J-J.Tyszler : The history of melancholy - 2

Seminar 2, November 11, 2012


Today, we shall study a particular term and its history from the perspective of medical and psychiatric training, one that has sadly disappeared from the nomenclature. Indeed, what we now call “mood disorders” (troubles de l’humeur) used to be called “melancholy.” As a side note, it’s worth pointing out that we tend to use the term “mood disorder(s)” without much reference to the wider situation of “moods ”(humeurs) in general.  It is in this context that the disappearance, indeed the mourning (le deuil) of certain words and ideas should be understood – like “melancholy,” “mania” or even “manic-depressive psychosis.” Nowadays we use terms that have far weaker historical references.  During our last meeting, I suggested that we think about melancholy under the term “imaginary”(imaginaire), with the historical dignity that the term deserves. The history of melancholy begins in Ancient Greece and ends with its artistic representation.  So we could name this historical investigation the “imaginary of melancholy” from the Greeks to its expression in painting as Saturn.

In today’s seminar, however, we’ll focus on the symbolic work within melancholy, by which I refer to the longstanding clinical work on the words surrounding melancholy.  I will discuss how the first French psychiatrists, the aliénistes, went about choosing the words to discuss these various affections, as well as their discussions and disputes.  So, after “imaginary ”and “symbolic,” we now turn to the third term, “real,” the “real ”of melancholy. 

Melancholy is indeed a genuine and real affection. It is the real tip of the iceberg that is depression.  There is nothing to interpret in melancholy.  As you’ll see, I call it “the real of melancholy” because it refers also to the object.  As such, one may ask which object is lost in melancholy (the object of identification, the object of love, etc…) It seems to me that in this context, meaning in order to approach the problem of melancholy differently, we should use Freudian texts about psychopathology, especially Freud’s dialogue with his friend Karl Abraham. 

Before beginning, however, I would like to address the pertinent question brought up during our last meeting, regarding the relationship between melancholy and the death drive. It’s true that with melancholy patients, we want to see the presence (seemingly “untied” (déliéé)) of the death drive through the intermediary that is the superego, a superego that is particularly cruel and untamable in melancholy.  This is what Freud will propose using his second topos, I/Id/Superego, which replaced the triad Unconscious/Preconscious/Conscious.

Now, remember that this is taking place after World War I.  And Freud, great clinician that he was, grasped very clearly the odious historical event that was about to occur. That is the context of his elaboration of the death drive, a context that other psychoanalysts didn’t appreciate to its full measure. So, of course, it seems natural to evoke the death drive for extreme affections wherein the patient finds himself in borderline situations (situations limites). They areborderline” in terms of thought, of psychology.

But melancholy isn’t the only affection in which the subject’s death drive keeps vigil. What we call “mental automatismis another one: the patient is constantly commented, and then he gradually dehumanizes himself under this constant comment.  Evidently, there are other “borders ”in mental illness, but melancholy carries an extreme point of acme.  Anne Cathelineau reminded us last time of the border that melancholy shares with paranoia in Cotard’s syndrome, in the delirium of negations, for instance.

When we find ourselves in these extreme zones, we get a sense with Freud that, for these patients, the death drive reigns supreme. Why is the death drive so difficult for us to read? Because its work within us isn’t solipsistic but always knotted, always in relation to something and luckily, that thing is eroticism.  When someone has a form of eroticism in which appears a bit of sadism (which occurs frequently in couples), Freud says that there’s a trace of the death drive.  Fortunately, however, that deep destructiveness is linked to eroticism, and therefore it remains alive.  Thankfully, not everyone has relationships that rely on aggressiveness.  In the zones we’re discussing here, however, that is the case.

Why does Freud use the expression “death drive”?  What do we make of it ? What traces remain in clinical practice and culture? And what do psychoanalysts think of it?  As I mentioned, not all psychoanalysts found Freud’s gift easy to accept.

As you recall, the first term we discussed was “passion,” in the etymological sense of passio, meaning suffering.  It’s the word used by the founders of modern psychiatry, like Pinel, when they began writing about melancholy.  They hadn’t forgotten that the Greeks distinguished two separate understandings of passion, one as “moral malfunction” (dérèglement moral), the other as an illness. Aristotle makes this distinction in Nichomachean Ethics. Why is this important?  Because on the side of “passion,” the patient has access to morals. But today, this idea (the moral treatment of mental affections) has been lost, unfortunately.  It’ gone.

