Why You Can’t Stop Thinking: Obsessional Neurosis

Uploaded 4/10/2023, approx. 40 minute read

Salvador Dalí's painting, Metamorphoses of Narcissus, 1937. It captures the way that obsession becomes dangerously introspective.

Today we're going to discuss obsessional neurosis.

What is it? How does it manifest? And what's the connection between obsession and dissociation?

In the myth of Narcissus, the youth falls totally in love with his own image.

It's a common mistake.

The youth, the young man in the myth, doesn't fall in love with himself. He falls in love with his reflection and he's so attracted to it, so inexorably drawn to it that he falls into the lake or the body of water and he drowns in it.

And this in a nutshell is obsession.

My name is Sam Vaknin. I'm a former visiting professor of psychology and the author of "Malignant Self-Love: Narcissism Revisited."

The two elements of obsession are, number one, dissociation.

The obsession takes a life of its own. It consumes the obsessed person.

The obsessed person loses touch, loses contact, even with his own body, let alone other parts of his mind.

And the second element is self-destructiveness.

Obsessional thoughts lead to self-destruction.

There was a famous case of, yeah, you guessed it, Sigmund Freud. Who else?

So there was a famous case of Sigmund Freud.

So let me get this.

It's another computer. It's a new computer and I'm not quite adept at using it.

So there was a case, a famous case of Sigmund Freud and he named it "The Rat Man." It was published in 1909 and it is the first description in depth of obsessional neurosis.

A client came to Zigmund Freud and he complained of obsessive thoughts. These thoughts would intrude. That's why they are called intrusive thoughts. They intrude, they occupy the mind and there's no reason or rhyme as to why they do so.

His thoughts, the thoughts of the rat man, were focused on something really bad is going to happen. They were catastrophizing thoughts. He believed fully. He was convinced that some kind of misfortune or mishap is going to strike a relative, loved one, someone close to him.

And then the rat man has to take some kind of action and the action was irrational. The action was not connected to the fear in any way, shape or form. It just was a ritual.

Freud described the case as a moderately severe case of obsession and neurosis, but he found it very difficult to comprehend. He felt much more comfortable with hysteria.

The real name of the rat man was Ernst Lanzer.

Freud learned that his patient is obsessively attempting to do things which will minimize the chances of something bad happening, as I said.

And then he found out to his utter shock that the patient's father had died only a few weeks, a few years before. So the patient's father was dead.

And so Freud called the patient and asked him about his behaviors.

Of course, his behaviors were compulsive. There was obsession with nightmarish ideas and fantasies, mainly about rats. That's why Freud called him the rat man. And there was compulsion, these bizarre actions that Lanzer took in order to allay the obsession, to somehow reduce the anxiety attendant upon the obsession.

And Lanzer's fears were revolved around punishments involving rats.

Lanzer has heard that military prisoners are punished with rats.

So the minute he heard of the punishment, he became worried that it would be inflicted on someone close to him, possibly his.

Yeah, dead father. That's what surprised Freud.

It is very hard to argue with obsession, as you can see. It is a pathological adaptation, even to something that had already happened.

Lanzer, the rat man, was worried that his dead father would be subjected to punishment. But of course, it's totally crazy. It's irrational. His father was dead. No amount of punishment could have touched him.

And yet the obsession was real, and the compulsion that followed.

Obsessions and compulsions are intimately linked to traumatic events.

The events could be minimal in the eyes of others.

And when you look at the events, as an observer, you could say, "These are not traumatic events. I've had a hundred like these happen to me."

But they're traumatic to the patient. The patient perceives them as traumatic.

For example, Lanzer heard about the torture of military prisoners with rats. As far as he was concerned, this was very traumatic.

The mind develops a defense against the trauma, and it is this defense that gives rise to the obsession.

So there is a point of being overwhelmed.

The sequence is like this, trauma or traumatic events, dysregulation, being overwhelmed, which is very reminiscent of borderline personality disorder.

