The Schizoanalysis Project, Part 4

On Freud's Regression Theory of Psychosis

“Schreber’s ‘rays of God’, composed of a condensation of solar rays, nerve fibers and spermatozoa, are in fact nothing other than the libidinal investments, concretely represented and projected outwards, and so lend his delusion a striking conformity with our theory…It will be for posterity to decide whether there is more delusion in the theory than I might like, or more truth in the delusion than others are today willing to believe.”

-Freud, “Psychoanalytic Notes on an Autobiographical Account of Case of Paranoia” (or, The Schreber Case)

Some of Freud’s clearest

statements on psychosis can be found in two brief articles from 1924 entitled “Neurosis and Psychosis” and “The Loss of Reality in Neurosis and Psychosis.” The first of these concise statements rearticulates insights about the psychoses already present in Freud’s study of the Schreber Case in light of the tripartite schema of ego, id, and superego that reaches its full development in the 1923 The Ego and the Id: “neurosis is the result of a conflict between the ego and its id, whereas psychosis is the analogous outcome of a similar disturbance in the relations between the ego and the external world.” Yet the contrast presents an immediate problem, for if neurosis and psychosis result from different kinds of conflicts, how can Freud nonetheless maintain that “[t]he etiology common to the onset of a psychoneurosis and of a psychosis always remains the same”?

Freud’s answer is that both derive from the unfulfilled desires of the infantile stage, “which are so deeply rooted in our phylogenetically determined organization,” but the resulting “pathogenic effect depends on whether…the ego remains true to its dependence on the external world and attempts to silence the id, or whether it lets itself be overcome by the id and thus torn away from reality.” But this only shifts the problem, for now we are forced to ask what determines the ego’s choice in this matter. It is true that “[a] complication is introduced into this apparently simple situation by…the existence of the superego,” but it is not enough to resolve the underlying problem, and Freud must conclude that “there remains to be considered of what the mechanism, analogous to repression, can be by means of which the ego detaches itself from the external world.”

Hence in “The Loss of Reality in Neurosis and Psychosis” Freud must face the objection that his formulation “does not at all agree with the observation which all of us can make that every neurosis disturbs the patient’s relation to reality in some way.” Though “[t]his contradiction seems a serious one…it is easily resolved” if we keep in mind the proper definition of neurosis. The error lies in equating a neurosis with the moment of primary repression through which it first forms. Neuroses are formed when underdeveloped drives in the id, fixed in the earlier, infantile stage, come into conflict with the rationalized demands of the ego, constrained as it is by the prohibitions of the superego and its “reality principle.” But the primary repression through which the ego banishes the transgressive drive into the unconscious is not the neurosis. For the repressed drive is not silenced, only diverted, made to redirect its energies into the distorted form of the symptom, which forces its way into consciousness again and again. Repression, as Lacan emphasizes, is always already the return of the repressed.

The most important similarity between neurosis and psychosis, then, lies in this “second step,” which “[i]n both cases…serves the power of the id, which will not allow itself to be dictated to by reality.” Even if both neurosis and psychosis are “the expression of a rebellion on the part of the id against the external world,” however, the question remains as to what explains the difference “in their first, introductory, reaction.” Neurosis distorts reality by fleeing from it, psychosis by remodeling it: “neurosis does not disavow (Verleugnen) reality, but simply ignores it; psychosis disavows it and tries to replace it.” Even while insisting upon this isomorphism between neurosis and psychosis, however, Freud still concedes that in the latter “the emphasis…falls entirely on the first step,” wherein some reality is not simply ignored but disavowed, “which is pathological in itself and cannot but lead to illness.” As before, whether the unconscious pursues the strategy of flight or disavowal will depend upon “the topographical difference in the initial situation of the pathogenic conflict–namely whether in it the ego yielded to its allegiance to the real world or to its dependence on the id.” Hence Freud again comes close to recognizing that psychosis involves a fundamentally different mechanism from repression, only to retreat into a simpler regression theory of psychosis: madness is the primary process run amok, overwhelming the ego’s flimsy defenses.

