Réflexions sur un cas d’érotomanie associée dans la perspective freudienne du délire comme « tentative de guérison » dans la psychose

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AimThe aim of the paper is to confront the non-deficient conception of delusion supported by psychoanalysis with the reality of the clinical setting, from the study of the delusional construction of an erotomaniac female patient. This means putting a Freudian theoretical hypothesis to the test of a clinical case: the Freudian perspective of delusion as a attempt to heal in psychosis. In this paper, we will also try to show how Lacanian developments on the formulae of sexuation and the concept of “push-towards-the-woman”, conceived in the Freudian logic of delusion as a healing attempt, can also cast light on certain aspects of the erotomaniac position. We will therefore try to highlight how erotomaniac delusion was able to have stabilizing and soothing effects for this patient, unlike the components of persecution delusion. MethodOur method will initially involve a historical review of the conception of erotomania in classic psychiatry, in order to trace the progressive definition of this clinical entity in the nosography. Thus, we will study the first definitions proposed by Esquirol, who like Ball, emphasized the chaste character of erotomaniacs and the absence of desire for realization, to show the contrast that appears between this conception and the medico-legal descriptions by Garnier and Portemer, who both underlined the dangerousness and the risk of violent acting-out. This will also lead us to study specificities of the theses defended by Clérambault, who identified erotomania as an autonomous entity independent from paranoia, whereas most of his contemporaries considered erotomaniac delusion only as one of the possible themes of paranoid or systematized delirium. Then, we will present the specificities of the psychoanalytic approach to erotomaniac delusion, starting from the study of Freud's “grammar” of delusion, and then Lacanian developments on foreclosure and the formulae of sexuation. Finally, we will adopt the methodology of the single case study in order to show the singular process of delusional construction in a psychotic patient. ResultsOur results cast light on the diachronic and progressive character of this patient's delusional construction by way of anamnesis, and they show the singular, soothing constructions that can sometimes conceal the erotomaniac position for a psychotic subject, in line with the Freudian perspective of delusion as an attempt at healing. We have also been able to show how the use of the Lacanian theory of the formulae of sexuation and the “push-towards-the-woman” concept makes it possible to cast light on the mechanisms of this pacifying effect of the erotomaniac delusional component. DiscussionOur discussion will focus on the possibility of establishing an analogy between the delusional construction of this patient and the construction operated by President Schreber, described by Lacan as “push-towards-the-woman”. The question is how the pacifying aspects of the erotomaniac position can be conceived as relating to the economic treatment of the “jouissance” facilitated by a position where the subject comes to embody the figure of “the woman” as an exception. The erotomaniac position could thus have had stabilizing effects in this patient, insofar as it brings about a pacification in the relationship with the Other, a form of consent to be the object of the Other's enjoyment–and this position is dialectically opposed to the delusion of persecution. ConclusionIn conclusion, the clinical relevance of the Freudian hypothesis of delusion as an attempt at healing in psychosis can be underlined, making it possible to envisage the delusional construction of a singular subject in a non-deficient perspective. The Lacanian approach to the formulae of sexuation and “push-towards-the-woman” can also be seen as the prolongation of this non-deficient conception. Nevertheless, caution is required for any generalisation of the results of this study, since it is probable that not all delirious erotomaniac constructions result from a “push-towards-the-woman” effect, and do not in every case have a stabilizing effect. Our article is merely intended to cast light on the mechanisms of the diachronic construction of this erotomaniac position in a singular case. This study should not suggest that every delirious erotomaniac construction inevitably presents these stabilizing effects. Nevertheless, since erotomania is a major component of psychotic transference, returning to the study of erotomaniac delirium via a review of the psychiatric and psychoanalytic literature alongside the case of this patient seems to us of fundamental interest, for its ability to cast light on the question of how to handle transference in the cure of psychotic patients.