About mania, Pinel says:

“One of the great principles of the moral treatment of patients suffering from mania is therefore to break their own will, and to tame it not through various wounds or violent undertakings but by imposing a fierce apparatus of terror which can succeed in convincing them that they are not the masters of their own will, that they cannot follow their will but must, in fact, submit to it entirely.”


Un des grands principes du régime moral des maniaques est donc de rompre à propos leurs volontés et de les dompter non par des blessures et des travaux violents mais par un appareil imposant de terreur qui puisse les convaincre qu’ils ne sont point les maîtres de suivre leur volonté fougueuse et qu’ils n’ont rien de mieux à faire que se soumettre. ”


Pinel called this “moral treatment.” Such a paragraph would be very problematic today. This quote shows that in the minds of the first psychiatrists, there was the idea of “breaking the will ”(rompre leur volonté) of the manic or melancholy patient by “imposing” what Pinel calls a “regime of terror.”  To be clear, he doesn’t mean physical terror; the means imposing a kind of terror imposed through discursive prescriptions.

Pinel, of course, is referring to the classics. In ancient Egypt, for instance, priests had methods for creating powerful diversions from megalomaniac or delirious ideas.  And such practices took place in temples dedicated to the god whom Romans named Saturn, temples that were highly attended by patients.  So the first aliénistes called “moral treatment” the revival of a kind of psychological pressure that used to be performed by priests in ancient Egypt, Greece and Rome. 

Pay attention to the term “moral treatment of mental affections.” It may seem so curious for us today but it’s very interesting. Beneath this “moral treatment,” appears in dotted lines the a theory of the subject – which implies that the ancients had a theory of subjectivity. The idea, as you can hear, is to reduce alienation in the name of Reason; it’s a call to “the reasoning part of Reason.” In Pinel’s psychotherapeutic project, the stake is Reason itself.

Is there any trace of that idea today? Of course, there’s many.  Not in this specific form of “terror,” but in all theories that assume the clinician can form an alliance with the part of the patient that is healthy – what we call ego psychology in North American tradition, for instance.  Still today, there are many forms of psychological theories that promote the idea of forming an alliance with the ego’s healthy component, of relying on the therapist’s empathy. The idea that beneath the folly itself, there’s a little man capable of reasoning is an old tradition, in fact. However alienated a man may be, there exists inside him a small man, the part of Reason, whom the therapist can solicit using various methods.  Of course, this approach can be criticized.  But criticism is itself a limited endeavor.  Behind all this lies a theory of subjectivity, a theory of the subject – and that’s what’s so interesting.  And of course, you can tell this has nothing to do with Freudian theory, nor even with the ideas of the classical alienists. The question of “partial delirium” always reappears in psychiatry, always and for all illnesses; there’s always been someone to say “hold on, isn’t it possible for a patient to be only partially ill?,” which implies its opposite, partially healthy. This idea consistently reoccurs in the history of psychopathology and even today. Keep this in mind.

Esquirol, Pinel’s student, starts working on words, and questioning “melancholy” in particular. Why didn’t Esquirol like the term “melancholy”? Because he finds it excessively laden with philosophical and poetic insinuations – for the very reasons I’ve explained.  It is because melancholy is so present in culture, and considered with regard, that Esquirol wants to find another word.  So he uses “monomania,” meaning an illness that consists of having a mania regarding a single object. The patient has one exclusive idea.  When you think about it, it’s quite true that the melancholy patient seems to live on a single ruin.  He sees the world and himself as a ruin. That’s his sole idea.  His entire world is concentrated on that object. 

“Monomania ”or “hypémania,” meaning “sad delirium.” I’ll skip the details but for now, suffice it to say that Esquirol describes “hypochondriac hypémanias ” with themes relating to the body.  Or he coins the term “persecution hypémania,” which brings us closer to paranoia, “suicidal hypémania,” etc… Once a term is fixed in psychopathology, there’s always a series of “subtypes ”that appear.  So much so that, in the end, the word itself becomes a fiction, since there are so many particular cases. Before one can have subtypes, however, an illness must be named. First name, then ramify.

