Post-vérité, un symptôme du lien social ?

ObjectivesThis work attempts to understand, on a subjective and societal level, the psychic processes involved in the phenomenon of the emergence and proliferation of narrative constructions concerning the post-truth.MethodTaking into account the unconscious aspects that contribute to the construction of narratives and beliefs within human groups, and putting these theoretical milestones into perspective with the psychoanalytical concepts of psychic truth, construction, and the need to believe will lead us to problematize our conception of post-truth.ResultThe study of this phenomenon in the light of psychoanalytical conceptions of the delusional construction, the elaboration of religious beliefs, and constructions in analysis will lead us to understand the discursive regimes of post-truth as collective unconscious products that can give a form to nuclei of psychic truth that are not fully developed by the social.DiscussionThis interpretation of the conspiratorial phenomenon will allow us to take into account how these “alternative narratives” could solicit unconscious processes of the people who adhere to them, because the post-truth may represent a deformed and inappropriate way of expressing that which does not find a place of enunciation in shared discourses and narratives.ConclusionsAs a symptom in the social bond, this phenomenon questions the forms of failure of the work of culture and the crisis of the structures of shared meaning. This exploration reminds us of the necessity of thinking critically about our own constructions and paradigms.     

La peur de l’accouchement chez des nullipares : lien avec la douleur lors de l’accouchement,les symptômes de stress post-traumatique et les symptômes dépressifs post-partum

ObjectiveFear of childbirth is common in women who are pregnant with their first child and is associated with important consequences such as abortions and miscarriages. Twenty percent of nulliparous women seem to exhibit a mild or moderate fear, while 6% present an excessive and irrational fear known as tocophobia. Tocophobia is suggested to be associated with many negative consequences such as postpartum depression (PPD) and Post-traumatic stress (PTS). However, there is little empirical evidence to support these relationships. Recently, Fairbrother and Woody (2007) did not observe a link between the fear of childbirth and symptoms of PPD and PTS in nulliparous women. Some results, near the significance level, could be explained by a lack of statistical power. The present study focused on the link between the fear of childbirth and the process of delivery, the perception of pain, PPD and PTS. More specifically, it aimed to test three hypotheses: (i) fear of childbirth will be linked to the process of delivery, especially regarding the perception of pain, the use of anaesthesia and the use of Caesarean section; (ii) a high level of fear of childbirth will be associated with more negative postpartum consequences (namely PPD/PTS symptoms); (iii) the process of delivery and pain will also be related to post-delivery symptoms. Mediation effects were tested.MethodData from a longitudinal study were used to meet the hypotheses. A total of 176 nulliparous pregnant women responded to questionnaires at two time measurements (during pregnancy and at 5 weeks postpartum).ResultsFear of childbirth is related to the perception of pain at birth among women delivering vaginally, in the absence of anaesthesia. It is also linked to symptoms of PPD and PTS, regardless of whether or not anaesthesia was used. Fear of childbirth also appears to be strongly associated to symptoms of PTS in women who have experienced an unplanned caesarean section. Thus, symptoms of postpartum PTS could play a mediating role in the link between fear of childbirth and PPD.ConclusionsThese results support the relevance of taking into account the fear of childbirth and perception of pain in connection with symptoms of PTS and PPD in nulliparous women. The unplanned caesarean section (including emergency caesarean) also appears to be important in the study of the relationship between fear and symptoms of PTS. Fear of childbirth could render the experience of childbearing more negative and predispose to PTS and PPD. Enabling psychological vulnerabilities could also be an interesting avenue for understanding these links. Limitations are discussed.     

