Psychosis can be seen as the sign or symptom of disturbances within our present cultural situation in the world. For a significant number of people, it is a way of escaping from unbearably destructive and maddening social situations.
The cultural nests or “cradles” of our civilization are precisely places such as the Mesopotamian historical foundations of Nineveh, Palmyra, Babylonia and other heritage sites; these treasures of our present system of sociological and historical values (e.g., the origin of writing in the Sumerian tradition) have become victims of maddening attacks in a world that finds itself in a state of mental and moral decline.
This is one of the reasons why so many people try to escape from those infected, contaminated places – some of which, like Palmyra, are in danger of envious destruction, an expression of a devastating and maddening chaos of a distressed humanity, of a non-human world.
Disseminated mass psychoses are symptoms of a sociological and human mental reality that is dismembered both geographically and historically. In attempting to understand some of those dislocations in the normal anatomy of a cultural background, the very nature of the physical and cultural landscape of our planet becomes extremely distorted.
In psychiatric social research, we could speak of a complex reticulum that has become the “locus” of the mass destruction of the body of nature, in which the annihilation of any cultural or artistic production of our forebears is a tragic fact.
In my own personal and painful manner of thinking as a human being, I would argue that trying to understand some of the complexities of the cultural crisis in which we find ourselves at present, as well as those of our personal and social discomforts and sufferings, is now part of our basic human experience.
I shall in another context examine what is going on in our present chaotic world. In this paper, which I presented in December 2014 at a conference in Naples, I express my feelings and experiences as a human being who is also a psychiatrist and psychoanalyst, in an attempt to contribute to current research into madness as encountered in our everyday life as citizens.
My preoccupation as a human being with the present catastrophic situation in the world has no impact on the usual capitalist position of those countries that appear to need wars in order to sell weapons, aeroplanes and other material. With respect to such situations, the pessimistic exchange of letters between Freud and Einstein, Why War? (1932), is very much present in my mind.
As regards the Congress in Naples, I began by speaking of Paris, which is the city in which I live most of the time. Nowadays, in a city like Paris, we observe the opposite of what happened in the Middle Ages when mentally-ill patients were put into floating institutions such as the Narrenschiff. The aim of that primitive floating mental hospital was to protect the city from the contamination of madness and preserve the daily life of the citizens from some “impurity” or other. At the same time it was a chance for mentally-disturbed people to learn how to pilot not only the ship on which they were sailing but also their own life.
In the imaginary landscape of the Renaissance, the Narrenschiff had the function of a scapegoat. In various primitive societies, the scapegoat symbolized a ritual of purification in order to get rid of a plague that put them in danger of contamination. The scapegoat is the Narrenschiff itself taking away the madness of the city. It would seem also to be related in mythology to the odyssey of the Argonauts. In primitive cultures, the scapegoat is represented as a boat that takes away all that is bad in the village.
In 1509, Erasmus of Rotterdam wrote In Praise of Folly (first printed in 1511).
The Narrenhaus or psychiatric institution is a further development of the Narrenschiff or Ship of Fools. It means that “floating” madness requires an anchor in order to gain stability on land and be transformed into a secure psychiatric institution. In the expression Ship of Fools, there is the idea of a wandering experience. In fact the first mental hospitals in France were originally places set up for handicapped soldiers, war-victims; they were used also to give a kind of formal protective shelter to wandering people, at that time called tramps. These were later to be the first mental hospitals in France.
Bosch’s painting of the Ship of Fools, in the Louvre Museum in Paris, gives us a colourful and moving image of an original group experience. In that odyssey, the disordered minds and bodies had to choose someone to lead them: a captain. That leader is a personification of the image of the father figure who gave some degree of structure and unity to the disseminated madness contained in the ship. Those sailing on board that mad-ship were, as a matter of necessity, in search of a certain degree of harmony so that the ship might navigate under the influence of a musician and a priest.
All contact with and relationship to the world of disseminated wandering madness demands a proper human container. My experience over many years with groups of chronic psychotic patients in institutional settings taught me a great deal about the possible transformation of a petrified and glacial group into a human one. The result of this experiment in the Saint-Anne Hospital in Paris (and also at the Santa Giuliana Clinic in Verona) enabled me to write the book Glacial Times, which has been translated into several different languages. In their despair, mentally ill patients found a pathological solution through the act of freezing all or most of their feelings. The subsequent de-freezing experience was of course a catastrophic transformation, but one that was necessary.
