Lacan on Madness

Madness, yes you can't

Patricia Gherovici, Manya Steinkoler, Patricia Gherovici, Manya Steinkoler

• Publisher: Routledge
• Year: 2015
• Print ISBN: 9780415736152
• eBook ISBN: 9781317587064
• Topic: Psychologie
• Subtopic: Abnormale Psychologie

This new collection of essays by distinguished international scholars and clinicians will revolutionize your understanding of madness. Essential for those on both sides of the couch eager to make sense of the plethora of theories about madness available today, Lacan on Madness: Madness, Yes You Can't provides compelling and original perspectives following the work of Jacques Lacan.

Patricia Gherovici and Manya Steinkoler suggest new ways of working with phenomena often considered impermeable to clinical intervention or discarded as meaningless. This book offers a fresh view on a wide variety of manifestations and presentations of madness, featuring clinical case studies, new theoretical developments in psychosis, and critical appraisal of artistic expressions of insanity.

Lacan on Madness uncovers the logics of insanity while opening new possibilities of treatment and cure. Intervening in current debates about normalcy and pathology, causation and prognosis, the authors propose effective modalities of treatment, and challenge popular ideas of what constitutes a cure offering a reassessment of the positive and creative potential of madness. Gherovici and Steinkoler's book makes Lacanian ideas accessible by showing how they are both clinically and critically useful. It is invaluable reading for psychoanalysts, clinicians, academics, graduate students, and lay persons.

Part I Madness Manifest

Encountering madness

1 The Case Of The Baby Diaper Man¹

Rolf Flor

DOI: 10.4324/9781315742755-2

Jay achieved only modest toilet training. At first, this was framed by his parents as a training issue. Thereafter it was framed as a health problem. Doctors were consulted; medications were tried; behavioral methods were laid out. However, the problem remained unsolved and unexplained. Extensive medical efforts to help Jay with enuresis continued into adulthood. Eventually Jay only feigned participation. He lost interest in solving what was no longer a problem. One might say, to the contrary, the problem had become its own solution.

In a particular crisis, his diaper began to feel good to him. Over time he added ways to comfort himself. Jay collected pacifiers and discarded children’s clothing. By the time he reached late adolescence, Jay began to photograph himself wearing a diaper, clutching the paraphernalia of infancy. He could admire these pictures and eventually shared them with others in online communities. With these images and objects, he found himself able to develop a quasi-symbolic matrix that made it possible to negotiate the challenges of connecting to others.

Now an adult, Jay sees himself as an “adult baby” and a “diaper lover.” His “solution” is not a flawless way of negotiating his connections; some people who know him closely, especially family members, object to his diapers. Despite their complaints, the only thing he wishes to change about himself is certain angry outbursts that punctuate his social experience. “I lose it and when I do I hurt people that I love very much.” Rage troubles him and for this he seeks help.

The setting and beginning of treatment

I am a psychoanalyst in private practice. I am also the clinical director for a community behavioral health agency. The agency provides what is called “human services,” a description that I personally value more than the notion of “behavioral health,” because it emphasizes that we provide our services one person at a time, rather than for the benefit of maintaining a norm. The case I will discuss is from the clinic.

A clinician with many years’ experience entered my office.

She said, “We have to figure something else out. This one is not for me. Somebody else should see him.”

I responded, “Who is he?”

“A guy sent over by the shelter specialist. At first he said he has urinary incontinence and needs to wear a diaper. Later in the interview he admitted he is registered as a level 3 sex-offender and he really wears diapers all the time because he likes them. Half way through the intake he started sucking on a binky!”²

I asked, “Why is he here?”

“He said he comes ‘from an angry family’ and that it was ‘rough at the shelter’ and that he is anxious about staying there because it is ‘making him mad.’ God only knows what he really wants . . .”

She interrupted herself with an apologetic tone and softened her demeanor.

“Look, I am sorry, but I am the wrong therapist for him. He needs someone that can work with his kind.” After a pause, she continued, “I bet he is here just for medications anyway . . . or maybe because of some parole officer.”

“Did he ask for medications?”

“No, not yet.”

“Did he say he was mandated to treatment?”

“No.”

“What did he say?”

The volume of her voice rose steadily as she said: “He said he pleaded guilty to sexually assaulting a six-year-old girl when he was eighteen and that was why he was labeled as a sex-offender.” Pausing, she added, “He admitted that he offered to lick the girl’s vagina.”

She continued with an ironic tone, “But then of course he also said he is ‘not a pedophile’ and he was ‘misled to a guilty plea.’ I tell you, this guy is a creep.”

I asked, “What did you say to him about next steps?”

“I told him that I was just doing an intake assessment and that I will not be his therapist. He is waiting outside. Should we tell him that someone will contact him when someone becomes available?”

“What is his name?”

“Jay.”

Meeting Jay

Waiting outside my door was a slender young man with strawberry blond hair. He appeared younger than his twenty-eight years. Jay wore loose clothing: overalls and an oversized baseball cap. Since I was already aware of it, I could not fail to notice the evident padding from a diaper. He seemed to be carrying his worldly belongings in a large diaper bag.

