Le positionnement de l’observateur en interdisciplinarité

In his current practice resorting to logic and computers the clinician also finds questions which occur in interdisciplinarity. We usually suppose an attitude of neutrality in order to respect the nature of the phenomenon studied. But further to the approximation this attitude includes, the clinical, logico-mathematical, and computerised positionings introduce operative filters which format the reception of the facts quite differently. These different perspectives are evoked by the authors who express schematically the role of their personal attitude, that of the theories to which they refer, that of the nature of the objects studied, and that of the language used. A modelling of the whole underlines these differences and allows envisaging an integrated and polyvalent positioning. It incites the clinician to enlarge his/her field of investigation, his/her approach, and to adopt for his/her observation, different and complementary attitudes according to the nature of the objects under study. The situation is the same for the other observers with whom he/she can obtain better comprehension. This modelling should result in an enrichment of knowledge.     

Langage et schizophrénie : l’intention en question

Language disorders in schizophrenia are of crucial importance for the social relationships and the living experience of schizophrenic patients. With notions such as context, intention and theory of mind, research devoted to language in schizophrenia is moving toward effective conditions of language production in this pathology, and to more specific troubles in the schizophrenic speech. Nevertheless, the usual cognitive and experimental paradigms ignore some of the fundamental dimensions in language: intentionality and inter-subjectivity. In a previous study, we stressed the importance of the social and inter-subjective bases of language, with a particular look at Vygotski’s works on schizophrenic speech and thinking. In the present paper, we have analysed more precisely the notion of intention in schizophrenic speech, and compared its meaning relative to cognitivism and phenomenology. Concerning cognitivism, Frith’s neuropsychological model is presented here paying specific attention to the main hypothesis: a deficit in the monitoring of intention. This deficit is supposed to affect both one’s intention (as in hallucination) and the ability to infer another’s intentions. Nevertheless, our core idea is the following: the intention, as conceptualized by cognitivists, can only be thought and studied by the means of a preliminary objectification, instead of by a foundation of subjectivity as in phenomenology. This particular point leads us to reconsider speech troubles in schizophrenia in the light of the subjective and lived side of language in this pathology. More precisely we have argued that language disorders in schizophrenia could be considered in the light of concepts such as empathy, conversion of meaning, and the splitting of intentionality itself. Indeed, language and intentionality in communication, as conceptualized by Husserl, cannot be reduced to mere transmitting of information. Two components are required: intention of signification, and intention of communication itself. These two dimensions lead, in each speech act, to a conversion from one side to another, between thought and language. In schizophrenia, this splitting of intentionality and the conversion of meaning could be extremely crucial to account for the inner links between the schizophrenic patient and his own speech, as we have tried to explain. In the same way, we have argued that the theory of mind, frequently invoked in schizophrenia, is here rather considered as a part of a more important notion, namely the notion of empathy. This point, as the previous one, cannot be reduced to a mere cognitive process by first involving the body in the process of communication. We have concluded by arguing that works on schizophrenic language should not ignore the subjectivity of intentionality, as well as the importance of the body dimension in inter-subjectivity, in order to obtain useful insights into the lived world of schizophrenic patients.     

Actualité de l’hystérie. Le féminin chez l’homme et la femme

What is hysteria today, since its paradigmatic definition that allowed S. Freud to conceptualize the psychoanalytic theory and method, until its withdrawal in current trends with the objective of rejecting sexual and sex differences? We illustrate the durability of hysteria neurosis with two case studies of both sexes that combine anxiety hysteria elements and conversion hysteria elements. The intrapsychic functioning has been explored with projective methods. Neurotic features and sexual representations are prevalent. They show that feminine within psychic bisexuality is a crucial problematic for these patients. The female patient is investing activity against passivity and seduction fantasies are lively in both active and passive positions. The male patient summons up his aggressive instinct and narcissist mechanisms of defence when confronted to passive position. For all that, can we say it is a refusal of feminine in both sexes?     