Nowadays, psychiatric patients need not be in an “asylum”; that institution is, as it were, gradually coming to a close. In my view, asylums were able to house seriously disturbed patients in a protective environment, which, over time, turned into a particular kind of city or township. Asylums, however, can no longer contain the growing madness of our world or offer the proper kind of treatment that was developed thanks both to new medication and to the progress of an appropriate psychoanalytical approach to psychosis, an approach that is part of my personal experience.
Some architects are attending this meeting, and I would like to show them an “autistic” model of a psychiatric hospital, as conceived in 1784 by Josef Ignaz Gerl (1734-1798) in Wien. The building follows the autistic principle of circularity and repetition, thus characterizing the mannerisms and stereotypes of the chronic psychotic patients that we used to find in asylums in those days.
As regards the architecture and misunderstandings concerning the idea of the life-space of mental patients, while I was attending the International Congress of Psychoanalysis in Geneva in 1959, I remember visiting a prestigious private hospital in Lausanne, where some schizophrenics of wealthy families lived in individual apartments and were therefore isolated from the other patients. Professor Enrique Pichon-Rivière, who accompanied me on that occasion, was quite disturbed by this compartmentalization within a social institutional setting. He and I were in complete agreement concerning the importance of the socialization of mental patients in an institutional setting.
When I lived in London, “Mildred”, a schizophrenic patient, was in analysis with me on a daily basis. In one session – it was on a Monday – she was very worried and said to me: “I discovered that, in the waste-paper baskets all around the consultation room, were pieces of the Sunday Times, pink in colour. I was very upset because I realized that everybody would discover that I am mad and know everything about me.”
I commented that she felt disseminated all around our session, adding that the key to understanding that aspect lay in her own name: “Mildred” – which could be read as Mild-red, i.e. pink. She was quite impressed by my interpretation; she wanted to get rid of her madness that was spread all over the area where the session was taking place and wanted me to take care of her bits and pieces and do something about them.
I remember also her saying in a humorous tone of voice on another occasion: “I know that I behave like a dog with you,” adding: “It’s a sad dog that wants to be understood and treated like a little baby.” One day she arrived late for her session, saying that she had gone to the Society for the Protection of Animals, in an attempt to make me feel guilty because I was not with her and taking care of her every single moment of the day. I felt that it was important for her to develop in the transference situation a kind of crazy but healthy playful sense of humour. She was thus able to set up with me a playful (ludic) transference.
After many years of analysis she improved significantly; she came to visit me in Paris to thank me for the work that we had done together in London.
Back to the city of Paris (it could well be Naples too, as in the illustration from La Napoli di Bellavista): tramps, homeless people, are all over the city – under the bridges, where they improvise a home for themselves, in the passageways of some buildings during the night, or simply out on the street, with the sky for their roof, or in an Underground station… if they are allowed to stay inside and get some warmth.
I will describe an apparently simple daily experience that I had as I walked early in the morning from the flat where I live to my professional address in the rue Bonaparte in Paris. I was on that walk one Friday morning, somewhat distracted as I often am at 7 o’clock in the morning. In the market in the rue de Buci, I was able to see and witness the waking up of a sleeping population of “clochards” (tramps). Some of them were well-known in that particular district of Paris; it was a cold morning, but they did not seem to be suffering because of that. They tend also to drink quite a lot the night before, which helps them fall asleep – a kind of anaesthetic, as it were. Some of them woke up saying things like: “What a day!” or “Quelle folie!” (“What madness!”). I could feel the cold, but the tramps were in a state in which everything was frozen, “a frigori” – which meant that they could cope with the external climate. In former times, before Pinel’s work, some people believed that mental patients were like animals that live naked in the frost. In his medical-philosophical book, Philippe Pinel takes issue with this idea of animality (Linneo).
Later, as I was going back home, I met in the le Marais district, near where I live, an old woman with psychiatric problems; she too was a homeless person, who, with a pile of cardboard boxes, was able to build for herself a personal asylum where apparently she felt protected from the climate. Everybody in that district liked her, and I was amazed when I discovered that apparently she did not suffer from the cold even though her naked feet were red – she did not have any socks to wear. One day a colleague of mine, out of pity, bought a pair of socks and gave them to her. But she did not wear them; they remained by her side.
She used to look at the pages of the magazine “Elle” all the time. What was she looking for in herself, in elle? I felt that she was suffering from a disseminated psychosis; she was therefore present in the whole district, as though she herself, elle, were a magazine with no covers. She was trying to see whether some of the pages of her life were going to come back so that she could get back in touch with her-self (“elle-même”). In fact she was not entirely in the magazine, but all over the place. Her multiple selves were dispersed, disseminated… Anglade, a French psychiatrist in the early years of last century, used to say that schizophrenic patients are like an unbound book: all the pages are present, but in a disorderly way. I would say however that, in that old woman, some of the pages were missing because they had flown out into different corners or places of the district that she identified with her own dispersed body-mind.