I gestured for him to come in and I introduced myself. He smiled wanly as he looked at my outstretched hand. “I understand you are asking for treatment and I am available. When is it possible for you to come back?” I shook his hand again after we agreed to a time the next day.

I saw Jay in the clinic, twice a week, for less than year. I would describe our work as psychoanalytic psychotherapy. For my work in the clinic I need to modify the range of options for variable-length sessions and must develop treatment-planning language that can withstand the scrutiny of third-party payers. Nevertheless, the work that I asked of Jay began very much like the work I ask of any patient (say everything that comes to mind, complete unfinished sentences, associate to dreams, reflect on parapraxes, etc.).

In the course of treatment, we established that he was not mandated to see me, and I never had any contact with authorities on his behalf. I found him to be engaged in the process and reliable in attendance. He had complaints about the world and how he was treated. There was also at least one specific thing he wished would change: although the events had been infrequent, he had occasionally found himself in a blind rage during which “I lost control of my body.” Though he did not develop this point at the beginning of treatment, he described “rage coursing through [his] body.”

Family history

Jay was born and raised in a large city in the southwest of the United States. He is the second of three children. He has a brother who is two years older and a sister who is three years younger.

Jay’s father, now disabled, was a long-distance truck driver. Early in the treatment, Jay told me that his father had recently been diagnosed with terminal cancer and that his siblings were encouraging Jay to go down and “make peace with him.” Jay refused because he thought he would not be able to control his rage in the presence of his father. He described his father as having been a “crazy asshole who beat the shit out of us.” He can “rot in hell for all I care.”

Jay’s mother held numerous unskilled jobs. He first described her as “pushy” and “controlling,” but in later sessions it becomes increasingly clear that he thinks he was at one point her favorite and he expressed nostalgia for better times with her. Sometimes he blames the change on the birth of his sister; at other times he blames the abusive father for having “ruined” things. In the arc of their relationship, his mother went from “loving to pissy.” His use of that phrase is interesting in the context of his life long struggle with enuresis. We can hear a unique significance in the phrase for Jay about the switch in valence in his relation to the (m)Other— from positive to negative—and about the emergence of a localized body symptom in a place of contestation between Jay as a subject and the Other.

Growing up in relative poverty, the family lifestyle and income were greatly impacted by both parents’ abuse of drugs and alcohol. Their habits dominated Jay’s childhood. Jay and his brother were taken away by family services and placed into care with his paternal grandparents when he was two. After the parents finished a course of substance abuse rehabilitation treatment, Jay and his brother continued to live briefly with those grandparents while his parents struggled to find employment and housing. In contrast to Jay’s father, Jay said that he really respected his grandfather, emphasizing in particular that he was a “church-going man,” even while also acknowledging that his grandfather was tyrannical with his faith and quick to use corporal punishment. Jay’s grandfather functioned in a more symbolic father role, perhaps setting a limit to jouissance. But it seemed that his mother disapproved of this role. This left Jay eventually in the clutches of his real father, a father who did not recognize such limits and who probably could not facilitate for Jay a metaphorization of the desire of Jay’s (m)Other.

Jay’s mother became pregnant while Jay was in the care of his grandparents. After the birth of a sister, Jay and his brother returned to live with his parents. The parents stayed close to the grandparents at first, his father making a show of remaining sober and attending church. Jay’s mother did not “buy into” his grandfather’s piety and expressed frustration with what she perceived as self-righteousness. When Jay’s father returned to work they moved again, and his father also gravitated back to a life filled with deadly pleasures. Jay’s father frightened everyone in their house with alcohol-fueled rages, magnified sometimes by cocaine abuse. His parents’ fights were quite violent, according to Jay’s report.

After several courses of rehabilitation, Jay’s mother began to avoid street drugs and alcohol and described herself as “in sobriety.” She managed her version of sobriety by complaining of pain and obtaining prescription pain relievers. At the same time she began to rely more on Jay. She asked Jay to help care for his sister even when he was quite young, which he says he was happy to do because she really was a “good little baby.” But his mother’s moods ran, in his words, “hot and cold.” This greatly confused him, because his very earliest memories are of a loving mother. When his sister was asleep and his father was away she favored him by waking him up and taking him to bed with her.

After a certain age he changed his own diapers. In sessions, Jay related several charged moments, long after infancy, when she changed his diapers. When his mother helped, it was often because she wanted to hurry him along; but he also suggested that helping to change his diaper was her “wanting to make up with me,” a phrase that suggests the patching up of a romantic relationship.

When Jay was six, it was decided that his younger sister should live with the grandparents. He does not understand exactly why that happened. Perhaps the mother did not have the time to take care of a pre-school child anymore. Perhaps the father’s doubt about Jay’s sister’s paternity reached some sort of head. Perhaps the father’s rages forced his mother to find a refuge for the girl. Jay raises all of these as options but seems unsure that any of them explains what happened, especially since his mother did not like the grandfather. But Jay is nevertheless certain that the decision to send his sister away came from his mother. It seemed odd to him that she could just “flush her away like that.”