During the same period, Morel considers these aren’t illnesses per se, only symptomatic states.  It seems strange, the robustness of these entities -  but that’s the way it is.  Great psychiatrists at the time responded in the following way: “We don’t recognize mania or melancholy as illnesses.  They don’t form whole entities. From our point of view, they’re only symptoms, syndromes that can potentially appear in any affection.” Again, there are traces today of this type of reasoning. And pharmaceutical labs exploit these complexities. Today, for instance, and whatever the illness may be, if one prescribes anti-depressants with any other kind of psychotropic drugs, it’s because (or so the argument goes) there are forms of “moods” in any associated pathology. So, while some psychiatrists were busy taking on the work of naming affections, others protested: “You say this is an illness, but it’s not so sure; I think it’s just a symptom.” According to this argument, one could find this kind of symptom in any other illness. And once the had debate begun, it never stopped.

Pinel, Esquirol, Morel, Baillarger … Together they form what can be called a “clinical school of passion” (clinique de la passion).  Mania, melancholy considered in its classical, antique sense as “passions,” forms of suffering, the loop of suffering (une souffrance en boucle).

Second term for today, a wonderful and very complex invention: the idea that mania and melancholy are affections of time, affections of temporality.  What an insight!  Remember, this is very long before Einstein!  Falret and Baillarger start a race for a prize at the Académie de Médecine (like the Prix Goncourt or the Prix Femina today). Months apart, they each send a thesis (un mémoire) to the medical academy to have their intellectual paternity recognized for the new description of mania and melancholy. 

1854.  Baillargerpresents to the Académie his Mémoire entitled : “Notes on a kind of madness whose bouts are characterized by two regular periods, one which consists in depression and the other, excitement” (“Note sur un genre de folie dont les accès sont caractérisés par deux périodes régulières, l’une de dépression et l’autre, d’excitation”). And, all the more incredible, he names this affection by adding:  “I call it, “Double form madness” (“J’appelle ça, “Folie à Double Forme.”)  This may seem like a detail to you, but naming this illness in this manner had never been done before. In Egypt, Greece and Rome, this kind of alternation between phases of mania and melancholy had been noticed, of course. But not until the nineteenth-century had anyone thought of stating “Since I notice these two states, I’ll join them under the term “double forme.”  So this is Baillarger’s signifying coup de force – he joined mania and melancholy.

Last time, Anne Cathelineau suggested that we could link melancholy and paranoia for reasons of method. But Baillarger was the first to unite under a single term these phases of mania and melancholy.  Still today, we say “paranoia and melancholy.”  We don’t have a word that substitutes a single signifier for both.  Baillarger did.  In 1854, he said “Folie à Double Forme.”  This kind of work is deeply structural in nature. Through language, Baillarger invents a new structure, a structure that clinical observations had proven to be joined, but which hadn’t yet been conceptually tied. 

The recent release of the feature film Augustine shows the general public’s renewed interest in the history of psychopathology.  If you think about it, there are incredible events marking the history of psychopathology, events that really lend themselves to romanesque narratives and representations. I’ve seen plays about de Clérambault’s patients, for instance, about erotomania, “passionate psychosis” (psychose passionnelle), the erotic delirium of fabrics (étoffes). That’s amazing to me – the fact that it’s possible to write an entire play around these sessions.  There’s no need to add anything. So, in this light, perhaps a film could be written some day about the following events:

A few months after Baillarger, Falret rushes to present his own report to the Académie, “On circular madness” (“De la Folie Circulaire”). So, in terms of structural analysis, Falret goes one step further than Baillarger ‘s “double forme.” What does this term “circular madness” imply? That temporality is indeed an intrinsic part of this “madness,” that temporality itself has entered the phenomenological description.  I’ll read:

This kind of mental patient (aliéné) rolls in a single circle of diseased states that reproduce ceaselessly as if by fate and are separated only by a rather brief interval of reason. Circular madness is characterized by the successive and regular evolution of the manic state, the melancholy state and a lucid interval of varying lengths of time. More than melancholy and mania, circular madness is a natural form insofar as it is not based on a single principal characteristic (the amount of delirium, sadness or agitation) but on the conjoining of three particular states, which succeed one another in a determined order that is itself possible to predict, yet are not susceptible to transformation. We shall call a bout of circular madness the conjoining of three periods whose succession forms a complete circle.”


“Ce genre d’aliéné roule dans un même cercle d’états maladifs qui se reproduisent sans cesse comme fatalement et ne sont séparés que par un intervalle de raison d’assez courte durée.  La folie circulaire est caractérisée par l’évolution successive et régulière de l’état maniaque, de l’état mélancolique et d’un intervalle lucide plus ou moins prolongé.  Elle est, à plus juste titre que la manie et la mélancolie, une forme naturelle car elle n’est pas basée sur un seul caractère principal (la quantité de délire, la tristesse ou l’agitation) mais sur la réunion de trois états particuliers se succédant dans un ordre déterminé, possible à prévoir et n’étant pas susceptible de transformation. Nous appellerons accès de la folie circulaire la réunion des trois périodes dont la succession forme un cercle complet. »


If this description were written today, the author would win the Nobel Prize in Medicine! You must realize, retrospectively, what’s going on here. A psychiatrist suddenly introduces not so much a more sophisticated or more complex description of the forms, as much as a new and entirely unexpected structural element: he tells us that time itself is part of this illness’s structure.

