Semiology, the science of signs, gains its meaning from being communicable within a given field of science. The same holds true for somatic medicine, following what Michel Foucault described in 1963 as the "fundamental isomorphism of the structure of disease and the verbal form that describes it." The sign indicates the symptom, just as a wheeze indicates pneumonia. Woven into the mesh of concrete banality and everyday life, psychiatric symptomology lends itself less easily to a system of directly meaningful and unchanging references. From this viewpoint psychoanalysis appears to escape any form of semiology that might be useful in treatment. But metapsychology, which theorizes experience and justifies procedure, does supply a form of semiology that is both specific to it and appropriate in certain situations.
The only semiology useful to the clinical situation is specifically context dependent, belonging solely to a particular analyst/analysand relation. The observer, the analyst, is involved in a unique relation involving the dynamic of transference and counter-transference. Therefore the reality involved in analysis, even when it concerns external facts, can only serve as a reference frame for a fantasy that supports the narrative at a particular moment, for reasons that are specific to it alone. At most the reality of analysis, its framework and the patient's attitude can, from one case to another, present some invariant elements. At all other times the sign will depend only on the context; to this extent, the symbol can express the contrary to what it might indicate elsewhere. We know that defenses can take the form of a movement of the drive and that interpretation provides no truth, but reveals a pathway of associations and reroutes energy between two sign-posts without any absolute value. And finally, nothing can at the same time be experienced and understood other than in small doses (Strachey, 1934).
Nonetheless, metapsychology can shape a semiology that can be applied in three areas. During the evaluation, it can help to understand psychic structure and function, and thus indicate modes of therapy. The ability to associate, observed during the interview, or their various avatars, the defensive methods of repression, denial, projection, and so on, the expression of affects, and regressive forms, are all elements that can constitute a system of signs for evaluating the manifestations of the unconscious and their dynamic in the organization and operation of psychic agencies. Similarly, one can read the inconsistencies and weak points in a conflict, where the risks of depressive or delusional decompensation are present. A semiotic method is perhaps even more useful in cases where a breakdown is manifested through psychosomatic symptoms. These same semiological data could be used by psychotherapy, in which the patient apprehends external reality. Such data can clarify fears of the phobic patient with regard to oedipal positions. The splittings and idealizations of the borderline patient can split, or idealize, for reasons of archaic violence and narcissistic fragility.
Finally, psychiatry as a whole can be entirely revised in light of psychoanalytic semiology, which intersects psychiatric semiology, introducing the dynamic of metapsychology into clinical situations, where the unconscious reveals its presence in the most biological manifestations and the most external events.
See also: Neurasthenia; Psychoanalytic nosography; Psychotic/neurotic; Symptom-formation.
Foucault, Michel. (1994). The birth of the clinic: An archaeology of medical perception (A. M. Sheridan Smith, Trans.). New York: Vintage. (Original work published 1963)
Strachey, James. (1934). The nature of the therapeutic action of psycho-analysis. International Journal of Psycho-Analysis, 15, 127-159. Reprinted 1969, International Journal of Psycho-Analysis, 50, 275-291.
Gay, Volney P. (1982). Semiotics as metapsychology: The status of repression. Bulletin of the Menninger Clinic, 46, 489-506.
Harris, Adrienne, and Aron, Lewis. (1997). Ferenczi's semiotic theory: Previews of postmodernism. Psychoanalytic Inquiry, 17, 522-534.
Olds, David. (2000). A semiotic model of mind. Journal of the American Psychoanalytic Association, 48, 497-530.