For Lacan, all knowledge is imbued with paranoia. Although this claim was largely unarticulated by Lacan himself, I attempt to give conceptual clarity to the epistemological process of paranoiac knowledge situated in Lacan's three contexts of being. Developmentally, knowledge is paranoiac because it is acquired through our imaginary relation to the other as a primordial misidentification or illusory self-recognition of autonomy, control, and mastery, thus leading to persecutory anxiety and self-alienation. Secondarily, through the symbolic structures of language and speech, desire is foisted upon us as a foreboding demand threatening to invade and destroy our uniquely subjective inner experiences. And finally, the process of knowing itself is paranoiac because it horrifically confronts the real, namely, the unknown. Through our examination of a clinical case study, paranoiac knowledge manifests itself as the desire not to know.