Le surgissement de l'originaire et le « retrait hallucinatoire » dans les formes délirantes de l'éveil de coma

The clinical investigation of delirious and hallucinatory states during the awakening from a coma reveals hallucinated representations of a polymorphic nature. The diversity of their contents suggests the implication of differentiated etio-pathogenic processes. The assumption followed here, based on the conceptualizations of P. Aulagnier, is that the emergency care awakening traumatism causes a prevailing reinvestment of various operating modes, from the recovery of a “pictographic production” due to the abolition of conscience, to the fantastical scenario characterising primary education that remobilises and upsets the identity bearing layers in which the essential moments of the instinctual history were elaborated. These symptomatic constructions thus express this “in-more” generated by the psychotic processes which combine the double movement of a regression and of a “redeployment” of the traces of the Primal. This second period fulfils the paramount requirement of a primitive development of the coma awakening experience following the “postulate” of the dominance of the Primal according to which any psychic object is seen initially metabolized in a pictographic representation. The stratification noted within these dreamlike formations reveals: on the one hand modes of composition of images similar to those of the night dream; and on the other a deployment of various imagos of archaic states of the parcelled out body; and finally “psychic residues” that re-appear in the form of “parasitic” reminiscences, analysable as resurgences of psychic activities resulting from the coma phase. Thus a representation of the data of the Primal is then generated and although these data are psychic they remain forever heterogeneous and external to the Unconscious and to the I. The common clinical term which supports this analysis is “hallucinated feeling” which, according to Aulagnier, emerges sometimes within a schizophrenic patient which could be understood as equivalent to an autistic withdrawal which we suppose to be here at the heart of the deliriousness of the awakening from the coma. Thus the proposal that two etio-pathogenic logics are at work in these acute episodes: 1/ one that is initiated in a movement of decomposition of the I, due to the multiple traumatic effects of the primary affection and of the emergency care awakening process, balanced by the variations of the state of consciousness of the patient. At the time of this regression the projective mechanism, combined with other defences such as rejection or cleavage, reveals scenarios in the psychic space which mobilize images of the body and perceptive or mnemonic fragments. 2/ the other trajectory is comparable to this dynamics of the “withdrawal in the hallucination”. The re-establishment of the specific processes of the primary and secondary agencies imposes a requirement of specific psychic work consisting in metabolizing this resurgence of the pictographic representations that originate in the (quasi) nothing of the coma.     

L' « Ouverture émotionnelle » dans les Troubles de la dépendance et les Troubles de la personnalité

Emotion processing is supposed to play an important role in psychological dysfunctions in alcohol and drug dependency disorders (DD), as well as in personality disorders (PD). The model of “Emotional Openness” (“Ouverture émotionnelle”) provides a multidimensional framework to analyze problematic patterns of emotion processing. Within this framework, it is suggested that drug- and alcohol-dependent patients as well as borderline and antisocial patients show reduced a) “cognitive/conceptual representation” of affective states; b) “emotion regulation”; and c) “expression and communication of emotion”; but d) increased “awareness of body internal indicators” of affectivity; and e) appropriate psychological treatment is supposed to improve these patterns. Drug-dependent patients with PD comorbidity (in particular borderline or antisocial) are supposed to present even stronger deficits in (a) and (b). The hypotheses are tested with the 36-item DOE questionnaire (“Dimensions of Openness to Emotional experiences”, trait version; [19]), assessing six main dimensions of emotion processing as represented by the subject (French and Italian version). The instrument presents satisfying reliability coefficients (mean alphas of the scales in two recent studies (N = 251; N = 435) vary between 0.74 and 0.82) and good factorial validity (6-factor PCA solutions with varimax rotation solutions in the two samples are highly coherent; the mean of Tucker's congruence coefficients is 0.93). Results of two clinical studies are presented, comparing N = 71 patients (21 drug-dependent without personality disorder; 30 drug-dependent with borderline or antisocial personality; 20 dependent in-patients receiving psychological therapy) with normal control subjects (N = 51 matched; N = 50 reference group), including one pre-post treatment comparison. Results confirm marked deficits of DD patients concerning “conceptual representation” and “emotion regulation”, as well as a reduction of “communication/expression of emotion” but an increased “awareness of body internal indicators” of affectivity. Differences of patients with a double diagnosis correspond to effect sizes of d = -1.33 for cognitive/conceptual representation of emotions and d = -1.25 for emotion regulation; differences in emotion communication and expression are also significant but less important d = -0.44. Awareness of body internal emotion indicators is increased (d = +0.27) but does not differ significantly from the control group. As supposed, patients with a double diagnosis (DD and PD) described significantly stronger deficits in conceptual representation and emotion regulation than the patients with dependency disorder only. In the second study, a group of DD patients receiving multi-component treatment, including individual and group therapeutic intervention, according to the client-centered approach, and working on emotion processing, showed marked differences from the reference group at the beginning of the treatment (d = -0.91 for cognitive/conceptual representation, d = -0.82 for emotion regulation and d = +0.46 for awareness of bodily internal indicators). As supposed, pre-post comparisons indicate improvement with change effect sizes of d = 0.99 for conceptual representation, d = 0.97 for emotion regulation, as well as d = 0.88 for emotion communication and expression. Furthermore, the changes following treatment are highly significant and substantial, except for the awareness of internal bodily indicators, which only slightly decreased. Patients “normalize” their emotion processing following treatment, describing increased conceptual representation and emotion regulation, as well as emotion communication and expression. Results underline the importance of dysfunctional modes of emotion processing in both pathologies, and underline the validity of applying the model and the DOE instrument. They are discussed with reference to the model of alexithymia.     