Yet how is it that the repressive mechanism involved in psychosis can be at once too strong and too weak? Stronger than repression, as the drive’s object is not displaced onto a substitute but removed from reality entirely; yet also weaker, since the ego nonetheless loses its struggle against the more powerful forces of the id. We are to understand that in psychosis the ego shatters and attempts to reconstitute its unity upon hallucinatory terrain, but what is it that precipitates the ego’s demise, and is the story as simple as infantile regression in the face of an overpowering drive?

We can see how this theory, along with the effort to contain psychosis in the familiar, Oedipal terrain of the neuroses, are already present in Freud’s interpretation of the Schreber Case. After recounting the case history, Freud’s opening move is to reverse Weber’s assertion that out of the two main features of Schreber’s fantasy–”the role of the Redeemer and the transformation into a woman”–the former, religious theme takes priority over the latter, sexual one, and his “task…will be to prove an essential, genetic relationship between these two elements” (The Schreber Case, p. 23). By the same token, Freud’s strategic decision to focus on “the factors which prompted [Schreber’s] illness” rather than “the delusional remarks of the patient himself” is as much a repudiation of Jung, whose “brilliant example” Freud mentions only to then ignore, as it is an affirmation of the psychoanalyst’s predilection for reading between the lines. With respect to the latter, we can certainly understand Freud’s choice of the “speaking birds” and the “forecourts of heaven,” plucked as if at random from the manifold elements of Schreber’s cosmology, on the model of those unacknowledged clues to the unconscious that surface in dreams, jokes, and slips of the tongue. But are these considerations strong enough to justify Freud’s decision to direct his attention almost entirely away from what Schreber himself described as the “factors which prompted his illness”–namely his loss in the elections to the Reichstag and his appointment as Senatpräsident–and almost exclusively towards “a small part of the case history that is not sufficiently acknowledged in the assessments…Schreber’s relationship with his first doctor…Flechsig”?

The closer we look, the more we see Freud presupposing the very assumptions his interpretation is meant to vindicate. Freud’s reversal of Weber’s interpretation is justified because “[w]e already know that the Schreber Case initially fitted the mold of the delusion of persecution, and that this became obscured only after the turning-point of the illness” (The Schreber Case, p. 29, emphasis added). In the same way, when Freud hypothesizes an identity between Flechsig and Schreber’s father, it is not on the basis of Schreber’s own words, but because the thesis, once posited, “must be of use for our understanding helping to enlighten us on incomprehensible details of the delusion” (The Schreber Case, p. 39). Throughout his career Freud repeatedly affirmed the unity of psychoanalytic theory and practice, the imperative that its conceptual armature remain firmly tethered to the analytical situation. Only here, with a subject whom he has never met, let alone treated, we see Freud proceed not inductively, proving the homology between neurosis and psychosis with the resources that Schreber’s account offers, but deductively, presupposing the validity of the Oedipal framework from the outset and testing how far the assumption takes him in understanding.

The basic contours of Freud’s interpretation of Schreber are well known. By paring away the vast social, political, and religious elements of Schreber’s fantasy and concentrating on his relationship with Flechsig, he quickly arrives at an explanation:

“We should not, I think, object any further to the supposition that the cause of the illness was the emergence of a feminine (passively homosexual) wishful fantasy, which had taken the person of the doctor as its object. This provoked an intensive resistance on the part of Schreber’s personality, and the defensive struggle, which might perhaps as easily been pursued in other forms, elected for reasons unknown to us that of a delusion of persecution” (p. 37, emphasis added).

