Les capacités d'élaboration : concept transdimensionnel

In everyday clinical practice, the term “ability of elaboration”, an empirical concept, is supposed to assess the mind's construction and structure. In psychiatric literature, terms with similar meaning exist, but they are not clearly defined. Does ability of elaboration have a conceptual strength? If so, is it a trans-dimensional concept? The empirical state of this concept frequently used at the end of a psychiatric examination justifies language, the translation of the patient's symbolic activity, to be considered as the beginning of our reflection. Subjects use symbolization to attribute subjective meanings to traumatic or non-traumatic events, language being the usual way of expression of this symbolization. It could result from the patient's ability to adapt. It would vary because of structural and contextual factors as affective maturation or emotional, psychological and physiological contexts. The way symbolization is processed can be modelled in different ways according to main psychiatric currents. Considering psychoanalysis theories, symbolization would result of complex mechanisms (meaning, coherence, psychic development). Psychic development links signifier to signified, restores symbolic activity, its main expression being language. Language gives the subject the possibility to transmit his psychic work. In clinical practice, psychic elaboration is predominant because trauma is intrinsically meaningless and cannot be spontaneously symbolized. Defence mechanisms could operate to make this trauma meaningful. The ability to put words on traumas would be a consequence of the ability of elaboration. But the ability would be insufficient or absent if language did not permit intelligibility. There would then be other ways to express elaboration: psychosomatic or behavioural signs. Ability of elaboration should be considered as the result of dynamic and protean tools. These tools would be necessary to resolve internal or external psychic conflicts. They would help to constantly adapt the subject to his environment. This would justify their importance in clinical assessment for diagnosis and prognosis. Ability of elaboration, empirically used, may finally be a trans-dimensional concept.     

Évolution historique du concept de somatisation

The concept of somatization is one of the notions that is frequently utilized both in psychiatry and in the medical field. However, it still suffers from a lack of precision that renders difficult and equivocal any reading of scientific articles on the subject. The authors of this article have focused on the historical development of the concept of somatization in an effort to elucidate the issue. The concept can be interpreted in two ways, one etiological and the other nosological. The former stems from the psychoanalytical movement, is principally etiological, and can be viewed as a synonym for conversion. The disturbed circumstances surrounding the creation of the term partly is account for the current confusion regarding its meaning. The latter meaning, which is derived from American liaison-psychiatry, has a mainly nosological character. It is at the very center of an epistemological turning point for the development of considerations on hysteria and its psychopathology, with the decline in importance of American psychoanalysis and the development of the neurosciences during the second half of the twentieth century. In fact, hysteria, a pathology that constituted the basis of psychoanalysis, has thus changed epistemological status to become an exclusive diagnosis, with a partial rejection of the contributory role of the psychopathology involved.     

Immatérialité de l’âme et matériau inconscient

The religions asserted, in diverse forms, the existence of an immaterial soul which contains the principle of the existence of the subject and which can outlive it. So, the western imagination was imbued for a long time with the Christian conception of the soul. The psychoanalysis was interested in the religious phenomena to try to understand it and also to find in it ways of exploration of the psychic functioning. It considers that the faith in the existence of the soul attests the desire of immortality of the human being. It shows the expectation of the return of the dead, a return which is feared as much as desired. These faiths remains profoundly rooted in the unconscious in forms which can be transformed and which want only to express themselves. Having regard to certain contemporary debates, it maybe necessary to remind that the psychoanalysis is materialism. The psychoanalysis chooses to be interested only in the dimension of the word to investigate the psychic functioning and allow the change.     

Les psychanalystes et le transfert de pensée : enjeux historiques et actuels

The concept of “thought transference” has a special position within the psychoanalytic field. It is first an object on the sidelines because it originated in the psychical sciences of the late nineteenth century. It is also an object extracted by psychoanalysis to the darkness of the occultism, Freud considering the thought transference as being its true nucleus. But it is also a foreign body because even if it was apprehended by different authors, it remains poorly integrated into the psychoanalytic corpus. In this review of the literature, we try to show how this concept had first played a heuristic role vis-à-vis the theorizing of transference and countertransference. We then see how it was taken over by successive generations of analysts as well as heated debate it engendered, participating to the division of the field of psychotherapy. Finally, we will bring out the relevance of this concept in terms of clinical and current theoretical issues.     

