failure of the paternal metaphor.

The treatment of the signifier

Damien's position in relation to the signifier manifests itself in a series of language problems. When he speaks, he stutters, stumbles over words and constructs sentences with difficulty. The words are cut into syllables, repeated and linked in disorder. For example, "Me, I love mama." becomes "Ma ma I love me mom me mom I love..." The sentence only ends because Damien is out of breath. Certain words, incomprehensible, are assemblages of many words, for example, "hippopo-cut-up-a-must." They don't make any sense to Damien, who is incapable of repeating them moreover.

His relation to signification is particular. He confuses words such as: death - deaf, head - had, Mark - mart, etc.

He operates two sorts of feedback of one signifier to another, which in no case represent the subject. The first form of feedback is the logical opposition big - little, nice - mean, etc. The signifier is fedback to its opposite without producing any signification. On the contrary, this operation divides Damien into two parts. His right hand and his left hand are characters incarnating a good side and a bad side, a big one and a little one, a strong one and a weak one. Damien is divided by the signifying opposition, not represented by it. He is thus not divided in the sense of the $, the divided subject, but petrified in the signifying opposition, massively identified to it.

The second form of feedback of one signifier to another is made by contiguity: devouring, incorporating, disemboweling, dividing, reconstructing, devouring, etc. These series are closed on themselves and turn round and round. The passage from one term to another doesn't produce signification, doesn't represent the subject. He is the devouring, incorporating, etc.

The foreclosure of the signifier for the Name-of-the-father produces for him a pluralization of master signifiers, a swarm of S1s without S2s and thus without the aphanisis of the subject.

The dissolution of the imaginary

This particular relation to the signifier has for correlate a dissolution of the imaginary order: "topical regression to the mirror stage," Lacan said1. This is manifest in the doubling of the ego. For example, when he draws a person, a second appears in the first. He recognizes himself as double: "It's me, Damien, the good and the bad." Other times, from each hand of the person drawn emerges several people. Note what he says of his reflection in the mirror: he says, "Two Damiens."

This dissociation is found again in his relations with his peers, particularly with children of the same size as him. He wants to put himself in their place, latches on to them or mimics their traits in a massive fashion. When he plays with the others and they appear stronger than him, they then become aggressors, persecutors. The other is suddenly the big one, the strong one, the cock, the monster... This makes an immediate return on the body and divides it in two. He bites one of his hands while threatening the other child with the other hand, sometimes with an object, or he might even give the other child this other hand. This sort of rage can also burst out when he finds himself separated from the other by a limit: the door or the street. The limit makes a mirror, a screen which puts him in a position of aggressivity. The axis of mirror symmetry sends him back to corporal symmetry (left-right), taken up again in the symmetry of the signifying opposition (mean-nice).

One may take bearings from the matheme for the master discourse that Lacan writes:

One sees that what we have discerned up to now in Damien's case is the status of signifier feedback (S1 ---> S2), of the subject ($) in its non-representation by the signifier, and the symbolic and imaginary consequences of these facts. The object a remains to be examined.

Attempt to make a hole of the object by positivizing it

Each time he arrived at Courtil, things went very badly with his mother, at least in the first part of his stay with us. He couldn't bear the separation, threw big tantrums, and tried by every means to tear out a piece of his mother, all while insulting her. When he couldn't levy a little piece of her, he slapped and looked for holes in the walls to enlarge or tore up whatever came to hand. He presented the same behavior when he had to leave Courtil or stop an activity that he liked.

Damien walked about with objects that he never let go of. At first, it was his coat. Moreover, it was very difficult to get him to change clothes, especially concerning those items which stick to the skin. Other objects followed. When someone asked him to change place, or activity or work with another person, or when something was forbidden, he then wanted to seize an object from the place he was leaving, or the activity or the person. Other times, he would introduce an object into a forbidden place, always with jubilation and excitement. When one hindered him from seizing an object at the end of a workshop, he might even take hold of his penis to exhibit it and urinate everywhere.

What is the status of this object that he takes away with him? One might say that it is a bit of the body, but it is also well outside the body.