And shortly you will see the confluence between obsession and borderline.

So there is an element of dysregulation and then a defense against the dysregulation.

A defense against drowning in the fear or the anxiety or in the defense is behavioral.

There is some compulsive behavior. The compulsive behavior is symbolic. It's not connected or linked or intimately attached to the specific fear.

Winnicott wrote an essay late in his life, and it was called "Fear of Breakdown." And what he did, he elaborated on Freud's idea.

Winnicott said that the patient's fear of impending breakdown is actually based on a breakdown that has already happened. The patient is using defenses, using obsessive thinking to deny his or her own disintegration. The patient already fell apart, decompensated. The patient is all over the place, but cannot admit it. It's terrifying to admit that you're no longer glued together, you're no longer put together.

So the obsession and the compulsion are a form of displacement. It's like, let me focus all my fears and all my anxieties and all my energy. Let me affect a series of intrusive thoughts which are so outlandish, so inane, and so rational that I can cope with them. I can cope with them by adopting rituals and ceremonies which can fend them off. They are powerless. These thoughts are powerless in the face of action.

When you fall apart, there's very little you can do about it. No amount of action will put you back together.

But if you were to displace your concern, move it elsewhere, focus on something else, then action is perceived as a solution and you can, there's a sigh of relief.

That's precisely the mechanism behind addictions.

So addictions are forms of obsession. Addictions tend to cut off and disconnect people from themselves and from other people.

The addict's primary relationship is with his own addiction. The obsessive person's primary relationship is with his own obsessive thoughts.

And the reason is that both the addiction and the obsessive thoughts are perceived as beneficial. They perceived as a saving grace.

The addiction and the obsession, this is something you can control. This is the foundation of eating disorders, for example. It's all about reasserting control.

Your life has spun out of control and now you develop an addiction, develop an obsession. You control the substances that you consume so you convince yourself. And of course, you can fend off the intrusive thoughts, just doing a series of minimal actions such as washing your hands.

In addiction, any type of addiction, I mentioned eating disorder. Eating disorder is an addiction. It's an addiction to not eating, in the case of anorexia nervosa.

But in addiction to food, to alcohol, to drugs, sex, gambling, you name it, the addiction serves two purposes. It restores the sense of control and the locus of decision making. It creates an internal locus of control. And it creates a fixed, dependable, reliable point in the addict or the obsessed person's life. It creates a kind of skeleton.

It holds the person together.

As long as the obsessive person can continue to obsess, nothing else matters.

The opposite, the antonym of addiction and obsession is not peace of mind, it's connection.

Some of you may remember Martin Scorsese's film, The Aviator, 2004.

It's about Howard Hughes.

Howard Hughes is on top of the world. He's a successful film producer, a navigation magnate, a tycoon, but gradually he falls apart. He becomes more and more unstable and he desperately tries to cope with his own dismantling by introducing obsessions into his life.

He becomes severely obsessive-compulsive.

Obsession, the etymology of the word obsession is from Latin, obsidare. It means to lay siege.

The obsessive thoughts, the intrusive thoughts, lay siege to the obsessed person. It's like being under siege.

Now we often mislabel certain behaviors and certain cognitive processes as obsessions. Actually they're not.

Consider for example rumination.

Rumination has been defined in 2008 by Nolan, Hoeksema, Watkins and others has been defined as rumination is the tendency to repetitively and passively analyze one's problems, concerns and feelings of distress without taking action to make positive changes.

So the ruminator dwells on the problem but never transitions from analyzing the problem to considering solutions.

There's an innate sense of learned helplessness, extreme anxiety and distress and it sounds as if rumination is a form of obsession but actually it is not.

That rumination and obsession involve the same cognitive mechanisms, the same cognitive processes, repetitiveness, intrusiveness, uncontrollability, so much that much is true but obsessions are involuntary. They're intrusive. They're unwanted at least according to the American Psychiatric Association whereas rumination is voluntary.

