JEP - Number 2 - Fall 1995-Winter 1996
Lacan as psychiatrist
or: comment ne pas etre fou (1)
René Major

Translated from the French by Claudia Vaughn

In the autumn of 1960, I began my internship in psychiatry in Professor Jean Delay's ward at the Hôpital Sainte-Anne in Paris. I was impressed by both the man and the place.
I had just finished a two-year post in a modern psychiatric center in Montreal, which had nearly as many doctors as patients, and where relations with the directors were quite amicable. But to enter Sainte-Anne was to penetrate another world: with its vast grounds, ancient buildings, great past and complex hierarchy it resembled more a fortified town. While in Montreal patients and doctors had been indistinguishable in their street attire, at Sainte-Anne it was impossible to mistake the one for the other. Arriving at work each morning, I was required to don a marine-blue redingote which assured that everyone recognized my duties and my place in the hierarchy. Of course the patients donned their asylum garb.
Professor Delay's ward was situated in a building with the inscription: Clinique des Maladies Mentales et de l'Encéphale (Clinic of Mental and Encephalon's Illnesses). I found the word "Encéphale" odd, presupposing as it did a strong and persistent belief in an organic genesis of the illnesses of the soul, or in a degeneration of this superior organ, considered the site of consciousness.
I met privately with Professor Delay on only two occasions, upon my arrival in his ward, and one year later, upon the renewal of my contract. His office walls were covered with honoris causa degrees from foreign universities. He cut a regal figure in his cloak, and the manner in which he wore it evoked the image of the Académicien he was eager to be. The few words he addressed my way dealt with Paul Valéry or André Gide; he never referred to masters in psychiatry or psychoanalysis. I knew that this man of letters, as a psychiatrist, preferred psycho-pharmaceutical research to the exploration of the unconscious, and neuroleptic treatments to psychotherapies. Nevertheless this bel esprit (as 17th century France would have called him) and paragon of classicist culture deigned to allow psychoanalytic consultations in his ward, even if this meant accepting a man like Jacques Lacan who, with no hospital career behind him, consequently appeared to him as something of a dilettante. But "Docteur Lacan" -- as his nearest and dearest always called him -- had a friendly relationship even with the other French Maître in psychiatry at that time, Henri Ey, the reigning Lord and Master of Bonneval. While Jean Delay was preparing three volumes on André Gide's youth -- which led to a chair in the Académie Française -- Henri Ey was developing his organo-dynamic theory of mental life and its destructuring. He was participating in, and even encouraging, the new psychoanalytic debate which was just starting in France. In 1960 he brought together some of the most renown philosophers of that time together with the sharpest psychoanalysts of the two existing schools, to discuss the notion of Unconscious. Lacan emerged as the hands down winner of this jousting match whose field was covered by his pupils.
I was puzzled by Lacan. It was said that, as an intern, he was often seen strolling about reading the comedies of Aristophanes in Greek. Like the Athenian poet, he seemed, even when silent, to dominate the scene of his supposed knowledge; and when he spoke, his ironic seriousness confounded the respectful ignorance of the audience. His manner of dress, as well as his speech, combined the ascetic and the sybarite, luxury and austerity, distinguishing him sharply from Jean Delay and Henri Ey. Yet like them, he was part of that French tradition of physicians with remarkable literary and philosophical backgrounds, although the sources of their shared tradition were different. Lacan may have inherited his taste in fabric and his love for style from Clérambault, his psychiatric teacher and master, but his grammar took inspiration from Pichon, the nationalist psychiatrist. Moreover his language, derived as much from Breton's haughty syntax and Mallarmé's theoretical prose as from La Rochefoucauld's maxims, much later became more Joycian. What was most surprising about Lacan was that he expected -- as much, if not more, from the unexpected effects of language as from a developing knowledge -- some precision about both the singularity of a case and theoretical elaboration.
I had decided to attend his Seminar and follow his consultations. There were just a few of us at that time. Observing his patients in the psychiatric hospital I wondered why, unlike Freud, he had such an interest in psychosis. The patients he supervised were, for the most part, delirious -- patients whom he, as a psychoanalyst, rarely saw in private practice. Freud may have discovered the language of unconscious desire through hysteria, but what could Lacan hope to bring to light by listening to the speech of madness? Could he more readily hear the discourse of unreason? Did not his theoretical language often take the opposing view of reason? Did he expect to find the fundamental language of the unconscious in the delirium? In any case, unlike in his private practice in rue de Lille, he would listen to these asylum patients for over an hour. His curiosity was insatiable -- as in the case of a paranoiac woman, what he called the "Aimée case", on which he based his dissertation in medicine.
"Dites-moi tout, mon cher" ("tell me everything, my dear"), he would exclaim upon arriving, this man who knew quite well that it was impossible to tell everything. Yet his manner of familiarity seemed to cancel the infinite distance created by this impossibility to tell all. Despite his initial easy manner, initiating the conversation proved more difficult: "Have a seat, my good man. You have created quite a bit of interest here. I mean, people are really interested in your case. Tell me about yourself". Then, in the ensuing silence, Lacan would say something startling: "I don't see why I shouldn't let you speak. You understand perfectly well what is going on with you."