La « sortie hors du corps » est-elle pensable par nos modèles cliniques et psychopathologiques ? Essai de clinique d'une marge. À propos d'un cas

From an account of “out of body experience” within the framework of child psychiatry, an examination of the history and recent topicality of this phenomenology is proposed. If it can be located within the general framework of the heautoscopy, it would be a particular method, linked to a situation of confrontation to the reality of death. It concerns the specular phenomena and allows us to check the duplication with fonds image of self.     

Les « pousseurs de métro » : à propos de huit cas de patients hospitalisés en unité pour malades difficiles

“Subway pushers” have been newspapers' highlights but also a forensic subject. Through eight case reports of offenders sent to high secure unit (unité pour malades difficiles Henri Colin), a profile of homeless psychotic man without any outpatient treatment has been found. Crimes seem unmotivated, where as delusions or hallucinations exist. Meta-analysis confirms this profile, though some alcoholic pushers have been described. Prevention of these tragic accidents rests on psychiatrists' awareness of homeless mentally ill people risk and safety subway programs.     

L'évolution du concept de mythomanie dans l'histoire de la psychiatrie

During the l9th century, morbid lying and imaginative exuberance are pointed out in several forms of the mental alienation: Intellectual monomania (Esquirol, 1819), hereditary madness (Morel, 1860), megalomania (Dagonet, 1862 and 1876), grandiose delusion (Foville, 1871) — with ideas of filiation — and over all hysterical madness (J. Falret, 1866; Lasègue, 1881). Several historical personages reincarnated (false Joan of Arc, false Louis XVII) have likely suffered from these disorders. For the first time in Germany, Delbrück isolates an autonomous form of pathological lying that he calls “pseudologia fantastica” (1891). The French alienist E. Dupré (1862-1921) describes in 1905 the mythomania and its three forms: 1) vain (fantastic boasting, criminal autoaccusation, malingering); 2) mischievous (hoax, slanderous accusation, anonymous letters); 3) perverse (swindlers, seducers, wandering mythomania). Dating from 1910, Dupré characterizes the delusions based on “imaginative” mechanisms, with grandiose ideas, either chronic (autosuggestion, confabulation), or acute (often symptomatic of delirium, dementia, amnestic or mood disorders). In 1919, he considers mythomania as the basis of hysteria, through its “constitutional” (or “temperamental”) theory of mental disorders. These conceptions are accepted by Delmas and Boll (1922), Heuyer (“délire de rêverie”, 1922), Vinchon (1926) and Dide (1935), but criticized by the pupils of Charcot (Janet), the phenomenologists (K. Schneider) and the “structuralist” school (Ey). Kraepelin's confabulatory and fantastic paraphrenias are compared with Dupré's imaginative delusions by the pupils of H. Claude (Nodet, 1937). But the intuition is separated from the imagination as an autonomous delusional mechanism (1931), whereas Delay (1942) and then Guiraud (1956) distinguish confabulation from mythomania. Since the DSM-III (1980), the word mythomania is no more retained into psychiatric classifications. The clinical entity of Dupré is divided in delusional disorders (grandiose type), facticious disorders, antisocial, narcissistic and borderline personality disorders. On the other hand, pathological lying is nowadays differentiated from malingering, delusions, Ganser's syndrome and confabulation. Its boundaries with histrionic personality disorder are not clear.     

