Honte et paranoïa

This study examines what happens to shame in paranoid psychosis, and emphasizes how the treatment of shame can follow on from delusion, via the construction of a persecuting ‘Other’. This may give rise to the impression that the paranoid subject is free from shame, placing all the shameful enjoyment on this ‘Other’. It will be demonstrated that this is not the case when this subject returning from their deluded state is convinced, in particular, that their dignity has been affected and that they have been reduced, by the ‘Other’, to the level of a shameful object.     

Joueurs de machines à sous dans une population française : étude de la dépression, de l’alexithymie et de la recherche de sensations

There are a multitude of factors implied in the acquisition, the development and the maintenance of gambling behavior. Among them, sensation seeking occupies an important place. Zuckerman originally suggested a relationship between sensation seeking and gambling. However, studies in this area have provided heterogeneous results. To explain these discrepancies, Zuckerman emphasized the fact that the type of gambling may be a crucial factor in the relationship with sensation seeking. Nevertheless, few studies have evaluated the link between the different types of gambling and problem behaviors. Furthermore, few studies were interested specifically on slot machines. While recent research has found high-levels of alexithymia in individuals with substance use and eating disorders only two studies have investigated the relationship between alexithymia and pathological gambling. Thus, these studies were focused on students. It is therefore important to study alexithymia in adult gamblers. Empirical data has shown that alexithymia levels may be influenced by negative mood states, especially depression. Some studies have found a positive correlation between alexithymia and depression scores, particularly in people with addictive behaviours. Nevertheless, studies found heterogeneous results. The main objective of this research was to evaluate scores on sensation seeking, alexithymia and depression (and the link between those variables) in gamblers of slot machines. Thus, slot machines gamblers were selected in the casino of Enghien-les-Bains, which is Paris nearest casino. Among them one distinguishes: regular gamblers (n = 45) from which were extracted pathological gamblers (n = 27), and occasional gamblers (n = 19). The South Oaks Gambling Screen and the criteria of the DSM-IV were used to measure the intensity of gambling behavior; sensation seeking was evaluated by the Sensation Seeking Scale form V; alexithymia by the Toronto Alexithymia Scale (TAS-20) and the depression by the Beck Depression Inventory. No differences appeared significant between the three groups of gamblers for the sensation seeking scores. Pathological gamblers obtained higher alexithymia scores than occasional gamblers. Nevertheless, these findings didn’t remain stable when controlling for the effect of depression. Among pathological gamblers, the BDI score is positively correlated to the ‘difficulty identifying feelings’ factor. This result is consistent with the literature, which shows that alexithymia is closely related to depression in addictive behaviors. Indeed, the ‘difficulty identifying feelings’ factor seems to be explained by depression severity. These results suggest that the emotional component of alexithymia would be thymo-dependent, whereas the cognitive component would be independent and constitute a stable clinical feature. Pathological gamblers who play slot machine are low sensation seekers who shun the more dramatic and extraverted form of sensation seeking. They play to reduce or avoid unpleasant emotional states like depression. Pathological gambling could therefore be in part a maladaptive coping strategy to deal with affective disturbances; the game may function as a self-medication to treat emotional states, which the gambler finds no other way of treating. According to previous studies, slot machine gambling is referred to as ‘escape’ gambling, where gamblers may dissociate.     

Réflexions sur le statut de la mythomanie délirante

Delusional mythomania is nowadays an underestimated issue. This author retraces the evolution of the concept from the beginning of the XIXth century to present times. Initially envisaged under the guise of megalomania, it was first seen as a subspecies of monomania, untill it underwent several attempts of integretion as a specific moment of the psychotic process. In the 1880’s, there was a heated debate at the Société Médico-psychologique in Paris between the supporters of Valentin Magnan’s “délire chronique à évolution systématique” who claimed that megalomania was a defense against persécution and the instrument of systematization that unmistakably preluded to final dementia, and on the other side clinicians like Mairet or Foville who claimed that in many cases no relationship could be evidenced between persecution and megalomania, and that the latter could usually be found at any moment of the psychotic process. At the end of the XIXth century, the discussions of psychotic mythomania within the German school mainly focussed on its relationship with memory errors. In his attempted systematization, Dupré described a “mechanism of imagination” which he separated from hallucinations and delusional interpretations. Nevertheless, neither he nor Kraepelin (paraphrenia) managed to derive a clear-cut clinical entity out of that. At the beginning of the XXth century, several syndromes were described that were clearly identified with psychotic mythomania: the Capgras syndrome, the Fregoli syndrome, and the intermetamorphosis syndrome, all of which were described as non-specific body-image disorders within various psychotic processes, rather than as independent disorders. Finally, this writer proposes to consider that delusional mythomania should be seen as an attempt by psychotic patients to describe the jouissance de l’Autre, such as it has been characterized by Lacan in his last seminars.     

