Extracts ‘Teachings from Case Presentation’ : 1977 : Jacques-Alain Miller

by Julia Evans on May 12, 2016

Translated by Stuart Schneiderman

Full text at Teachings of the Case Presentation : 1977 : Jacques-Alain Miller or here

Towards the XIVth Congress of Psychoanalysis New Lacanian School :

Discreet Signs in Ordinary Psychosis. Clinic and Treatment :

2nd & 3rd July 2016 : Dublin :

Compiled by Yves Vandeveken :

Extract One:

“Is recognizing and classifying mental patients a deciphering? There is a grid that permits us to do it. The grid was developed by psychiatrists in the last century and at the beginning of our own. Doubtless the grid is not absolutely consistent for different psychiatrists—the dividing lines of the one are not those of another, and a symptom described here is neglected there. Some of the clinical forms are marked by the names of their discoverers. But we will not scrutinize this closely; the knowledge of classical psychiatry is designed for manuals and forms a simple, solid corpus that responds in the large to the demands of everyday practice and, I would add, will not be replaced, if only because chemistry nowadays does not permit the symptom to follow its course as it did in the past.

Doubtless at Henri Rousselle this psychiatric corpus is the obligatory reference point; this doxa is the foundation of the place itself. But, to tell the truth, it seems to me to be no less present in the institutions that renounce it, simply because it is the element that determines and justifies any hospitalization. To renounce it, or purely and simply to deny it, is to fall even more under its sway. Breaking away from it requires more of a ruse than that.

Lacan’s questions are sustained by this reference, which gives a sense to the “supposed” diagnosis that he will offer. But curiously, at the moment when this sense is going to be solidified or frozen, it is suspended, it becomes a question. Turning on the reference point that was its inspiration, it puts that point into question, suspending its certainty. When I see that, I cannot prevent myself from thinking of what Roland Barthes once wrote about Brecht: that he knew how to affirm and suspend a sense in the same gesture, to offer it and to disappoint the expectation. All of Brecht’s plays, Barthes said, finish implicitly with a “Look for the way out!” addressed to the audience.

With Brecht we know immediately that the way out is there; the play is constructed to persuade us that it exists. With the case presentation, however, who would not be persuaded of the truth that Lacan has articulated, namely, that there is no place for hope? “Clinical work,” he says, “is the real as impossible to support.” Thus the clinical dimension is tragic. It is so for the patient, but also for the therapist. Is it not that which is verified every time—that this real is insupportable for therapists, and more so, the more they devote themselves to it? “Look for the way out.” The way out: it is we who name it that; the way out, his way out, the so-called patient has already found it—it is his illness. And if we seek the way out for him, in his place, well, that is perhaps our way of being ill.

If this is a truth that we grasp during Lacan’s presentations, then clearly it cannot be the object of a dogmatic teaching. We would denature it by making it the only truth when it is only one among others. Nevertheless, this truth is sufficient to temper the spontaneous activism of those who devote themselves to psychotics.”

Jacques-Alain Miller, Teachings of the Case Presentation,

in Returning to Freud: Clinical Psychoanalysis in the School of Lacan,

Ed. and Trans. Schneiderman S., Yale University Press, 1980. p. 43-45.

Extract 2

“Clérambault, our only master in psychiatry”, wrote Lacan, and I remind you that he added, “His mental automatism… appears to us… closer to what can be derived from a structural analysis than any other clinical effort in French psychiatry ” […]

[…] Mental automatism is de Clérambault’s version of Occam’s razor; and precisely because it is an instrument, he came to reduce it to the first letter of the word “syndrome”.

The introduction of this S yields an extraordinary simplification in the clinical approach to psychoses. Attacking the old approach, de Clérambault deconstructed the well-established clinical entities like Magnan’s psychosis and wiped the slate clean. French clinical psychiatry had always excelled in the description of the nomenclature of delusional states. This S is not of the same order: de Clérambault proposed it as the initial form of all psychosis (excepting true paranoia and purely interpretative delusions, such as those isolated by Sérieux and Capgras, which are most often mixed with mental automatism). As such, S is athematic and neuter, which is to say that contents and effective coloration come to it later, according to the “depths”— paranoiac, perverse, mythomaniacal, interpretative—on which it is produced or according to whether or not it is associated with a passion. S is autonomous; it does not depend on these passional givens but refracts itself and differentiates itself, thus giving the diverse clinical pictures.