Expériences de possession et symptômes dissociatifs chez un échantillon de sujets pratiquant l’exorcisme

Possession experiences remain poorly studied from a clinical viewpoint. The objective of this study was to evaluate psychic phenomena associated with these experiences of practicing exorcism. The study was conducted in natural settings by clinicians (psychiatrists, physicians, and psychologists) with a sample of subjects of Mexican nationality practicing exorcism rituals. After approval of the local religious authorities, evaluators attended exorcism practices performed by priests on 25 subjects who consented to the study. Subjects were observed by clinicians throughout the ritual. They were evaluated in the days preceding the ritual with clinical interviews and questionnaires for diagnostic purposes (Structural Clinical Interview for DSM [SCID], Brief Psychiatric Rating Scale [BPRS], Global Assessment of Functioning [GAF], Clinical Global Impression [CGI]). A second interview and assessment using the CGI was made one hour after the ritual. The results showed the presence of psychopathological syndromes and signs in the initial evaluation: dissociative symptoms and DSM Axis I or II disorders, with a moderate impact on the overall functioning of the subject. During the ritual dissociative states were identified, sometimes preceded by anxiety, such as are described in trance states. Post-ritual evaluation of the symptoms initially identified revealed that these had either significantly reduced or completely disappeared. The CGI severity was significantly decreased. This data allows better understanding of the psychopathology of these subjects describing their possession experiences and exorcism practices. It also shows the diagnostic complexity, in particular due to their cultural component. There remains a need for further research to better assess these phenomena and to understand the processes involved in the changes reported by the subjects after these rituals.     

Efficacité d’une unité cognitivo-comportementale sur les symptômes psychologiques et comportementaux des démences

IntroductionCognitive-behavioral units (CBUs) have been created in the context of the national Alzheimer plan 2008/2012 for the management of behavioral disorders of patients suffering from Alzheimer's disease or related diseases. The Alzheimer plan promotes the evaluation of these units through the observation of the evolution of behavioral and psychological symptoms of dementia (BPSD). The aim of this study was to assess the effects of the memory center of Lyon (hospices civils de Lyon) CBU on BPSD.PatientsThe neuropsychiatric inventory (NPI) was rated by the patients’ caregiver (NPI-F) at admission to the CBU and 2 weeks after the discharge. The NPI was also rated by the nursing staff (NPI-NS) 3 days after admission in the CBU and at discharge.ResultsAll patients admitted in the CBU between July and October 2001 were included in the study for a total of 28 patients. A significant reduction of NPI-F scores between admission (58.93 ± 24.8) and 2 weeks after the discharge (27.07 ± 19.70) (P < 0.0001) was observed. Improvement was specifically observed for delusions, agitation, depression, anxiety, disinhibition and aberrant motor activity symptoms. No significant changes were found on NPI-NS scores.ConclusionThis study discloses benefits of CBUs in terms of BPSD reduction in patients 2 weeks after CBU discharge. These units have the potential to achieve their principal objective of reducing behavioral problems.     

Victor Dumontpallier (1826–1899) et l’hystérie,ou l’infortune d’un plagiaire mystifié

Victor Dumontpallier (1826–1899) was a contemporary of Jean-Martin Charcot. Both of them, along with Jules Luys, were chosen by Claude Bernard, on behalf of the French Academy of Medicine, to perform an expert assessment of Victor Burq's work on treatments for hysterical anaesthesia and paralysis involving the application of metal plates to desensitized areas. From that point forward, Dumontpallier gave up his earlier work, focused on gynecology, turning instead to hysteria and, especially, hypnotism. With the goal of out-doing Charcot and his lessons at La Salpêtrière, he opened his teachings not only to students and physicians but also to the public, which was fascinated by mysteries and the supernatural. With the help of two students, Paul Magnin and Edgar Bérillon, he imagined that he had discovered a special force in the human body, the “force neurique rayonnante” (radiating neuric force), which caused hypnosis. He supported spectacular research claims, e.g. “the functional independence of the cerebral hemispheres”. This scientific catastrophe shows how Charcot's fame led some of his Parisian colleagues to try to outdo him with phantasmagoria, tarnishing their reputations. They may have copied appearances, but they did not possess Charcot's knowledge.     

Théorie de l’esprit : un médiateur entre symptômes et fonctionnement dans la schizophrénie ?