La Scientologie : un délire systématisé inspiré par les Études sur l’hystérie, de Breuer et Freud

Was Lafayette-Ronald Hubbard, the famous founder of the Church of Scientology, psychotic? From this question, we have tried to rethink the analysis of this sect. We approached the scientologist doctrine in the Freudian way, that is as a “recovery attempt” – like the delirious, which enabled Hubbard to treat, through his writings, the teeming elementary psychotics phenomena, which harassed him. The study of his first “philosophical” book, Dianetics: The modern science of mental health, will show us, in a quasi-experimental way, the intense work of the delirious, which enabled him to put back together his broken-down universe, to inject sense into the sluggishness resulting from his psychotic decompensation, and finally to reintegrate the social tie. Scientology's writings will then reveal to us their hidden source: Studies on hysteria, by J. Breuer and S. Freud, which had strongly inspired Hubbard. Through a comparative analysis of these two texts, we will show how Hubbard managed to adapt hysteria's etiology into the way of his own psychotic experience, so as to include it inside his delirious system.     

L’illusion des sosies de Capgras : une interprétation délirante d’un trouble spécifique de la reconnaissance affective des visages. Revue de la littérature et proposition d’un modèle séquentiel

Capgras’ syndrome is the first misidentification syndrome described. It was originally individualized in 1923 by the French psychiatrist Joseph Capgras who termed it “l’illusion des sosies”. The subject has the delusional belief that people emotionally close to him have been replaced by doubles physically similar to the originals, but psychologically different. The impostors are generally persecutors. There is sometimes double of the self. Capgras’ syndrome is the most common of the delusional misidentification syndromes (Fregoli syndrome, the syndrome of inter-metamorphosis and the syndrome of subjective double) but is relatively rare, occurring predominantly in the context of paranoid schizophrenia. However, more recently, it has been estimated that a quarter to a third of these cases are associated with neurological, toxic or other organic disorders. And the course of the Capgras syndrome generally follows the course of the basic illness. Thus, there is some discussion in the literature about whether the delusion of doubles should be considered as a syndrome or a symptom. Moreover, neuro-imaging exploration suggests a link between Capgras’ syndrome and right hemisphere abnormalities (particularly in the frontal and temporal regions). Neuropsychological research has reported the presence of impairments in facial processing (which is an established right hemisphere function). Ellis and Young adapted Bauer’s two routes to face recognition model: one ventral visual-limbic route for the overt recognition and one dorsal visual-limbic route for the covert recognition. These authors propose that Capgras patients present an intact ventral route which leads to physical face recognition, but a disconnected dorsal route which prevents the affective confirmation of this recognition. Capgras delusion would be the mirror of prosopagnosia resulting from the preserved overt recognition coupled with a loss of affective responses. After a review of the literature relative to the psychodynamic approaches of Capgras’ syndrome (feelings of depersonalization, problem of ambivalence, affective trouble, incestuous desires…), we have described an original case of Capgras’ syndrome occurring without an organic or psychiatric context. We suggest a re-examination of this curious trouble: the Capgras’ syndrome would be an autonomic entity, which could consist firstly in a functional deficit of affective identification face, this affectivity trouble could be rationalised by the patient and would lead secondly to a delusional interpretation. Capgras patients would recognise the intimate’s face physically but not affectively. The deficit of affective face identification could be caused by organic lesions or functional troubles (psychiatric troubles) or, in our case, by an isolated functional trouble. This loss of affective familiarity of a close relative could be explored by the Bruyer and Schweich face recognition Test. In the case we are considering, patients would attempt to explain this contradictory information by a delusion. This dissociated perceptual experience (known face but strangeness feelings) could be interpreted to make sense and would then produce Capgras delusion.     

Phénomènes d’allure télépathique dans la relation thérapeutique avec des patients schizophrènes : hypothèse d’une potentielle nocivité de la pensée soignante

Telepathic phenomena within the transference relationship with psychotic patients are regularly described by many authors, well-known serious psychoanalysts; many examples will be proposed. Telepathy was a noted subject of scientific studies between the end of the 19 and the beginning of the 20-century. Many examples got from the author's clinical experience will show that in the frame of a long-term therapy with psychotic patients, some telepathic-like phenomena can occur. We propose to name “telepathic identification” such moments when the therapist stops to pay attention to his patient's speech, monopolized by a sudden concern, and when the patient begin to talk about this very concern as if it was one of his own. Many explanatory hypotheses will be developed. The author emphasizes also the possible iatrogenical influence of the therapist's mental objects, as well his concerns as his theoretical models. At last, the hypothesis of a “telepathic identification” is considered as a manner to avoid being abandoned by the therapist, a mechanism, which originates in the early mother-infant interactions.     

