Teachings of the Case Presentation : 1977 : Jacques-Alain Miller

by Julia Evans on January 1, 1977

This article was first published as “Enseignements de la présentation de malades” in Ornicar?: Vol 10: July 1977 : p13-24


Part One, The Psychoanalytic Interview, Chapter 2 : P42 of ‘Returning to Freud – Clinical Psychoanalysis in the School of Lacan – Selections’ : 1980 : Stuart Schneiderman (Editor & Translator) : Yale University

Information & availability ‘Returning to Freud – Clinical Psychoanalysis in the School of Lacan – Selections’ : 1980 : Stuart Schneiderman (Ed) or here

Available here


P46 : “Clérambault, our only master in psychiatry..” :

Psychoses of passion : 1921 : Gaétan Gatian de Clérambault : Information and availability here

P46 : Shall we way that this praise, given in 1966, has even more weight because it contradicts Lacan’s thesis of 1932?

The thesis of 1932:

‘The Case of Aimée, or Self-punitive Paranoia’: Jacques Lacan: 1932 or here

The praise from 1966:

Reference to: Écrits : 1966 : Jacques Lacan : Information and availability here

Quotes from Écrits:

i) Quote from ‘On My Antecedents’ : 1966? : Jacques Lacan :

P55-56 English Écrits : p65-66 French Écrits : It stems from the work of Gatian de Clérambault, my only master in psychiatry : Translated by Bruce Fink :

His notion of “mental automatism,” with its metaphorical, mechanistic ideology, which is assuredly open to criticism, seems to me, in its attempt to come to grips with the [patient’s] subjective text, closer to what can be constructed on the basis of a structural analysis than any other clinical approach in French psychiatry.

I was sensitive to the hint of a promise that I perceived in it due to the contrast between it and the decline that could be seen in a semiology that was ever more bogged down in assumptions related to rationality.

Clérambault was very familiar with the French tradition, but it was Kraepelin, whose clinical genius was of a higher caliber, who trained him.

Oddly enough, but necessarily, I believe, I was thereby led to Freud.

For faithfulness to the symptom’s formal envelope, which is the true clinical trace for which I acquired a taste, led me to the limit at which it swings back in creative effects. In the case included in my dissertation (the case of Aimée), there were literary effects – of high enough quality to have been collected, under the (reverent) heading of involuntary poetry, by Éluard.

The function of ideals presented itself to me here in a series of reduplications that led me to the notion of a structure, which was more instructive than the account the clinicians in Toulouse would have provided, for they would have lowered its price by situation it in the register of passion.

Moreover, the sort of gust effect that, in my subject, blew down the screen known as a delusion as soon as her hand touched, in a serious act of aggression, one of the images in her theater – who was doubly fictitious for her since she was also a star in reality – redoubled the conjugation of her poetic space with a gulf-like scansion.

This brought me closer to the stage machinery of acting out [passage à l’acte] and, if only by confining myself to the all-purpose word “self-punishment” that Berlin-style criminology offered me through the mouthpieces of Alexander and Staub, I was led to Freud.

The way in which a knowledge [connaissance] is specified on the basis of its stereotypy, and also of its discharges, providing evidence of another function, [seemed to me to] lead to an enrichment which no academicism, even that of the avat-garde, could have turned away.

Perhaps it will be understood that by crossing the doorstep of psychoanalysis, I immediately recognized in its practice knowledge-related biases that are far more interesting, since they are those that must be eliminated in its fundamental listening.

ii) From ‘Presentation on Psychical Causality’ 28th September 1946 (Bonneval) : Jacques Lacan

Time-line: This presentation was given on September 28, 1946, at the psychiatric conference held in Bonneval. It was published in [Evolution Psychiatrique Xll, I (1947): p123-65, and in] a volume entitled Le Problème de Ia psychogenèse des

Névroses et des psychoses (“The Problem of the Psychogenesis of the Neuroses and Psychoses”), by Lucien Bonnafé, Henri Ey, SvenFollin, Jacques Lacan, and Julien Rouart (Paris: Desclée de Brouwer, 1950), p23-54

Quote from Presentation of Psychical Causality : p124 English Écrits & p152 French Écrits : Translated by Bruce Fink :

Organicism is being enriched with conceptions that range from mechanistic to dynamistic and Gestaltist ones. The conception that Ey borrows from Jackson certainly lends itself to this enriching, to which his own discussion of it has contributed – showing that Ey’s conception does not exceed the limits I have just defined. This is what, from my point of view, makes the difference between his position and that of my master, Clérambault, or of Guiraud negligible – and I should note that the position adopted by the latter two authors has proven to be of the least negligible psychiatric value, and we shall see in what sense further on.

