In his paper, ‘The Loss of Reality in Neurosis and Psychosis’, Freud put his finger on a problem which was, according to Lacan, not the loss of reality but of what takes its place. [1] Freud doesn’t focus on it only in 1924 but also in 1911 in the paper on Schreber where he writes that what distinguishes Schreber’s case from others is its further development and the transformation it underwent. [2] What counts for Freud, and Lacan follows him, is the subject’s compensatory invention producing a transformation in the case. The transformation is the effect of what Freud called variously, compensation, construction, sublimation, new reality and even a patch.

I suppose it’s Kraepelin who provides the first definition of this phenomenon. He achieved it in 1896 and 1899 in his Textbook: paranoia is the gradual development of internal causes, motivating a progressive evolution of a stable delusional system that is impossible to disturb, establishing itself with preservation of clarity and order of thought, will and action. Lacan adds his own caveats: it is not necessarily gradual; it is not quite that stable in that new material is often used to develop it further when this becomes necessary- let’s add to come to the support of its compensatory value. [3] I myself am unable to say whether Kraepelin thought it had the value of a compensation.

In his 1899 report on the patient Schreber, Dr. Weber, the Director of the Sonnenstein Asylum, shows that he does not understand that there is a link between the patient’s ‘transformation’ and the delusion. According to Dr. Weber, Schreber shows no signs of confusion, his intelligence is unimpaired, his mind is collected, his memory is excellent, he has at his disposal a considerable store of knowledge, he takes an interest in events in the world of politics, science and art. We could say that in the course of his psychosis the outcome is the establishment of clarity and order of thought, will and action- which complies with one part of Kraepelin’s definition of paranoia. [4]

What about the other part of the definition? From Dr. Weber’s report we learn that a redeemer delusion had become systematised, that Schreber constructed a belief about his mission to redeem the world and to restore mankind to its state of bliss, the pre-condition being his transformation from a man into a woman. For this to happen an enormous number of female nerves invaded his body, and these nerves in a state of great excitement exert an attraction on God. This will happen over centuries. In some century or other these nerves will be impregnated by God and a new race of men created to redeem the world. This is by no means the complete unabridged delusion. Schreber insists that he does not wish to be transformed into a woman. He would prefer to remain in his own honourable, masculine station in life. He says that he is constructing something based on the Order of Things. [5]

In spite of clarity and order in thought, will and action, Dr. Weber writes in his report of 1899 that the patient is full of pathological ideas which have formed themselves into a complete system, and are more or less fixed and inaccessible to correction by means of any appreciation of the external facts. And this is one of the reasons that the Director of the Asylum was against his discharge. [6] Dr. Weber did not grasp the connection between clarity and order of thought, will and action and the systematised delusion.

Jacques-Alain Miller asserts that the psychiatric foundations of psychoanalysis are absolutely necessary. [7] Kraepelin well founded the concept of paranoia, Freud emphasised it and Lacan made it a Freudian cause. Miller honours this device by providing it with its own signifier, namely compensatory make-believe (CMB). [8] It seems that the notions of make-believe and the pluralisation of the Name-of-the-Father are stepping stones in the shift from the early to the late teaching with respect to psychosis, that is, the shift from the early teaching on psychosis to le sinthome.

In S11 Lacan touched on the concept of make-believe under the name mimesis. Miller often translates Le semblant into English as make-believe whilst everyone else translates it as semblance. I’ll follow Miller in this. The best definition by Lacan that I’ve ever come across makes out that The Name-of-the-Father cannot hold up without thunder which is the sign, he says, of the very figure of the make-believe. [9] I think that’s a good definition, and I’ll use it: He who has to huff and puff to make a point is a make-believe. But it’s not simply dependent on character. What kind of character does the phallus have? It huffs and puffs, doesn’t it? Lacan calls the phallus a paper tiger in, I think, The Four Fundamental Concepts of Psychoanalysis. I only think because I can’t find the reference. Chairman Mao at the height of the Vietnam War called American power a paper tiger. To my mind a paper tiger is the very sign of the make-believe. The Name-of-the-Father who guarantees the phallus its station in the world and the paternal ideal are turned into make-believes in one fell swoop.

The pluralisation of the Name-of-the-Father (names-of-the-father) constitutes a further downgrading. [10] The Name-of-the-Father is without peer. ‘I am the One God.’ So goes the monotheistic message, which for Lacan gives it a pure symbolic status. The pluralisation of the signifier signifies that the name of the father is one amongst others. The names of the father are no longer purely symbolic but fall apart into symbolic, imaginary and real elements, [11] and these elements can become compensatory devices, the symbolic Father no longer being a safe option.