Even then, Lacan had quite an unusual style for a psychiatrist. He obviously had in mind from the start the role the unconscious played in the conversation. He did not assail the patient with questions in order to break the silence, but showed that he knew that the patient might think he would not be allowed to speak. And if Lacan did ask questions, they seemed directed not towards making a diagnosis -- something he rarely did -- but towards a treatment. His questions were an attempt to decipher the patient's discourse rather than to reveal this deciphering. And if by answering a question Lacan by chance risked revealing it, the deciphering remained as enigmatic as that which was deciphered, one enigma echoing another. Although Lacan's style broke sharply with hospital tradition, I always wondered why he still respected that most classic form of exposing patients to an audience, his only concern apparently being to learn from them, without any consideration for the status -- some would say the dignity -- of the subject. In doing so, was he supporting the segregationist discourse of reason on madness, or was it his intent to subvert this discourse from within?
The question became even more troubling when, after listening to a patient rave on for more than an hour, Lacan would state: "He's completely normal." This affirmation, which would have appeared strange, to say the least, to a classic psychiatrist, invoked the question: "Comment ne pas être fou?" ("How could we not be crazy?" or "How to avoid not being crazy?"). Undoubtedly, Lacan was opposed less to reminding society of its madness than to adapting the mad person to society. Since he thought that we are spoken when we speak, and that our speeches come to us from the Other, for him there was no longer any qualitative difference between speeches imposed by voices rising from the real and those the subject carries on by means of an internal voice. Lacan's presentation of patients was based on the axiom that there is no more madness in communicating with voices actually heard in the absence of an interlocutor, than there is in communicating with people when the essence of this communication is incomprehension. That incomprehension is at the core of communication is undeniably a Freudian truth, yet Freud permitted the subject a margin of autonomy which allowed him the possibility of inscribing unreason within the frame of reason. And yet, in his untiring listening to psychosis, Lacan would explore more than anyone else the path opened up by Freud to understanding psychosis. He went further than Freud ever dared -- and risked, in every analysis, reaching the psychotic bottom hidden within each of us.
Lacan's proximity to psychosis was nevertheless accompanied by an extremely rigorous approach. This approach was not objectified through a diagnostic view or by classifying the patient in a predetermined category, nor did it lose itself in a subjectifying identification wherein the roles of psychiatrist and patient are interchangeable. Each realized that that particular discourse -- held in the name of the psychiatrist or patient (and the place where it was held), even if imposed as is one's name -- was the discourse which best resolved, at least in this situation, the conflict of existence where desire engages the transformation or the reconstruction of reality.
Yet, as it happened, the encounter tightly bound their speeches together. A young man appeared one day claiming to hear voices speaking of an "assassination politique" (which would be something like inventing "political murderation" in English) -- a portmanteau word of the kind Lacan often invented, combining "assassinat" (murder) and "assistant" (assistant). He was being overwhelmed by phrases such as: "He is going to kill me the blue bird. This is an anarchistic system". At times he believed himself the reincarnation of Nietzsche or of Artaud -- he had been born the year Artaud died, and shared his astrological sign. He dissected his name, Gérard Primeau (2), turning his Christian name into that of a bird, the Geai rare (rare Jay); the signifier Prime codified his discourse. His break-down followed a failed love affair, and the woman he had loved was named Hélène Pigeon. Thus he was able to find her again in the real of his imaginary world, or in a non-human realm. But he did not confuse the imaginary and the real, saying: "Je débranche du réel les gens qui m' entourent, et les phrases imposées sont des ponts entre le monde imaginaire et le monde qu'on appelle réel... Dans le monde imaginaire que je me crée par le langage, je suis au centre. Le mot Prime -- le premier -- est celui qui codifie." ["I unplug the people surrounding me from reality, and the phrases that impose themselves on me are bridges between the imaginary and the so-called real worlds... I am at the center of the imaginary world I create for myself through language. The word Prime -- the first -- is that which codifies."
The thought of madness -- that contained by madness as well as the thought thinking itself, when madness reaches that point of thinking itself -- heightened Lacan's curiosity, which was not so much a curiosity which attempts to appropriate what should be known, but rather that which allows one to escape from oneself. In reading President Schreber's Memoirs, even Freud was struck by how Schreber's way of knowing through his raving resembled what Freud himself had elaborated theoretically, to the point that Freud acknowledged the self-healing power of both the theory and the raving: "The future will decide whether there is more raving in my theory than I am prepared to acknowledge, or whether there is more truth in Schreber's raving than we are ready to believe." At the end of his encounter with Gerard Primeau, Lacan concluded: "Today we have seen a very clearly marked case of 'Lacanian' psychosis, with its 'imposed discourses', the imaginary, the symbolic and the real. [Gérard had read both Artaud and Lacan.] It is precisely for this reason that I am not very optimistic about this young man... Here is a clinical case you will not find described anywhere, not even by such an excellent clinician as Chaslin".
One should look more closely at what is a psychosis with Lacan's name, in the name of Lacan, and as viewed by Lacan the psychiatrist.

(1) The title is purposedly ambiguous: it means both "how not to be crazy" and "how not avoid to be crazy." Transl.

(2) The name here has obviously been changed. This case is published in English (it is unpublished in French) in Returning to Freud, edited by Stuart Schneiderman (New York: Yale Univ. Press, 1980.) I developed this further in "La logique du nom propre et le transfert", Cahiers Confrontation, 15, 1986.