Case of AimÃƒÂ©e
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 ). 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.
* Abraham, Karl. (1927). A short study of the development of the libido, viewed in the light of mental disorders. In Selected Papers of Karl Abraham (Douglas Bryan and Alix Strachey, Trans.). London: Hogarth Press. (Original work published 1924) * Allouch, Jean. (1994). Marguerite, ou l'aimée de Lacan (rev. ed.). Paris: E.P.E.L. * Dalí, Salvador. (1933). Le mythe tragique de l'Angélus de Millet. Minotaure, 1. * Freud, Sigmund. (1922b ). Some neurotic mechanisms in jealousy, paranoia, and homosexuality. SE: 18: 221-232. * Lacan, Jacques. (1932). De la psychose paranoïaque dans ses rapports avec la personnalité. Paris: Librairie le François. * ——. (1966).Écrits. Paris: Seuil. * ——. (1976-1977). Le séminaire XXIII, 1975-76: Le sinthome. Ornicar? 2-5. * ——. (1993). The seminar of Jacques Lacan. Book 3: The psychoses, 1955-1956 (Russell Grigg, Trans.). London: Routledge. (Original work published 1981) * ——. (2002). On a question prior to any possible treatment of psychosis. In hisÉcrits: A selection (Bruce Fink, Trans.). New York: Norton. (Original work published 1959)