I won’t get into some of the clinical difficulties posed by his definition, for now, like for instance whether this interval can really be considered “lucid” or not. What you should really focus on is the coup de force of such a nomination.

Baillarger says “folie à double forme.” A few weeks later, Falret, gets peeved that his discovery is escaping him, so he invents the term “folie circulaire.”  These terms show you the genuinely structural debate that’s taking place.  In his description of these successive states, Falret insists on the notion of intermittence, of repetition. You recall, of course, that the question of repetition is fundamental for Freud : everything repeats itself. The unconscious is nothing but repetition, reproduction.  With Falret, then, and for the first time in the history of psychiatry, “mania ”and “melancholy ” are completed by a third, very dense and rich term, “circulaire.”

  With the great Kraeplin, these three terms conjoin to form “manic-depressive madness” (folie maniaco-dépressive).  And the terms we still use today, “manic-depressive disorder,” or “manic-depressive psychosis.” Now you can certainly appreciate the inanity of the term “bipolar disorder.” I don’t even know what it means, quite honestly.

Why did Kraeplin win the game of nomination? During the same historical period, German psychiatrists were trying to describe the same affections as French psychiatrists.  Their work culminated in the nosographic work of Kraeplin’s 6th edition (I can’t stress enough how brilliant this psychiatrist was), which finally fixated the term “manic depressive psychosis,” which refers to the same idea as “folie circulaire.”

What is this circularity?  How can it be conceptualized? How is it possible for a clinician to meet an 18 year-old boy suffering from a delirious rush (bouffée délirante) that looks like an atypical manic episode - and twelve years later, the same psychiatrist meets him again at the age of 30, in the throes of a melancholy episode. And how do we generally respond to this situation? We medicate. Unfortunately, however, things don’t improve for this patient. Every two or three years, he is admitted back into the hospital during characteristic episodes. What’s going on?  Where is this circularity located in the unconscious? This issue raises some amazing questions, questions that remain entirely invisible if the problem is reduced to a biological problem.  Regrettably, that’s the position that’s often chosen today. The biological argument shuts down all questions; it systematically reduces complexity to simplicity.  But listen, to this extraordinary question: “How is it possible during the course of an entire life for the unconscious to experience this kind of circularity?” This is a very interesting question, a question that remains entirely unattainable if the problem is viewed through the biological lens.

Before continuing with Falret, I’d like you to think about your experience when you attend patient presentations in various hospitals around Paris.  This is a crucial aspect of your training.  And yet, surely some of you have probably been disappointed to have never come across a typical manic episode.  Two reasons explain why such episodes are more rare nowadays.

First, the over prescription of psychotropic treatments, treatments often prescribed by GPs, in fact.  As a result, these formidable affectations end up being “clipped off” (écrêtées). The peaks and crests have been dulled out. Even upon arriving at the hospital, patients nowadays rarely have this extraordinary efflorescence they used to show.

The second reason brings me back to Falret.  Keep in mind that psychotropic treatments didn’t exist when Falret was formulating this reason. He writes:

“These two states whose continuous succession constitutes circular madness are generally neither mania nor melancholy per se, with their usual traits. In a way, it is the depth of these two kinds in their relief.”


“Ces deux états dont la succession continuelle constitue la folie circulaire ne sont en général ni la manie ni la mélancolie proprement dite, avec leurs caractères habituels.  C’est en quelque sorte le fond de ces deux espèces dans leur relief.”


This remark is beautiful.  What Falret is describing here has a name in psychiatry; it’s called “mixed states” (les états mixtes). The patient who seems joyful, agitated, jumping from one thing to another.  But when you start asking questions, the patient suddenly starts weeping and allows a bout of massive depression to appear.  So, as Falret says, this patient would have “both depths at the same time” (“les deux fonds en même temps”) - neither entirely manic nor melancholy. Both reams of fabric are mixed. This observation is extraordinary, because it describes exactly what we encounter most of the time – mixed states.