The status of the body is not the status of the organism. The organism is the living being from which the subject is sustained. The living being is the pure being of jouissance, a primordial unbridled jouissance, auto-erotic, entirely the jouissance of the mother. It is the non-symbolized real. For an organism to become a body requires the effect of a metaphor. Some jouissance can in this way be symbolized by the introduction of a signifier. The body is thus the effect of this metaphor, of this substitution of the living being by a signifier, thus by the Other2. The body constitutes the passage of the living being to the status of signifier. It is a levy on the organism, a levy of jouissance, a (-1). It is the introduction of signification that one calls phallic signification (Io) marked by a negativity (- phi).

This has two consequences. Firstly, a loss of jouissance and correlatively a separation of the body from its jouissance. On the other hand, the presence of a remainder of jouissance, remainder of what jouissance the living being couldn't symbolize. This remainder is the object a. This remainder is the one that Lacan constituted in the myth of the lamelle3. It is the libido insofar as it is that which, of the living being, subsists after the symbolic incorporation. What escapes and cannot be symbolized is a part of the living being of the organism, an outside the body that the organism relinquishes. It is to this place that the objects a come. This separation is not made just any old way. The breast of the mother is part of the child; the cut is between the mother and the breast, illustrating how this object is outside the body4.

Damien attests, by the object he seizes, that this object is outside the body. It is necessarily outside the body for him to seize it. We had seen that his relation to the signifier organizes his body in a particular way and divides it into two parts: good and bad. He has a body, a body organized by the signifying opposition in which he is petrified, but there is no metaphorization. Something fails and is in default by the foreclosure of the Name-of-the-father.

On the one hand, if there is a loss of jouissance for him, is this jouissance necessarily forbidden? Can he separate the jouissance from his body? On the contrary, this jouissance returns in the real of the body and divides it in two.

On the other hand, in relation to the remainder of jouissance, Damien testifies that this object outside the body, this lamelle, he cannot relinquish it and thus remains encumbered with it. The object remains present in the real for him. It is not lost; it is not lacking. To seize the object then functions as an attempt to make a hole of the object a in the place where the hole is lacking (- phi). Through the object that he seizes, he introduces a supplementary organ, introduces a (+1) because it is not possible for him to introduce a (-1). "The psychotic subject cannot consent to efface itself ($) before the object which, there, makes a hole. To cause the desire of the Other, he would have to consent to this."5

Confronted by an Other that is not barred by the paternal metaphor, which is to say, an unquestionable desire of the Other not positioned for him as desire, Damien finds himself completely the object of the Other's jouissance, and he comes to fulfill entirely his mother's inoperative lack. He fulfills his mother's lack, but at the same time, this lack disappears, is no longer a lack. In seizing the object, Damien attempts to recreate a lack in the Other and in this way constitute an Other who can desire elsewhere.

A question as to the differences of the sexes

Not having access to phallic signification, Damien has a problem as to the question of sexual differences. It is for him a question, but is it truly one? A few examples will illustrate our proposition. In the pasture there are three sheep: two ewes and a lamb. Damien always asks, "Male or female?" He doesn't wait for an answer, but starts naming them, pointing, "He's male, she's female, he's the baby." When one explains to him that there are two females and a baby, in his opinion that cannot be. As soon as there are two, they are surely male and female. In the chicken coop, shortly after the elimination of the cock, Damien asked, "And the cock?" When one explained that the cock had disappeared, he said, "No," and, designating a hen, added, "Him. There's the cock." A hen is designated as cock; she is the cock and will remain so for the rest of her days.

What trait can designate male and female? Damien doesn't know. Male and female constitute a signifying opposition which harks back to nothing, which represents nothing. The difference is a pure opposition. To define a class requires the exclusion of a trait. What Damien lacks is the possibility of this very exclusion. The traits are put side by side without a dialectical relation between them. He cannot imagine a "one might say its a cock, but it remains a hen." He isn't lacking the signifier (- phi) which permits him to pose the question "What is a woman?" But to designate a woman, he levies a trait: "udder" or "fat belly." It is all plus and no minus. Consequent to being unable to exclude this trait, Damien cannot situate himself as sexuated being. He cannot say "I am like..." He is entirely the Other through which he is petrified.

