The clinical roots of the

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schizophrenia concept

TRANS LA TIO NS OF SEMINAL EUROPEAN

CONTRIBUTIONS ON SCHIZOPHRENIA

Edited by
JOHN CUTTING
Consultant Psychiatrist, Bethiem andMaudsley Hospitals , London
M.SHEPHERD
Professor of Epidemiological Psychiatry
Institute of Psychiatry, London

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212 E. Minkowski

We cannot imitate the states of mind described by our patients, and

so, when we try to deepen our theoretical and practical understanding
of the human personality, we need not be afraid of applying our own
instincts and our own intuition to the task.

JACQUES LACAN

DE LA
PSYCHOSE PARANOiAQUE
DANS SES RAPPORTS
AVEC LA PERSONNALITE
SUIVI DE

PREMIERS ECRITS SUR

..
LA PARANOIA

EDITIONS DU SEUIL
27, rue Jacob, Paris VI0
Jacques La can (1900-81)

Jacques Lacan is regarded as the father of French psychoanalytical

thinking. He trained in mainstream psychiatry and his doctorate
thesis was supervised by Gaetan de Clerambault. After the Second
World War he became a cult figure in French intellectual circles,
mixing Freudian ideas with social comment. As with many French
intellectuals, he founded an ephemeral one-man movement with
many followers, who have dwindled sharply since his death.
The following extract from his thesis contains one of the clearest
expositions of a psychogenic psychosis, the life history of the patient
whom he calls Aimee, after the heroine of her own romantic
autobiography, which is described affectionately and with insight.
The 'case of Aimee' stands as a sensitive and understandable
rendering of the links between a certain personality and a certain
psychotic development.

The case of Aimee, or self-punitive paranoia

J. Lacan (1932)
(Second Part, Le cas Aimee ou la paranoia d'auto-punition, of
De la Psychose Paranoiaque dans ses Rapports avec la Personalite. Le
Fran~ois: Paris)

This paper examines the theoretical basis an9- the developmental

origins of paranoid psychosis in terms of the personality development
of a single case presented in detail .. .
••
Case history
The assassination attempt. On 10 April at eight o'clock in the evening
Mme Z., a celebrated Parisian actress, arrived at the theatre where she
was playing that evening. She was accosted at the stage-door by a
stranger, who asked her: 'Are you Mme Z?' When she replied in the
affirmative, the stranger, according to Mme Z., assumed a different
facial expression, quickly took a knife out of her handbag and, with a
look of hatred, raised her arm ready to strike her. Mme Z. tried to
protect herself by seizing the blade, in the course of which she severed
two tendons in her hand. By this fune, the stranger had been overcome
by two stagehands and the police were called. The stranger, whom we
shall call Aimee from now on, was taken to the prison of Saint-Lazare,
214 J. Lacan
where she was kept for two months before being transferred to the
Asylum of Saint-Anne.
On initial questioning Aimee explained her behaviour by saying that
the actress had been instigating 'scandal' against her. According to
Aimee, she had been mocking and menacing her for a number of years.
I Her accomplice in these acts of persecution was a £amour writer, P. B.,
~ who had disclosed various incidents of her personal life in his novels.

JS'{ Patient's life situation. Aimee was aged 38 at the time of this incident.
She had been born in the Dordogne of a peasant family. She had two
sisters and three brothers, one of whom had risen to become a teacher.
She was currently employed as an administrator in one of the railway
companies, and had been in this job since the age of 18. She was
married to an employee of the same company, but for the last six years
they had led separate lives, and she lived alone. She had one son, who
lived with his father, but whom she saw regularly.

s:
Previous forensic and psychiatric history. ~ars before, she had been a
voluntary patient in another psychiatric hospital. She had remained
there for six months and the following extracts from her case-notes give
some idea of her condition at that time: 'Psychiatric disorder of one
year's duration ... People in the street make insulting remarks, accuse
her of extraordinary vices; people around her say all sorts of evil things
about her; the whole town of Melun knows about her behaviour and
regards her as depraved ... Evidence of mental disorder, delusions of
persecution and jealousy, illusions, misinterpretations, grandiose
ideas, hallucinations, excitement: incoherence . . .' She was released
after six months at the request of her family, although 'not cured'.
About a year before the present incident she was reported to the
police by a communist journalist for continually pestering him to
release copies of articles in which, she claimed, he had drawn attention
to her grievances against a certain famous writer. Five months previ-
ously she was again reported to the police, this time for assaulting an
employee of a publishing house which had rejected a manuscript. On
this occasion she was not arrested, but merely reprimanded by the
police ...