The diagnosis of repressed homosexuality meshes naturally with the regression theory of psychosis. According to Freud, it results from fixation in the narcissistic stage of infantile auto-eroticism, prior to “the attainment of heterosexual object-choice” (The Schreber Case, p. 52). In the normal course of development, Freud tells us, the homosexual inclinations expressed in infantile narcissism are later sublimated and redirected into prosocial tendencies such friendship, community, and “the general love of mankind” (The Schreber Case, p. 52). In homosexuality, a refusal of the heterosexual object-choice that prompts this sublimation results in “the choice of an object with similar genitals” (The Schreber Case, p. 53). The key to Schreber’s identification between Flechsig and God, then, “the return of another similarly loved but probably more notable person,” that is, the regression to a “boy’s infantile attitude towards his father,” with its characteristic “combination of reverential subordination and rebellious resistance” (The Schreber Case, pp. 39-40). Despite all of the exotic features of Schreber’s fantasy, “we once more find ourselves on the distinctly familiar ground of the father conflict,” in which “[t]he father’s most dread threat, that of castration, has furnished the material for the wishful fantasy (initially resisted then accepted) of being transformed into a woman” (The Schreber Case, p. 43). And if the sun too turns out to be “nothing other than a sublimated symbol for the father,” then Freud “cannot be held responsible for the monotony of the solutions provided by psychoanalysis,” for this is simply the nature of the unconscious and its stubborn symbolism (The Schreber Case, p. 42).

On this account, paranoia is caused by “a flood of libido” fixated in the narcissistic stage and “which finds no other outlet…subject[s] [the] social drives to sexualization and so reverse[s] the sublimations that they have achieved in the course of their development” (The Schreber Case, p. 54). Crucially, then, the paranoid delusion develops out of the paranoiac’s effort “to fend off such sexualization of their investments of social drive.” This “pathological disposition,” lodged at a “weak point in…development…between auto-eroticism, narcissism and homosexuality” that is responsible for “Kraepelin’s dementia praecox or what Bleuler has called schizophrenia” (p. 53). But what seems to be missing here is not only an explanation of why the ego’s defense mechanisms should prove so insufficient, but also why Schreber’s surge of homosexual libido “finds no other outlet.” We can see all of the elements of the Oedipus complex in the Schreber case on the very surface of his text, but we still have no answer to the question we set out with, namely why Schreber’s unconscious should response to this “flood of libido” with a psychotic fantasy rather than the formation of a neurosis. For if it is simply a quantitative matter of the libido’s strength relative to the ego’s weakness, we cannot explain why Schreber’s desire for Flechsig should erupt with such force eight years after he had last seen the doctor. Nor do we have good reason to doubt Schreber’s protest that he found the idea of becoming a woman “foreign to [his] whole nature”; that is, we have no evidence that Schreber struggled with sexual attraction to men before this point. To the contrary, we saw that at a critical moment in his interpretation Freud admits his perplexity at why Schreber’s attraction to Flechsig should transform into a persecution fantasy when “the defensive struggle…might perhaps as easily have been pursued in other forms” (The Schreber Case, p. 37). What is it about psychotic desire that proves so resistant to sublimation and so autocratic in its creation of a hallucinatory world?

Louis Sass has raised serious doubts about the “Dionysian” view of schizophrenic psychosis as regression to infantile auto-eroticism, which he credits Freud’s text on Schreber with establishing. As Sass also points out, however, Kraepelin, Bleuler, and Jaspers all offer variations on the same theme, indicating the extent of its dominance in 20th century psychiatric discourse on psychosis. But if Kraepelin is correct in maintaining that dementia praecox (schizophrenia) entails “inevitable and progressive mental deterioration” into the equivalent of senile dementia, then Schreber surely offers the most remarkable counterexample, as Freud’s own “anxiety of influence” over the Memoirs and its theoretical sophistication suggests. Indeed, Schreber described his condition as one of “constant thought.” Similarly, Sass focuses on phenomenological features of schizophrenic psychosis that evince the opposite of the regression hypothesis: not the suspension of reason but its intensification, a kind of hyperreflexivity, or “acute self-consciousness and self-reference,” that threatens to trap the schizophrenic consciousness in a web of philosophical paradox made real. “Could the disorganization [of the ego] in question be something more intricate, not a process of being overwhelmed by antagonistic forces but more of a self-undermining–like something turning in upon itself until, finally, it collapses of its own accord?” (Madness and Modernism, p. 8).

