Changes

The [[full ]] title of the doctoral [[thesis ]] that signaled Jacques [[Lacan]]'s entry into [[psychiatry ]] was De la [[psychose ]] paranoïaque dans ses rapports avec la personnalité (On [[paranoiac ]] [[psychosis ]] as it relates to the [[personality]]). The [[work ]] was dated September 7, 1932, when Lacan was thirty-one years old.

Readers of the work were uniformly impressed with the breadth of [[scientific ]] learning that Lacan displayed. To Georges Heuyer, who had doubts [[about ]] the sheer quantity of bibliographical references, Lacan responded that he had, in fact, read [[them ]] all. Furthermore, Lacan claimed to have personally evaluated about forty cases. And his familiarity with [[German ]] [[texts ]] clearly distinguished his scholarship from the chauvinism characteristic of the two great [[schools ]] of psychiatry of the [[time]]. The [[French ]] [[school ]] was his [[model ]] because of the high quality of its observation and because of its elegance and precision. But the Germans supplied Lacan with the doctrinal [[authority ]] required by his [[goal ]] of methodological [[synthesis]].

"Then came Kraepelin" (Lacan, 1932, p. 23). Emil Kraepelin succeeded in imposing differential diagnoses in the field of the [[psychoses]], where previously the [[category ]] of [[paranoia ]] had been extended to every kind of [[delusion ]] and cognitive disorder in a way clearly contradicted by observation, despite the fact that paranoia was defined very narrowly. Lacan wrote in glowing [[terms ]] of Johannes Lange, coauthor of the 1927 edition of Kraepelin's Manual of Psychiatry, whose study of eighty-one cases noted that classical paranoia was extremely rare, and assigned the curable cases to the category delineated by Kraepelin. As for "genuine paranoia," the question was whether it could be acute, whether remissions were possible. This was a question that Lacan asked from the outset (1932) and that would still preoccupy him twenty-five years later in "On a Question Prior to Any Possible [[Treatment ]] of Psychosis" (1959/2004). For Lacan, the work of Robert Gaupp supplied an affirmative answer to this question. In short, Lacan endorsed Kraepelin's inclination toward a psychogenetic conception of paranoia, and what Lacan called "psychogeny" became a main theme of his thesis. Hence Lacan's harsh criticism of organicism, the constitutional [[theory]], and the [[ideology ]] of degeneracy—all then still prevalent in French psychiatry.

To stymie these tendencies, Lacan [[chose ]] to [[speak ]] of "personality." To solidify this [[notion]], he drew upon Ernst Kretschmer, Pierre Janet, [[Karl Jaspers]], and, finally, Eugen Bleuler. Bleuler and the Zurich school were Lacan's main route into [[psychoanalysis ]] from the [[psychiatric ]] study of [[the psychoses]]. Lacan sought to relate [[mental ]] disturbances to personality, as Janet did, and, like Kretschmer, to explain them in terms of the [[individual]]'s [[history ]] and "[[experience]]" (Erlebnis) (1932, p. 92), with "its [[social ]] and [[ethical ]] stresses," rather than by evoking "congenital defects" (1932, p. 243). All this implied a "comprehensive" approach to psychotics consonant with the [[phenomenology ]] of Jaspers. For this [[reason]], Lacan enlisted the masters of psychiatry and [[psychopathology ]] in support the open-minded approach to mental [[illness ]] characteristic of his friends at the journal L'évolution psychiatrique.

Lacan argued that pathological manifestations in psychosis were "[[total ]] vital responses," which, as "functions of the personality," maintained meaningful connections with the [[human ]] [[community ]] (1932, p. 247). In short, they were meaningful—a realization that defined the young Lacan's approach and influenced the [[choice ]] of his inaugural [[case]], that of "[[Aimée]]."

