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It has long been customary to refer to Lacan's theory of the four discourses as a theory of four specific forms of social link. An understanding of each of the terms in question, however – both ‘discourse’ and ‘social link’ – must be developed in its own right in order to develop a fuller understanding of the meaning of this formula. In this essay, we will explore the employment of the term ‘social link’ in the work of Émile Durkheim and Ferdinand de Saussure, in an effort to better grasp the manner in which Lacan can be understood to have drawn from each. By clarifying the understanding of the term ‘social link ‘that was operative in Lacan's work, we can restore the centrality of the sociological influence upon Lacan, which has important implications both conceptually and clinically.

Despite considerable scientific interest in the negative symptoms of psychosis, the subjective dimension of these experiences has barely been studied.This paper aims at addressing this shortcoming ...

This study aims at mapping and interpreting what is at stake in Lacanian psychoanalytic supervision. Using interview data of participants' personal accounts of supervision, the authors applied a thematic analysis to gain insight into what they believe are crucial components in these accounts of supervision. We interpret the data within the context of Lacan's text, 'Direction of the Treatment and the Principles of its Power', in which he articulates his conceptualization of psychoanalytic treatment. His views on interpretation (tactics), transference (strategy), and lack-of-being (politics) as the three elements that structure the actions of the analyst, guided our data-analysis. Participants indicate how their supervisor focuses on the symbolic dimension of speech, helping them avoid getting deceived by the dimension of the imaginary. During the supervision process, the supervisor does not respond from a master position, nor coach the supervisees. Supervisees develop their own style and framework for clinical work. Through discussing cases, supervisees learn to construct cases and focus on the singularity of the case, beyond structural diagnosis. Lastly, Lacanian supervisors only focus on the cases discussed, not on the person of the supervisee.

While atypical sensory processes have become central to scientific explanatory models of autism, such models usually do not explicitly address first-person experiences of sensory processes by autistic individuals. Detailed phenomenological research of this subjective domain is nonetheless essential to ground explanatory accounts in the actual experiences and challenges faced by autistic individuals. Therefore, our study consisted of an interpretative phenomenological analysis of 18 semi-structured interviews with autistic individuals about their experiences of hypersensitivity. Overall, our analysis showed how hypersensitivity pertained to disturbances at a basic level of bodily self-experience and also affected other crucial phenomenological experiential dimensions such as the subjective perception of time and space, sense-making processes, intersubjectivity, and moods. Hypersensitivities were described by participants as intrusive experiences of being vulnerably exposed to overwhelming stimuli that invaded their bodies and were simultaneously related to an invasive, chaotic, unpredictable or threatening perception of the (social) environment. Our study highlights the impact of hypersensitivities on experiential domains outside the strict sensory register, thereby providing further evidence for altered sensory processing as a potential core mechanism involved in a variety of autistic symptoms. Our study also indicates the clinical importance of therapeutic interventions that act on a fragile sense of embodiment in autism. Lay abstract Research shows that the way autistic individuals perceive and process sensory stimuli differs from those of non-autistic people. However, while current research often focuses on what sensory differences in autism are and which neurocognitive processes may explain these, it often does not explicitly address what it is like to experience the world through the senses of an autistic person. To explore this understudied dimension, we conducted 18 in-depth interviews with autistic individuals in order to better understand how they personally experienced hypersensitivity from a first-person perspective. Participants described hypersensitivity as a feeling of being bombarded by intrusive stimuli that seemed to invade their bodies and from which they had difficulties distancing themselves. They also indicated how due to hypersensitivity they often perceived their (social) environment as invasive, chaotic, unpredictable or threatening. Hypersensitivities were thus not only described as unsettling bodily experiences but also related to challenges in perceiving, understanding and interacting with the (social) world. By focussing on the subjective dimension of sensory processing in autism, our study thus highlights how sensory difficulties are not peripheral features of autism but play an essential part in the daily challenges faced by autistic individuals.

Although negative symptoms of psychosis are frequently researched, the subjective experience of these symptoms is not often studied in detail. This paper addresses this shortcoming by reviewing qualitative research about first-person perspectives on negative symptoms. A systematic literature search using Web of Science, Scopus, PsychArticles, PubMed, CiNAHL and Embase revealed 12 relevant studies. Our review yields a model with five clusters: failing social interactions; experiences of disconnection; overwhelming psychotic experiences; an eroded self-image; and detrimental side effects of psychotropic medication. In the discussion, the authors conclude that disturbances underlying negative symptoms should be studied in greater detail, starting explicitly from theoretical frameworks like phenomenology or psychoanalysis.

