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Admiration and caution should mark the stance of a discussant upon reading an analytic treatment of such a disturbed patient, leading to evident positive results, and articulated in such a clear and moving manner. The admiration is both for the patient, for showing great courage in the face of ongoing psychotic liabilities, and for the analyst, for keeping his wits about him and for showing such respect for the patient's courage that he took it upon himself to articulate the exemplary aspects of the work for the rest of us to learn from. Caution enters because this discussion does not take up what should be done next or what might have been done better but rather attempts to join with the original author in opening up additional aspects of this exemplary situation.
I have attempted to write about working with psychotic patients (Muller, 1996) in a manner that relates the patient's anxiety to some Lacanian notions of psychotic processes. In 1946 Lacan stated, “Not only can our being not be understood without madness, it would not be our being if it did not bear madness within itself as the limit of its freedom” (1966, p. 176, my translation). In 1958 Lacan restated his position, adding, “What I am saying here is that it is the business of reason to recognize the drama of madness, … because it is in our relation to the signifier that this drama is situated” (1977, p. 214). I take “the signifier” here to be a metonymy for the entire symbolic order, the semiotic context of language, ritual, social custom, gesture, and sign, out of which signifiers arise to mediate aspects of human experience. Lacan's shorthand for this vast domain of language and culture is “the Other,” the “locus in which is constituted the I who speaks to him who hears” (1977, p. 141), “the Other qua locus of the