Compulsion au viol et répétition

The analysis of clinical case of authors of violence shows that they present sometimes post-traumatic disorders which can lead to interpret acting out behavior as an attempt of elaboration of the trauma and which the release of the act is less ritual than compulsive. This dimension is particularly locatable in the repetitive acts, of which sexual attacks or repeated rapes. Which consequences we can understand about of “dangerous behavior”? In this article, authors study the psychic dynamics of several rapists and sexual aggressors, and notably a case known for the literature (Balier [1988]) [1] who notably introduce compulsive characteristics, and tendency to the repetitiveness. It is more traits than of organization of the personality. The origin of acting out is associated by the subject himself to a rehearsal of one or several previous moments which, in a sense, crystallize in these acts. The trespass appears as taking place in a scenario of reviviscence and could be defused only by analyzing with the subject with kind of secondary profits he obtain from this scenario. But existence of this base which induce to repeat trespass interrogates about concept of “series” applied to these rehearsals.     

Le trauma et l’émotion : apports de la théorie janetienne et perspectives nouvelles

The current designs of trauma associate a symptomatology with specific characteristics of an event. Symptomatology is characterized by a syndrome of repetition regarded as pathognomonic. It consists of a reviviscence of the traumatic experiment in the form of flashback, nightmares, lived “as if” in an intrusive way in psychism of the subject. Current research showed that there exist a dissociative experience made up of depersonalization or derealisation whose, presence at the time of the experience, could predict the gravity of the trauma. This peri-traumatic dissociation is brought closer to dissociation such as defined Janet and which consists of a psychic disintegration. This one comprises a reduction of the field of the conscience and a difficulty of synthesis due to an emotional upheaval. Currently, work of Frijda (1985) around the function of the emotions and their consideration in terms of motivation can help us to give to dissociation a specific direction. This one would not be then related any more to disintegration, but would approach a radical psychic avoidance. This avoidance would be the characteristic of a specific emotion, the fright, whose tendency would be a dissociative motivation. This hypothesis rests on the distinction of the psychic trauma of another trauma such as it appears in hysteria and that Janet considered without distinction. The trauma would result then in to fix the images and the feelings associated with experience. The repetition would appear by the reappearance of this fixing when the state of consciousness of the individual changes. We see how the concept of dissociation at Janet enables us, by his complexity, to consider in a new light the question of the trauma and its demonstrations. It implies that the psychopathological demonstrations are studied in any rigor beyond the a priori which too often lead us to create an ad hoc mechanism to explain a phenomenon. The reference to work of Janet within the framework of current research opens new prospects of research around a definition of the trauma, place of peri-traumatic dissociation and post-traumatic dissociation, emotions and repetition.     

Réflexions éthiques sur les interventions médicopsychologiques auprès des victimes

Recognition of the psychic injury potentially inferred by a traumatic event's reality led to cares reproduction for the persons concerned by the event (victims, families, rescuers). These “urgence medicopsychlogiues” interventions are conceived for potentially traumatic events, meaning sudden, violent, unpredictable events leading to life threatening experiences. Being confronted to death's reality leads to the annihilation of the usual defence mechanisms and to an incapacity to be able to elaborate what is being experienced. Confrontation with the trauma can have multiple and unpredictable consequences. Premature psychic cares for the persons implied are therefore implemented, as are somatic cares. If these processes allow coverages (care) adapted to the clinical demonstrations (appearances) of the psychic injured (wounded) persons, they can lead (drive) to multiple drift of which their use for not traumatic facts. If these processes allow care to be adapted to the clinical demonstrations of the psychic injured persons, they can lead to multiple drift, among them, being treated for non traumatic events. This, in particular, may lead to “psychiatrisation” of reactions nevertheless adapted to critical events, to standardized cares and to the illusion that a one and only intervention could be enough to dike all risks linked to post-traumatic disorders. Cares as close as possible to the traumatic event are only one of the many answers to be brought to the persons involved and can not be organized without frame, limit and an ethical position of the professionals who participate in it. Our comment, which is based on our experience in coordinating more than 300 medical psychological emergency interventions, aims at announcing our thinking about what ethic is at stake when taking care of these psychic victims. The current situation is paradoxical: on one side there is a bigger recognition of the reality of the psychic wounds and the potential consequences caused by a traumatic event and of other, this systematic consideration leads to a collective identical demand of the traumatic fact transforming it into a political stake. The social and political recognition of the psychic traumatism is parallel to its instrumentalisation and exploitation. That leads inevitably to maintaining the subjects involved in a state of dependence, vulnerability and psychic incompetence, that of the victim. In the absence of ethical reflection on early psychological care, the medical psychological emergency diversion of care is inevitable with its main consequence: the stake in the show of the psychic suffering is leading to the fact that every implied person is dispossessed of its own history. The traumatic fact having become a social and political stake, the medias do participate in the overbid with, for some, drift which lead to the systematic call to the psychiatrics and psychologist in order to comment on the slightest event, to a psychiatrisation of demonstrations of distress, to a stigmatization of people involved into the reducing category of the traumatized “victims”, to a focus on a one and only type of suffering, to a generalization of traumatic events and to an attempt of instrumentalisation of the medical psychological emergency devices. The traumatism has to remain a clinical event, which requires specific care joining a medical logic and must not become an object of demand joining a social and political logic.     