As I mentioned earlier, however, Falret’s description raises the serious issue of

what he called “lucid intervals.”  Why is the idea of intervals of lucidity so problematic? Because, usually, a patient is either insane or not. Period. Until then, we didn’t quite know what it meant to be insane “at times” but perfectly reasonable or lucid at others. Generally, it was one or the other. So the question of intermittency was very unusual in psychopathology. In its own way, without being treated in its entirety, you see how this question does arise. The patient has an “insane” moment; his manic episode requires hospitalization and constraint.  And two years later, he has a melancholy episode, which also requires protection and supervision on account of the risk of suicide.  But what about between those two states? What happened between these two moments in the patient’s psychology? Did he return to a “natural,” a so called “normal” state ?

            That is one of the major difficulties posed by Falret’s work: how can we appreciate the patient’s state outside of these efflorescent states? Can you really describe as a lucid “interval” a period that lasts 2, 4 or 10 years?? It would be scandalous to even name this state a “psychosis.”  How could you use the word “psychosis” to refer to different states separated by years?  So Falret’s description raises huge questions about the conception of this affection, as well as the restitution of the patient’s subjectivity in between these phases.

The aliénistes weren’t able to answer these questions.  We have to wait for more psychoanalytically oriented work, work based on observation, for descriptions of the traces left by these manic/melancholy episodes in the patient’s subjectivity. Because, of course, there are subjective traces.  Recall that this interval is called the “free interval” (l’interval libre). But is it really “free” of everything? It’s not likely. 

The diagnosis of “manic-depressive psychosis ”generally implies a prophylactic treatment likely to last an entire lifetime. Rare are the patients whom we must warn that they’ll probably have to withstand a thymoregulator like lithium over a very long period of time. By the way, as a side note, do you know that we actually have no idea how lithium works? This is normal in medicine, of course. Many treatments were used once and, coincidentally, we realized they had an effect.  There are hundreds of medical articles on lithium.  We don’t know how it works, but it does seem to have a “protective role ”(although it certainly doesn’t heal anything.) Science doesn’t know how to heal these affections.  So be very weary of this point.  But there’s a vast difference between “healing ”and doing nothing. And we aren’t entirely without resources in the face of illness. A kind of accompaniment can take place with manic-depressive psychosis, one that requires prophylactic treatment. If the affection is recognized as such, these patients will get lithium or some other thymoregulatorStill, such treatments are problematic because many of them are derivatives of anti-epileptic drugs. It does mean spending one’s whole life taking such treatments. It’s a complex treatment.  And I won’t even get into the topic of safeguarding : safeguarding assets, patrimony, etc… Don’t forget that psychiatry is a medico-legal discipline. We’re on the borders (confins).  We have to protect patients form themselves, sometimes from their own families… So once this diagnosis is confirmed (avéré), things get very complex.

How can one simultaneously conceive of very long “free intervals” and lifelong treatments? Conceptually, you see how this poses a real technical difficulty for a doctor.  At the same time, I can consider that these bouts will occur at wide intervals; still, as a practitioner, I take measures over this life that are basically definitive.  How do we justify this?  And yet, it’s necessary.  It will happen.

All these words, these expressions, these debates among colleagues at the time establish very durably a casuistry, a nosography, and also a practice.  We all operate within a practice induced by this essential foundation (mise en place).  If you say “this is nothing at all; they’re only symptoms, social symptoms.  There’s no illness.  It’s capitalism that creates illness, so let’s not bother.”  Of course, this kind of practitioner would be faced with the refusal of very precise measures framed by law and medicine.  So the work of these first aliénistes anchors our work today, still.

So far, we’ve spent time thinking about the history of a problem whose traces are still visible.  In fact, it’s likely that the term “bipolar disorder” results from what Falret was saying, since his particular contribution was to add the notion of time.

Will there be other possibilities throughout the history of this term?  Yes.  Especially from the German school of phenomenology, where mania/melancholy will be viewed as a disorder of affect, meaning a disorder of “being in the world,” a disorder of “Dasein,” to use Heidegger’s term, one that affects subjectivity at its deepest core.  So in the German school, you get incredible work, including Gressinger’s remarkable notion of “moral pain,” meaning “the pain of not being affected.” This means that the melancholy patient (I’ve come across this a lot during my various experiences in hospitals) complains that she isn’t affected; she doesn’t feel anything. Family, children, husband – they all come to visit her and after they leave, she complains about not having felt anything; they are strangers to her, in a way.  This is a “moral” pain.  The patient says: “I don’t understand.  These people are my people; I realize that.  But they no longer affect me. What they experience, what they think – it no longer matters to me.” This very unique pain was also called “affective anesthesia” – anesthesia of affect. The angle of psychopathology isn’t infinitely open, but it is very wide. 