Lacan’s use of the notion of ‘enigmatic void’ and ‘perplexity’ is inspired by the phenomenological approach of Jaspers, according to Wachsberger. [12] It is found in the Écrits: ‘What is actually involved is an effect of the signifier, in so far as its degree of certainty (second degree: signification of signification) takes on a weight proportional to the enigmatic void that first presents itself in the place of signification itself.’ [13] My supposition is that the loss of reality in psychosis in Freud’s doctrine follows the phenomenon of the enigmatic void in the psychiatric, phenomenological tradition. The subject as a speaking being is certain (first degree) that the phenomenon of enigmatic void is charged with signification from which he cannot yet extract any meaning: S/s0. In this moment the speaking being will only receive effects of the signifier and suffers perplexity. There isn’t that much certainty at the onset of a psychosis, and the speaking being may be motivated to raise certainty to a second degree. A second degree of certainty arrives when the CMB is constructed enough to allow the second signification. This is the subject’s own meaning. It will be delusional. It will be the subject’s new reality, as Freud calls it.

Schreber is not mentioned in the paper; nevertheless it is clear to me anyway that Freud’s thoughts are with Schreber. The delusion which is taking the place of the lost reality Freud also calls reparation which constitutes a new reality, [14] a specialised delusion constructed as a compensation. [15] In another paper, ‘Neurosis and Psychosis’, published a little earlier he calls this new reality a patch placed on a rent. [16] Should we say that this rent is in reality? We have to work from Lacan’s topology, RSI. The rent is in the symbolic. The patch is reparation, that is, a construction filling in the hole in the symbolic. Schreber constructed it with acts of language, [17] providing the subject with a world he can live in a little more comfortably than previously. [18] We can find other terms that Freud used which would achieve this aim: for instance, compensation and sublimation. [19] Lacan gives us the structure, namely, signifier over signified which speech in action stabilises in the delusional metaphor. [20] This is a structural approach to Freud’s reparation.

Prior to any possible treatment the paranoiac is, evidently, treating himself. In his paper on Schreber Freud is focusing on a subject treating himself. Maybe one cannot imagine anyone treating the paranoiac but the paranoiac himself. One especially cannot imagine treating the paranoiac by insisting on homosexuality as cause of his condition. The regression to narcissism that is part of the psychotic process- and is not homosexual in origin- occurs as a result of foreclosure of the Name-of-the-Father. The ego ideal that dominates the mirror stage in neurosis is a paternal ideal. Foreclosure of the Name-of-the-Father subverts the function of the ego ideal, and the imaginary in paranoia functions autonomously free of any ideal constraints unless the new construction introduces them. The ego is restored to the subject but in a grandiose form called pathological narcissism in the post Freudian movement.

Prior to any possible treatment we have to reckon with Freud’s pessimism about treatment in these cases. He thinks that in the case of psychosis transference is limited to a negative one which would mean that there is no possibility of treatment. [21] Is he following a logic which he himself introduced into his doctrine or is he following his experience? The logic he introduced is that psychotic structure is the reverse of neurotic structure, neurosis being the model. If the transference is mainly positive in neurosis, it is mainly negative in psychosis. The unconscious is hidden in neurosis, it is observable in psychosis. Although psychotic structure is in opposition to that of neurosis, the paranoiac lives life very close to normality. For Kraepelin paranoia is the only psychosis that has a psychogenetic origin. Briole tells us that, according to Kraepelin, the normal subject faced with a real injustice could develop a legitimate paranoia. But Briole does add that a subject can live its paranoia in a neurotic manner, that is, with a bar placed with more or less efficiency across the Other. [22]

‘Loss of Reality in Neurosis and Psychosis’ begins with the neurotic subject who, guided by reality, represses a piece of the id. By involving reality in the neurotic subject’s relations the psychotic is counted out of reality. [23] A better formulation would be- in my opinion, of course, that the neurotic subject on choosing the symbolic has little access to the real. The neurotic is someone who says ‘yes’ to the signifier of the Name-of-the-Father, as a result of which between the signifier and the real there is an incompatibility. This provides the subject with the potential for a peaceful life. Not many analysts now agree that the Name-of-the-Father necessarily provides the subject with a peaceful life.