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.     

Prise en charge du deuil post-traumatique chez l'enfant suite à une catastrophe naturelle

Subjects facing traumatic grief during natural disasters have to deal with a double psychic event: trauma (they escaped from a horrible death and witnessed death of known or unknown persons) and massive and sudden loss. The authors first recall the concepts of trauma, grief, traumatic grief, post-traumatic grief, and also particularities of grief for children. They then report the beginning the psychotherapy of two children (sisters), after they had survived the tsunami of 2004 that had killed their father. In order to take care of children in such circumstances, clinicians have to consider the following aspects of psychological suffering: the irreversible loss of a parent and the traumatic event, and the way they interact.     

Trauma et symbolisation chez Edvard Munch. Art et psychanalyse

This article examines the evolution of the concept of trauma from a psychoanalytic perspective and the psychic elaboration of the consequences of trauma through painting, taking as an example the life and work of Norwegian Edvard Munch. The traumatic experiences of artist's childhood find their place in his art and in his vision of the world. Art allows us to “psychically work out” the effects of these catastrophic childhood experiences. The representations of childhood trauma through painting are an opportunity to give a “figurability”, a meaningful representation to the traumatic experience. Thus, visual art, as a work of symbolization and psychic treatment of trauma, is a kind of bulwark against unbinding and destructiveness. With the famous painting “The Scream” by Edvard Munch, which bears the motif of repetition, we want to show the artist's ability to choose a “positive destiny” for his traumatic experience, where the “repetition of the same” takes the form of a “working-off mechanism” aimed at gradually eliminating tension and overexcitations of traumatic origin.     

L’identification projective dans la toxicomanie

In this article we shall see how using drugs disturbs the activity of projective identification and symbolical processes. The addict clinic makes known the early difficulties of expression of projective identification in correction with mother object apprehended like persecuting or idealizing. Because of real trauma or difficulties to realize the process of separation-individuation, the repression has not succeeded to put up or has become insufficient. In the same way, the psychic work of projection and introjection has been put in parentheses by the drug. This one, by activating a narcissistic libido to hold the representations of destructive instincts, substitutes an incorporation act to introjection, signs the breaking off the object relation and compromises the process of symbolization. The incorporation act expresses a traumatic experience, which has not been symbolized in an incorporation fantasy. It’s going on by a process of demetaphorisation. Contrary to psychotic personality, the stop of the projective identification avoids the loss of the identity feeling. The percept system is distorted to accuse the destabilising effects of an external and internal reality.     

Expérience d’une consultation spécifique pour victimes de harcèlement moral

The participation in an original experiment of multi-field reception of the victims of moral harassing in the work allowed us to verify the aptness and the utility of the so psychoanalytical but classic psychiatric concepts to shine the importance and the gravity of the phenomenon and its consequences. In this particular setting, our understanding of the concepts of perversion, perversity, psychic trauma, post-traumatic states but also on the psychodynamic level: of envy, of elaboration, of depressive position, of potential space, of scapegoat, is enlightened and enriched. These same concepts are essential to set up a psychotherapic attitude adapted to the consequences on the psyche of the victims of this large scale psychopathologic phenomenon. The reflection on this experience allowed us to suggest hypotheses on the socio-cultural determinants their increasing frequency.     