« L'expertise » de fin d'hospitalisation d'office médicolégale (article L 3213-8 du code de la santé publique)

The “expertise” required by article L. 3213.8 of the Code of Public Health is exceptional within the statute of “compulsory hospitalization” (Police-instructed compulsory hospitalisation in France corresponds to the juridical or court-ordered hospitalisation in Anglo-Saxon law). This paper proposes a critical analysis of this “expertise” and of the ensuing situation of pathological criminals based on an extended practice of expertise and taking into consideration the recent evolution of the concept of dangerousness.     

De quelques enjeux épistémologiques de l'usage de la notion d'analogie

The notion of analogy and the phenomena it refers to were poorly thought of in the cognitive psychology domain and in psychoanalytic theory as well during many years. The first domain, under a developmental paradigm influence, reduced most of the analogy time to a group of “primitive” processes of knowledge, to be overtaken by abstract reasoning. As for the second, most of the time it treated this notion as an imaginary expression, suspected of standing on the side of deception and delusion. But, for about twenty years now the situation has been moving in a relatively convergent way in the two areas. Analogy is being recognised again. The present article proposes bringing out some of the epistemological implications of this notion's renewal in the psychoanalytic theorisation area. The author explores three angles of research that resort to the notion of analogy. The first theorizes about transference (does it present an analogical structure or not?); the second theorizes about metaphor; the third theorizes about the signifying called “archaic”. This thought relies on a methodological process that distinguishes three levels of study among the analogical processes: a level that tries to study the analogical processes itself (cognitive psychology); a level that tries to study the relation between the subject and his own analogical processes; a level that questions analogy's contribution to scientific discovery. From such a methodological process, we can show the specificity of each one of the theoretical levels and we can envisage a dialogue. Using the analogy notion leads to a relativization of the specific binary thought of the structural processes and to restore the nobility of the thought processes implying references to space, to the body, to an illusion of continuity between the psyche and the world.     

Le soin en famille d’accueil : théories du « care » et quotidienneté

Receiving people in situation of psychological vulnerability in foster families implies, beside a shared everyday life, a concern for these persons and for their well-being, in other words a form of care, different from cure treatments. The current development of “theories of care”, in the field of moral and political philosophy, helps to specify the dimensions of care, including its intrinsic ethical dimension. These ones turn out to be relevant in the context of foster families. People take care not only of other people, but also of the shared and everyday world in which they live together. This care of the shared world is to be itself shared.     

Déjouer le jeu. Réappropriation et détournement de l'univers de jeux vidéo dans la création contemporaine

