About Schizophrenia Hallucinations as Symptoms of Schizophrenia
Of great difficulty is the psychiatric diagnosis of psychosis, merely because of hallucination.
According to structural theories, such as those of Lacan, and unlike those theories within a medical paradigm, hallucination is present in all of the structural categories of neurosis, perversion and psychosis. However, Fink said that Lacan stated that reality was not a helpful way to distinguish fantasies from hallucinations, rather, ‘certainty’ is a more useful concept.
Voices as Auditory Hallucinations in Schizophrenia
The psychotic person is convinced of the certainty of the hallucination and not necessarily of the reality of what he/she sees or hears.
Resnik pointed out that the ability to discriminate between the repressed and the repressing parts of the ego was crucial. The psychotic part of the ego, knowing nothing about repression, becomes no more than a device for ejecting inner experience. Thus, combined with the idea of certainty, thinking itself becomes reified.
At a 1959 British Institute of Psycho-Analysis seminar, Melanie Klein and Herbert Rosenfeld argued that ego splitting and projection, when intense, caused fusion between the self and its objects, implying a lack of differentiation between the original object and its symbolic representation. Thus, the symbol becomes a concrete object and the psychotic person lives thereby in a world of factuality.
In this vein, Mitchell noted Laing’s proposition in The Divided Self that if the child could not see him/herself in the mirror, it was thought that he/she would believe that the self was gone. This would involve the employment of a schizoid presupposition with the help of the mirror, and it was in this respect that Freud noted that Schreber identified the sun with God.
Nature of Bona Fide Psychotic Hallucination About Schizophrenia
Fink concluded that a bona fide hallucination required a sense of subjective certainty which was attributed to external agency, related to the return from the outside of something that had been foreclosed. Grigg concluded that the real which had been excluded from the symbolic field, might nevertheless appear in the form of a hallucination.
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A final perspective, given by Symington, is that “a hallucination comes about through a discharge of a hated element from within onto the outer, whereas a true perception comes about through an inner element that is embraced or loved.” In order to reconcile Symington’s view that those of Lacan, the English word “hate” must be understood in its full etymological derivation, as having come from the Hebrew word meaning sin. Hence, the forensic psychotherapist should look for hallucinations where the client has committed a criminal offense.
Bruce Fink, A Clinical Introduction to Lacanian Psychoanalysis, Harvard University Press, Cambridge, MA.
Salomon Resnik, The Delusional Person, Bodily Feelings in Psychosis, Karnac, London
R. D. Laing, The Divided Self Penguin, Harmondsworth,
Mitchell, Juliet Psychoanalysis and Feminism Penguin Books, Harmondsworth,
The Standard Edition of the Complete Psychological Works of Sigmund Freud Volume XII, The Hogarth Press, London
N. Symington, The Blind Man Sees – Freud’s Awakening and Other Essays, Karnac Books, London