État antérieur,accidents de la vie et vulnérabilité

The authors show the difficulties of analyzing the evaluation of a previous state in adults who have suffered a terrorist attack generating post-traumatic syndrome causing a disruption of the psychic functioning mode. The taking into account of a possible previous state is an important moment of the expertise. However, the traumatic experience of the victims must be understood in its entirety with the concern to take into account the need for recognition of the victim.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

Abstract

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Response of traumatized patients with depersonalization --from the perspective of attachment theory]

We recognized that several traumatized individuals re-lived the danger associated with trauma on recollecting the original traumatic event; moreover, some of them experienced a similar traumatic event. In this article, we report these cases and show that this tendency is exhibited more frequently in victims of sexual abuse. Van der Kolk, who treated veteran soldiers who served in Vietnam, became aware of the compulsion of patients to repeat their trauma through treatment. He expressed this repetition compulsion as re-enactment or re-victimization of past traumatic experiences, showing how the trauma was repeated at a behavioral level in his article. After their treatment, he published his research on traumatized people as Post-Traumatic Stress Disorder in the 1980's. Nowadays, generally, this repetition compulsion behavior is not included as a symptom of PTSD in Japan. Van der Kolk insisted that these repetition compulsions caused further suffering for victims and their relations. We also thought that these repetition compulsions can disturb rehabilitation. In our article, we expressed the condition as active compulsion repetition. We considered that it should be distinguished from passive conditions including instructive symptoms such as repetitive nightmare and flashback. We also represented how active compulsion was repeated in our cases, which was not consistent with the concept of PTSD on DSM-IV. When the active repetition compulsion was acted, we noticed that patients showed depersonalization. We thought that an understanding of the depersonalization following reenactment and re-vicitimization was important in order to comprehend the mechanism of PTSD.     

Factors that hinder post-traumatic growth: A systematic review

People who experience major life crises often report post-traumatic stress. However, the literature suggests that traumatic experiences can also be “catalysts” for positive change (i.e., post-traumatic growth; PTG). PTG can include improved relationships, new possibilities for one's life, a greater appreciation for life, a greater sense of personal strength, and spiritual development. Furthermore, it has been suggested that PTG may decrease feelings of distress following exposure to trauma. While a large number of factors may help promote PTG, others may impede the development of growth (e.g., attachment style). These factors constitute key aspects for clinicians working with victims of trauma. Thus, this review aims to present these hindering factors in order to provide guidance for trauma psychologists and future research.     

Maltraitances sexuelles infantiles et répétition victimaire dans les relations conjugales à l’âge adulte

AimsIn this article, we show the consequences of childhood sexual abuse on psychic development and its implication in victimary repetition in adulthood.MethodThe case study presented in this article is from a doctoral research project in psychology about the impact of early relationships on the experience of intimate partner violence in adulthood. This case appears emblematic of the rest of our population. The elements mentioned are anonymized and analyzed from a psychoanalytic perspective.ResultsThe results show the conscious and unconscious consequences of childhood sexual abuse on the victims’ psychological development. Indeed, the psychic intrusion following early sexual abuse hinders the construction of the self and prevents the psychic instances from functioning properly. This intrusion also leads to repetition in violent intimate relationships. Oscillating between primary and secondary processes, the person can cut her/himself off from a part of her/his emotional life to avoid psychic and/or somatic disorganization.DiscussionAfter experiencing early sexual trauma, even if the psychic apparatus is temporarily able to keep the traumatic elements far from the conscious mind, these elements still act in the unconscious. The work of shame and guilt, which are constitutive elements of moral masochism, lock the subject into a deadly repetition compulsion that can promote the experience of repetitive intimate partner violence (physical, psychological, sexual) in adulthood.ConclusionTo prevent, detect, and care for women victims of childhood sexual abuse, it is necessary to consider their modalities of psychic functioning, the formation of their Self, and their ability to psychically transform the trauma they suffered.     

Psychotraumatologie : prendre en charge les traumatismes psychiques

Why and how to manage psychic trauma? The phenomenon of psychotrauma is probably as old as the beginning of humanity and has already been described in many ancient writings. In France, we really began to show interest after the attacks in 1995. Since then, many studies have shown the importance of early support for victims of traumatic events. In this interview, mental health professionals of SPEcialized Home Center in the Tracking and Treatment of Psychological Injuries (Caspertt), will describe psychotrauma, will detail the different therapeutic approaches proposed in psychotraumatology and will explain how the management of psychological trauma is an important issue, particularly in terms of prevention of other disorders. The Caspertt is fully integrated into this care perspective by using different traditional but also innovative therapeutic approaches such as TIM-E program (Temporal Identity Model & Experiencing) or HTSMA.