In my nostalgic fondness for the psychiatric revolution of Philippe Pinel, I used to imagine him, with his principal colleague Mr Poussin, following the dispersed spatial and temporal happenings of their patients. Pinel himself understood that hibernation was a spontaneous “treatment” for human mental pain.
Pinel was influenced by the Encyclopaedists and the culture of the Enlightenment and also, to a significant extent, by contemporary figures such as Antoine Destutt de Tracy; Condillac, who had a great influence on him, introduced the concept according to which delusion (or the delusional world) is a sort of ideological system of ideas. German psychiatrists used to speak in terms of Wahnideen; delusion in English has to do with fundamental dis-illusion and with new illusions of a delusional kind. In the concept of delusion, there is also the idea of ludere in Latin: to play – as if the infantile self of the delusional person either has a different way of playing or is not able to play at all, hence a kind of paralysis of imagination and creative thinking. On the other hand, in my experience as a psychoanalyst treating psychotic patients, the deflation of a delusional world or a delusional ideology can be extremely traumatic, sometimes to the extent of giving rise to suicidal tendencies.
The ideological aspect of a delusional world may be the expression of a basic unconscious misunderstanding which, when “inflated”, can turn into a sort of philosophy or religion. It is particularly painful in cases where a delusional form of belief exists.
Psychoanalysis is part of a particular experience with oneself during one’s training, based on a psychoanalytical relationship with another person: the training analyst. Freud pointed out that, in itself, psychoanalysis is also a system of ideas that has to confront the patient’s psychotic and non-psychotic ideologies. This requires the setting-up of an important transference relationship in which, in my view, the infantile self and the capacity to play with the other person play an essential therapeutic role in the psychoanalytical process.
Huizinga, the great Dutch philosopher, wrote an important book and invented a major concept concerning the capacity to play with others. He called it homo ludens; this concept is developed in the book he wrote with the same title in 1938. But of course ludic transference is not simply a matter of playing; it is a creative experience in which two persons, patient and analyst (or the other participants in a group psychoanalytical setting) will need to get involved with their own unconscious wishes, desires, fears and systems of ideas.
In my most recent book, The Logics of Madness, I try to explore the concept of playful or ludic transference as a possible way of dealing with the delusional world of the patient.
Leonard, a chronically-ill patient whom I have been treating for several years, once said: “My madness is due to a conflict with the human world”. “And what about the animal world, inasmuch as we belong also to that kingdom?” After a while, Leonard said: “I sometimes feel that I am a dog or a mad cat, a diabolical one.” Sometimes he felt that he was entering inside an alsatian dog, a very crazy one, like the one that his father brought into their home, a dog that really scared him and his two older brothers. It would not allow them to play; at the same time Leonard’s father, who was an important judge who had sentenced some of the main leaders of the Red Brigades, seemed to need that dog in order to protect his family from the threats made against him by members of that terrorist group.
The alsatian dog was a dictator figure for Leonard; it aroused within him an intimidating and persecutory super-ego which, on the one hand, was supposed to protect him, his brothers and his family yet at the same time paralyzed them and prevented them from playing together. The persecutory inner/outer father-like dog set up a kind of discordance in the patient, giving rise to a serious schizophrenic state that used to be called folie discordante (Chaslin, 1912). The dictatorial inner and outer German-shepherd/“Nazi” dog could not admit any kind of link and refused to allow any playing inside its territory.
Sometimes Leonard, trapped inside the skin of the tyrannical dog, would become a delusional despot or dictator with respect to his own family. He would also say that he was turning into a diabolical cat. All these persecutory images were attempting to find some kind of balance with his delusional religious state in which he became Krishna, Buddha, Bouddo, Krishnamurti, Christ and sometimes an Italian actor, whom he admired very much: Carmelo Bene. One day his mother, in Leonard’s presence, said to me that sometimes he would talk to the television set. Leonard commented: “No, I was just having a dialogue with Carmelo Bene.”
In Italy, Carmelo Bene was very much admired as a television personality but sometimes he could be quite strange. Leonardo’s mind was also taken up with Krishna, Buddha and Krishnamurti, the great mystic writer, often in a situation of mutual conflict. One day he decided to put on his desk a photograph of Krishnamurti together with images of Christ and Buddha; that made him feel much better – as if he were henceforth able to deal in a projective way (i.e., placed outside / in front of him) with the struggle between different and disseminated ideologies or religions.
