Fundamentals of Psychoanalytic Technique: A Lacanian Approach for Practitioners

Classical Lacanian clinical structures (e.g. neurosis, psychosis, perversion) are not homologous to character types or personality organizations. And therefore, are neither determined by some form of innate nature, nor are they strictly the byproduct of nurture. Clinical structures are not statistical disorders, nor phenomenological experiences. In order to understand well clinical structures, I’d recommend Bruce Fink’s “A Clinical Introduction to Lacanian Psychoanalysis” (especially chapters 6-9), and his “Fundamentals of Psychoanalytic Technique” (Ch. 10). The whole point is to (1) comprehend what is understood by “clinical structures”, and how they relate to other Lacanian concepts such as desire, Big Other, Name-of-the-Father, among others; (2) get a good grip on what’s at stake in psychosis. By the end of the XX century, Lacanian thought started a debate regarding “unclassifiable cases” — cases which did strictly adhere to the functioning of classical clinical structures. That debate led to at least two unresolved dimensions of Lacanian practice: (1) autism as a fourth clinical structure (see Maleval, 2021); and (2) ordinary psychosis. As you pointed out, a similar discussion had begun in other psychoanalytic circles (although it is important to notice that the psychoanalytic and epistemological foundations differ). It might be also important to underscore that "ordinary psychosis" as a clinical type is not a strictly Lacanian notion, but rather a later development, lead by Jacques-Alain Miller et al., following a Lacanian conceptual framework. And whether it is a “clinical structure” stricto sensu is still a debate. Miller (and others) have addressed the clinical framework behind ordinary psychosis in various texts and presentations (see, just to name a few, here, here, here & here).