Aimée was a thirty-eight-year-old [[woman ]] who, with "eyes filled with the fires of [[hate]]" (1932, p. 153), had tried to stab the celebrated actress Huguette [[Duflos]]. As a result of this attempted "magnicide" on April 18, 1931, she was immediately imprisoned. Lacan began to see her one month later at [[Sainte-Anne ]] Hospital. He reconstructed "almost the full gamut of [[paranoid ]] themes" (1932, p. 158): [[persecution]], [[jealousy]], and prejudice for the most part, themes of grandeur centered chiefly on [[dreams ]] of escape and a reformatory [[idealism]], along with traces of [[erotomania]]. Her cognitive functions were unaffected. To this classic picture, which Lacan established by means of thorough biographical inquiry, Lacan added what he considered a decisive consideration: after twenty days of incarceration, the [[patient]]'s delusional [[state ]] diminished dramatically. This [[development ]] Lacan viewed as evidence of the acute [[nature ]] of her paranoia. Connecting Aimée's criminal act with this remission, he set out to discover the [[meaning ]] of her [[pathology]], and with this in [[mind ]] he proposed a new diagnostic category: "[[self]]-[[punishment ]] paranoia."

Aimée also aroused Lacan's curiosity because of her attempts at [[writing]]. Lacan had already evinced an interest in the writing of psychotics, and in his thesis (1932) he published selected passages from "Aimée"—the [[name ]] [[being ]] that of the heroine of the patient's projected novel. Aimée's writings and the sensational aspects her case brought Lacan's work to the attention of a [[public ]] well beyond psychiatry. The spirit of the [[times ]] saw [[links ]] among art, [[madness]], and psychoanalysis. The dreams related by André [[Breton ]] in [[Communicating ]] Vessels date from 1931, and his [[exchange ]] of letters with [[Freud]], which followed the publication of this book, date from 1932. René Crevel, PaulÉluard, Salvador Dalí, Joë Bousquet all echoed Lacan's thesis. In 1933, in the first issue of the [[Surrealist ]] magazine Minotaure, Dalí cited "[[Jacques Lacan]]'s admirable thesis" and praised the thesis of "the paranoiac [[mechanism ]] as the force and [[power ]] acting at the very root of the phenomenon of personality." Lacan took pride in this acknowledgment. In hisÉcrits (1966), he described his thesis as merely an introduction to "paranoiac [[knowledge]]" (p. 65), an unmistakable allusion to Dalí's "paranoiac-critical method." He never revised this attitude: as late as December 16, 1975, he declared, "Paranoid psychosis and personality have no [[relationship ]] because they are one and the same [[thing]]."

[[Left]]-wing [[philosophers ]] likewise fell under the spell of Lacan's book. [[Paul ]] Nizan, a careful reader of Jaspers, published a [[summary ]] of it the [[communist ]] daily L'humanité for February 10, 1933; Lacan's talk of a "[[concrete]]" [[psychology ]] related to "social [[reality]]" sufficed to open that [[particular ]] door. Jean Bernier, in La critique social, a journal to the left of the Communist Party, offered a brilliant [[reading ]] of Lacan's thesis, despite being marred by misunderstandings of psychoanalysis so common among revolutionary critics.

Lacan's [[doctoral thesis ]] was significant in [[another ]] way too: it was his declaration of allegiance to psychoanalysis. He undertook a personal [[analysis ]] and trained under the auspices of the recently established Société psychanalytique de [[Paris ]] (Paris [[Psychoanalytic ]] [[Society]]). In his thesis, he hailed "the scientific import of [[Freudian ]] [[doctrine]]," the only theory capable of apprehending the "[[true ]] nature of pathology," as opposed to [[other ]] methods, which, despite their "very valuable observational syntheses," failed to clear up uncertainties (1932, p. 255). Lacan's study of the case of Aimée and his overall view of the psychoses were thoroughly imbued with Freudian [[teachings]]. Thus he saw the psychogenesis of Aimée's pathology in light of the theory of the development of the [[libido]], as rounded out a few years earlier by Karl [[Abraham ]] (1924/1927). And he [[understood ]] delusion as the [[unconscious ]] offering itself to the [[understanding ]] of [[consciousness]]. "Ça joue au clair," Lacan reiterated in his [[seminar ]] on the psychoses (1981/1993, [[session ]] of 25 January 1956).