You choose to ruminate. It's a totally controlled cognitive process. It's a mode of responding to distress that involves repetitively focusing on causes and consequences of symptoms.

So rumination is not obsession.

So what is obsession and even more to the point what is obsessive neurosis?

Here's a checklist.

Do you suffer from unwelcome intrusive thoughts that you cannot control?

Never mind. How hard you try?

Do you feel guilty? Do you feel you may have done things that have let other people down or harmed or damaged them? Do you have to observe certain rituals like repeatedly checking if you lock the door or wash your hands compulsively or make sure you don't touch certain things or not step on certain pavement clusters or tiles?

If the answer to any of these is yes, then you're touched by obsession.

Intrusive thoughts, obsessional patterns of thought, feeling and behavior, the draining, the very exhausting, the create relentless pressure on the mind.

And so you would know if you were obsessed because you would feel fatigued. It's like chronic fatigue syndrome. You will feel totally devastated and unable to move.

There's negative impact not only on you, but there's negative impact on everyone around you.

It creates pressure on intimate relationships, in the workplace.

And this exacerbates the situation and you get caught up in endless repetitions, all kinds of mantras and ceremonies and crazy rituals.

And this plunges you even deeper into the obsession because at some point you begin to develop the erroneous conviction that if you were to not engage in these rituals, something horrible is going to happen.

If you're going to engage your time, they are taken up completely by these rituals and ceremonies.

It starts with an idea. It starts with an idea, usually some kind of thought or worry. And then it leads to a misguided and dysfunctional attempt to solve the conundrum, to solve the enigma or the puzzle.

The idea is threatening, distressing. The thought is unsettling, discomforting.

And so you need to do something that is familiar. You need to act in a familiar way. And you need to do something that you fully are in control of.

That way you restore your sense of control. You restore your sense of being in charge, of being the boss.

And so you engage in magical thinking.

If I'm in charge of this ceremony, for example, if I'm in charge of washing my hands, if I'm fully in control of washing my hands, because I count how many times I wash my hands.

So the act of counting is a form of control. Then I will also be in control of all the dangers and threats and mishaps and misfortunes that await me. I will stop catastrophizing.

So these behaviors are anxiolytic. They reduce anxiety.

There is a common misconception that obsessional thoughts, intrusive thoughts and obsessional emotions, ideas, they're very simple. That they're very basic and irrational and stupid. That is not true at all.

Actually obsessive thoughts resemble scientific theories. They are very complex. They are multilayered. They are structured. They are ordered. They have long histories that usually begin in childhood. They hide, they're hard to deconstruct and to decipher and to decode. They are like elaborate works of fiction coupled with a pseudoscience imposed over them. There's a layer, an over layer of pseudoscience.

So there's a narrative and then there's a desperate attempt to explain the narrative or to account for it using pseudoscientific methods. A lot of arguing and analyzing and synthesizing and synoptic judgment and so on and so forth.

Obsessions are among the most complicated phenomena.

This is the only case where Freud admitted defeat.

Freud throughout his career kept saying that obsessions and obsessional neurosis are the only ones that he couldn't tackle, couldn't handle.

It's also extremely difficult to trace the obsession or the obsession on neurosis back in time. Difficult to find the roots.

There's a dense labyrinth of rules, details and they're interrelated and they all seem to give rise to each other.

So it's a snake consuming its tail, you know, and it's endless. It's cyclical. There's no way to lay down the obsession in a linear manner.

And so everything else looks inconsequential by comparison. Even life itself, even one's own body, other cognitive processes, loved ones, they all look plain two dimensional and not very important because they don't hold the key to reducing the overwhelming, dis-regulating, life-threatening anxiety of the obsessive person.

Obsessional thoughts are hard work. These are rules that you must live by and you must observe on pain of horrendous, unspecified usually, punishment.

And the curious thing is the vast majority of obsessions center around or focus on events that already happened, that had already happened. Things that have already gone awry or wrong. All most obsessions are past oriented, not future oriented.