Clearly the un-metaphorized desire of the mother remains enigmatic, but not one that leads to formulate this as a question; instead, it is only “odd” that she can “flush” Jay’s sister away. His diaper may be a way to hold her back from doing the same to him.

Enuresis and the “baby thing”

Jay had only ever achieved a modest toilet training. Nighttime enuresis forced him to remain in diapers when he went to bed. Daytime accidents led to many embarrassing moments. Until he turned five, the enuresis was framed as a training issue, and thereafter it was framed increasingly as a medical problem. His mother was most troubled that accidents also happened during the day.

After the family reunified, and without the presence of grandparents, Jay’s father first ridiculed Jay and then grew ever more frustrated over time. Jay was a target for his father’s anger because of the constant washing of sheets and the expense of unsuccessful treatment. The fact that his accidents were more frequent when Jay was upset did not change his father’s responses. Jay’s accidents became a lightning rod for family problems as his mother protected him by her own acts of violence towards his father.

A few weeks into treatment Jay told me the following story. His father frequently complained about the smell of urine. Jay lived in fear of the days when he was at home alone with the father (Jay’s brother would find ways to not be home). Shortly before his eighth birthday, home alone with his father, after his sister had been sent to live with the grandparents, Jay’s father sat in the kitchen drinking and smoking. When his father went to the bathroom Jay heard him bellow in anger as he passed Jay’s bedroom. “What the fuck is wrong with you? You stupid fucking thing, this room smells like piss!” Associating to these words, Jay remarked that his father often called him a “fucking baby” and he did not fail to notice that his father was equating a “baby” with a “thing.”³ As his father sat on the toilet, he kept yelling out to Jay about the smell of the urine in the house. Jay feared where this was going. He slipped out of his own room and moved anxiously from corner to corner of the house, unsure where to find refuge, desperate to not let his father see him. His anxiety mounted as Jay thought about “how he was going to beat me.” Finally Jay slipped through his parents’ bedroom and to the small room beyond, a room originally intended for his sister. As his father intermittently bellowed from the toilet, Jay hid himself behind boxes and luggage, wondering how long it would be before his father got up from the toilet and found him.

“I rocked myself to stay calm—I thought my heart was going to jump out of my chest when I realized I had just had another accident—piss got onto the rug —I took off my clothes to try to soak it up—to rub it dry—I could still smell it— I don’t know why I but—I was cold?—anyway I reached into a box—then I was putting on my sister’s clothes—I don’t know why—I crawled into a ball and hid in the corner—rocking—then I—felt—good—and . . . and . . .”

He stopped at this point in his story. After a pause, I asked, “And . . .?” He said the calmness he “discovered” while sitting rocking and wearing his baby sister’s clothes faded when he suddenly worried that his mother might find him. I was surprised that his worry was about her. At that moment in his story an enraged father was stewing on the toilet or perhaps even already looking for Jay to beat him. When I repeated his words, “mother might find me,” he said, with irritation in his voice, “Yes, well, she didn’t.”

From that day on, Jay had something he could use to “baby” himself literally. His very own diaper felt good to him. He could also wear things in addition to a diaper that helped him feel okay. Over time he collected discarded children’s clothing and other comforting clothes. He hid pacifiers in several places and he would suck on these when he was alone. He preferred to wear nothing but the diaper when he did this. He took pictures of himself, which he would look at later.⁴

The next years involved continued medical efforts to help Jay with his enuresis. He wore special clothing and took precautions at night. His father continued to belittle him. Publicly, his mother defended Jay against the father, deflecting the father’s abusiveness. When they were alone, however, she reproached Jay, saying that he should “try harder.” Jay says he lost interest in solving what was “not anybody’s problem.”

Jay’s parents separated when he was ten. When the father moved out, the sister returned to live with them. Jay changed school several times, since they moved often, but he appreciated the ability to start over and learn new ways to hide his practices from kids at school. He said nighttime enuresis abated during this time but he still wore a diaper day and night to control “accidents.”

A “sissy” in “AB world”

Early in his treatment, as he was relating his family history, Jay casually asked if I had “heard about the adult baby world?” I asked him to tell me about it. He picked up my pen and wrote the address of a website on my notepad. “Check it out. You’ll see.” His eyes brightened as he excitedly told me what I could expect there. Jay described how an internet search in his early teens unexpectedly brought him to the realization that “there are millions of us.” “There are adult babies everywhere. Places you would never even suspect. There are cops who are adult babies and diaper lovers—I have met some online—I even know an FBI agent who is a diaper lover.” He expla...

Table of contents

• Cover Page
• Halftitle Page
• Title Page
• Copyright Page
• Table of Contents
• Notes on contributors
• Acknowledgements
• Introduction
• PART 1 Madness manifest: encountering madness
• PART II The method in madness: thinking psychosis
• PART III Madness and creation: environs of the hole
• Index