Mental state on admission. By the time she was transferred to hospital the
conviction attached to her delusions had completely disappeared. She
was well orientated, had no intellectual impairment, showed no evi-
dence of thought disorder and her attention was unimpaired. When
I
The essential disorder of schizophrenia 215

recalling the themes of her delusions she felt ashamed and realised that
they were ridiculous ... However, her emotional response during the
initial interviews, particularly the detached manner in which she
referred 1:o the victims of her assaults, suggested a lack of sincerity and
even of dissimulation in her responses ... In subsequent interviews
she became more trusting and at this point it became apparent that,
although her delusions had lost their intellectual appeal, some of them
still evoked emotion. For example, she might say: 'I did that because
someone wanted to kill my child'. The grammatical form in which she
recounted the reasons for her behaviour, her defiant manner - head
held high, arms crossed, trembling and hushed voice - and particularly
the pallor which came over her face at such times, all suggested that
they still exercised a powerful influence over her.
There were other signs which could not be taken for mere reticence:
regular gaps in her memory, for example, and misunderstandings,
consistent with the continued influence of delusional themes.

Development and content of delusions. Aimee's delusional state illustrated

almost the entire range of paranoid themes. There were delusions of
persecution, expressed through ideas of jealousy and prejudice. There
were delusions of grandeur, with dreams of escaping to a better life and
notions of having a grand mission to accomplish. Eventually she
showed systematised erotomania attached to a royal personage. There
were no hypochondriacal delusions, however, and no beliefs about
being poisoned.
It was possible to date the onset of her psychiatric condition to when
she was aged 28, ten years prior to her current admission. At that time
she had been married for four years, was still working in the same
office as her husband and had just become pregnant.
The first manifestation was a vague feeling, on her part, that col-
leagues at work were against her. They seemed to be criticising her
work unduly, maligning her behaviour and saying unkind things to
her. Later, passers-by in the street seemed to be whispering about her
and showing their contempt for her. She noticed allusions to herself in
newspapers. She was puzzled at the time by these incidents: 'Why do
people behave like this? They must want my child inside me to die. If
my child does not survive they will be to blame'.
1st The depressive element in all this is clear. She later wrote: 'During
my pregnancies I f-elt sad. My husband would reproach me with this;
this would cause a row; and then he would accuse me of having been
with another man before I knew him. This caused me a lot of pain .. .'
216 J. Lacan

She reacted in an aggressive manner. One day she slashed the tyres
of a colleague's bicycle. One night she threw a jug of water at her
husband's head; another time she threw an iron at him.
Her child was born dead . It was a girl, asphyxiated by having the
cord around its neck. She was devastated. She blamed it all on her
enemies, and in particular on a woman who for three years had been
her best friend. This woman, who worked in a distant town, tele-
phoned soon after her delivery to find out how she was. Aimee
thought this strange, and her hostility crystallised from that moment.
A second pregnancy brought a return of her depressive state. She
gave birth to a healthy child this time, a son, and devoted herself to
looking after him. She breast-fed him until he was 14 months old, and
during this period she became hostile and querulous, making all sorts
of misinterpretations. She provoked a scene with the driver of a car
which she considered had passed too close to the child's pram.
Her husband discovered that she was secretly planning a trip to
America. When he confronted her with this information she said she
was going to make her fortune there as a novelist. She said she would
abandon her child, but then changed her mind, and said the trip was
for his benefit.
This was the time of her first stay in a psychiatric hospital, after
which she was better but 'not cured' according to the hospital records .
Following her discharge she refused to go back to work or even stay
in the same town because, as she said, the persecution had made it
unbearable. She obtained a transfer of her job to Paris and from that
time onwards she became progressively preoccupied with Mme Z., the
actress whom she eventually stabbed. She became convinced that
Mme Z. was endangering her son's life. She later recalled: 'One day at
the office, while I was as usual wondering where the threats to my
son's life came from, I heard someone mention Mme Z. and I knew
then that she was the one who wished us harm'.
One cannot help noticing-the flimsiness of her evidence against Mme
Z. We enquired carefully among her colleagues for any mention by her
of this actress, and all we were able to discover were vague remarks
directed at 'theatre people in general .. .' Aimee had only seen the
actress twice before the assassination attempt, once on the stage and
once on the screen. She could not even remember, however, the name
of the play or film, or even if it was a classical or modem piece. This was
so extraordinary that we have to regard it as a selective amnesia, hiding
her true emotions.
Over the next five years her misinterpretations increased in number.
/
Self-punitive paranoia 217