Now, Freud.

Freud will immediately be confronted to this problem of affect because of something that didn’t interest others, but which intrigued him deeply: self-accusations. The melancholy patient accuses himself or herself of having allegedly committed “monstrosities,” like infidelity, financial ruin, family ruin, causing trouble among colleagues, etc… The patient sees him or herself as a monster, a terrible person.  One could almost call this affection “a megalomania of ruin.”  There’s a beautiful current in painting that’s all about ruins. That’s the melancholy person: (s)he’s ruined everything around him. 

Freud was fascinated by this question and took the following position: self-accusations are accusations. Period. Through self-accusations, the melancholy patient is actually aiming at a lost object.  The problem with that remark is that Freud is modeling this view against mourning.  The lost object is what you find in “Mourning and Melancholia.”  When someone dies, it’s true that idealization takes place. Suddenly, everyone blesses this dead person. The same person everyone criticized when he was alive is now adored. Of course, in mourning, there’s also lot of repressed aggression. “Why did you leave?  You’ve left me with all the nonsense to deal with. You leave me alone, and I have to take care of everything now.” That’s what interested Freud: how the accusations of mourning turn into self-accusations.

The problem with Freud’s idea is that he places the object of mourning and the object of melancholy in the same bag. Bouts of melancholy are rarely related to mourning, however. These patients haven’t lost anything.  Nothing has happened.  This is the way Freud thought about it, probably because the question of affect interested him so much.  So basically, Freud neither went through the classical temporality, nor through passion. He took the problem of melancholy from the side of pain, the pain of being alive. What alerted him was the issue of “affective anesthesia.”

Let’s turn to a few references about the “dualism of drives” (we no longer say “dualism of instincts,” and yet in French, we still say “instinct de vie,” “pulsion de mort”).  Freud is intellectually close to Schopenhauer.  And of course, later, close to Nietzsche.

Freud didn’t like it when psychopathology was linked to philosophy.  That wasn’t his thing at all. The issue wasn’t whether he liked certain philosophers or not. What he wanted was for the signifiers of psychoanalysis to form a corpus specific to psychopathology itself.  He didn’t like the way people forced psychopathology towards this or that philosopher.  Things are very different in Lacan’s case. Lacan’s work is full of references to various philosophers.  And he always names his references. Lacan dialogues and even argues with past authors.  For instance, he translated Heidegger’s “logos” into French.

Not Freud; and that’s the reason why most psychoanalytic terms cannot be translated into philosophical terms. How does one translate “phantasy,” “drive,” “identification” into philosophical vocabulary?  A philosopher doesn’t know what all of this means.  We stumble upon an interesting difficulty, something specific to the Freudian corpus, but which Freud justified.  Freud’s corpus is first and foremost clinical, psychopathological in fact.  It’s not “borrowed” from philosophy. 

Schopenhauer formulated some very delicate ideas, like this one:

“The greater a man’s awareness of nothingness and of the chimerical nature of all things, the greater his awareness of his intimate self’s eternity.”


Plus un homme a clairement conscience du néant et de la nature chimérique de toutes choses, plus aussi il a clairement conscience de l’éternité de son propre être intime.”


There’s something very interesting for psychopathology in this citation: in order to posit one thing, you start with its opposite. The process of thinking requires a wall against which on can think one’s own position. It is through opposition that we recognize the nature of things, much like the way the passenger takes note of the vessel’s speed by looking at the land, and not by staring at the vessel itself. 

From which vantage point does one contemplate clinical practice? From which angle does psychopathology establish itself? Schopenhauer is asking an extremely important question, which is: “From whence do we behold the representation of something?” “From where” do we utter the terms “mania,” “melancholy” or “schizophrenia”? From which point of view?

            Schopenhauer, again:


“Our existence resembles the planet that would collide with its sun as soon as it would cease its own irresistible march forward. Agitation is therefore the nature of existence.”


“Notre existence ressemble à la planète qui se heurterait avec son soleil dés qu’elle cesserait sa marche irrésistible en avant.  L’agitation est donc le type de l’existence.”