The catastrophizing is retroactive.

We have no similar phenomenon, no similar psychodynamic and no similar etiology or etiopathology in any other mental health condition.

Obsessions are retroactive, backward looking. It's as if by engaging in rituals compulsively, by ceremonially washing your hands or whatever, the offending of not something that is about to happen in the future, but the knowledge of something that had happened in the past.

And that's why obsessions resemble dissociation a lot. Dissociation is a mental mechanism intended to allow you to forget about the past, to deny, to repress traumatic events.

Obsessions have exactly the same function. It's arguable whether obsessions are not actually forms of dissociation, exactly like amnesia, derealization and depersonalization, because all obsessions include these three elements. They include forgetting. They include a disrupted relationship with one's body. And they include the feeling of imminent doom and gloom that is utterly unrealistic, very fantastic, very dystopian, very narrative-like, very theatrical, so cinematic if you wish, like a movie.

So all the elements of classic dissociation exist in dissociation, sorry, in obsession.

The obsessive may not be aware, but what they're trying to stop has happened already.

And so the careful observing, observance of the obsession is not going to change anything.

It's not about outcomes. It's not self efficacious. It's not about trying to change the environment or trying to secure beneficial outcomes in the future.

It's nothing to do with the world. It's a divorce from the world, exactly like dissociation. It relates to something that had already gone wrong in the past.

And this is the foundation of obsessional neurosis.

Sometimes obsessive neurosis is renamed conceptual neurosis, ideational neurosis, abstract neurosis, because the entire person is reduced to this single thought.

The subject becomes nothing but his all-consuming intrusive thoughts.

There's a struggle against the risk of being overwhelmed by uncontrollable emotional states.

And the content of the obsessive impulse is about harm, harming oneself, harming others, or harm about to befall others.

So it's about damage. It's about pain. It's about hurt.

There is a superhuman effort, if you wish, to introduce a distance, safety between oneself and these extremely menacing emotions, to detach oneself from anything that could cause oneself harm, one's body included.

I mean, you could commit suicide. That's very harmful.

Last time I checked.

And so the obsessive intrusive thoughts would push you away from your body, because your body is a potential source of harm.

The term obsessional neurosis, or compulsive neurosis, is, of course, about intrusion upon the mind, and it has to be unwilling, involuntary.

Images, ideas, words, thoughts, flood the mind.

The patient's consciousness is swamped with his data packets.

And yet consciousness is never suspended in obsession.

It remains lucid. The power to reason remains intact.

Conventional obsessions are experienced even by the obsessive person as morbid.

They deprive the individual of freedom of thought, freedom of action, while at the same time preserving the individual's ability to realize his growing paralysis.

It's very much like falling into a vegetative state.

There is a condition called the locked-in syndrome, where you are in a coma, you're in a vegetative state, outwardly your body is in coma, but your mind is alert and bright as ever. You just can't communicate. You're locked inside your body. That's very much obsession.

And so sometimes the defenses can eliminate the anxiety.

And this is the core of obsession.

It is the main idea to reduce the symptoms, but the price the obsessive person pays is huge.

The price is displacing characteristics.

The primitive obsession involves uncontrollability, compulsions.

And so the defense mechanisms that the obsessed person, the obsessive, deploys, they themselves become the problem because they're very primitive and they're out of control.

And so it's a catch-22. You're faced with a threat in your mind, at least. You're faced with a menace. You're faced with anxiety.

And then to fend it off, you need to obsess.

But in order to obsess, you make use of defense mechanisms which render the situation even much worse.

Obsessional neurosis was first described, who else, by Sigmund Freud in 1894 in The Neuropsychosis of Defense, an essay.

And it was again a revolution.

The neuropsychiatry until 1894, until Freud, said that, stipulated that the cause of obsession and neurosis is the existence of an intrapsychic conflict of a sexual origin.