What's more, this interest in sexuation rejoins one of his mother's massive preoccupations. She has one passion, the raising and reproduction of different species of birds. It is for her and her entourage a knowledge, an absolute knowledge that she alone detains. Thus a particular knowledge. Before moving, she possessed a large number of cages. However, at a certain moment, the birds had been exterminated by an epidemic. So there only remains a few couples of different species. Since then, she arranges these birds become rare with precious care. She isolates the female at the right moment and puts her with the male at the right moment. She speaks a lot of this to Damien. She explains to him that the bird keepers aren't as competent as herself. She is the only one who knows how to recognize the sexes. One day, Damien's mother even got angry at the birds that hadn't lain eggs at the right time and punished them by separating them from the other birds as if there had been some malevolent intention on their part. Note that, to no one's astonishment, one often surprises Damien in the act of hopping like a bird. His mother often calls him "rare bird."

Damien is visibly caught in a knowledge without holes that his mother possesses, in everyone's opinion, on the question of the difference between the sexes. He is clearly in position to represent the truth of the object of the maternal phantasm6.

The work realized in institution

It was the work in "workshops" that permitted us to grasp Damien's problematic and clarify what happened in the more quotidian work7. The reflection made on his case and the theoretical essay have aided each and every member of the team to position him/herself.

The first year after his admission, Damien participated in a workshop called "Playdough" with two other children, fact which would prove to be important. There he repeated his problematic and confronted me with two types of problems. Firstly, he made the equivalent of a series of signifiers (S1-S1-S1...) with the materials. He thus made animals summarily represented and named them (snake, crocodile, etc.) took a knife, gutted them and asked for help, adding, "It's bleeding." He gave them to me so that I would abandon them in a corner where they would lose all their blood and die. The animals became people whom he asked me to help him make. This was carried out in the following way: "It's the mama's belly," and he would cut a bit off..."It's the baby," the two are hungry and die. And he made prolongations of his hands that he would cut. He covered my hands with clay, said there was a monster in there, the finger came out, ate the hand, he killed the monster that ate the hand, etc. In all this activity, Damien put me in a position in which I was non-existent insofar as desiring subject. He used me to introduce me into his infernal circuit as Other insofar as simple prolongation of himself. He remained, himself, entirely fixed by the signifiers of the Other.

A second problem appeared right from the start; that of stopping the activity. The series developed might continue for hours without stop. Stopping was unbearable for him and rendered him very agitated and anguished. He would turn around and around without being able to leave the room, trying to seize a bit of clay that he would then hold onto, sometimes for several days, even at night. It was also impossible for him to make and save under whatever nomination an object without transforming or destroying it.

After several months, one of my interventions would produce an important modification. This had to be stopped; I refused that day to work with him, to play his game, and I told him, designating another child at work, "That's enough. Look at Sabine. She at least makes something with the clay. And what's more, she sells the objects she makes." Damien looked at me surprised, stopped, looked at Sabine and left the room without taking away anything this time. The following weeks he refused to come to the workshop. Then he came back and told me, "Me too. I do like Sabine, make eggs." From then on he made objects that he took to give away as gifts. He repeated this for several weeks then quit coming.

Important consequences came out during the weeks that followed. Damien was integrated into the school and brought each time an object to Courtil and inversely from Courtil to the school. This object would end up being reduced to almost nothing, for example a bit of paper. He even installed a circulation of objects between Courtil and his family. The temper tantrums and anxiety attacks linked to separation disappeared. In their place, he accumulated objects, a voluminous collection that encumbered his room and the hall before each return home for the weekend. Each time, I would sort them with him and reduce the big pile to one object for each family member. This operation was completely appeasing for him.

What happened in this intervention? Firstly, I said no to the jouissance, and I decentered my attention on another, marking that I desire elsewhere, that what interests my desire is something other than him. This allowed him to be able to make himself loved for an object other than himself, and to give what he doesn't have – as if in the register of love – but in positivizing it. What here resembles love is, in fact, a localization of jouissance in an object destined to circulate.

