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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.
"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."