Freud gives us the structure of the psychotic subject as he who withdraws from a piece of reality in the service of the id. [24] It’s the opposite case, as you saw, with the neurotic who in the service of reality represses a piece of the id. The Lacanian concept is that, as the effect of foreclosure of the Name-of-the-Father, the symbolic in its dimension of the big Other in the case of paranoia becomes real; in the case of schizophrenia the entire symbolic becomes real, including the body. Reality is not foreclosed. For the paranoiac enjoyment is situated in the place of the big Other. Enjoyment comes to the subject from the big Other by way of speech, for instance the insult, which is a frequent interpretation of the paranoiac subject. In schizophrenia enjoyment is situated in the body. The symbolic is foreclosed, and the possibility for a peaceful life disappears. If one wishes to think psychosis in terms of reality, the paranoiac is detached from reality in his relation to the big Other and nowhere else.

The chief operator in neurotic structure is what Freud calls Verdrängung (repression) which leaves the symbolic intact. For psychotic structure Freud uses three terms. In this 1924 paper the honour passes to Verleugnung (disavowal) which does not leave the symbolic intact. It’s best used in fetishism where the symbolic is left intact. In Freud’s case on Schreber the chief operator in psychotic structure is Aufhebung (abolition). In the Wolf Man case it became known as Verwerfung which is the signifier Lacan eventually translated as foreclosure, the term now in general use.

In psychosis the subject is operating in the service of the id or in the service of dislocated drives. In neurosis the subject is operating in the service of reality in repressing a drive. He also says that a neurotic can have such disturbed relations to reality that it leads to a flight from life. [25] This doesn’t fit very well with a subject guided by reality in order to trigger an act of repression. The best formulation Freud achieves is that the neurotic subject does not become symptomatic until repression fails. [26] Lacan puts it in his own aphoristic way that repression is already a return of the repressed: The subject then seeks compensation for damage to the id as a result of repression. [27] What is this damage to the id. Repression acts on drive producing a loss of enjoyment once experienced by the subject as satisfaction. He will no longer be able to enjoy it. The loss is turned into the cause of desire and desire is the compensation for damage to the id, that is, for a loss. Here Freud is using psychosis as a model for neurosis, desire being the CMB, that is, the compensation for the part of the id that has been damaged.

Freud says that demand for repression comes from reality and that a loosening of the relation to reality occurs when the subject reacts against repression, struggles against the repressive forces. What is the neurotic subject’s reality if not the big Other? What is the neurotic subject’s loosening of the relation to reality if not an attempt to separate from the Other? The subject goes against repression at the point the demand for repression ensues. The attack on the repressive forces is an act that tends towards separation not from reality but from the big Other. [28] There is a relation of conflict between the subject and the big Other. The Other’s demand is articulated in a signifying chain that is alienating. On the other hand, the signifiers of the Other support the subject’s identifications against drive. [29] Associated with the Other’s demand is the object (a) which is a substantial object as left-over-enjoyment, but it is also the loss undergone by the subject who is always returning from separation to alienation. The subject, says Lacan, operating with his own loss returns to alienation, that is to say, to desire. [30] In other words, he or she returns to the Oedipus cleaned up of enjoyment. It’s a failed separation.

In psychosis the ego is dragged away from reality, according to Freud. [31] For Lacan it’s the symbolic from which the subject is dragged away. As a result of foreclosure, the symbolic has a hole in it, and the subject eventually seeks a new reality to fill in the hole. In this event Freud writes there are no restrictions on the id once the ‘old reality’ has been lost. [32] There is no repression in such a clinical structure. Freud says that the psychotic subject re-establishes relations with reality by creating a new reality which does not raise the same objections as the old reality. [33] The new reality is constructed in an act of reparation. The psychotic remodels reality, a remodelling that has the character of reparation- which nevertheless remains delusional. [34] Freud’s new reality is a symbolised real. There are degrees of symbolisation of the real. Eric Laurent calls it a new language, constructed in a linguistics of speech in action to the point that a new language emerges. It will always be partial and always delusional. A CMB is presumably symbolised to a degree sufficient to make it compensatory. It often fails, says Freud.