La médicalisation de la sexualité. Foucault et Lantéri-Laura : un débat qui n'a pas eu lieu

Lanteri Laura's book : Reading perversion : a history of its medical appropriation (Lecture des perversions : une histoire de leur appropriation médicale) was published in 1979, three years after Michel Foucault's first volume of The History of Sexuality. These two books deal with the history of sexuality in the XIX° century, yet strangely Lanteri Laura does not cite Foucault. A close reading of both texts demonstrates two points. (1) While Foucault was mainly concerned with the relationship between sexuality and truth, power and knowledge, Lantéri-Laura worked more specifically on sexual perversions and the way in which psychiatry redefined them by withdrawing them from the fields of religion and law. (2) Moreover, Foucault did not undertake a critical analysis of psychoanalysis. Instead, he used the psychoanalytic model to construct the model of of the “apparatus of sexuality” based on language. For his part, Lanteri Laura provided evidence of the limited withdrawal of Freud reagrading the sexological categories of his time and a return within lacanian psychoanalysis to categories that were anchored in the dominant social morality of the time. Finally, whereas Lantéri-Laura attempted to objectify psychoanalysis and to place it within a historical and ideological perspective, Foucault was in the end actively inspired by the psychoanalytical model and used it in the social and historical construction of sexuality.     

L’accouchement : un événement psychique

The psychic process of maternity is a widely recognized and studied mechanism, and its diachronic aspect has been the most frequently described. The present study focusses on the moment of expulsion, and we have attempted to determine the reactions that take place at a psychic level both in the mother and child during the process of childbirth. Expulsion, an act that marks the separation between two bodies has its psychic aspect, denoted by what Freud referred to as “a sense of hatred”, in which what was until then contained within undergoes a movement towards its being expelled, and is then finally expelled outside, an experience which inaugurates the first within-without distinction. Pierra Aulagnier’s conceptualization of the life of the psyche provides a means of representing the mother’s rediscovery during childbirth of suppressed psychic material associated with her own infantile history, that of her own birth, a rediscovery which is only made possible by the process of regression that is characteristic of maternity. The maternal psyche thus serves as a mould for the infant, who will utilize this pictogram of birth transmitted by his mother to come to terms with and represent the process of upheaval that he is experiencing. In Freudian terms, as expulsion gives rise to the psychic experience during this movement of a “a sense of hatred”, we thus postulate that a transgenerational transfer of this birth pictogram may take place - or in other words, a “pictogram of a sense of hatred” — and that this representation provides childbirth with an additional psychic dimension.     

L’hallucination télépathique ou véridique dans la psychopathologie de la fin du xix siècle et du début du xx siècle

Recent research on the process of autonomisation of psychology at the end of the xixth century could show how objects which appear illegitimate to us today took part in an institutionalization of the knowledge and discipline. The telepathic hallucination was one of these objects; it then constituted a field of division and exchange between incipient psychology and sciences known as psychic but also mental medicine. At the time of the debates around this concept, it caused criticisms of the mental specialists as psychopathologists insofar as this lived hallucinatory were supposed to exist at the healthy subjects and, moreover, did not correspond by no means to the traditional definition esquirolian of the hallucination but was affirmed on the contrary like signal of an external object (anguish of a close relation) being given to perceive. However these debates were contemporary those proceeding in the field of alienism which sought with better specifying the concept even of hallucination, in particular by releasing the category of the onirism. Consequently, one will try to show in what the telepathic hallucination constituted a object-border within the social sciences and spirit, transitory object of division for an adjustment of the speeches and an assertion of the conceptualizations. Its rejection, its marginalisation, its psychiatrisation soon, were the signs of another division, segregative that one, between what became legitimate and illegitimate in these sciences, not without leaving the rest which took name of parapsychology, then of metapsychic.     