This literature review aimed to summarize the scientific knowledge concerning the links between psychosocial functioning and social cognition. Social cognition, and particularly Theory of Mind, is strongly disturbed in patients with schizophrenia. There were strong arguments that psychosocial functioning was more strongly associated with Theory of Mind than with neurocognition (defined as nonsocial information processing in contrast to social cognition). The functional capacity mediated this influence. Moreover, longitudinal studies suggested a unidirectional causal pathway with primary neurocognitive disorders leading to secondary deficits in social cognition, which in turn led to disturbances in psychosocial functioning. Studies using structural equation modelling showed that positive, negative and disorganization symptoms were associated with disturbances in psychosocial functioning. Regarding negative symptoms and disorganization, the influences were mediated by social cognition. The influence of positive symptoms on psychosocial functioning was independent of social cognition. This literature review suggests that social cognitive remediation in patients with should improve the psychosocial functioning in patients with schizophrenia.     

De la monstruosité du matricide à l’élaboration d’un altruisme délirant

The authors propose to study two matricide cases: two young men passed to the act and killed their mother in order to put an end to the unbearable aspect of the jouissance. This crime which could have been the solution was considered as an altruist act by Pierre Rivière in 1835, but it did not salve him as he had expected. On the contrary, he brusquely appeared as monster on the world scene, and from that time he just wanted to die as he could not assume this identification. As far as Louis is concerned, the psychoanalytic work under transference enabled him to build altruism as an interpretation. It also allowed him to accept the subjective responsibility of his crime. Therefore, we will examine what the exact function of altruism is in these two delirious cases. We will also study if the historic category is valid or not to give an account of what really happened for these two subjects.     

Présentation d’un outil d’évaluation de l’évolution des processus psychiques au sein d’un dispositif thérapeutique en clinique du traumatisme

ObjectivesOur project consists in the implementation and the evaluation of a care system for children in a child protection NGO in Cambodia. In view of the cultural differences and specificities of the field, taking into account only the symptoms do not seem to sufficiently account for the processes involved within the system. Based on the observation that there is a lack of tools that would allow us to apprehend these processes, our study focused on the creation of a scoring grid for psychological processes that could be used in the humanitarian field and could support clinical practice.MethodDuring one year, we met ten children confronted with traumatogenic events, within a device based on therapeutic mediations. The corpus studied is based on observation notes inspired by Esther Bick's methodology. The study of the corpus and its theoretical linkage made it possible to identify five main processes as well as six channels of transfer.ResultsUsing the NVivo software, the observation notes were rated using the grid. Each of the sessions with the children was thus analyzed. By means of a matrix crossing query, we identified the processual evolution over the whole follow-up.DiscussionThis rating grid allows us to identify the psychic movements at play during the encounters and raises new questions about the diagnosis on humanitarian grounds.ConclusionThis work has allowed us not only to create a rating grid but also to enrich and complete it during the rating process. This grid allows a processual evaluation within the therapeutic follow-ups and constitutes a support for the clinician confronted with a loss of reference points and a massive counter-transference.     

Admission en soins psychiatriques a la demande d’un tiers : de l’appel au SAMU a l’hospitalisation

BackgroundInvoluntary psychiatric hospitalization (IPH) is a heavy and complex psychiatric exception measure. In the Seine-Saint-Denis department (low medical density), the evaluation of the patient in psychiatric decompensation is the responsibility of the out-of-hours general practitioners (GP) mandated by the call center. Their feeling is the non-achievement of the procedure once the patient arrives at the emergency room. We aimed to evaluate the outcome of patients following a request for IPH from these GP.MethodsWe conducted a retrospective study based on all requests for IPH received during 2016 at the Seine-Saint-Denis emergency medical call center. The characteristics of the call and the patient, as well as the decisions of the regulator and the GP were collected. The decision of hospitalization in the emergency room was sought for patients referred for IPH.ResultsOf the 7541 calls for decompensation, 539 were for an IPH. These calls occurred during non-working hours in 55 % of cases. A GP was involved in more than two-thirds of the cases and requested an IPH for 240/304 (79 %) patients. Patients were male in 56 % of cases with an average age of 40 (± 16) years. IPH was confirmed for 132 (61 %) patients. This rate did not differ from the 65 % reported in the literature (Z-test, P = 0.26). Voluntary hospitalization was performed for 37 (17 %) other patients.DiscussionThe IPH rate for patients referred by GP mandated by the call center was comparable to that following the requests of the attending physicians, validating their intervention in this critical context.