In the era of cyber culture and collective intelligence, video game establishes itself more and more nearby the artistic disciplines historically settled. Its aesthetics and its way of revisiting the real reveal a new “formal representation” and an increasing number of contemporary artists use it as an expression mean. The spatial development of video games is comparable to contemporary installations; it presents itself as a distinctive space recreated into a public or a domestic dimension. Video games, like installations, intensify the feeling of displacement or ubiquity that any kind of show may provide. The installations using video games mechanism make us pass from the idea of “esthetique relationnelle” introduced by Nicolas Bourriaud to a participative aesthetics where the spectator takes the place of the protagonist. The analyze of different works: “Vigilance 1.0” of Martin Le Chevalier, Kolkoz in “Hong Kong 2002”, “Nekropolis” of Tobias Bernstrup, and “Sam” of Palle Torsson shows some examples of reappropriation and diversion of the video games universe in contemporary art. Those examples allow us to see in a new way the world of video games. The contemporary artists appropriate this form of expression to make new plastic and participative explorations far of from the first play and entertainment finality. In these pieces the role of the spectator in the device is fundamental and it produces a total experience mobilizing at the same time: the vision, the hearing and the touch. The video game represents a post-modern form where contemporary artists may express the idea of “Gesamtkunstwerk” evoked by Richard Wagner in the second half of the XIX century with his theory of the “complete art work piece”. We are witnessing a turning point in the way of experimenting life which consists in interrogating the body into space and time in synaesthesia. Contemporary artist seem indisputably to make their own the Duchamp's words: “the viewers are the ones who make the painting”, the art of work remains unfinished until the spectator hasn't received it, the viewer turns up into an actor in a spectacular dynamics and his relation to the work of art goes beyond a simple passive contemplation.     

Les sources janétiennes de l’œuvre de Proust

It has been acknowledged for some time now that Marcel Proust's work had been influenced by the medicine of his time. But the scientific sources concerning two major themes from In Search of Past Time were discovered only recently. Hervey de Saint-Denys’ Les Rêves influenced Proust's interest in sleep and dream functions. In turn, experimental psychology works from the late xix century influenced the key concept of the “other self”, considered by Proust to be the real author of the books. In his work, Edward Bizub (Bull Marcel Proust 56 (2006) 41-51) has highlighted the novelist's in-depth readings about experiences in dual personality conducted by a myriad of Charcot's alumni, including Pierre Janet and… Adrien Proust. Knowledge about the division of consciousness and preFreudian laws of the unconscious allowed the hidden self of the hero of In Search of Past Time to emerge.     

Déficit de mémorisation d'information à contenu émotionnel chez le patient souffrant de schizophrénie

Studies in the relationship between cognition and emotion are still ongoing. This new perspective has led Andreasen, among others, to consider the disturbance of the cognition-emotion relationship in schizophrenic patients as a fundamental aspect of the illness. This aspect is central in the care of these patients, since the difficulties engendered by it have a great effect on their quality of life. This study examines the process of recalling information with an emotional content among schizophrenic patients. The participants were divided into two groups (a group of 15 schizophrenic subjects and a group of 14 comparison subjects) and were asked to listen to a story containing information with both emotional and factual content. This information was presented both explicitly and implicitly. The participants then had to provide instant and delayed recall of the information. The results underlined a marked deficit in the immediate and delayed recall of information with an emotional content for the group of schizophrenic subjects regardless of how the information was presented or how long the delay in retention was. This indicates that memory deficit among schizophrenic patients increases when they have to remember information that is emotionally charged. On the other hand, it seems necessary to develop some cohesion around the terms used (“emotional memory”, “memory of information with an emotional content”) to further this type of research.     

Un modèle de conscience de soi suggéré par la psychosociologie de l'invention

Knowledge in the making can be regarded as a relational system. Through concepts and apparatus linked to them, the scientist build a relation with nature that fits with the idea she has about it. This model can be applied to consciousness in general, apart from that form of consciousness induced by scientific knowledge. Like scientists, our consciousness is built through a fusion-differentiation process from other people leading to the building of culture as an ethnotheory. This process leads to a “consciousness in action” depending from the success or the failure of expected roles and real behaviors of nature and the energetic balance of these cycles. This model fits with a specific contemporary psychotherapy. It leads to phenomenology and anthropological psychiatry.     

Approche psychanalytique du « démoniaque » à partir de l'œuvre de Ian McEwan

This study examines a few epistemological reflections establishing the interest that literature and psychoanalysis can have for each other. It then attempts, through a structural analysis of the works of the contemporary English novelist Ian McEwan, to elucidate a point of theory: the use of the term “demonic” by Freud to qualify the death instinct. This leads us to raise anew the question of evil in relation to the forms taken by the rejection of castration as existential trauma. The emphasis is laid in particular on the perverse montage.     