La psychanalyse entre athéisme freudien et ouverture à l’écoute de l’évènement intérieur du sujet

The question left open by Freud in his 35 new conference is perhaps more interesting today than before World War II: how psychoanalysis is going to take place in the conflict between religious and scientific world conceptions. To start to answer, we shall return to the question of Freud's identification with “the man Moses”, we shall also take into account his words: “I am an infidel Jew”, and we shall examine his attitude towards religious beliefs and mysticism. In the end, we will be able to understand why his view on spiritual life can enlarge our conception of psychic personality.     

Fragilité de l’environnement et événement psychique chez l’adolescent placé en institution : une étude clinique

This clinical study addresses fragility of environment, construction of psychic event and its update in emotional development of the youth placed in institutions for protection. It is made from a device practitioner Social Children's House, which involves in the field of Child Protection. Through a case study structured around three analyzers: process development, environmental quality and occurrence of the event, we show the complexity of a chaotic life actualized in institutions and outlining professionals to participate in the repetition of the traumatic history of the adolescent.     

Dynamique criminelle et vulnérabilité psychique

This article presents four criminal dynamic and psychic processes, which take part to the offense. These points studied in a dynamic way consider context, environment and criminal opportunities effects on psychic's vulnerability actualisation. This work is about violent offences author. Those four problematics and action processes refer to the following, has been defined from a psychocriminological integrative model briefly presented therein. The first is relative to the mental construction, which implies a psychic process whose primary function is one of “discharge and externalisation”. The second involves the concept of “loss”, the construction of which demands the implementation of an “anti-depressive” process. The third problematics deals with the “boundaries and their permeability”, a process with a psychic function of “regulation of the relational distances”. Finally, the fourth problematics is that of the “ideality and image”, whose psychic process primarily functions as a “narcissistic restoration”.     

Fonction identitaire et place du corps à l'adolescence chez des sujets élevés dans des familles adoptives ou d'accueil

The major aim of this study, based on semi-directive interviews, is to discuss the identity role of the body in subjects undergoing puberty and adolescence in a family with which they do not share biological links. The question of the role of the body in the occurrence of potential suffering during this period appears later.Results indicate the importance of the body's role of identity support in this population. Similarly to that in the so-called traditional population the body is felt as sometimes foreign, but also as the external representation of an internal life that is being reorganised, and as a support that may be used as an identity searching tool; as a way to get back some control over this period of psychic fuzziness.On the other hand, the body seems lived as doubly destabilizing because it renders the mechanisms of separation, individuation and filiation more complex during adolescence.     

Étude de la limite dans le dispositif de la présentation du cas

A study of the limit in the case presentation setting. The pedagogic setting of clinical presentation can be considered as a limit-practice since « Leçon clinique »'s birth, as well as from the reactions it raised up than from the theoretic mouvements it inspired (Charcot, Ribot, Freud, Lacan…) The formation and transmission aim is studied and valued according to the concept of limit, which allows to show its full implications, its efficiency and its risks, and therefore, conjointly, its strength and its fragility. At the junction of the unversity and the hospital, of general and individual psychopathology, it stands today at the cross-roads of psychiatry and psychoanalysis. It embodies the history of transition from showing to verbal relation, from scopic dimension to psychoanalytic listening. The inherent violence of unconscious and instinctive strengths which work through this clinical and pedagogic act, produces a particular interference on the three protagonists - clinician, patient, audience; by this way, pass over tracks are founded, offering to the future clinicians, through a shared work, the main tools of listening and analysis of a clinical situation.     

