The role of the advocate for the detained patient: a Lacanian psychoanalytic perspective of advocacy in psychosis

What is the role of advocacy in psychosis? This is an important question but complex to give a straightforward answer. In an attempt to approach this question for the first time in the field of psychoanalysis, this thesis examines the possibilities of advocacy for the detained patient who may have a psychotic structure through the lens of the Lacanian psychoanalytic theory on the approach to psychosis. From the time when advocacy was introduced as a right in 2009 under amendments to the Mental Health Act (1983, 2007), detained patients who are diagnosed with a serious mental illness and deemed to be a danger to themselves or others can utilise advocacy as a means to express their own views, obtain information, secure and exercise their rights and participate in decisions about their care and treatment. The current approach of the literature on advocacy focuses mainly on its effectiveness to safeguard patient’s rights and promote patient’s views, involvement and wellbeing. In contrast, a review of the literature from the Lacanian orientation shifts the focus towards stabilisation and the creation of a social bond. Furthermore, the Lacanian emphasis on the importance of language is of particular interest to those charged with ‘speaking on behalf of one’ when, in psychosis, there is a withdrawal from shared language.

This thesis argues that Lacan’s writings on psychosis provide a framework to discuss the relationship between advocacy and psychosis. In light of the Lacanian theory, the advocate, through effective listening and noting of the patient’s speech, can hold a stabilising function for the psychotic, notwithstanding the effects of the foreclosure of the Name-of-the-Father that keep the psychotic disconnected from the Other and imprisoned in their private discourse. To illustrate this argument, I offer qualitative vignettes drawing on cases from the advocate’s practice. Additionally, advocacy’s ultimate goal, that of self-advocacy, is approximated as a potential sinthomatic possibility that is traced back to Schreber’s case, which demonstrates, clearly and powerfully, the impact of self-advocacy in psychosis. Based on the argument that the role of the advocate, like the role of the analyst, is to be the secretary, which means to support the transition from ‘being spoken for’ to ‘speaking up for oneself’, the prospect of the psychotic’s acquisition of the ability to self-advocate can pave the way for creating a link with the Other. Finally, by bringing together the two disciplines (advocacy and Lacanian psychoanalysis), and despite their differences, I develop the idea of a ‘psychoanalytic advocacy’ that can be a factor of stabilisation for psychotic subjects.