These were not confined to the actress, but included photographs of

the house where she was born and newspaper references to her son
being killed. Other persecutors emerged over this period, including
the actress, Sarah Bernhardt, and the writer whom she had asked a
journalist to vilify. Another writer, P.B. , assumed a prominent role . He
was, according to her, the cause of her divorce, as she had come to love
him. As with Mme Z., the entry of P.B. into her delusions was
uncertain in time and vague in its logical development . . . She recalled
subsequently: 'I couldn' t believe that Mme Z. was working alone and
so I came to the conclusion that someone important must be working
alongside her'. She thought she had found allusions to herself in P.B.'s
novels, and for this reason she identified the author as an accomplice
of Mme z. Later still she came to believe that a career in literature had
been marked out for her, and then that she was an expert in chemistry.
At other times she thought she must be someone important in Govern-
ment circles, an influence on the morals of others 'like Krishnamurti' .
She went through a phase of soliciting men in the street and,
although she would take them back to a hotel, her main motive was not
sexual satisfaction but to satisfy 'a great curiosity concerning men's
way of thinking . . .'
She then developed an erotomania centred on the Prince of Wales.
She sent him poems, and avidly collected newspaper cuttings of trips
abroad, but never tried to meet him. Her erotomania was entirely
platonic in nature .. .
Several months before the assault and her arrest she became increas-
ingly agitated and desperate. She felt she had to see her main enemy
face to face. One month before the incident she bought a knife and by
her own account, on the evening of her actual encounter with the
actress, she was in a state of extreme arousal and frenzy.

171 Literary productions. Her main literary productions were two novels,
both written in the eight months before her arrest. From a literary
point of view the first is better than the second, but both are well
written. [The heroine of the first novel is called Aimee. In the first
chapter, entitled 'Spring', she is pictured in an idyllic setting, as a
country girl in the age of chivalry, dreaming of marriage. In the second
chapter, 'Summer', two strangers make their appearance. One is a
'courtesan' who destroys the innocent atmosphere and of whom
Aimee feels intensely jealous. In the third chapter, 'Autumn', disaster
strikes, as Aimee and her fiance become the subject of gossip and
scandal in the town. She responds by thinking purer and purer
218 J. Lacan
thoughts. In the last chapter, 'Winter', she dies, just after the strangers
go away- [Synopsis, Tr.]
In the second novel, one of the most significant passages is this
invective against 'women of the theatre':
High class prostitutes are the scum of society. They undermine it and
destroy it. They make other women the slaves of society and ruin their
reputation.
Coming out of the theatre one night I saw a procession go by. The
main figure in this was an old hag whose thighs must have been
entered by millions over the years. There she was with her retinue of
parasites, procurers and pimps, in the form of journalists. Her flabby
body was perched on top of one of the carriages. Beauty, I heard one
of her followers say to another, lies in the coccyx; generosity in the
groin; intelligence in the little toe .
I was told that this was how things went on round here. All I could
see was a she-wolf made up to be a queen; following her there was an
evil goddess wearing a dog-skin; then came the rest of the retinue
poisoning the air with their foul breath; bringing up the rear was a
she-goat who had just come out of the National Theatre with a wet
rose in its mouth, all sticky and with a wig on its horns, whom the
journalists were making eat all the pretty flowers in Paris.
Poets came up one by one to talk to the old hag. Passers-by would
grab hold of her thighs and the owner of the main newspaper in the
city had his way with her in front of everyone. I couldn't go on. The
procession $topped me. I asked people what the whole thing meant,
but no one would tell me. It must be a secret of the theatre, something
to do with the formalities of society: the motto was Honour and
Nationhood.
It really is too crude, Madame, but you do it nonetheless. You
would never regard it as sinful. The whole thing is like a flying
brothel, the sort of thing you can buy in special bookshops.
Diagnosis. The most striking aspect of the whole case is the delusional
state. It was systematised, and its two main features were the accom-
panying emotion (predominantly anxiety), and the peculiar way in
which it developed, particularly with regard to the seemingly casual
choice of victim.
We can first of all exclude organic dementia, acute confusional state
and dementia paranoides, as there was no evidence of intellectual
impairment. Similarly, we can rule out both a chronic hallucinatory
delusional state ... and paranoid schizophrenia, because there were
no hallucinations to suggest the former and no disturbance of ideation
or affectivity to support the latter ... Could it be a manic-depressive
psychosis? Although Aimee was depressed during her first admission
I
Self-punitive paranoia 219