And this conflict kind of mobilizes or blocks all the flows of energy.

And this creates obsession.

This was what Freud said in 1894.

And this was a major break from classical psychiatry.

Because in classical psychiatry, there was a theory of degeneration.

So let me summarize it for you.

Freud said in 1894 that an obsession, the cause of obsession on neurosis is some intrapsychic conflict of sexual origin that mobilizes and blocks energy.

Until 1894, the prevalent view in psychiatry was that obsession is a result of a weakness of the ego.

There is some degeneration of internal structures and constructs. They're not able to function properly and defend and protect the individual.

And so the individual falls apart and develops obsession.

And that was a view of Pierre Genet when he described what he called "psychosthenia."


So Freud came on the scene and was the first to connect obsession with trauma.

He said, trauma causes this.

An early sexual event occurs before puberty.

But what Freud said is the event was a source of pleasure to the child.

Freud distinguished between two types of early childhood sexual trauma.

Trauma that causes trauma.

Trauma that causes distress and anxiety and fear and so on.

And sexual event before puberty that actually causes pleasure.

So sexual abuse that causes pleasure.

It was very daring, Sigmund Freud. That was a very daring thing to suggest.

Even today, by the way. I think if you were to propose this today, he would have spent a stretch in prison.

So Freud said some children enjoy the sexual abuse and then they experience strong feelings of guilt and self-reproach.

This guilt and self-reproach overcome them, overwhelm them.

So they repress these feelings.

And instead they replace the primary feelings that they had just repressed.

The guilt, the reproach, self-reproach, the shame.

They repress all these and they substitute another set, another system of symptoms and traits.

So they develop scrupulousness. They develop thoroughness, perfectionism, shame, a mistrust of self.

And these defenses allow the individual to go through an apparently healthy period.

But eventually these defenses consume a lot of energy and time and they're exhausted.

And there is a return of the repressed memories and an outbreak of the illness and its attendant symptoms.

Today this view that obsession and neurosis is always the outcome of early childhood, pleasurable sexual experiences and the ensuing guilt, shame and self-reproach.

Today this thinking has been largely discarded.

And today we've simply retained from Freud the belief that obsessions do have something to do with trauma, that they are post-traumatic defenses.

In the disposition to obsessional neurosis, a contribution to the problem of choice of neurosis, Freud defended the idea that the choice of neurosis is linked to developmental inhibitions.

He stressed the role of fixation and regression and so on and so forth.

And so in object relations, according to Freud, hate precedes love, precedes love.

And then obsession and to quote what he says, obsessional neurotics have to develop a super morality in order to protect their object love from the hostility lurking behind it.

That was another revolutionary thought because it led to the conception or to the concept of ambivalence.

Love is a late comer in Freudian chronology.

We first learn to reject separation, divination, first learn to hate.

And only then when we develop object relations with other people, we learn to love.

And the opposition between love and hate for the object is exactly at the core of his interpretation of the rat man case.

You remember how I started the lecture when we were all much, much younger?

The essay is titled "Notes upon a case of Obsessional Neurosis, 1909."

When he tried to interpret the behaviors and choices of the rat man, he reached the conclusion that there was a conflict there between hate and love.

And this opposition, this dissonance between hate and love was a source of doubt, compulsions, ambivalence, all very characteristic of obsessional function.

One of them is known as undoing, and the other is known as isolation.

Let's first discuss undoing.

Undoing means making something that had already happened, un-happen, reverse the course of history, time travel to the past, and eliminate the traumatic, problematic, and distressing event. Undo it.

But since this is an impossibility, at least in our universe, you cannot travel back in time, you cannot undo events, decisions, choices, and so on, this is a given, you have to survive somehow with this information.

So undoing is symbolic. There is symbolic motor action. We do something with our body which represents the undoing of past events.

You can find this also in magical practices, in folk customs, and in many religious rituals, where bodily action is a symbol, represents a symbolic attempt to connect with the past and often to change it.