For Lacan, the notion of personality certainly implied "a conception of oneself" (1932, p. 42), but in his view this conception was based on "[[ideal]]" [[images ]] brought up into consciousness. Under the acknowledged influence of Angelo Hesnard and René Laforgue's report to the Fifth Conference of French-[[Speaking ]] [[Psychoanalysts ]] in June 1930, Lacan advanced his hypothesis of psychosis as "self-punishment" under the influence of the [[superego]]. He suggested that a nosological [[distinction ]] be drawn for cases where an element of hate and a "combative attitude" turn back upon the [[subject ]] in the shape of self-accusation and self-depreciation, and concluded by proposing the category of "psychoses of the [[super-ego]]," to include contentious and self-punishing forms of paranoia (1932, p. 338).

The most striking aspect of Lacan's thesis, in the context of the time, was the evidence it offered of his solid Freudian grounding, gleaned in part, no [[doubt]], from his [[translation ]] into French, in that same year of 1932, of Freud's paper "Some [[Neurotic ]] Mechanisms in Jealousy, Paranoia, and [[Homosexuality]]" (1922b [1921]). What Lacan drew from this important work underlay his assertion that "Aimée's entire delusion" could "be understood as an increasingly centrifugal [[displacement ]] of a hate whose direct [[object ]] she wished to misapprehend" (1932, p. 282). At the beginning of his [[discussion]], Lacan derived a general proposition from the same source: "The [[developmental ]] distance, according to Freud, that separates the [[homosexual ]] [[drive]], the [[cause ]] of [[traumatic ]] [[repression]], from the point of [[narcissistic ]] [[fixation]], which reveals a completed [[regression]], is a measure of the seriousness of the psychosis in any given case" (1932, p. 262).

The case of Aimée continued to play a part in Lacan's [[life]]. For one, he had [[good ]] cause to [[remember ]] it when, years later, Aimée turned out to be the [[mother ]] of one of his [[patients]], the [[psychoanalyst ]] Didier Anzieu. Furthermore, the themes explored in De la psychose paranoïaque continued to preoccupy him in his later work. Most significantly, his resolutely psychoanalytic approach to the psychoses was confirmed by his defining work of the 1950s (1993, 2004), whose great [[theoretical ]] import was rivaled only by what he called "fidelity to the [[formal ]] envelope of the [[symptom]]" (1966, p. 66). This remark does far more than endorse the precepts of a grand [[clinical ]] [[tradition]]; it distills certain constants of Lacan's [[thinking]]. As he adds in the same passage, the formal envelope of the symptom may stretch to a "[[limit ]] where it reverses direction and becomes creative." This was a crucial issue for Lacan throughout his life, and in many different ways. The culmination of this concern was his engagement with the work of [[James ]] [[Joyce]], which informed his seminar of 1975-1976 on the "[[sinthome]]" (1976-1977). On the same page ofÉcrits (p. 66), Lacan, reviewing his own [[past ]] itinerary, described what might be considered the function of the symptom: to keep up, despite the ever-[[present ]] risk of slipping, with what he called "confronting the abyss." Psychosis exemplified such confrontation, which was why Lacan returned here to how "passing to the act" may serve to "fan the fire" of delusion—an original theme explored in his thesis. How such [[acts ]] relate to [[literary ]] creation, the function of the symptom, and passing to the act were thus just so many issues first broached in the case of Aimée.

See also: Anzieu, Didier; Bleuler, Paul Eugen;Évolution psychiatrique (l' -) (Developments in Psychiatry); [[Lacan, Jacques]]-MarieÉmile; Paranoia.[[Bibliography]]