to hospital, her mood was not strikingly abnormal during the current
admission and we cannot therefore attribute her entire condition to a
manic-depressive psychosis . . .
We are therefore compelled to place Aimee's psychosis among the
large body of conditions labelled paranoid psychoses. She fits the usual
criteria perfectly: egocentricity, logical development from false pre-
mises and gradual use of defence mechanisms to consolidate it . .. Of
the various types of paranoid psychoses one of the most well defined
is that described by Serieux and Capgras - a misinterpretative delu-
sional state. Aimee fits this description very well. The only unusual
features were the lack of any feeling of injustice and the absence of a
sense of exaltation, both of which are common in misinterpretative
delusional states, and the presence of a feeling of self blame which is
uncommon in these states. Aimee believed that her child was being
harassed because she herself deserved to be punished. Another
unusual feature was the fact that the persecution was not entirely
'centrepetal', in that the child was the focus of some of the imagined
threats .. .
In the next section we shall examine the actual way in which the
psychosis developed.

Discussion
Does Aimee's psychosis represent an organic process? In order to elucidate
the psychotic mechanisms, we shall first of all examine those
phenomena which are primitive or elementary ... These comprise
symptoms which express the determining factors of the psychosis ...
In our case the role of the puerperium was clinically obvious. The two
initial thrusts of the delusional state both occurred during her two
pregnancies. In addition, one should consider her thyroid dysfunction
which may have contributed to the initial psychiatric disorder, and one
should also note that she abused the thyroid medication. In the
established phase of her delusional state her menstrual rhythm deter-
mined the fluctuations in her anxiety level . . . Let us now examine the
primitive mental symptoms which seem to have been caused by these
organic factors ... We can group them into four types:
zrl (1) Oneiroid states, often coloured by anxiety; (2) incomplete perceptions;
(3) misinterpretations; and (4) illusions of memory . .. Oneiroid states are
those states of altered consciousness which resemble dreams. In our
patient dreams played a major role in her mental life even before her
first admission. Quite often, after the delusional state had set in, her
220 J. Lacan
morbid mental state would begin as a dream and persist for several
hours into her waking life. For example, on one occasion, she feared
the arrival all morning of a telegram announcing her son's death; she
had dreamed this the previous night and the belief had carried over
into her waking state . . . Associated with these are atypical modifica-
tions, more or less in larval form, of perceptual structure .. . Misin-
terpretations are characterised by their selectivity, the sense of compul-
sion with which they arrest our attention, and the personal significance
which they convey . . . Illusions of memory result from a weakening of
the power of remembering which produces an invented image -
whether itself "the product of a perceptual association, a dream or a
delusional complex - in place of a true memory image .. .
Our concept of the psychopathology of misinterpretative delusional
states differs from the classical account by putting more weight on a
'psychasthenic' origin, that is to say that the social components of
perception and memory are selectively affected. The classical account
puts most weight on a disorder of reasoning .. . Our account has the
advantage that one can link these misinterpretative states with certain
organic states . . . But can one explain Aimee's delusional state in the
light of the organic factors which were identified - the puerperium,
thyroid dysfunction, abuse of thyroid medication, the menstrual cycle?
Organic psychiatrists tend to regard a delusional system as the intellec-
tual elaboration of organically-determined phenomena. Its structure,
according to them, is of little importance. We cannot accept this
formulation. We believe that the primitive phenomena discussed
above (oneiroid state, incomplete perceptions, misinterpretations, illu-
sions of memory) cannot explain how a delusional system can become
established or account for its particular organisation. In our view the
crucial factor lies in the personality of the subject, and this allows us to
regard the development of the psychosis as a process disorder.

