Stijn Vanheule

Psychotic disorders are among the most disabling and stigmatizing conditions, posing major challenges for affected individuals, families, communities, and health systems. Services have historically...

This paper examines the Lacanian psychoanalytic approach to understanding and working with autistic persons, with a specific focus on the insights of Jean-Claude Maleval. Building on recent developments in Lacanian theory and practice, we explore Maleval’s theoretical and clinical framework, with particular attention to the role of preferred objects and specific interests in the lives of autistic persons. Maleval argues against the conventional view of autistic withdrawal as a fundamental trait, proposing instead that it stems from an anxious response to the desire of the Other. He explains how autistic persons employ a retention of drive objects as a defense mechanism, especially by not “giving up their voice” in shared linguistic discourse. Additionally, Maleval highlights the concept of the autistic rim , wherein autistic objects or specific interests are singular subjective inventions that serve not only as protective measures against anxiety and intrusion but also as potential pathways to social connection. By placing Maleval’s ideas in dialogue with earlier thinkers like Leo Kanner and Francis Tustin, this paper underscores the evolution of psychoanalytic thought on autism. Finally, through the analysis of a clinical case study, it shows how Maleval’s insights can inform Lacanian analytic practice and open new possibilities for engaging with autistic persons.

This article examines central ideas from Jacques Lacan’s later psychoanalytic theory on psychosis. In the 1950s, Lacan formulated a structural model of psychosis, asserting that the central element of symbolically organized mental life, the Name-of-the-Father, is missing, leading to a latent vulnerability for psychotic episodes. In the 1970s, Lacan made significant changes to this model by introducing two new concepts: Father-of-the-Name and père-version. These concepts are plays on the original Name-of-the-Father concept and refer to two other aspects of the father function: the creative act of naming and embracing modes of life, respectively. Furthermore, in the 1970s, Lacan suggested that creating coherence in mental life does not necessarily require an exemplar of a paternal identification figure. Drawing from the case of the modernist writer James Joyce, he argued that singular inventions can just as effectively establish stability. This argument is elaborated upon by introducing the concepts of “sinthome” and “escabeau.”

Background: Being subjected to or witnessing coercive measures in mental health services can have a negative impact on service users, carers and professionals, as they most often are experienced as dehumanising and traumatic. Coercion should be avoided, but when it does happen, it is important to understand how the experience can be processed so that its consequences are managed. Method: A systematic review and meta-ethnography was used to synthesise findings from qualitative studies that examined service users’, staff’s and relatives’ experiences of recovery from being exposed to coercive measures in mental health care settings. We identified, extracted and synthesised, across 23 studies, the processes and factors that were interpreted as significant to process the experience. Results: Recovery from coercion is dependent on a complex set of conditions that support a sense of dignity and respect, a feeling of safety and empowerment. Being in a facilitating environment, receiving appropriate information and having consistent reciprocal communication with staff are the means through which these conditions can be achieved. People employ strategies to achieve recovery, both during and after coercion, to minimise its impact and process the experience. Conclusions: The findings point to the importance of mental health care settings offering recovery-oriented environments and mental health professionals employing recovery-oriented practices, that would empower service users to develop strategies for managing their mental distress as well as their experiences in mental health care in a way that minimises traumatisation and fosters recovery.

This paper examines the principal ideas from Jacques Lacan’s psychoanalytic theory of psychosis. According to Lacan’s theory in the 1950s, the central organizing element of symbolically organized mental life, the Name-of-the-Father, is missing in psychosis. That theory changes with later conceptual developments in Lacan’s work that focus on the incompleteness of symbolic functioning. This connects with how, in his works from the late 1960s and the 1970s, Lacan embraces the idea of a fundamental non-rapport and symbolic non-existence at the basis of mental life. In a second step, the paper explores what the Lacanian model of psychosis implies with regard to ethical positioning, addressing the unconscious, handling transference, and crisis and stability in psychosis. A clinical case discussion focuses on a yearlong therapeutic trajectory with a young man with Down’s syndrome who suffered from psychotic experiences.

In this contribution we discuss manic language phenomena within a Lacanian framework. Although Lacan only touches upon the phenomenon of mania on a few occasions, his seemingly scattered and scarcely elaborated comments on mania allow for the development of a coherent view of mania as a phenomenon of language. First, we situate flight of ideas as a phenomenon of the signifier rather than of signifieds, of language rather than of ideas, and propose to call this flight of signifiers. Then we comment and elaborate Lacan’s comments on mania. Lacan qualifies the manic subject as being delivered to the endless metonymy of the signifying chain; and describes manic excitation as a return to the real of language. In both these instances, Lacan situates mania within the realm of psychosis and considers mania as a form of language gone mad. Next we discuss Lacan’s notion of llanguage as a parasitic force of dysregulation and how this affects Lacan’s view on manic language. Manic language is now no longer considered an instance of language gone mad, but is rather thought to reveal something of the madness of llanguage lurking beneath the surface of language. Throughout Lacan’s sparse comments on mania the element of language is always prominent as is the question what manic language reveals about language as such.

This paper discusses how, starting from Blaise Pascal’s Wager about God, in his later teaching Lacan rearticulates his Name-of-the-Father concept. Building on a discussion of Lacan’s (1963) single seminar session on the Names-of-the-Father and his 1968–1969 discussion of Pascal’s Wager in Seminar XVI, the author examines what this changing conception implies for the Lacanian approach of psychosis. It is argued that – contrary to what Lacan suggests in the nineteen fifties – within these works from the sixties the Name-of-the-Father no longer refers to a privileged signifier, but to an act of faith concerning the virtuousness of the Other. This act of faith functions as a guarantee for the articulation of the subject, separates the subject from what Lacan calls “object a”, and establishes a positive expectant relation with the Other. The strength of Lacan’s revised conception is that it opens new perspectives on the psychoanalytic treatment of psychosis.

The recovery processes of persons with complex mental health needs take a slow and unpredictable course. Despite the fact that a number of essential building blocks of recovery in this population have been identified (e.g. social relationships, treatment, personal beliefs), the actual process of recovery in persons with complex mental health needs largely remains a black box. The aim of this study was to gain insight into how the recovery processes of persons with complex mental health needs take place, by applying a relational geographical approach and scrutinizing the place-making dynamics of one low-threshold meeting place in Belgium engaging with this group. Data collection took place during the height of the COVID-19 pandemic by means of 11 in-depth interviews with different involved actors (service users, staff members, volunteers) and analyzed thematically. Results showed how the daily practice of the meeting place is continuously reproduced through place-making rituals that create an inclusive space of hospitality, are fueled by creative processes and form an indispensable counterweight for service users’ mental health needs. To further open up the ‘black box’ of recovery in persons with complex mental health needs, it is vital to focus our analytic gaze onto recovery as a dynamic and relational practice.