“Delusion is a superstructure” declares de Clérambault, and this “ideation is secondary” The primal S of psychosis imposes itself as an irreducible fact of thought, an absolute fact. […] Also in question […] are the phenomena of enunciation.

What is the “echo of thought” which de Clérambault makes the original positive phenomenon of mental automatism, if not a disturbance between statement and enunciation that emancipates a parasitic source? The subject finds himself continually shadowed by a double that emancipates him, accompanies him, or follows him and cannot say anything. Fading, mute, empty, this double still has the power to suspend the subject in the position of receiver. De Clérambault calls this independent enunciation a “purely psychic phenomenon,” and he names the play on words (signifiers) that it liberates “verbal phenomena”. The terms that I substitute for those of de Clérambault indicate that it is not in some obscure “deviation of influx” that we can found the syndrome of mental automatism but rather in the grasp of intersubjective communication. It follows that the sender of a message becomes its receiver and that the psychotic disturbance consists only in his experiencing himself as such.

The construction is sufficiently Lacanian for us to take the S of de Clérambault and make it the first letter of the word “structure.” The structure bared— […] but it was nevertheless no less decisive in instituting a break between psychology and the order of structure.

In a word, de Clérambault made his automatism into something mechanical, but he did this in order to hold on to its autonomy, leaving to Lacan the discovery of the symbolic order. […] Lacan made the symbolic primal and neutral, instituting it thus as signifying and structural. And when he made it athematic, sustaining the point of view that the symbolic is produced first “in the ordinary form of thought, in an undifferentiated form, and not in a definite sensory form,” he proposed an idea that is debatable from the point of view of observation but has a logical import that cannot be misconstrued. S means nothing, and this is implied in its name “echo”. In question is a purely signifying effect that becomes mad when a delusional deciphering invests it with imaginary meaning.


When the slight separation of the enunciation from itself is amplified until it engenders individualized and thematized voices that appear in the real, when the subject feels himself transpierced by bursts of messages, by a language that speaks of itself, when he feels himself spied on in his inner core and subjected to injunctions or inhibitions whose productions he cannot annex, we then have the great “xenophobia” that Lacan founded in the field of language with his matheme of the Other. Would it be too much to say that the discourse of the Other was already there, in the clinic of psychosis, before Lacan invented it and linked it to the prehistoric Other that Freud found in Fechner? Xenopathic emergences are founded on structure, if structure wants all speech to be formed in the Other. The question is no longer “What is a madman?” but “How can one not be mad?”

Why does the normal subject, who is no less affected by speech, who is no less xenopathic than the psychotic, not become aware of it? The question is more subversive than the identification proposed above. By what inversion do we misconstrue the fact that we are the puppets of a discourse whose syntax preexists all subjective inscription? What is normal is xenopathia. A subject for whom the Other is no longer veiled is certainly not going to be attained through imaginary manipulations.

Jacques-Alain Miller, Teachings of the Case Presentation,

in Returning to Freud: Clinical Psychoanalysis in the School of Lacan,

Ed. and Trans. Schneiderman S., Yale University Press, 1980. p. 46-49.


Circulated on nls-messager [www.amp-nls.org] :

Extract 1 : 2062.en/ NLS Congress – ORIENTATION 10 : 12 May 2016 at 14:30:03 BST ; Available http://www.amp-nls.org/page/gb/49/nls-messager/0/2015-2016/2534

Extract 2 : 2063.en/ NLS Congress – ORIENTATION 10 (cont’d.):13 May 2016 at 14:47:12 BST : Available http://www.amp-nls.org/page/gb/49/nls-messager/0/2015-2016/2537


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

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

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

Écrits : 1966 : Jacques Lacan : Information and availability here

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

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

I have also updated where Jacques Lacan comments on the ‘as if’ Helene Deutsch case at the following location:

Some forms of emotional disturbance and their relationship to schizophrenia (‘as if’ case) : 1942 : Helene Deutsch or here

Further relevant posts from:

Gatian de Clérambault : here

Jacques Lacan : here

Jacques-Alain Miller : here

Stuart Schneiderman : here

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

Ordinary Psychosis : here