Objective:A significant proportion of adjuvant-treated breast cancer patients experience cognitive decline, challenging the person’s ability to return to normal activities after treatment. However, not every patient experiences cognitive problems, and even in patients with impairments, determining clinically important cognitive decline remains challenging. Our objective was to explore differences in neuropsychological performance following adjuvant chemotherapy (CT) in patients with breast cancer.Method:We conducted a prospective observational study in an Oncology Breast Clinic and assessed neuropsychological performance before and after adjuvant CT and in non-CT-treated women with breast cancer and healthy controls (HCs). Standardised between-group differences and regression-based change scores were calculated.Results:CT-treated patients (n= 66) performed significantly different from non-CT-treated patients (n= 39) and HCs (n= 56). There was a significant effect on verbal fluency (p= .0013). CT performed significantly worse than non-CT and HC [effect size (ES) = .89,p< .001 and ES = .61,p≤ .001, respectively] and from HCs with regard to proactive interference (ES = .62,p≤ .001). Regression-based scores revealed more severe cognitive decline in the CT-treated group [24.24% (16/66)] than in the non-CT-treated group [15.20% (6/39)] and HC group [7.14% (4/56)]. Patients who underwent CT and showed cognitive decline were less educated and older, with significantly lower baseline scores.Conclusions:CT-treated patients showed more vulnerability on cognitive control and monitoring than non-CT-treated breast cancer patients and HCs. Older patients with less education and lower baseline cognitive performance represent a group at risk for cognitive decline following CT. Identification of patients at risk for decline could improve targeted support and rehabilitation.

Background Today, international mental health care increasingly focuses on creating recovery-oriented systems of support. This study aims to unravel the daily practice of an inpatient psychiatric ward that engages with persons with complex mental health needs. Methods 17 in-depth interviews were conducted with patients and staff of the ward. Data was analyzed by means of thematic analysis. Results Three important functions of the ward were identified in the participants’ experiences. First, it functions as an asylum, a safe environment where patients can ‘simply be’. Second, the ward is experienced as a particularizing space, as support is organized in an individualized way and patients are encouraged to reconnect with their own identity. Third, the ward functions as a transitional space towards a valuable community life, in which finding adequate housing is of central importance. Conclusions The results show that inpatient forms of support tally with personal and social dimensions of recovery and fulfill important roles in recovery-oriented systems of support.

The aim of this study is to contribute to the understanding of recovery from and dealing with experiences of mania within a Lacanian psychoanalytic framework and to build on existing Lacanian theory to clarify processes of identification involved in recovering from experiences of mania. Based on a qualitative interview study including 18 individuals with experiences of mania, the authors undertook a thematic analysis of the interview transcripts, resulting in six themes that form a trajectory of identity construction. The first part of the results provides a thematic description of the steps that participants took in regard to living with their manic experiences. Subsequently, the authors interpret the results of the initial bottom-up thematic analysis using Lacan's model of the double mirror, a theoretical model of identity and subjectivity concerning the relationship between drives, drive-regulation, and identification. In terms of Lacan's model, the authors describe the trajectory of recovery as one of gaining mastery over manic experiences by developing ways of representing the drive and by adopting and further developing a shared narrative about the drive.

Background Delusions in schizophrenia are commonly approached as empirical false beliefs about everyday reality. Phenomenological accounts, by contrast, have suggested that delusions are more adequately understood as pertaining to a different kind of reality-experience. To date, however, the specific nature of delusional reality-experience has not been subject to systematic empirical study. It is also unclear howthis alteration of reality-experience should be characterized, which dimensions of experiential life are involved and whether delusional reality may differ from standard reality in various ways. Furthermore, little is known about how delusional patients value and relate to these experiential alterations. This study aimed to investigate the natureof delusional reality-experience, and its subjective apprehension, in individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis.Methods In this study, individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis formed a purposeful sample. Phenomenologically driven semi-structured interviews were conducted to explore the nature of delusional reality-experience and participants’ subjective valuation of these experiences. Interpretative Phenomenological Analysis (IPA), a qualitative method tailored to the in-depth exploration of participants’ first-person perspective, was used to analyse participants’ accounts.Findings Between Mar 2, 2020 and Sep 30, 2020, 18 adults with a clinical schizophrenia-spectrum diagnosis and lived experience of delusions participated in the interview-study. The findings suggest that delusions are often embedded in wide-ranging alterations of basic reality-experience, involving quasi-ineffable atmospheric and ontological qualities that undermine participants’ sense of the world as unambiguously real, fully present, and shared with others. We also found thatdelusional reality-experience can differ from standard reality in various way (i.e., in a hypo –and hyper-real form), across multiple dimensions (e.g., meaningfulness, necessity/contingency, detachment/engagement), and that participants are often implicitly or explicitly aware of the distinction between delusional and standard reality. Finally, delusional experience can have an enduring value and meaning that is not fully captured by a strictly medical perspective.Interpretation Increased awareness and recognition of the distinctive nature of delusional reality-experience, in both clinical and research settings, can improve diagnostic accuracy, explanatory models, and therapeutic support for delusional individuals whose lived realities are not always evident from an everyday perspective. ispartof: LANCET PSYCHIATRY vol:8 issue:9 pages:784-796 status: published