The second defense mechanism that Freud said is in operation, in obsession with neurosis, is isolation.

It involves the motor sphere, the motoric sphere, motion, the motion of the body, muscles, tendons, and bones, and what have you. And isolation means that after there is an event which is unpleasurable, distressing, anxiety producing, etc., there is a pause, there is a break in time, during which nothing further can happen, no perception is possible, no action can take place.

Motor isolation functions to guarantee a break in the connections of thought. And you immediately see the close similarity to obsession.

This obsession is exactly this. Obsession divorces you from your own body, from the environment, from other people, from events in the past, and from catastrophes in the future. Obsession in other words is a fantasy. It's a fantasy defense.

And exactly like every other fantasy defense, it's a language. It's a language element.

We will discuss Lacan's view of obsession at the end of this video.

But it's a language. It's a fantasy.

The obsessional patient enacts some kind of taboo. It's like a theater play. These rituals and ceremonies, they're very theatrical, takes a lot of thespian skills.

So a taboo against touching, a taboo against stepping on certain pavement stones, a taboo against locking the door only once. These are all taboos and they involve enactments.

Because there is a fear that contact with the object will force the patient to face his unbound ambivalence, ambivalence between love and hate. Direct contact with the world, direct connection with other people, direct communication with one's body, direct access to one's thoughts, images, imaginations, ideas, any directness such as this is bound to provoke the underlying ambivalence of love and hate, the extreme excruciating uncertainty, the feeling of derealization, depersonalization. It's not really me. I'm not really here.

In short, it's bound to provoke extreme dissociation.

The isolation of an impression or an activity by means of a break in the chain of thoughts symbolically indicates that the patient does not want to allow thoughts relating to the forbidden event or the forbidden emotion to contaminate other thoughts.

Obsession serves as a barrier, as a firewall between a contaminated area, Chernobyl of the mind, Chernobyl of the mind and the pure area. In the contaminated area, they are repressed, forbidden, hateful, dangerous, anxiety inducing thoughts, menacing, threatening, unsettling thoughts, ideas, images, memories. They all reside in this contaminated region.

And it is separated with an obsessive compulsive partition, an obsession on neurosis, obsessive compulsive partition from another region of the mind, which is controlled, which is symbolic, which is ritualistic, which is therefore pure and unadulterated.

This prevents contamination and the punishment attendant on contamination.

Because if you contaminate the pure zone, you will be punished.

The punishment could be internal, but something bad will happen.

This impending doom and gloom and catastrophe are all the time in the mind of the obsessive.

In this regard, because organized obsessional neurosis, sometimes extremely debilitating, we need to ask ourselves, how come such a dysfunctional solution had arisen?

Normally, even dysfunctional solutions such as, for example, pathological narcissism, emotional dysregulation, they still have some benefit. They still, to some extent, self-affications.

But obsessional neurosis is paralyzing. It's mortifying. It's debilitating.

So why would it give rise? Why would evolution give rise to this?

Psychological evolution, at least.

And obsessional neurosis has a few factors that are very typical of it. And we can't find them in most other mental health conditions.

First of all, there is a self-retaliation by the ego. The ego is self-directed.

In healthy people, the ego is directed outwardly, is directed to the outside. The ego provides reality testing. The ego tells you, "This is real. This is not real. You shouldn't do this because this would be the realistic consequences of your actions.

And so on. So the ego is a reality principle.

But in an obsessive person, the ego is inwardly directed. The ego regards the internal landscape as the only reality.

And this is very similar to narcissism. Very similar. It is so similar that it's easy to conceptualize pathological narcissism as a form of obsessional neurosis, or actually, or maybe obsessive compulsive disorder.

The ego looks to the inside and regards the reality inside and informs the individual about the internal reality so as to optimize outcomes internally rather than externally.

So externally, there's paralysis. There's debilitation. There's secession of functioning.