Le sentiment de culpabilité et de honte chez les survivants de l’Holocauste

Participants in the study were Jewish Holocaust survivors (n = 89). A total of 70 respondents constituted the trauma group. The remaining 19 participants were regarded as the controls. The control group consisted of persons of Jewish nationality who had experienced the trauma of anti-Semitic persecution, but their life had not been directly threatened. The aim of the study was to find out whether feelings of guilt and shame are still present in narratives of the Holocaust survivors, years after their traumatic experiences. A quantitative analysis of responses concerning guilt and shame feelings revealed no significant differences between the study group and the controls. The paper presents a historical outline of thought regarding survivors’ guilt and shame. Combining data reported in the literature and contemporary narratives of the survivors, it can be hypothesized that we are confronted with a dynamic process of the survivor's working through grief and bereavement. An open question remains whether the bereavement process can be completed in survivors – it is difficult to complete because of the extent of trauma. Completion of the process is perhaps possible, but requires more time, besides, some conditions must be fulfilled first – particularly, a place for the Jewish Holocaust should be acknowledged and affirmed not only in personal narratives, but also in social discourse.     

Le syndrome de Münchhausen sur l’enfant

Extreme shape of child abuse during the most premature stages of the development the syndrome of Münchhausen continues to mobilize the clinical analyses and psychopathological interrogations about construction of child-mother relationship. The clinical polymorphism involving the child sends back to the complexity of the theorical elaborations of the early link.     

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.     

Le burn-out des médecins généralistes : influence de l’iniquité perçue et de l’orientation communautaire

Several studies suggest that general practitioners (GP) are among the professional groups particularly exposed to burnout. However, to date, only a few studies have investigated the causes of this psychological syndrome among GP. In the present study, we hypothesized that a perceived lack of reciprocity in relationships with patients impinges on GP's burnout. Indeed, some scholars have pointed out that establishing reciprocal relationships at work is essential for the individual's well being. According to equity theory, people pursue a balance between their investments in and the rewards gained from their work, such that their own investment/reward ratio is the same as that of similar others. Disturbance of this balance is expected to result in a variety of negative outcomes. Therefore, it was hypothesized that the lack of reciprocity in relationships with patients will be linked to burnout among GP. However, in situations of perceived inequity, the individual characteristic of communal orientation (i.e., a desire to give benefits in response to the perceived needs of others), has been found to buffer burnout. We therefore expected a moderating effect of communal orientation on burnout among GP who were high in communal orientation and who perceived their relationships with patients as inequitable. A sample of 259 GP (Response rate = 52%) completed a questionnaire designed to evaluate perceived inequity, communal orientation, and burnout. Perceived inequity was measured using Adam's formula. Communal orientation was measured using the French version of the scale elaborated by Clarks, Ouellette, Powell, & Milberg. Burnout was measured using the Maslach Burnout Inventory. Our results revealed a high prevalence of burnout in our sample. Furthermore, we observed that the majority of GP (52.4 %) felt underbenefited in their relationships with patients. And, as predicted, Analysis of Variance (ANOVA) confirmed that when they perceived their relationships with patients as inequitable, in particular when they experienced feeling of being underbenefited, general practitioners were more vulnerable to burnout. We also observed, as expected, a moderating effect of communal orientation on burnout in situations of perceived inequity. Therefore, this study confirmed that equity enhances our understanding of the influence of relationships with patients on the burnout of GP.     

Le repérage de l’affect dans l’entretien clinique avec le patient souffrant de schizophrénie : proposition méthodologique

The authors take up the question of expression of affect in clinical interview with schizophrenic patient from analysis of interactions; they underline that verbal interaction enable privileged investigation of affect rationality. They propose a reflection about a model of analysis and formalisation; this one may initiate the construction of a model which emphasizes the types of conversational shapes underlying therapeutic strategies of change. The emotive dimension, as it is studied in psychanalytic theories can be questionned by cognitive and conversational theories. Indeed, cognitive and conversational enlightenment are used to bring out marks of affect expression, on the one hand, about syntactic and semantic structure of utterances, on the other hand, about shapes of conversational structures. So, this article presents a method which permits to study structure of conversations as ground of accomplishment of affect expression in interaction. From an illustration, the authors explain how some clinician's interventions are a prop of exploration of affect in conversation. The studied conversational sequence invite to think that some modalities of interaction organize connection of subject with his own affects, updating it in therapeutic relation. The authors brings out the idea that conversational relation facilitate the creation of a specific psychic space permitting mutual prop between intersubjective ties and intrapsychic.     