Origine et renouveau du concept de démence dans la schizophrénie

An increasing amount of current literature on schizophrenia is devoted to the role dementia may play in its course. This renewed interest had the way paved by the very history of the dementia concept. Before Kraepelin coined the term of "dementia praecox" as the hallmark of a common terminal state for hebephrenia, catatonia and paranoid psychosis, dementia acquired, as soon as the end of the 18th-century its cognitive meaning. In France, Pinel yet spoke of an "abolition of thinking", but in the same time considered dementia as one of the four forms of mental alienation, alongside with mania, melancolia and idiotism. During the 19-th century dementia was defined as an acquired deficit of intelligence supported by a brain disease, but which could be due to a mental illness. Owing to progress in neuropathology, several diseases such as Alzheimer or Pick illnesses were identified as causes of dementia, so that the concept was annexed by neurologists and received less interest from psychiatrists, during the last century. That seemed to change, twenty years ago, when clinical discussions emerged around the issues raised by depressive (pseudo) dementia. In psychiatry, the broader conceptualization of schizophrenia introduced by Bleuler in 1911 has not been widely adopted, many authors having been continuing sharing the Kraepelinian view that, at least one form of the disease, was a chronic progressive illness leading to severe impairments in cognitive and social functioning. Historical variations in diagnostic criteria used for schizophrenia had an impact on the way psychiatrists assessed outcome of the disease, leading some of them to consider schizophrenia as a nosological category without natural boundaries and propose to abandon the concept. However the use of narrow criteria is currently prevailing. Advances in neurocognitive testing and changes in theoretical models allowed, at the end of the last century, to document that schizophrenia was characterized by a broadly based cognitive impairment. Deficits were found in various domains: global and selective verbal memory, non-verbal memory, bilateral and unilateral motor performance, visual and auditory attention, general intelligence, spatial ability, executive function, language and interhemispheric tactile-transfer test performance. The hypothesis according to which the vast majority of these cognitive deficits had a neurodevelopmental origin was recently challenged by findings from longitudinal neurocognitive and neuroimaging studies. Some studies, for example, show that if first episode patients have smaller left hippocampal volumes as compared with controls, there is also an association of smaller right hippocampal volumes with increased illness duration in chronic schizophrenia. Others have shown that neuropsychological evaluations before treatment permitted differentiation of primary deficits from changes secondary to medication or chronicity. Clinicians reported that in some cases of chronic schizophrenic patients, dementia could be a complication of the disease, sharing common neuropsychological features with frontotemporal dementia. The effect of age was discussed too, as seeming to play sometimes a part. Even if the cause of the degenerative process that appears to occur in the brains of some schizophrenic patients remains largely unknown, advances in neuropathological models of degeneration in the brain as well as in mechanisms and factors underlying its process, gave rise to hypotheses liable to explain how degenerative dementia could occur in schizophrenia. Excess products of membrane degeneration which was evidenced by magnetic resonance spectroscopy suggests increased apoptosis in some schizophrenic patients. Deficits in neurotrophic factors, free radical oxidation, excess glutamate activity have been implicated as well as abnormalities in dopamine and cortisol metabolism. Growing evidence that some newer antipsychotics seem capable to interfere with these processes, slowing down their progression and even stopping it, has contributed to the renewal of the concept, opening new avenues to preventive strategies in the treatment of schizophrenia.     

Emotions and affect in psychoanalysisis

The goal of this paper is to give some indications on the concept of affect in psychoanalysis. There is no single theory of affect, and Freud gave successive definitions, which continue to be deepened in contemporary psychoanalysis. We review some steps of Freud works on affect, then we look into some present major questions, such as its relationship to soma, the nature of unconscious affects and the repression of affect, which is particularly developed in the field of psychoanalytic psychosomatic. From Freud's definitions of affect as one of the drive representative and as a limit-concept between the somatic and the psychic, we develop some major theoretical perspectives, which give a central place to soma and drive impulses, and which agree on the major idea that affect is the result of a process. We then note some parallelism between psychoanalysis of affect and psychology and neurosciences of emotion, and underline the gaps and conditions of comparison between these different epistemological approaches.     

Psychiatrie et psychanalyse

There are three different domains of Freud's heritage that help to understand the relationships between psychiatry and psychoanalysis in the past and today, even after the development of international classifications, biological psychiatry and cognitivism.The first is the concept of man being defined by the unconscious. This idea was considered revolutionary at the time and still is today. However it was not accepted by all psychiatrists depending on their cultural background and their theoretical options. It is a very profound concept but cannot apply to everybody.Psychotherapy is the second technique. Many psychiatrists may reject it but, nevertheless, although they do not practice it themselves, they are willing to propose it to their patients.The third technique deals with Freud's writings on preconsciousness. It can be a significant help in identifying illnesses and in an understanding of psychic functioning. It can be used by all psychiatrists, even those lacking a psychoanalytical background. Psychiatric practice would be impoverished if this technique was not used.