But internally, equilibrium and homeostasis are restored. The self-recrimination by the ego causes a lot of guilt and shame and provokes the obsessional defenses.

When the ego looks inwardly, it is not happy with what it sees. It informs the patient and advises the patient to act now, soon, before it's too late.

The second element, which is typical of obsessive neurosis, is the adherence to insistent preoccupations. We call them compulsions.

That's repeating the same activities all the time and so on. And there is deployment of elaborate defenses.

In the obsessional patient, effective isolation allows the ego to cut itself not only from the outside but also from emotions, affects, desires.

In saccusses, the ego is cut off from reality. In obsession, it is cut off both from reality and from passion, desire, volition, the drive, the internal drive.

So, the tendency to equate obsessional neurosis with saccusses is very wrong, actually, for the reasons that I've just mentioned.

Okay, let's wrap it up. Obsessional neurosis is a form of psychoneurosis.

And the dominant symptoms are obsessive thoughts and compulsive behaviors, obsessive rituals.

Obsessive thoughts are not like normal thoughts. They are experienced by the patient as unspontaneous, distracting, repetitive, ruminative, and coming from elsewhere, not from himself.

The subject matter is absurd, bizarre, irrelevant, threatening, obscene. The compulsive behavior is repetitive, stereotype, ritualistic, and superstitious.

According to the classical theory, obsessional neurosis centers around regression and ambivalence toward parental figures, hate love, and the introjects of parental figures.

Again, there is an interface here, a confluence with narcissism.

But more recent formulations focus, center around the high degree of internalization, the need to control impulses.

And the symptoms, they are failures to achieve control, they are attempts to accomplish control that fail. They're examples of the return of the repressed.

Obsessional neurosis is a kind of disorder that occurs in people whose personality development has been based on alienation from instinct and emotion.

The obsessional ego is anti-libidinal, anti-impulsive, anti-emotional.

And the symptoms are either breakthroughs from the alienated aspects of the self, obsessional thoughts, or defenses against these breakthroughs, obsessional rituals.

And I promised all of you there. What we've all been waiting for, Jacques Lacan, who looks like my spitting image.

I swear to you, actually I look like his spitting image. I swear to you, we're identical twins, especially in his later years.

It's unsettling. It's enough to cause me obsessive neurosis.

Lacan dealt with obsessional neurosis in his very extensive work, "Nevros Obsessionel." He said that obsessional neurosis includes symptoms like obsessions, recurrent ideas, of course, impulses to perform actions which seem absurd or abhorrent to the subject, and rituals, compulsively repeated actions such as mentioned washing hands and so on.

So in this, Lacan does not depart from the classical and currently accepted view of obsessional neurosis.

But Lacan saw these symptoms and argued that the obsessional neurosis designates not a set of symptoms, but an underlying structure which may or may not manifest itself in the symptoms typically associated with it.

Again, we see Lacan's linguistic term, his belief that everything mental is always symbolic in many ways.

The subject may well exhibit none of the typical obsessional symptoms and yet still be diagnosed as an obsessional neurotic by a Lacanian analyst.

So the symptoms don't matter. The structure, the inner structure does.

Sometimes it gives rise to symptoms, sometimes not.

In the "Foo steps of Freud," Lacan classifies obsessional neurosis and says that obsessional neurosis is one of the main forms of neurosis.

In 1956, Lacan developed the idea that, like hysteria, hysteria, by the way, called hysteria a dialect.

Freud was the first by far to suggest that there is some confluence, some venn diagram, some merger of language and psychology.

Psychology just describes sets of languages and dialects.

So he called hysteria a dialect.

And so in the "Foo steps of Freud," Lacan said that exactly like hysteria, obsessional neurosis is a question which is being posed to the subject.

It's like the subject's existence or the subject's being poses a question to him or to her.

And the answer to the obsessional neurosis is the compulsion.

The question which constitutes obsessional neurosis concerns the contingency of one's existence.

Question about death, to be or not to be.