Le concept de l’insight en psychiatrie

It was in France (particularly in the Société Médico-Psychologique 1869 to 1870) that the concept of insight into mental disorder began to appear around the middle of the 19^th century. Amongst other things, changing views concerning the nature of insanity, particularly the emergence of the notion of partial insanity, led to debates about the question of insight in patients with mental illness. Following a resurgence of interest in insight in psychiatry numerous empirical studies have sought to explore the relationship between patients’ insight and clinical variables. Results however have been variable and contradictory. Explanations for this can be found in the complexities inherent to the concept of insight. In order to tease these out, it is essential to distinguish between the concept and the phenomenon of insight and to view insight as a relational concept. Clarifying these issues around insight helps to define the ways and limits in which it is possible to capture insight empirically. In addition, it facilitates an understanding of insight as a mental state whose fluctuations are dependent on an interplay of psychological, pathological and wider sociocultural factors.     

Relations paradoxales entre l’internalisation et l’externalisation en psychopathologie de l’enfant : exemples de l’hyperactivité et de la dépression avec idées suicidaires

Introduction

The difference between internalising disorders (anxious and depressive disorders) and externalising disorders (conduct disorder and oppositional defiant disorder) is largely accepted by clinicians and researchers. Although hyperactivity may seem linked with the externalising disorders, recent empirical research suggested it could be often comorbid with depression, and recent theoretical research suggested it could be, at least partially, founded on psychodynamic mechanisms intended to master separation anxiety. These works suggest that the internalising dimension of hyperactivity may have been underestimated in empirical research. The purpose of this paper is to assess the level of internalisation in hyperactivity.

Method

Twenty five hyperactive children were compared with children presenting anxious disorders (N = 22), depressive disorder without suicidal ideation (N = 28), with suicidal ideation (N = 20), and academic learning disorders (N = 23). All diagnoses were made according to the ICD-10 criteria, which are very similar to the DSM criteria for anxious, depressive, and academic learning disorders, but are more stringent regarding hyperkinetic disorder than the DSM criteria for attention-deficit/hyperactivity disorder. Internalisation and externalisation were assessed by the Child Behavior Checklist (completed by one of their parents), and the presence of suicidal ideation was assessed on the basis of the Children Depression Inventory item 9.

Results

Hyperactive children exhibit more internalisation problems than those with learning disorder, but less than those with anxious and depressive disorders. Unexpectedly, depressive children with suicidal ideation presented high levels of delinquent and aggressive behaviour, equal or superior to those of the hyperactive children.

Discussion

These findings bring partial support to the psychodynamic view of hyperactivity. But they also underscore the unexpectedly high rate of externalising symptoms among depressive-suicidal children, whose pathology is theoretically regarded as a typically internalising disorder. In conclusion, these results suggest the relationship between externalisation and internalisation could be more complex than is generally assumed, and support the possibility of simultaneous presence of high levels of externalisation and internalisation in some disorders.     

Intérêts et limites de l’approche biologique pour l’étude des comportements agressifs

The complexity of violent behaviours (self or towards another person) implies multidimensional facets. Biology and neurosciences help to understand these phenomena.This work is a critical review of scientific literature in this area. Our goal is to underline elements implicated in criminal or suicidal behaviours.We describe : 1 - the main nervous structures involved, 2 - researchs on neuromediators, 3 - the influence of hormones, 4 - genetic outcomes, 5 - Acquired biological factors.     