Quote from Presentation of Psychical Causality : p137-138 English Écrits, pp167-168 French Écrits : Translated by Bruce Fink :

This is why, in an anthropology that takes the register of culture in man to include, as is fitting, the register of nature, one could concretely define psychology as the domain of nonsense [l’insensé], in other words, of everything that forms a knot in discourse – as is clearly indicated by the “words” of passion.

Let us follow this path in order to study the signification of madness, as we are certainly invited to by the original forms that language takes on in it: all the verbal allusions, cabalistic relationships, homonymic play, and puns that captivated the likes of Guiraud [P. Guiraud, “Les formes verbales de l’interprétation délirante,” Annales médico-psychologiques LXXIX, 5 (1921) : 395-412]. And, I might add, by the singular accent whose resonance we must know how to hear a word so as to detect a delusion; the transfiguration of a term in an ineffable intention; the fixation [figement] of an idea in a semanteme (which tends to degenerate into a sign here specifically); the lexical hybrids; the verbal cancer constituted by neologisms; the bogging down of syntax; the duplicity of enunciation; but also the coherence that amounts to a logic, the characteristic, running from the unity of a style to repetitive terms, that marks each form of delusion – the madman communicates with us through all of this, whether in speech or writing.

It is here that the structures of the madman’s knowledge must reveal themselves to us. And it is odd, though probably not coincidental, that it was mechanists like Clérambault and Guiraud who outlined them best. As false as the theory in which these authors included them may be, it made them remarkably attuned to an essential phenomenon of such structures: the kind of “anatomy” that manifests itself in them. Clérambault’s constant reference in his analysis to what he calls, with a slightly Disfoirus-like term, “the idiogenic,” is nothing but a search for the limits of signification. Employing a method involving nothing but comprehension, he paradoxially manages to display the magnificent range of structures that runs the gamut from the so-called “postulates” of the delusions of passion to the so-called basal phenomena of mental automatism.

This is why I think that he has done more than anyone else to support the hypothesis of the psychogenesis of madness; in any case, you will see what I mean by this shortly.

Clérambault was my only master in the observation of patients, after the very subtle and delectable Trénel, whom I made the mistake of abandoning too soon in order to seek a position in the consecrated spheres of professorial ignorance.

I claim to have followed his method in the analysis of the case of paranoic psychosis discussed in my thesis; I demonstrated the psychogenic structure of the case and designated its clinical entity with the more or less valid term of “self-punishing paranoia.”

Quote from: Presentation on Psychical Causality : p141-142 English Écrits, p173-174 French Écrits, : Translated by Bruce Fink :

More familiar to us and, also, more amusing in my book, is Molière’s Alcerte [from The Misanthrope] …. It all stems from the fact that Alceste’s “beautiful soul” exerts a fascination on the highbrow literati that the latter, “steeped in classics,” cannot resist. Does Molière thus approve of Philinte’s high society indulgence? “That’s just not possible!” some cry, while others must acknowledge, in the disabused strains of wisdom, that it surely must be the case at the rate things are going.

I believe that the question does not concern Philinte’s wisdom, and the solution would perhaps shock these gentlemen, for the fact that Alceste is mad and that Molière demonstrates that he is – precisely insofar as Alceste, in his beautiful soul, does not recognise that he himself contributes to the havoc he revolts against.

I specify that he is mad, not because he loves a woman who is flirtatious and betrays him – which is something the learned analysts I mentioned earlier would no doubt attribute to his failure to adapt to life – but because he is caught, under Love’s banner, by the very feeling that directs this art of mirages at which the beautiful Célimène excels: namely, the narcissism of the idle rich that defines the psychological structure of “high society” [“monde”] in all eras, which is doubled here by the other narcissism that is especially manifest in certain eras in the collective idealisation of the feeling of being in love.