Freud invented two different, clinical structures for two concepts we owe to Kraepelin, paranoia and dementia praecox that Bleuler called schizophrenia. Regression to the stage of narcissism is operating in paranoia wherein the Other exists as a malicious Other. A further regression to autoerotism is the case for schizophrenia producing somatic phenomena charged with real enjoyment. Schreber also suffered an episode of catatonia, a schizophrenic phenomenon, in which the Other is absent. Lacan credited Schreber with a topographical regression to the mirror stage. The clinical phenomenon was the portrait the voices gave him of himself which reduced the mirror stage to its mortal impact: ‘a leper corpse leading another leper corpse.’ [35] The two objects are in a symmetrical relation which gives us the structure of the mirror stage, but the imaginary has become real, and the subject will have to work hard for his delusional self-love. Schreber is persecuted as a paranoiac and his body is tortured as a schizophrenic. Amongst a long list of somatic phenomena is the delusion that aggregates of foreign nerves were implanted. Some of them were feminine nerves implanted in the bust area. These nerves were to become one of the stepping stones to a delusion that could be called compensatory. Schreber was becoming convinced of the development of a fine feminine bust which he adorned with feminine refinements. [36] In this construction Schreber has access to real and imaginary elements which will fit into a delusion which depends on his capacity to attract God. As circulating bodily enjoyment was trapped in a systematised delusion, regression to autoerotism lessened. He held to the level of narcissism supported by the delusional appearance of a feminine body in his chest over which he lingered in front of the mirror. This is not transvestism or homosexuality but a delusional construction that would entrap the dislocated enjoyment circulating in his body.

Freud acted as a great champion of the category ‘paranoia’ as Kraepelin presented it. Both types of regression are present in the Schreber case, to autoerotism and to narcissism, creating both paranoiac and schizophrenic phenomena. It led Freud to a compromise in the title of the paper on Schreber calling it a dementing paranoia which doesn’t comply with the original place Kraepelin gave to paranoia in the 1896 revision of his Textbook where it is associated with clarity and order of thought, will and action, a list of characteristics which do not describe a dementing process. The centrepiece is the unshakeable delusion. If you think of the category of dementia praecox, Freud created a dementing paranoia which would account for Schreber’s clinical structure. Freud must have been thinking about a future for paranoia in psychoanalysis. Kraepelin considered paranoia to be the one psychosis that falls into the field of psychology. The causality is psychical. If the patient’s inventive construction can reverse regression to autoerotism holding it at the narcissistic level, it probably has a future in psychoanalysis. Lacan made it a Freudian cause.

The central affect in the construction of this compensatory invention is anxiety which is a sign that, according to Freud, the construction of a new reality in psychosis is carried out against forces that oppose it violently. [37] In any form of treatment we would want to deal with that if possible. Flechsig and God were his enemies opposing its construction. It became evident to Schreber that God was far removed from the perfection ascribed to him by religions. Schreber who was a doubter in religious matters before his illness was, after it triggered, convinced that God was incapable of dealing with living men, and was only accustomed to communicating with corpses. [38] God behaved badly to Schreber in the matter of the urge to evacuate his bowels (or to shit, to spell it properly and give Freud his revenge). [39] The rays of God mocked him as Miss Schreber, alluding to his emasculation. According to these rays, the Senatspräsident let’s himself be fucked. [40] This is not a grand homosexuality but persecution by something that can represent his father, namely God, Flechsig being a fraternal figure. Despite such divine persecution, Flechsig was his true enemy.

The delusion involving Flechsig certainly cannot be called a compensatory make-believe: Schreber was to be handed over to a certain person, his soul delivered up to him and his body to be transformed into a female body and surrendered to the person in question; the person in question was Flechsig. [41] He called Flechsig a soul murderer. Flechsig committed soul murder upon him. [42] It was not a CMB but a classical, persecutory delusion. Schreber could never say anything about it, about what constitutes the true essence of soul murder. [43] Soul murder is without a signified, S/s0, a pure signifier, a signifier associated with the real, hence a neologism. It is associated, according to Lacan, with a disturbance that occurred at the inmost juncture of Schreber’s sense of life, the nature of which, Lacan thinks, fell to a censorship in the Autobiography. [44]

At the beginning of the construction of Schreber’s new reality God was sometimes an ally, other times this same God fell under the influence of Flechsig who opposed the construction. Schreber could not avoid the thought that God himself played the part of instigator in the plot against him: Schreber’s soul was to be murdered and his body used like a strumpet. [45] This situation was preventing a compensatory device from being constructed. He was pursued by his father in the form of God far into his psychosis, which was obviously one of the forces opposing the construction.


Richard Klein, Finsbury Park, London


About the author:

Richard Klein is a practising analyst living and working in London. The following papers issue from clinical experience, textual labour and his characteristic commitment to the transmission of psychoanalysis in the Lacanian orientation.


