Palimpsest

The last thing, therefore, treatment should aim to do with severely disturbed patients is to crash in and rob them of their delusion or snuff out their minds with drugs. With paranoid patients, any such intervention is likely to be experienced as an assault. For Leader, the question the analyst should be asking is not how can I cure or help the psychotic, but what use can she or he make of me? One of the strongest impressions conveyed by this book is the immense respect Leader feels for his patients. Above all he wants to listen. In the words of one of his patients: “I have to make you into a hearer.”

It is fundamental to a Lacanian understanding of psychosis that something in the world of meaning has been breached. Usually, language just about holds to its rules, fixes the world into some kind of symbolic network, and passes without too much trouble between the one who is speaking and the one who is addressed. In psychosis it fragments or takes on grotesque, inflated proportions, voices emanating from nowhere or from God. Even in these deformations, however, there is something we might recognise. After all, language first comes at the infant as voices against which there is no defence.