Célimène, at the mirror’s focal point, and her admirers, forming a radiating circumference around her, indulge in the play of these passions [feux]. Alceste does too, no less than the others, for if he does not tolerate its lies, it is simply because his narcissism is more demanding. Of coure, he expresses it to himself in the form of the law of the heart:

I’d have them be sincere, and never part

With any word that isn’t from the heart.

Yes but when his heart speaks, it makes some strange exclamations. For example, when Philinte asks him, “You think then that she loves you?,” Alceste replies, “Heavens, yes! I wouldn’t love her did I not think so.”

I suspect Clérambault would have recognised this reply as having more to do with a delusion of passion than with love.

P49 : This detour brings us back to the presentation of patients and precisely to the only one Lacan talked about in his seminar last year, the one he labeled a case of pure mental automatism or a “Lacanian psychosis.”

A Lacanian Psychosis: 1976: An encounter between Gérard Primeau & Jacques Lacan : Information here

Probably Seminar XXIII: The Sinthome or Joyce and the Sinthome: 1975-1976: beginning on November 18th 1975 : Jacques Lacan : Information here : Probably 17th February 1976, Ch VII, See below

Seminar XXIII : 17th February 1976 : p5 to 8 of Cormac Gallagher’s translation : www.LacaninIreland.com : quote

Namely, at the same time if the Symbolic is freed, as I clearly marked formerly, we have a way of repairing that, which is to make what for the first time I defined as the sinthome. Namely, the something that allows the Symbolic, the Imaginary and the Real, to continue to hold together, even though here no one of them is held by another, thanks to two errors.

I have allowed myself to define as sinthome not what allows the knot, the knot of three, to still make a knot of three but what it preserves in such a position that it seems to be a knot of three. This is what I put forward very gently the last time. And, I re-evoke it for you incidentally, I thought- you can make what you wish of my thinking – I thought that it was the key to what had happened to Joyce. That Joyce has symptom which starts, which starts from the fact that his father was lacking (carent) : radically lacking, he talks of nothing but that.

I centred the matter around the name, the proper name. And I thought that – make what you wish of this thought – and I thought that it was by wanting a name for himself that Joyce compensated for the paternal lack. This at least is what I said. Because I could say no better. I will try to articulate that in a more precise way. But it is clear that the art of Joyce is something so particular, that the term sinthome is indeed what is, what is appropriate to it.

It so happens that last Friday, at my presentation of something that is generally considered as a case, [JE: see A Lacanian Psychosis: 1976: An encounter between Gérard Primeau & Jacques Lacan : Information here] a case of madness assuredly. A case of madness which, which had begun with the sinthome : imposed words (paroles imposées). This at least was how the patient himself articulated this something which is the most sensible of things in the order, in the order of an articulation that I can describe as Lacanian. How can we not all sense that the words on which we depend, are in a way imposed on us? This indeed is why what is called a sick person sometimes goes further than what is called a healthy man. The question is rather one of knowing why a normal man, one described as normal, is not aware that the word is a parasite? That the word is something applied. That the word is a form of cancer with which the human being is afflicted. How is it that there are some who go as far as feeling it?

It is certain that Joyce gives us a little taste of this. I mean that the last time I did not speak about his daughter, Lucia, since he gave his children Italian names, I did not speak about the daughter Lucia with the intention of not getting into, into what one could call gossip. The daughter Lucian is still alive. She is in a nursing home in England. She is what is called, like that, nowadays, a schizophrenic.

But the matter was recalled to me during my last case presentation, by the fact that the case that I was presenting had undergone a deterioration. After having had the feeling, a feeling that I consider, for my part, as sensible, the feeling that words were imposed on him, things deteriorated. He had the feeling, not simply that words were imposed on him, but that he was affected by what he himself called telepathy. Which was not what is usually meant by this word, namely, being made aware of things that happen to others, but that on the contrary everyone was aware of what he was formulating himself, in his own heart. Namely, his most intimate reflections, and quite especially the reflections which came to him in the margin of these famous imposed words. For he heard something : ‘dirty political assassination’ (sale assassinat politique). Which he made equivalent to ‘dirty political assistantship’ (sale assistanat politique). One can clearly see here that the signifier is reduced to what it is, to equivocation, to a torsion of the voice. But to ‘dirty assassination’ or to ‘dirty assistantship’ described as political, he said something to himself, in reply. Namely, something which began with a but, and which was his reflection on the subject. And what really terrified him, was the thought that in addition, the reflection he was making, in addition to what he considered as these words that were imposed on him, was also known by the others. He was then, as he expressed it, a telepathic broadcaster. In other words, he no longer had any secrets. And this very thing, it was this that made him to attempt to end it all; life having become for him by this fact, by this fact of no longer having any secrets, by no longer having anything in reserve, led him to make what is called a suicide attempt. Which was moreover the reason why he was there and why I in short had to be concerned with him.