With these characterizations in mind, Freud’s concluding remarks on the Schreber case appear in a new light. Why is it that “various…details of the formation of Schreber’s delusion sound almost like endopsychic perceptions of the processes” that Freud describes in his own theory as “constitutive for the understanding of paranoia” (The Schreber Case, p. 66)? Freud insists that he is “able…to call on a friend and expert in the field to bear witness that I developed the theory of paranoia before the contents of Schreber’s book came to my notice,” and Eric Santner has argued convincingly that the Schreber case reflects Freud’s anxiety of influence over whether the “unshakable dogma” of his sexual theory would remain the core of the emerging discipline of psychoanalysis (see Santner, My Own Private Germany). But what is at stake here is much more fundamental and goes to the very heart of the psychoanalyst’s claim to reveal the truth of the unconscious. If Schreber’s fantasy is indeed an astonishing endopsychic perception of the unconscious and its mechanisms, then what Freud sees as a regressive resexualization of higher, social drives risks becoming its dialectical opposite: the insight, uncannily similar to the psychoanalyst’s own, that the symbolic forms of human social organization are nothing more than sublimations of more fundamental, sexual drives. Is the psychotic’s shattered ego the result of regression to a primordial state of desire prior to the formation of the subject? Or is it instead a mobilization and acceleration of thought at its most abstract and sublimated until the fiction of the subject and the entire history of repression that produced it finally collapses?

Though Sass is interested in comparing schizophrenic hyperreflexivity to the preoccupation with alienation and introspection in modernist art, he hastens to avoid making any “causal” claim about the relationship between social repression and psychic repression, settling instead for sketching a series of formal parallels. Our reversal of Freud’s order of priority in the two parts of Schreber fantasy, however, forces us to ask whether a sociopolitical etiology is inescapable when explaining a paranoid delusion so rich in social and political themes. Here the question is whether Schreber’s sexualized investments in the social drive result from an overpowering surge of infantile libido from the id that overwhelms the ego’s defenses, or whether, instead, it is a crisis in the social order responsible for facilitating the sublimation of sexual desire that, once consciously recognized as an empty space that must be filled, provokes a resexualization of the entire social field. Only in light of this latter hypothesis, and not through the eternal return of the father, can we understand how Schreber’s constant production of voluptuousness is able to bear the whole weight of the Order of the World, in a moment in which all moral limits to voluptuous excess are abolished and Schreber is no longer either woman or man but “man and woman in one person having intercourse with myself” (Memoirs, p. 250).

Freud comes closest to a solution to this problem at the conclusion of “The Loss of Reality in Neurosis and Psychosis.” Both neurosis and psychosis involve the loss of reality, but

“whereas the new, imaginary external world of a psychosis attempts to put itself in the place of external reality, that of a neurosis, on the contrary, is apt, like the play of children, to attach itself to a piece of reality–a different piece from the one against which it has to defend itself–and to lend that piece a special importance and a secret meaning which we…call a symbolic one.”

The neurotic’s obsessive attachment to or hysterical avoidance of this special object is the symptom from which he suffers, and the cure is attained when the psychoanalyst succeeds in restoring the Oedipal “primal scene” that the symbolism both conceals and reveals. But having seen the difficulties of applying this schema to Schreber, we cannot avoid the suspicion that the psychotic, having already seen through all the symbols, suffers from the Oedipalization of the unconscious itself. To understand this side of the psychotic’s plight, we must now turn to Lacan, who puts Schreber at the very center of his return to Freud.