Changes in the forms and cultural meanings of work have gone deep during the last decades, with the transient nature of work becoming the norm rather than the exception. This is impacting particularly on youth employment, as Italy’s case epitomizes. Based on interview and focus group data, our study provides a multidimensional model to read and map the multiple tensions young people experience, at an emotional level, on entering today’s corporations. Our findings show, on the one hand, that young professionals’ expectation of work as a place of social learning and exchange clashes with the corporate focus on assimilating young people into target-oriented environments. On the other hand, both in younger and older workers, we found the experience of labour relationships that struggle to direct themselves towards a creative purpose and a developmental prospect, while tending to collapse emotionally inwards, in a fight for security.

While the recovery concept strongly resonates in clinical mental health care today, it first arose in service user-led contexts. A major risk of this professionalization shift is that recovery prim...

Objective Coercion is a controversial issue in mental health care. Recent research highlights that coercion is a relational phenomenon, although, it remains unclear how this intersubjective context should be understood. The aim of this study is to propose an interactional model of the relational aspects of coercion that enhances theoretical understanding, based on the assumptions of patients. Method The research question was studied by means of interpretative phenomenological analysis. Twelve people who had psychiatric hospitalisations were interviewed in-depth, using broad open questions relating to the experience of coercion and power in psychiatry. Data were collected in 2016 and 2017 in Belgium. Results Across participants' accounts we observed a specific structure. The relational quality of coercion seemed to be embedded within a process where individuals were one-sidedly approached as a ‘sick patient’, which led to profound segregation between staff and patients. This segregation caused a form of de-subjectivation: participants felt that important aspects of their subjectivity were neglected and they experienced professionals as de-subjectivated. They felt as if power resides within the (non-) interactions between patients and mental health workers. De-subjectivation arose and was enlarged within relations by broken contact, by silence in coercive acts, and by the necessity of patients to conform to the professionals' treatment regime. Helpful encounters that were not deemed coercive were those where patients and staff were individuated, which altered their relation. Conclusions To understand the relational quality of coercion, interventions like seclusion and house rules should also be understood within this structure of de-subjectivation. We need to tackle this dynamic if we want to reduce coercion in psychiatric care.

Supervision is crucial to most forms of talking therapy. This article focuses on psychoanalysis and explores how supervision can be conceptualized from a Lacanian point of view. We discuss two principal ideas about supervision from Lacan's work: making the analyst sensitive to the symbolic component of the unconscious and becoming sensitive to the interrelation between language and jouissance. These ideas comprise two stages that Lacan discerned in the process of supervision: the 'stage of the rhino' and the 'stage of the pun'. We illustrate Lacan's distinction between these stages by means of vignettes of analysts who were supervised by Lacan. We argue that an additional third stage should be discerned, concerning the challenge of incarnating the position of the so-called object a. Last, we discuss the pitfalls that an analyst might experience when conducting and directing the analytic work, namely the consistency of the imaginary, the delusion of the symbolic and the real of the body.

Summary Background Delusions in schizophrenia are commonly approached as empirical false beliefs about everyday reality. Phenomenological accounts, by contrast, have suggested that delusions are more adequately understood as pertaining to a different kind of reality experience. How this alteration of reality experience should be characterised, which dimensions of experiential life are involved, and whether delusional reality might differ from standard reality in various ways is unclear and little is known about how patients with delusions value and relate to these experiential alterations. This study aimed to investigate the nature of delusional reality experience, and its subjective apprehension, in individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis. Methods In this qualitative phenomenological study, we recruited individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis from two psychiatric-hospital services in Belgium using homogenous sampling. Criteria for participation were having undergone at least one psychotic episode with occurring delusional symptoms, present at least 1 year before participation, on the basis of clinical notes assessed by the attending psychiatrist; a schizophrenia-spectrum diagnosis, ascertained through clinical interview by the attending psychiatrist upon admission; being aged between 18 years and 65 years; and having the capacity to give informed consent. Exclusion criteria included worries concerning capacity to consent and risk of distress caused by participation. We did phenomenologically driven semi-structured interviews with the participants to explore the nature of delusional reality experience and their subjective valuation of these experiences. We used interpretative phenomenological analysis, a qualitative method tailored to the in-depth exploration of participants' first-person perspective, to analyse their accounts. Findings Between March 2, 2020, and Sept 30, 2020, 18 adults (13 men and five women, aged 19–62 years) participated in the interview study. The findings suggest that delusions are often embedded in wide-ranging alterations of basic reality experience, involving quasi-ineffable atmospheric and ontological qualities that undermine participants' sense of the world as unambiguously real, fully present, and shared with others. We also found that delusional reality experience can differ from standard reality in various ways (ie, in a hypo-real and hyper-real form), across multiple dimensions (eg, meaningfulness, necessity and contingency, and detachment and engagement), and that participants are often implicitly or explicitly aware of the distinction between delusional and standard reality. Delusional experience can have an enduring value and meaning that is not fully captured by a strictly medical perspective. Interpretation Increased awareness and recognition of the distinctive nature of delusional reality experience, in both clinical and research settings, can improve diagnostic accuracy, explanatory models, and therapeutic support for individuals with delusions whose lived realities are not always evident from an everyday perspective. Funding FWO Flanders. Translation For the Dutch translation of the abstract see Supplementary Materials section.