Le contingentement de la jouissance dans la paraphrénie

At 1913, in the eight edition of its Treatise, E. Kraepelin changed its own classification of chronics delirium because he wanted to insert in it the group of paraphrenias; at 1978, H. Ey, in its Treatise of hallucinations, showed that he had conserved some interest for this clinical type that he named delirious fantastic psychosis. At 1996, J.-C. Maleval introduced a progressive logic of delirium where paraphrenia appears as the end of therapeutic work of delirium. We study more precisely here the case of a paraphrene subject who had one's moment of glory at 1905 in Paris where he was the object of a hoax played by J. Romain: J.-P. Brisset was elected prince of thinkers. In this example, the evolution of paraphrenic delirium preserves the subject from the “jouissance de l'Autre”.     

« Secondes personnes ». Une anthropologie de la relation

The goal of the article is to put to the fore the importance and the relevance of the « second persons » in the framework of a relational ethics where the person as being related has a primacy over the individual as an isolated subject. While using the psychiatric work of the urgency team E.R.I.C (in french : Equipe Rapide d'Intervention de Crise) as a leading thread, we seek to show the anthropology of being related which underlies the practical ethics of such an urgency team. Such an anthropology is revealing of a change of epistemology which goes hand in hand with the taking into account of the method of the phenomenology, the épochè. The latter corresponds to a radical transformation of the way the subject looks at the world : from the individual to the person, you leave loneliness in order to reach relatedness. Nevertheless, the latter requires not to be understood as an immanent or transversal relatedness (with a tendency to anonymity) but as a self-transcendent dynamics, which alone lets the person emerge in its plenitude, that is, as a primordial place of relationships. Hence the necessity, in order to confirm the epistemological relevance of such a practical phenomenology, to start with the emergentist, enactive and neurophenomenological methodology of the cognitive sciences, which puts to the fore the co-generative relationship between the first, the second and the third persons. On the basis of such a taking into account of the second person, as an intersubjective validation of objectivity in the cognitive neurosciences, it is possible to reveal the specificity of the phenomenological ethics of relatedness which is at the core of the post-psychiatry at work in ERIC.     

L'influence de Henry Ey dans la psychiatrie roumaine : un témoignage

Although less applied, the Henri Ey's thinking is well-known in Romania. The translations of Ey's works (“The Consciousness” and “Psychiatric Studies”) into Romanian, as well as the writings of the Professor Pamfil, who was one of the Ey's students, contributed to propagate his theories. The paper's author considers the organodynamic conceptualization as a premise on his own conception of the rehabilitation of the psychiatric patient, as described in his Textbook of psychiatry, published in Bucharest in 1997. The author suggests that the Ey's main idea was the concept of normality. That represents a fundamental idea in the psychiatry, as well as in a social field. The original contribution of Henri Ey is the theory of the mind dominated by the structures of the ego (reality reflection, self-consciousness and identity). Therefore, Ey unifies the psychoanalysis, the psycho-organic theory and psychogenetics. Henri Ey was a real anthropologist. He elevated the psychiatry to a theoretical initiation.     

L'inquiétante étrangeté à l'opéra. À propos du Tour d'écrou de Benjamin Britten

The concept of “disturbing weirdness” was first introduced in psychoanalysis by Freud based on a single opera: Offenbach's Hoffmann's Tales, but this work is far from being the only one to be built on such an atmosphere of “disturbing weirdness” (Unheimlichkeit, in German). Benjamin Britten's The Turn of the Screw, for instance, shows the same characteristics and suggests a new extension of the Freudian concept. The story, first written by Henry James, takes place in a strange English manor, where two children Miles, a boy, and Flora, a girl, seem to have been corrupted by a former female private tutor and a male servant who are supposed to be dead but who are still appearing as ghosts on a high tower or across a lake. Nobody is sure they are really dead, because they keep talking and singing to attract and seduce the children. Distress and anguish hang over the entire opera, which ends tragically for the boy who dies when the new governess tries to extract the secret she thinks he keeps in his mind from him. The author investigates all the possibilities of clarifying the situation and proves that this opera might suggest new meanings and new significations to the Freudian concept of “Unheimlichkeit”.