What pushed me today to speak to you about the daughter Lucia, is very exactly the fact, I was really careful about it the last time, in order not to get involved in gossip, is that Joyce, Joyce fiercely defended his daughter, his daughter the schizophrenic, what is called a schizophrenic, from being taken over by doctors. Joyce only articulated a single thing, which was that his daughter was a telepath. I mean that, in the letters that he wrote about her, he formulated that she is much more intelligent than anybody else, that she informs him, miraculously is the word to be understood, about everything that is happening to a certain number of people, that for her these people have no secrets.

Is there not here something striking? Not at all that I think that Lucia was effectively a telepath, that she knew what was happening to people about whom she did not have, about whom she did not have any more information than anyone else. But that Joyce for his part attributes this virtue from a certain number os signs, of declarations that he, he understood in a certain way. This is really something where I see that in order to defend, as one might say, his daughter, he attributes to her something, an extension of what I will momentarily call his own symptom. Namely – it is difficult in his case not to evoke, not to evoke my own patient and how this had begun with him – namely, that with respect to the word, one cannot say that something was not imposed on Joyce. I mean that in the more or less continuous progress that his art constituted, namely, this word, the word that had been written, to break it to dislocate it, to ensure that at the end what seems in reading him to be a continual progress – from the effort that he made in his first critical essays, then subsequently, in the ‘Portrait of the Artist’, and finally in ‘Ulysses’ and ending up with ‘Finnegan’s Wake’ – it is difficult not to see that a certain relationship to the word is more and more imposed on him. Imposed to the point that he finishes by, by dissolving language itself, as Philippe Sollers has very well noted, I told you that at the beginning of the year, to impose on language itself a sort of breaking, of decomposition which means that there is no longer any phonological identity.

No doubt there is here a reflection at the level of writing. I mean that it is through the intermediary of writing that the word is decomposed in imposing itself. In imposing itself as such. Namely, in a distortion as regards which there remains an ambiguity as to whether it is a matter of liberating oneself from the parasite, from the wordy parasite of which I spoke earlier, or on the contrary something which allows itself to be invaded by the properties of the word that are essentially of the phonemic order, by the polyphony of the word.

In any case the fact that Joyce articulates in connection with Lucia, in order to defend, that she is a telepath, seems to me – by reason of this patient whose case I was considering last time when I made what is called my presentation at Ste Anne – seems to me certainly indicative. Indicative of something as regards to which I will say that Joyce, that Joyce bears witness at this very point [Refers to Fig. VII-6 which has not been reproduced] which is the point that I designated as being that of the paternal lack. What I would like to mark, is that what I am calling, what I designated, what I am supporting by the sinthome which is marked here by a ring, by a ring of string, which is supposed, by me, to be produced at the very place where, let us say, there is an error in the layout of the knot.

It is difficult for us not to see that the slip is what, in part, the notion of the unconscious is grounded on. That the witticism should also be so, is not, it is to be paid to the same account as I might say. For, after all, it is not unthinkable that the witticism should result from a slip. This at least is how Freud himself articulates it, namely, that it is a short circuit; that, as he puts forward, it is an economy with a pleasure, a satisfaction in view. That it should be at the place where the knot fails, where there is a sort of slip of the knot itself, is something that we should clearly retain, that I for my part, as I showed here, happen to fail on occasion. This indeed is what, in a way, confirms that a knot can fail. A knot can fail, just as much as the Unconscious is there to show us that it is starting from, that it is starting from its own consistency, that of the Unconscious, that there are a whole lot of failures.

Further relevant posts from:

Gatian de Clérambault : here

Jacques Lacan : here

Jacques-Alain Miller : here

Stuart Schneiderman : here

Ordinary Psychosis : here