You see how Freud could have latched on to this idea, with the way Schopenhauer formulates the idea of incessant repetition? Later, Lacan will address the fact that everything repeats itself.  Does this mean that everything is the same, or can we expect some kind of difference in relation to the question of repetition?  Existence as misunderstanding… Life as disillusion… It’s all in Schopenhauer. 

So it’s probable that Freud’s death drive can be framed within a certain philosophical tradition, a tradition that interested Freud but probably didn’t suffice either. The ruptures of life and history were necessary as well, not just the question of mourning (which comes up now that Freud’s letters to his children are being published).

For the idea of the death drive to be possible, Freud needed the double historical juncture of his century, meaning the rupture caused by two consecutive world wars. That’s probably how Freud found the strength to say some very unusual things on the history of the death drive.

As a conclusion, I’ll offer you a few reading suggestions:


Even if the author seems obsolete nowadays (wrongly so, in fact), I highly recommend the very important Freud/Abraham correspondence (1911). As you know, Freud’s correspondence is incredible. It is comprised of hundreds of interlocutors, thousands of letters, some of which are amazing from the clinical point of view.

Why such a correspondence?  In terms of mania and melancholy, Freud only saw two patients.  Why?  Because his was a private practice and, as such, most of his patients had neurotic symptoms (as we used to say), suffered from hysteria and traumatic neuroses, etc… Freud is a doctor, so whom does he see?  Well, he sees patients that one can see at home… Consequently, he saw very few patients presenting signs of mania and melancholy…Evidently, even today, it would be insane to send a patient suffering from a highly manic or melancholy episode to a private clinician. Freud didn’t see many cases of paranoia either.  Paranoia made him uncomfortable; he didn’t quite know what to do about it.  Nor schizophrenics. 

Nowadays we can follow privately some manic-depressive patients (I do), as well as certain forms of paranoia, including schizophrenics. Remember that one hundred years have passed.  So the practical field of clinical application is now much greater.  We know how to deal with some of these illnesses far better now. This doesn’t mean we know how to deal with everything, of course; we just deal with them better. The distinction is crucial. Many colleagues are able to see psychotic patients in their private practice. And not only with medication, I mean – with proper sessions as well.

Freud had only two cases, but he had that incredible ability to describe a whole world based on a single patient. That’s the mark of genius, surely. We wouldn’t be able to do that.  But his friend Karl Abraham worked in a hospital, and he had eight cases.

Remember that the French alienists were working in the 1850s’.  The Freud/Abraham correspondence takes place in 1911, only fifty years earlier. That’s not very long, one or two generations. What’s particularly interesting is the incredible shift in language between the 1850 and the “alienists,” and 1911 with  “Freudian psychopathology.” The terminology is completely different. In fifty years, new terms appear, like “introjection,” “identification,” “incorporation,” “lost object,” “object of love”… And these new terms are not readily juxtaposed onto the older ones…

1911: Abraham’s “Notes on the Psychoanalytic investigation and Treatment of Manic-depressive Insanity and Allied Conditions” (Préliminaire à l’investigation et au traitement psychanalytique de la folie maniaco-dépressive et des états voisins.”)


In this text, Abraham works on the interesting problem of the dyad anxiety/depression (whose emphasis in today’s medicine is rather abusive, to be honest).  Nowadays, the same treatments are prescribed for both, which is really unbelievable! Doctors hear it all the time from pharmacies… “We have a range that works for many ailments, from anxiety to insomnia and depression – So, you might as well just give them this one.”  Why do I use the word “anxiety” for one patient (and as you know, there are paroxystic/cataclysmic anxieties), and “depression” for another? 

Abraham also addresses the problem obsessive neurosis/melancholy.  He really struggles to distinguish obsessive neurosis (névrose de contrainte) and melancholy. It seems like an odd and rather theoretical problem today, but at the time it was a truly epistemological question. Today, it’s a given that obsessive neurosis and melancholy are clinically distinct. Of course, some clinical symptoms bare a certain resemblance, but still… It’s one thing to have doubt, verification and obsessions. It’s an entirely different thing to encounter the megalomaniac self-accusations of melancholy. Abraham wanted to figure out how to distinguish neurosis, in which there is punishment (châtiment) from melancholia. 

Finally, and this will please Anne Cathelineau, the third term… Abraham was concerned with differentiating paranoia from melancholy. As I said, Freud hadn’t seen many cases of paranoia.  Still, he wrote the amazing book on the Schreber case, which, as you remember, is a literary analysis… Freud conducts a psychopathological examination based on what Schreber says about his own illness in the book. Freud never actually met Schreber! And ever since Freud, all analysts use the case of President Schreber as a reference. 


