Abby and Patrick welcome Loren Dent, a clinical psychologist in the Lacanian tradition. The topic is psychosis, both as understood theoretically by Freud and Lacan, and also as experienced and encountered by real people in New York City, where Loren practices and where he has helped establish an innovative program of treatment and care. Starting by tackling a basic question – what is “psychosis?” – the three chart Freud’s struggles to grasp psychotic phenomena, his messy efforts to make the notorious case of Judge Daniel Paul Schreber fit his theories about sex, and his late-career notion of “disavowal” as a mechanism of psychosis distinct from neurotic repression. Loren then describes how Jacques Lacan took this last concept, often translated as “foreclosure,” and integrated it with his own accounts of language, desire, and otherness. When taken together with therapeutic innovations by radical psychoanalytic thinkers like Félix Guattari, François Tosquelles, and Jean Oury, Lacan’s insights, as Loren explains, lay the groundwork for a robust and efficacious approach to treating psychotic patients in ways that challenge traditional hierarchies in hospitals, group homes, and beyond. After walking Abby and Patrick through what talk therapy looks like with patients with psychosis, Loren outlines his recommendations for treatment and support in the clinic and beyond. As Loren explains, this approach goes against the grain of how psychotic patients have been processed by institutions under contemporary neoliberalism, and has grown only more urgently necessary in New York City under the mayorship of Eric Adams. It also forces us all to confront and manage our anxieties about “madness,” from which Freud himself was hardly immune, which haunt commonplace assumptions about normative behavior and market rationality, and which manifest in day-to-day acts of avoidance, confinement, neglect, and violence that people with psychosis encounter in urban life.

Key texts cited in the episode:

Gilles Deleuze and Félix Guattari, Anti-Oedipus

Bret Fimiani, Psychosis and Extreme States: An Ethic for Treatment

Freud, Civilization and its Discontents

Freud, “Psychoanalytic Notes on An Autobiographical Account of a Case of Paranoia (Dementia Paranoides)”

Nev Jones & Robyn Lewis Brown, “The absence of psychiatric C/S/X perspectives in academic discourse: Consequences and Implications.” Disability Studies Quarterly, 33(1).

Darian Leader, What is Madness?

Camille Robcis, Disalienation: Politics, Philosophy, and Radical Psychiatry in Postwar France

Stijn Vanheule, The Subject of Psychosis: A Lacanian Perspective

Foundation for Community Psychoanalysis: https://www.communitypsychoanalysis.org/

Fountain House: https://www.fountainhouse.org/

The Greene Clinic: www.greeneclinic.com

A podcast about psychoanalysis, politics, pop culture, and the ways we suffer now. New episodes on Saturdays. Follow us on social media:

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