  • [1] Lacan, ‘On a Question Prior to Any Possible Treatment of Psychosis’ (1957/58), Ecrits, W. W. Norton & Co., p. 454.
  • [2] Freud, ‘Psycho-Analytical Notes on an Autobiographical Account of a Case of Paranoia (Dementia Paranoides)’ (1911), SE 12, pp. 47, 48.
  • [3] Lacan, The Seminar, book III, The Psychoses (1955/6), Routledge, 1993, pp. 17, 18.
  • [4] Ibid., p. 15.
  • [5] Ibid., pp., 16, 17.
  • [6] Ibid., p. 15.
  • [7] Jacques-Alain Miller, in his preface to Guy Briole’s paper: ‘Emil Kraepelin, The Fragility of a Collosal Oeuvre’, Hurly-Burly issue 8, October 2012, p. 126.
  • [8] Jacques-Alain Miller, ‘Effet retour sur la psychose ordinaire’, Quarto 94-5, January 2009, p. 44.
  • [9] Lacan, Le Séminaire, livre XVIII, D’un discours qui ne serait pas du semblant (1971), Editions du Seuil, 2006, p. 15.
  • [10] Lacan, ‘Introduction to the Names-of-the-Father Seminar’ (Nov. 1963), Television, W. W. Norton & Co., 1990.
  • [11] RSI, S22, session of 11 march 1975. I cannot vouch for the accuracy of my source.
  • [12] Herbert Wachsberger, ‘Du phénomème élémentaire à l’expérience énigmatiqe’, La Cause freudienne, revue de psychanalyse, issue 23, p. 15.
  • [13] Lacan (57/58), p. 451 in the English edition.
  • [14] Freud, ‘The Loss of Reality in Neurosis and Psychosis’ (1924), SE 19, pp. 184, 185.
  • [15] Jacques-Alain Miller calls it a compensatory make-believe (CMB) in ‘Effet retour sur la psychose ordinaire’, Quarto 94-5, January 2009, p. 44.
  • [16] Freud, ‘Neurosis and Psychosis’ (1924), SE 19, p. 151.
  • [17] Eric Laurent, ‘Produced in a linguistics of speech in action, the language acts of the psychotic subject modify the language he uses to the point that the new language modified by language acts can take on board the meaningless messages that were circulating outside any norm.’ ‘Psychosis or Radical Belief in the Symptom’, NLS Messager, Nov. 10, 2002.
  • [18] Freud, ‘Psycho-Analytical Notes on an AuLtobiographical Account of a Case of Paranoia (Dementia Paranoides)’, SE 12, pp. 70-1.
  • [19] Ibid., p. 48, 73, respectively.
  • [20] Lacan (57/58), op. cit., p. 481.
  • [21] Freud, ‘The Dynamics of Transference (1912), SE 12, p. 107.
  • [22] Guy Briole, ‘Emil Kraepelin, the Fragility of a Colossal Oeuvre’, Hurly-Burley, published for the Freudian Field by the New Lacanian School, issue 8, October 2012, p. 139.
  • [23] Freud (1924), op. cit., p. 183.
  • [24] Ibid., pp. 184-5.
  • [25] Ibid., p. 183.
  • [26] Ibid.
  • [27] Ibid.
  • [28] Ibid.
  • [29] Lacan, The Seminar, book XI, The Four Fundamental Concepts of Psychoanalysis (1964), The Hogarth Press and the Institute of Psychoanalysis, 1977, p. 218.
  • [30] Lacan, ‘Position of the Unconscious’ (1960, rewritten 1964, ?rewritten 1966), Ecrits, W. W. Norton & Co., 2006, p. 716.
  • [31] Freud (1924), op. cit., p. 184
  • [32] Ibid., p. 185.
  • [33] Ibid.
  • [34] Ibid.
  • [35] Lacan (57/58), op. cit., p. 473.
  • [36] Freud (1911), op. cit., p. 33.
  • [37] Ibid, p. 186.
  • [38] Freud (1911), op. cit., pp. 24, 25.
  • [39] Ibid., p. 25.
  • [40] Ibid., p. 20.
  • [41] Ibid., p. 19.
  • [42] Ibid., p. 14.
  • [43] Ibid., pp. 38, 39.
  • [44] Lacan (57/58), op. cit., p. 466.
  • [45] Freud, SE 12, pp. 19, 39.

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