1916: Abraham’s “Investigations regarding the Earliest Pregenital Stage of Development of the Libido.” (“Examen de l’étape prégénitale la plus précoce du développement de la libido.”)


No alienists ever spoke like that.  Aside from “genital,” they don’t know any of these terms. “Development of the libido,” that’s Freud.  Why does he say that?  Because of the problem that is “orality” (l’oralité). As I mentioned last time, even in the Classical texts we understand this gluttonous orality.  “Chronos devouring his children,” Goya’s painting in Madrid, we understand immediately… Goya grasped something structural about that big mouth, swallowing. In this text, you find Abraham’s reflections on the concept of orality in psychoanalysis.


1915: Freud’s “Mourning and Melancholy

In this text, Freud asks the crucial question: how does melancholy differ from the experience of mourning? We think we know mourning, and how it works.  But frankly, our ideas on mourning could really use clarification, all the more so now that societies no longer quite know how to accompany mourning. I’m always amazed by the children I meet. Someone has died, and the parents explain to me how they didn’t bring the child to the funeral: “We figured it wasn’t worth it,” they say.  Sadly, this is increasingly more common. On a mass scale, as a culture, we’re making sure children avoid knowing the experience of mourning, the rituals that accompany death.  Even physically, they don’t know this experience since parents no longer bring them along. Children don’t even know where the tombs are anymore.

Back to Freud’s text and to the question of how to distinguish mourning from melancholy.  It is a beautiful text indeed, like an open sky cathedral, like Gaudi’s cathedral in Barcelona. The foundations are extraordinary, but there’s no roof.  Freud cannot draw a conclusion in this text! Not because he doesn’t want to, but because he can’t – and he knows it.  Freud simply lacks the sufficient material to draw a conclusion around all the paths he’s opened.

So, even with Freud, you won’t find the answer! You won’t know how to distinguish mourning and melancholy.  And it’s fine that way.  It’s very important for Freud to have opened the question, without having the pretense of answering it.  Most Freudian texts are like that.  They’re questions.  Answers, as Freud would say, can wait.


 “The Loss of Reality in Neurosis and Psychosis” is another important text on account of its nosographic status as an intermediary to manic depression. Still today, I find this text absolutely brilliant!  Here we are, around 1910, and these two friends, Freud and Abraham, are working hard to elucidate these issues… And when you follow Freud’s texts, you realize that he’s still wondering about the very same questions 15 years later!  Over the course of 15 years, Freud continues to ask the same questions questions, and wonders where he’s going to place manic depression inside his models, between the ego and the superego, or the Id?  How does it all fit? 

You must take notice of this fact: clinicians were able to stick to the same question for 15 or 20 years without settling it. And throughout these exchanges, and throughout various articles, you’ll find lingering traces of the same questions. That really is incredible to me.  And that’s what qualifies as “scientific”: the capacity to ask a question and to keep it open, to retain this question and pose it to colleagues, to friends, to ask them what they think of this questions, how do they contest it, etc.. 

So why doesn’t this question get settledBecause there are questions that Freud can’t settle that easily.  Consequently, psychoanalysts really worked hard at grasping Freudian topology, Lacan in particular.

Earlier, I mentioned the Superego. I suggested that one could say of melancholy that it is a mental affection in which, in a paroxysmal manner, the superego overburdens itself with the death drive – in a way.  That could be a definition. When I say that, however, I am also pretending to know exactly what the superego is. I’m using the word “superego.” but…

With Freud, you’ll have the hardest time distinguishing the superego from the ego’s ideal (l’idéal du moi). At first glance, the terms appear separated: the ego’s ideal is what the child hopes for himself, what he idealizes about his future position, his projects, how he will elevate himself through life. The superego appears equally simple: it’s the bad conscience that always tyrannizes the subject whenever he makes a mistake, and accuses him: “Why did you do this?!  You should have done that!!”

Although things seem simple enough, Freud gets tangled within this simplicity and argues that it’s hard to distinguish the superego and the ideal ego (le moi idéal). Evidently they’re not difficult to distinguish in theory.  But Freud is a practitioner, a practitioner of cures - not a theoretician. Much like us, his entire knowledge of the human psyche comes from his patients. Inside the unconscious, these two positions (one touching upon the superego and the other touching upon the ideal ego) are very difficult to differentiate. This will be one of the many problems Lacan inherits from Freud.