Does Aimee's psychosis represent a reaction to a vital conflict and emotionally-

determined traumas? In order to answer this question we carried out a
detailed enquiry of her background and personality from numerous
sources. The most prominent traits and incidents were as follows:
As a young child, she was, by all accounts, very strong-willed. She
was the only one in the household.who could stand up to a tyrannical
father. She was regarded by her parents as the brightest child and the
only one most likely to succeed in life. She derived various privileges
from this status. For example, her underwear was of better quality than
Self-punitive paranoia 221

that of her sisters, a fact which her sisters bitterly resented, and still did
when interviewed years later ...
The person who was responsible for her favourable treatment within
the family was her mother. This led to an intense emotional bond
between the two of them. Aimee said later 'We were like two friends'
and often regretted ever having left her side. Her mother, moreover,
had always been a suspicious person. On one occasion, for example, a
neighbour had predicted that one of her cows which was ill would not
get better. When the beast died, her mother accused her neighbour of
having wished its death and of having poisoned it . . .
One trait, in particular, was noticeable from an early age. She was
always slow and late for things. She was never ready at the same time
as the others. This, as Janet pointed out, is typical of those who develop
psychasthenic symptoms . . .
She was always rich in imagination, as could be seen in her adoles-
cent writings. These were notable for a certain quasi-erotic precocity,
with themes of her being a child of nature and accounts of passionate
experiences . . .
At the age of 17 there were the first signs of a deficiency in psycholog-
ical functioning. Until this time she had been top of the class at school
and she thus obtained entry to a Teachers Training College. But within
a short while of being there she received a minor setback and gave up
the course. We can consider this too as evidence of a professional abulia
or lack of will, within Janet's concept of psychasthenia. This is often
associated with another symptom, which was to be quite marked
throughout her adult life, that of a need for moral direction. One of her
teachers commented at this period: 'Just when you think you know
her, she escapes you'. He considered her a born liar.
After her return from Teachers Training College she decided on a
career in administration. At this time, also, a close girl-friend died of
pneumonia, and this affected her deeply.
We should not leave the period of infancy and adolescence without
mentioning an incident which achieved almost a 'quasi-mythical value'
in the family. The family were out for a walk in the country, and at some
point Aimee was left behind because she was arranging her hair. In
an attempt to catch up she took a short cut across a field and was
chased by a bull. The incident recurred often in her dreams and in her
writings ...
Aimee's first contact with the wider world was in a provincial town
far away from her birthplace. She lived there with her older sister who
222 J. Lacan
had married an old man when she was only 15. Aimee was soon
dominated by this sister, whose influence on her was even more
striking later in her life. The most significant event at this stage,
however, was her first love affair. Her seducer appears a comic figure
in retrospect. He was a small-town Don Juan and a poet in a group of
'regional artists' . At first Aimee found his advances repulsive, but she
later gave in, and was then told that it was all a game to him. She left
soon afterwards to work in another town, but he remained in her
thoughts for three years. She wrote numerous letters to him and gave
up all social life to devote her thoughts to him. At the end of these three
years her emo_tions suddenly turned to hate. She later referred to him
in this way: 'He can drop dead, for all I care. Don't talk to me about this
chap, this ill-mannered lout .. .'
The next phase of her life, which lasted for four years until her
marriage, was marked by a close friendship with a female colleague at
work. This girl c~e of a noble family, but her branch of it had fallen on
hard times. Despite this the girl behaved as if she were intellectually
and morally superior to those around her. Aimee was first of all
overwhelmed by this friend with her social airs and domineering
attitude. Later, however, she began to keep, as she put it, 'a secret
garden' within herself. Later still, she became irritated with her and the
other girls in the circle: 'Women are only interested in gossip, intrigue
and their own narrow lives', she wrote. She noticed at this time that her
attitude and way of thinking were closer to a man's and recalled: 'I had
an intense curiosity about men's minds . . .'
Aimee then married one of her colleagues, who offered her the
chance of moral stability and practical security. The husband was a
ponderous man, totally opposed to anything vain, decorative or crea-
tive. Her behaviour, in this respect, annoyed him intensely, and
together with her sexual frigidity this led to marital rows. Both parties
were jealous of the other. Aimee's reaction was predictable. She
became retarded, 'abulic' and contrary in her behaviour. If asked to go
for a walk, she would make any excuse to stay at home but, once out,
she would prolong it for hours. Eight months after her wedding,
however, something happened which was probably the most decisive
event in her life. Her elder sister, the one with whom she had lived after
leaving home, became a widow, and took up residence with Aimee a~d
her husband. From our discussions with this sister it is quite clear that
she had an immense influence on Aimee. She would give advice on
everything and before long was the dominant member of the house-
hold. Aimee, as a result, became more and more estranged from her
I
Self-punitive paranoia 223