Un anxiolytique naturel : l’hydrolysat trypsique de caséine alpha-s1 de lait bovin. Son intérêt en médecine humaine et vétérinaire

Tryptic hydrolysate from bovine milk alpha-s1 casein (THC), a natural product, contains a specific active decapeptide called alpha-casozepine which shows interesting pharmacological properties. Preclinical and clinical trials, as well as tests carried out on both humans and animals (rats, dogs, cats) demonstrated certain qualities of this hydrolysate. It shows a marked affinity for GABA-A receptors with a benzodiazepine-like profile and a tranquilizing and antistress activity associated with good tolerance characterized, in particular, by the absence of any habituation, dependence, sedation, memory impairment and toxicity. THC is a nutritional supplement (French regulatory status) which cannot be used as a substitute for psychotropes, such as benzodiazepines, in the treatment of severe anxiety and sleep disorders in respect of the medical recommendations. However, it could be effective in cases of slighter signs of these disorders. It could also be appropriate in the medical prevention and follow-up of subjects who have difficulty adapting to changes and stressful situations of daily life. An original pilot clinical trial respecting good practice and representative of the cases observed by General Practitioners (GPs) showed the interest of a global management program for benzodiazepine withdrawal. This global management program which included the use of THC opened a new application for it in general practice. As a result of a certain neuropsychiatric similarity between man and the domestic dog, we took the opportunity of presenting this natural tranquillizer in its application in both human and veterinary medicine.     

Les destins de l’inceste

The clinic of patients, victims of incest in childhood, invites us to question the fate of such psychical trauma and working-through issues offered by psychoanalytical treatments. Differentiation and articulation between the registers of the act and the factual reality, and those of fantasies and psychical reality, are at the heart of the psychoanalytical approach of incest. But, despite the theoretical contributions of Ferenczi on early trauma and because of a misunderstanding of the “abandonment of Neurotica” by Freud, psychoanalysis, until recently, has been accused of ignoring the specific sexual trauma by favouring only the psychical reality. A reassessment of this theory precedes a reflection on various figures of incest worked through in psychoanalytic literature: if the father-daughter incest is considered relatively often, mother-child incest, which is more rare in its genital forms, is nevertheless common on the form of perverted care, and is just as psychologically harmful. The difficulties of counter-transference work under intense transference reactivation show that the psychotherapist is attacked in his mental capacity to contain and associate. The particular destructiveness of incest trauma lies in its attack of the œdipal organization and its structuring value.     

Le SMPCAA : un espace pour les combattants de l’air

The SMPCAA, a service of psychology applied to aeronautics, was created in 1963 by General André Missenard, military psychiatrist, who wished to receive aviators in a specific medical space (fighter or transport pilots, helicopter pilots, flight engineers and other combat systems officers) in difficulty or in suffering in their professional activity. Since that time, several generations of psychologists and psychiatrists took turns to continue this mission and to support these air fighters, relentlessly and in any circumstances, in peacetime (the training) to war. From the common suffering of everyone (but which prevents to cope with the requirements of military aeronautics) to the war psychic disorders, the SMPCAA is a unique place where anything may be said and heard, with often the sole intention of flying to complete the mission.     

Le ravage au féminin : une quasi-structure inscrite dans la logique de l’amour

The author proposes to show in what devastation does it is to be apprehended like a “quasi-structure” relative to female, registered in the logic of the love. Report/ratio with the mother with the report/ratio with the lover, the devastation is done put to the test of the love, highlighting a logic beyond the phallus and implying the body. The paradigm of adolescence and more particularly the symptom anorexic clarify the statute of the body and its pleasure for the female subject. Behind the pretences, when they are untied, emerges the reality of the devastation. The love leads to the devastation when he asks even more identity, to be even more. The devastation leads to the hainamoration, this zone of the analytical experiment that Jacques Lacan highlighted in the vein of what it names passions to be. Hatred as fundamental passion is questioned here in its statute to be rehabilitated in a contemporary social link, which is harnessed to evacuate the dimension of the lack and the otherness whereas the body, place of the Other par excellence, pays the price of them.     

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.