When he was in analysis with me in Paris, he would go to the church of Saint Germain des Prés, which lies in the rue Bonaparte just a few yards from my consulting-room. There, he told me, he was able to speak with Christ before coming to his session. In that way, thanks to hallucinations or illusory day-dreaming experiences, he was able to control the conflict between his idealized and discordant religious mentors.
One day, before coming to his session, he went to the church as usual. This time, he was very disappointed because the Christ-image spoke to him in his own voice. He was thus able to understand that he was hallucinating his own self into the image of God. He realized that, as a kind of gifted puppeteer, he was able to put his own voice into those idealized religious mentors, who therefore became as it were puppets for him to manipulate.
Another patient of mine, Samuel, who was younger than Leonard, began his analysis with me by saying that he was part of an army of Carolingian warriors who protected him from his present persecutory life. One day he discovered that he could read cards and control the persecutory images that he felt were around him at any given time – it was this that caused him to regress into another time which, although also persecutory, was more in agreement with his illusions. He felt that he was able to transform the “soldiers” – who used to talk all the time during the session, thereby preventing Samuel himself from communicating with me – into cards, which he could then read. His transference relationship was dispersed into different places in different times. At times, some priests would mingle with the soldiers either as real hallucinated people or as cards.
One day, after a long silence, he said in a very thoughtful way: “I hope that one day my hallucinations will become real ideas… as happened before, when I was sane.” After several years of analysis, Samuel’s hallucinations diminished and he became able to think properly; his life began to acquire shape and colour. One day he said: “I can think with colours and also with sounds.” He felt that he was able to resonate with the world around him. “Sometimes I wear glasses with which I am able to see what you are giving me and what is going on inside me.”
He began to dream, and also to play the guitar. “What guitar?” I asked him. He made a drawing of a flat, bodiless/body-less guitar. “Now,” he said, “I feel almost asleep, abandoned and sad.” I understood him to mean that his own body was a sort of guitar – flat, depressed and not very well accorded. Perhaps he wanted me to become a guitar – or piano-tuner, because inside each piano there is a guitar.
In another session, he drew a guitar which this time was not flat – it was three-dimensional and alive. Samuel commented: “How can we help people who are such delicate musical instruments, who are not always alive and are so fragile?”
To return to my main topic, disseminated madness: is it disseminated from the mind? This would seem to be the case if thoughts were flying ones, escaping from their mind/nest. In what ideal context can the disseminated mind recover its original nest? The upper part of one’s head is an inverted nest in which everything that is being produced by the life of the body has its representation in the mind.
There is, however, no such a thing as a separate body and head: every animated being is confronted with a living environment. That environment may be disturbing at times: if present, we appear to be surrounded by a very disturbed world in which insane people, distressed uncontrolled masses, move all over our planet in a negative way, searching for a positive aim. A disturbed leader may resemble Leonard’s mad dog, arousing fear and at times crazy beliefs with respect to any creative source that mass envy cannot tolerate.
At the beginning of this paper, I referred to that moment in which the cradle of our culture, with its social and democratic organizations, is put in danger by an accumulation of madness similar to what Freud suggested in his book on mass psychology (1922). The present dilemma is the result of a painful confrontation between different systems of ideas, between our inner world and the outer one, in a context in which so many human beings are attempting to escape from fear and death, yet without knowing where to go. We live in a dismembered world, as in a dismembered body of which the head that cannot think is being cut off.
Dr Salomon Resnik became a member of the International Psychoanalytical Association in 1956, after specializing in work with autistic children and young schizophrenic patients. He then studied anthropology and philosophy in Paris with Maurice Merleau-Ponty, Claude Lévy-Strauss and Roger Bastide. In 1958, he went to London to work with Melanie Klein and underwent analysis with Herbert Rosenfeld, supervisioned by Bion and Mrs Esther Bick from whom he gained a new insight into child and adult analysis. With Rosenfeld particularly he was able to get deeper into dream interpretation and psychotic transference. In the same year, he began working with some of the pioneers of group analysis, including Foulkes, Malcom Pines, Demare and Skinner. A former senior lecturer in psychiatry at the University of Lyon (France) and Visiting Professor at the medical school of the Catholic University of Rome, he is now a practicing psychoanalyst in Paris and Venice. He was working for many years with groups of psychotics in Argentina, England and Paris. For ten years he also worked as a consultant psychiatrist in Verona at the Santa Giuliana Hospital. His latest work, The Logics of Madness: On Infantile and Delusional Transference, is published this week by Karnac Books.