Damien thus passed from a position where he tore a bit of the body of the Other, an attempt to avoid himself being the object of the Other's jouissance, to a position where he proposed to the Other another object, which, while not what he lacks, is here a real object put into circulation, allowing him at the same time to circulate from one place to another and procuring him a great deal of appeasement. The object that he exchanges comes to mediate the separation and put me in a position of third.

A new period then opened, new material became accessible: painting. He then began a work of reorganizing the universe in two parts around the differentiation of male and female. He asked me each time to be equally the element that separates the two for this reorganization. He drew very rapidly, at first tracing a meany and a nice guy who argued and devoured each other once again. But he now concluded, "That's enough," and stopped. He then reconstructed the drawing by dividing it in two with a line or with a person and enclosed the ensemble with a circle.

After that, he sorted out a series of animals, arranging on one side the males that he recognized by a trait – penis or horn – and the females on the other, distinguished by another trait – udder or fat belly. He would take out two males who fought while the females watched. He asked me to say, "Arrested, in prison." He would then terminate by arranging the males in one cupboard and the females in another. Thus, he needed a real limit, which produced a partitioning accompanied by a noticeable appeasement lasting several hours.

Damien entered puberty and grew quickly. This transformation of his body had catastrophic effects in fixing him once again under a swarm of signifiers: big, male, strong, cock, monster. He became dangerous, above all with the little ones. He then completely identified to a big person who transformed; he attached himself to a television character, the Hulk. Imitating this demi-monster hero, it was particularly at moments when he was alone that he said, "Me. All green. Hulk," mimicking the transformation; tearing his clothes under the pretext that they had become too small, he roared and simulated a horror mask.

It was at this point that I took up again regular work with him, which appeased him right away. Hulk became once more a television character, no longer himself. I intervened in two ways. Each time he froze in this sort of erection, I introduced a little difference. I told him, for example, "One can be big, strong and not mean." Or I said, "When one is big and strong, one can work." And I did repair work around the buildings with him. He took this very seriously. What's more, since he was big, the moment was come when he could change schools and learn the rudiments of a trade.

In the workshops, he was interested once again in the partitioning of animals and clay. He pursued his reconstruction of a divided world always on the same plan. But new organizations appeared. He would construct houses out of the clay, and he introduced new classifications. The domestic animals went inside the houses, the wild ones stayed outside. He associated the male and the female of the same family, adding the baby. He then found himself very embarrassed. He lacked animals to form complete families and discovered that the baby is the only one who can be adopted and become the son of any father who can sustain the words, "You are my son." The father is the one who works, the son helps him. This discovery was very important for Damien and produced a remarkable appeasement. Every weekend he worked with his father at masonry and took up in a massive fashion the traits of the profession.

A work on identifications has now become possible through the reinforcement and fixing of a socially acceptable trait: "worker." Where can all this go? If there is appeasement, will the reinforcement of identifications suffice to stabilize him? Damien still often needs the real intervention of the Other so that things can be organized. Can one replace the Other, or should one consider this impossible?



1Lacan Jacques, "On a question preliminary to any possible treatment of psychosis" Ecrits: A Selection. trans. A. Sheridan. Norton, 1977; p. 209.

2cf. Miller Jacques-Alain, "Cause et consentement" course of 1987-88. Unpublished, courses of the 20th and 27th of April, 1988. Also J.-A. Miller, "Schizophrenie et paranoia," Quarto, n°10, 1983, pp. 18-38.

3cf. Lacan J., "Position de l'inconscient," Ecrits, Paris, Le Seuil, 1966; pp. 846-848.

4Lacan J., ibid; p. 848 and J.-A. Miller. "Schizophrenie et paranoia." op.cit., pp. 32-33.

5Miller J.-A., "Cause et consentement." op.cit., April 27, 1988.

6Lacan J., "Deux notes sur l'enfant", Ornicar ?, n°37, 1986; pp. 13-14.

7For a definition of the work in "workshop", see Dominique Holvoet. "D'une tentative de localisation de la jouissance avec un enfant autiste", Les Feuillets du Courtil, n°2: May, 1989; pp. 69-79.