‘What were we doing when we unchained this earth from its sun?’ –Nietzsche
Many of the great clinicians who studied psychosis in the last two hundred years became famous for their specific nosologic contribution when they sought to define and uncover specific psychotic entities or illnesses. Other clinicians owed their fame to their description of certain original symptoms of psychosis. However, when possible, few of them were able to avoid the temptation to formulate their own nosology, and subsequently engage in scholastic disputes in defending their findings. Insofar as a clinical approach to psychosis implies a high focus on symptomatology, few researchers and clinicians would attempt to formulate a global system to define and explain psychotic symptomatology and the mechanisms for the production of psychotic symptoms. Many of those who did attempt to do so failed because they were unable to reconcile what seemed to be contradictory concepts, or because they often failed to coherently recognize, define and categorize the disparate symptoms of psychosis. However, one clinician was able to succeed. Gaëtan Gatian de Clérambault was able to formulate an exhaustive and coherent system of psychotic symptom categorization. As a result, in retrospect, Clérambault would most likely emerge as one of the most prominent figures of descriptive psychopathology of psychosis.
This French alienist of the early part of the twentieth century was a complex man who was recognized to hold a variety of expertises in many areas. Clérambault is most well known in the Anglo-Saxon literature for his work on the ‘psychose passionelle’ (erotomania) otherwise known as Clérambault’s Syndrome. He also excelled in ethnographic anthropology and his lectures at the Beaux Arts and the Sorbonne in Paris were said to be legendary. However, it is his contribution to psychiatric semeology which would prove to be most fundamental. He was able to establish a coherent system whereby the understanding of the basic characteristics of psychotic symptoms would go in pair with the description of their alleged underlying neural processes. These underlying neural processes would be defined in terms of abnormal behaviors of neural connectivity. Rather than simply drafting an arbitrary listing of symptoms, Clérambault would provide an exhaustive taxonomy of psychotic symptoms based on the description of their most subtle features and nuances. Clérambault’s catalogue of psychotic symptoms is original in the sense that each symptom finds its place within a category defined by either a specific characteristic or a specific predominance of one or several characteristics. He would create groups and subgroups for these symptoms when deemed necessary. These groups would be placed into subcategories which were in turn grouped into larger categories. The main categories would include the sensory, the motor and the mental phenomena. However, the great value of Clérambault’s system is that all the groups, subgroups, subcategories and categories, and therefore all the categorized psychotic symptoms, would be defined by one characteristic common to all, their automatic and autonomous nature.
The psychotic symptoms would thus become referred to as automatisms.
Generally speaking, the notion of automatism is a synonymous concept to that of a very basic category of psychotic symptoms. In fact, aside from delusions, automatisms represent all other psychotic symptoms. However, one of the novelties of Clérambault’s concept is that automatisms can occur in the context of normal or subnormal function, that is in the context of the normal thinking process and the so-called subnormal conditions when the nervous system is strongly challenged. As we will see, within the larger concept of automatism, the boundaries of psychosis and normal function are redefined.
{ Paul Hriso | Continue reading }
French psychoanalyst Jacques Lacan attributed his ‘entry into psychoanalysis’ as largely due to the influence of de Clérambault, whom he regarded as his ‘only master in psychiatry.’