Am I dead or alive? Why do I exist?

The response of the obsessional, of the obsessive person, is to feverishly attempt to justify his existence.

Why do I exist?

Because I exist. To justify one's existence, the question about death, there is a feeling of ominous thunderclaps.

Like if I don't answer this question now, I will die.

I need to justify my existence. I need to testify, attest to my existence.

And this, of course, indicates strongly the special burden of guilt felt by the obsessive.

There's a lot of guilt and shame there. And the guilt and shame, the message of the guilt and shame is, you don't deserve to exist. You don't deserve to have a life.

Justify yourself. Prove to us that you should live rather than, for example, die.

The obsessional performs compulsive rituals because he thinks that this will enable him to escape the lack in the other, the castration of the other, if you wish.

And it is a fantasy. The idea that other people can't provide you with justification for your own existence, actually may even think that you don't deserve to exist. That's a lack. That's a deficiency, which is life-threatening.

And so you, the obsessive fantasizes about this deficiency and kind of inverts it.

Rather than say, "Others are lacking. Others are castrated. Others are deformed."

The obsessive says, "Something bad is going to happen to others. They're going to be castrated. They're going to be deformed. They're going to be disabled."

In other words, he catastrophizes. It's a form of projection, of course. He projects his ill will, his recognition of other people's deficiencies. He projects it as if he were worried for them, as if he wants their well-being, as if he, all he wants is for things to be good. And he's even willing to invest in it by engaging in compulsive activities. That's a fantasy, of course.

This projection is a fantasy. Fantasy is any divorce from reality.

And here's a situation where the reality is that other people are deficient. But the obsessive doesn't dare to admit this because then his ambivalence of hate and love will overwhelm him.

So instead he says, "They are not deficient, but they're about to become deficient. Something evil is going to happen to them if I don't stop it. I'm the only one with the power to stop it, grandiosity."

And so he stops it. He stops it with his rituals and ceremonies.

In the case of Freud's obsessional neurotic, you remember the ratman, Ranser, the patient developed elaborate rituals and he performed his rituals.

What is the aim of these crazy rituals? To ward off the fear of a terrible punishment about to be inflicted on his father or his beloved.

The only problem was his father was dead, has been dead for years.

The obsessive ratman found himself embedded in and trapped and captured in a fantasy.

And these rituals both inform and incontant. That's what led Freud to draw parallels between obsessional neurosis and its structures and the structures of religion and Lacan concurred.

The hysterical question is about the subject's sexual position. Am I a man or am I a woman?

When sexual identity is fuzzy or creates guilt and shame, hysteria ensues.

The obsessional neurotic is not concerned with this. It's not about sex. He rejects both sexes. He's asexual, not in the sense that he doesn't practice sex, but in the sense that he's sexless. He has no sex. He doesn't call himself male or female because he has no body.

The obsession divorced him from his body. He is neither male nor female and both at once.

So he's not concerned with this particular question. He's concerned with existence. He's concerned with securing the existence of himself and of others.

He believes, psychotically if you wish, or grandiosely if you are so inclined, he believes that he has the power. He has this magical power to prevent catastrophes and disasters.

Lacan draws attention to the way that the obsessional neurotic's question about existence and death has consequences in multiple domains.

For example, his attitude to time, perpetual hesitation, procrastination, while waiting for the inevitable death, considering oneself immortal because one is already dead. Other features of obsessional neurosis have to do with a sense of guilt, close connection with mortification.

The obsessional neurotic does not only transform his excretions into, shall we say, Lacan used a different word, which won't sit well with YouTube. So he doesn't only transform his excretions into gifts and his gifts into excretions, but he transforms himself into his excretions.

It's a timeless situation because only bodies die. Only bodies die. And anything that emanates from a bodyless mind that has the capacity to prevent disasters and catastrophes is by definition a gift.

Obsessive is God's gift to the world. And in this sense, of course, it's a prime subspecies of narcissism.

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