husband. Because her character was both sensitive and psychasthenic

she could neither give in completely to her sister nor take refuge in
daydreams . She experienced the situation as a moral humiliation. Her
personality was such that she could not react simply with a combative
attitude, which would be the typical paranoid response. The sister's
most powerful weapon against Aimee was not so much her authority
as Aimee's own conscience, for Aimee could recognise her sister' s
value, her virtues and her concern. It was this combination of the
struggle to· resist the sister's authority, and the recognition of her
sister's qualities and her own humiliation, which formed the roots of
her psychosis. In the town, it was common knowledge that her sister
had supplanted her. Far from denying this or fighting it, Aimee would
glady admit the fact . . .
The actual mechanism by which her sister became transformed into
her 'enemy' will be dealt with in the next section. Before concluding
this section, however, we shall contrast the main features of a typical
paranoid personality with those found in Aimee.
Paranoid personalities are essentially proud and vain, whereas
Aimee was both self-conscious and prone to crises of moral uncer-
tainty. The former are distrustful in all situations, whereas our patient
was intermittently anxious. The overriding psychological deficit in
paranoid personalities is that of false judgement. In Aimee's case the
problem is better regarded as one of an abundance of imagination
which affects faculties such as judgement but which maintains some
link with reality. Her faulty reasoning is a secondary effect, resulting
from a primary emotional disorder, and in particular her morbid
conscience.

Aimee's psychosis is based on self-punitive mechanisms which dominate her

personality structure. Before embarking on the complex issues involved
in this argument we should consider what is meant by personality
functions. They consist of two sorts of reactions to events. There are
those which have a social component and which play a part in the
general well-being of those around them. Others are more concerned
with maintaining the well-being of the subject in the face of judgements
from others. There is a conscious aspect to each of these sets of
functions and this means that they are intentional. The new discipline
of psychoanalysis has thrown much light on the unconscious aspects
of personality and on the distortions which appear to us as conscious
intentional reactions.
It is not our primary aim here to consider whether the methods of
224 J. Lacan
psychoanalysis, undoubtedly of value in many areas of psychopatho-
logy, can be applied to psychosis. We do not believe that one can apply
psychoanalytical methods to psychosis just because they have been
useful elsewhere. In our view it is justifiable to use psychoanalytical
principles, but in the rest of the discussion we hope to show that
Aimee's psychosis can be regarded as psychogenic purely by observing
the psychosis itself . . .
The first point to note, in support of a psychogenic cause of Aimee's
psychosis, is the fact that her symptoms disappeared abruptly on the
20th day of her imprisonment. She was 'cured', and remained cured for
the year and a half that we observed her in hospital. Perhaps we should
take heed of the old maxim, that the nature of the cure will show you the
nature -0f the illness . The way in which her symptoms remitted was
unlike that seen in organic, schizophrenic, depressive or manic condi-
tions. These resolve slowly, with frequent oscillations, and then only
partially. In Aimee's case the entire delusional system evaporated
rapidly. Usually, cures of this sort are only seen in one set of cir-
cumstances - in subjects with delusional states based on passion who
have accomplished the murder of the person who is the object of the
delusion. Such subjects experience a characteristic relief accompanied
by an immediate resolution of all their delusional convictions. In
Aimee's case, however, the aggressive act against the actress did not
result in immediate. relief; she obtained no satisfaction in contemplating
her victim's plight. Nor did her delusions disappear immediately; they
persisted for another 20 days . But it did seem to us as if something had
changed as a result of her attack. She was made to undergo a punish-
ment: in prison she was forced into the company of criminals; she was
in daily contact with their behaviour, opinions and cynical remarks on
her situation; and she had to suffer the scorn and desertion of everyone
she knew. For this reason, there were similarities between Aimee's
case and delusional states of passion. Her delusional state did event-
ually resolve and she did later experience relief. The delay in her case
represented the time it took for her to become aware of her punishment
and it was at the point that 'relief' came .. .
We have thus tentative evidence for a self-punitive trait or a feeling of
culpability in Aimee's case which underlay the development of her
psychosis. This hypothesis explains other features of the case, for
instance the content of her delusions. Her persecutors were trying to
harm her child 'in order to punish the mother'. On one occasion, when
asked why she had believed her child was being threatened, she