Delusions are commonly conceived as false beliefs that are held with certainty and which cannot be corrected. This conception of delusion has been influential throughout the history of psychiatry and continues to inform how delusions are approached in clinical practice and in contemporary schizophrenia research. It is reflected in the full psychosis continuum model, guides psychological and neurocognitive accounts of the formation and maintenance of delusions, and it substantially determines how delusions are approached in cognitive-behavioural treatment. In this Review, we draw on a clinical-phenomenological framework to offer an alternative account of delusion that incorporates the experiential dimension of delusion, emphasising how specific alterations to self-consciousness and reality experience underlie delusions that are considered characteristic of schizophrenia. Against that backdrop, we critically reconsider the current research areas, highlighting empirical and conceptual issues in contemporary delusion research, which appear to largely derive from an insufficient consideration of the experiential dimension of delusions. Finally, we suggest how the alternative phenomenological approach towards delusion could offer new ways to advance current research and clinical practice. ispartof: LANCET PSYCHIATRY vol:8 issue:3 pages:237-249 ispartof: location:England status: published

Background: Delusions in schizophrenia are commonly approached as empirical false beliefs about everyday reality. Phenomenological accounts, by contrast, have suggested that delusions are more adequately understood as pertaining to different kind of reality-experience. To date, however, the specific nature of delusional reality-experience has not been subject to systematic empirical study. It is also unclear how this alteration of reality-experience should be characterized, which dimensions of experiential life are involved and whether delusional reality may differ from standard reality in various ways. Furthermore, little is known about how delusional patients value and relate to these experiential alterations. This study aimed to investigate the nature of delusional reality-experience, and its subjective apprehension, in individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis. Methods: In this study, individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis formed a purposeful sample. Phenomenologically driven semi-structured interviews were conducted to explore the nature of delusional reality-experience and participants’ subjective valuation of these experiences. Interpretative Phenomenological Analysis (IPA), a qualitative method tailored to the in-depth exploration of participants’ first-person perspective, was used to analyze participants’ accounts. Findings: Between Mar 2, 2020 and Sep 30, 2020, 18 adults with a clinical schizophrenia-spectrum diagnosis and lived experience of delusions participated in the interview-study. The findings suggest that delusions are often embedded in wide-ranging alterations of basic reality-experience, involving quasi-ineffable atmospheric and ontological qualities that undermine participants’ sense of the world as unambiguously real, fully present, and shared with others. We also found that delusional reality-experience can differ from standard reality in various way (i.e., in a hypo –and hyper-real form), across multiple dimensions (e.g., meaningfulness, necessity/contingency, detachment/engagement), and that participants are often implicitly or explicitly aware of the distinction between delusional and standard reality. Finally, delusional experience can have an enduring value and meaning that is not fully captured by a strictly medical perspective. Interpretation: Increased awareness and recognition of the distinctive nature of delusional reality-experience, in both clinical and research settings, can improve diagnostic accuracy, explanatory models, and therapeutic support for delusional individuals whose lived realities are not always evident from an everyday perspective. Funding Statement: FWO Flanders - 12Q3319N Declaration of Interests: We declare no competing interests. Ethics Approval Statement: Ethical approval for the study was obtained from Ghent University Hospital Ethics Committee (EC/2019/0042). All participants gave written informed consent, including for use of anonymized quotes.

Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion and receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence (1) can retroactively become part of a topic closure sequence, (2) can become shaped as an intra-topic silence, and (3) can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels.

The authors examine the opening stages of the psychoanalytic process from a Lacanian perspective through the concept of logical time. We outline three key moments in Lacan’s theory that elucidate t...