I
Self-punitive paranoia 225

replied: 'To punish me, because I did not accomplish what I set out to
do .. .'
A second striking feature of the case is the peculiar nature of her
persecutors. There were several of them, but none had any relationship
in real life with Aimee. This fact highlights the purely symbolic
significance of these persecutors. They were, we might say, second,
third and successive moulds of a prototype. This prototype has two
aspects, emotional and representational.
The emotional power of the prototype is to be found jn the real life of
our patient. We suggested earlier that it mainly derived from her
feelings for her elder sister, on account of whom Aimee had suffered
moral humiliation and reproaches to her conscience. To a lesser degree
it also derived from envy of her close girlfriend, who represented for
Aimee the social adaptation and superiority which she herself felt she
lacked.
The representational value of her persecutors is obvious. The sense
of freedom and social ease which writers, actresses and women of the
world reputedly possess were the very qualities which she herself
dreamt of obtaining. They were her ideal, and at the same time the
object of her hate. In striking the actress, Aimee struck her externalised
ideal, in the same way as someone driven by passion strikes the unique
object of their hate and their love. In Aimee's case, however, the value
of the object was purely symbolic, and the act did not by itself lead to
relief. But by the same blow which made her guilty in the eyes of the
law, she received a blow to herself. When she had time to comprehend
this, she experienced the satisfaction of a desire accomplished; her
delusions, rendered ineffective by this realisation, vanished.
In this way we have, it would seem, demonstrated that the nature of
the cure reveals the nature of the illness.
What of the link between the personality of the patient and the
fundamental mechanisms by which her delusions arose? Aimee is best
described as possessing traits of two clinical personality disorders: the
psychasthenic and the sensitive. Obsessional scruples, continual
doubts about ethical matters and internal moral conflicts are among
their prominent features. Unlike someone with a normal personality,
where mild organic insults and life events leave a relatively small trace,
soon compensated for, someone with a self-punitive personality reacts
entirely differently. The emotional and intellectual consequences of
such events are not easily accommodated; they become fixed and
persist. Thus, the development of a psychosis, such as we have
226 J. Lacan
described in the case of Aimee, is to be regarded as an effect of organic
insults and life events acting on a pre-existing psychological anomaly.
The psychological anomaly we regard as a disorder of personality, and
our whole concept of psychotic development in this case can be termed
psychogenic.
Index

Abraham, K., wish fulfilment 44 agnosias, paralogical thought disorder

abstraction, disorder of 189 in relatio
abulia, professional 221 ee, the case of (self-punitive
activity paranoia) 213--26
level of physical, in simple the assassination attempt 213--14
schizophrenia 28 development and content of delusions
mental, insufficiency of 51--8, 117 215--17
acute delusional states 169 diagnosis 218-19
misinterpretations based on 179--80 life situation 214
acute insanity, differentiation from literary productions 217-18
hebephrenia 156 mental state on admission 214-15
acute stages of schizophrenia, prognosis previous forensic and psychiatric
of 64-5, 69 history 214
Adler, A., 126 psychotic development 219-26; organi
affect influences 219- 20; reactive
in catatonic dementia praecox 39 components 220-3; self-punitive
delusional ideas and 117 personali structure and 223--6
dream content and 43:-4 co o , e ec onsc op erucso
flattening of, prognosis of 67, 70 alcoholic dementia, differentiation from
in mild dementia praecox 15 simple schizophrenia 32
in simple schizophrenia 28 alcoholic psychoses, delusional
suspiciousness as an 129 perception in 107
see also delusional mood states; alogical thought disorder in
depressed mood; emotions; manic schizophrenia, organic nature of 77--8
mood amentia
affective dementia in schizophrenia 200 anxiety associated with 39
affective psychosis, delusional states of differentiation from catatonic dementia
passion secondary to 183--4 praecox 38
affective symptoms amnesias, word 75
in acute schizophrenia 64 amnesic syndrome, perplexity associated
at onset of dementia praecox 17, 18-19 with 82
see also anxiety; depression; Anglade, D., dissociated patients 190
manic-depressive illness anthropology, influence on
age, development of delusions and 130-1 psychopathology of 137--8
age of onset 'anti-psychiatry' movement 2, 6, 139-40
dementia praecox 22-3 anxiety
hebephrenia 154 in amentia 39
paranoid insanity 156 distinction of perplexity from 79
simple schizophrenia 30-1 misinterpretation and 106