Qu’est-ce qu’une clinique de l’exil ?

This article examines the clinical and theoretical situation that leads us to propose the concept of a ‘psychotherapeutic approach to exile’ which we have considered for a dozen or so years, in order to re-examine the mental disorders of immigrants linked to the mouvement away from their place of origin. On the one hand, it involves a critical approach to the psychopathology of ‘immigration’ and ‘transplantation’, in which the model of direct traumatic causality and the adaptive target frequently dominates, followed by the culture-based model developed by French ethnopsychiatry. On the other hand, the therapeutic approach involved is based on listening to the patients, and on taking into account the subjective incidence of moving from place to place over several generations. During our studies, the question of ‘place’ emerged as the most critical issue to the extent that it is a risk factor, which could have an effect on both existential and psychic habitability.     

Désir de corps, désir de l'Autre

Desire Lacan explains, is neither demand, nor need. The desire of the psychoanalyst, defines the praxis in a cure, and this in this perspective that I have questioned the difference between the desire referred to the Other which the analyst is, represents for a patient, and the desire that can arise between two persons linked and moved by transference. A psychoanalyst, meanwhile, should not forget that his function give him a certain power and that, in all cures, the specific place of the body depends on him; so that the real physical jouissance is strictly forbidden by psychoanalytic ethics.     

La réaction à la nouveauté : un indice de dépistage précoce de l’autisme ?

A certain number of autistic children seem to develop normally for the first 12 months of their lives to regress then or have their development stop, and manifest a pathology of autism near 18months. From the data present in the literature, and our clinical observation in this article we will attempt to demonstrate that it is possible to diagnose the autistic pathology within the aforementioned category of infants before the appearance of the obvious symptoms, that is to say during their 1st year as well as to propose a reflection on the aptitudes that fall into place during this period and which prepare the sequel of their development, and finally, to examine the possible role of the reaction to the novelty of the stimuli in the early diagnosis of this pathology. It has to be said that the clinical observation of autistic children, the testimony of their parents and of young high level autistic adults underline a recurrent symptom in this population, whatever their age or level of achievement: It is the difficulty or even the impossibility they experience when faced with new situations, demonstrated by a marked resistance to changes in their daily routine. These subjects appear to present an obsessive and anguished need to preserve a stable environment without the slightest transformation. It seems that they have an extremely intense reaction to the novelty of stimuli. Does this particularity exist in the infant who will become an autistic child, could parents identify this particularity, and could it constitute a sign for the early diagnosis of autism? Around 60 % of these children “become” autistic after their first birthday. In some, the developmental curve shifts and the signs of autism appear gradually. In others, a phenomenon of regression is described at the same time as the emergence of behavioral problems. The fields where this regression is most obvious are language and social interaction. Our hypothesis is that the syndrome of autism does not suddenly appear at the age of eighteen months, but that its ‘emergence’ is in the making during the infant's first months through a series of dysfunctional phenomena, that are unobtrusive and so go unnoticed by the parents. We have explored these phenomena, using the cognitive genesis habitually described in children with a typical development. We arrived at the conclusion that the subtle disorders relative to the perceptive-sensorial treatments have since the beginning gradually invaded the sphere of their relation to the surrounding world, perturbing their experience of closeness and bonding. Anomalies which lead to faults in the pattern of expected aptitudes, faults which undermine and weaken the foundations, leading to a movement of reversal during the second year and to the massive actualization of the signs of autism, which had previously been latent because the aptitudes, which should have been the base on which the subsequent ones stand, cannot develop due to the missing support of the previous ones, so that the evolutional dynamics are interrupted. Communicational and social behavioral disorders in autistic subjects might come, at least in part, from a major difficulty early on, in processing new aspects of their environment, which are often saturated with dynamic informations. Our study leads us to think that the abnormal reaction of patients with autism faced with the novelty of a situation constitutes one of the key deficits of autism and could be a sign for the diagnosis of this pathology in the first months of life.     

Gilbert Ballet et la médiumnité. Contribution à l’histoire de la psychose hallucinatoire chronique et à celle des divisions subjectives

The mediumnistic state played a central role in the history of psychopathology, but it was often ignored or barely commented upon in psychiatric reports. The example of Gilbert Ballet’s introduction of the concept of chronic hallucinatory psychosis in 1911 provides us with a means of determining the social, clinical and epistemiological context at the time and of showing the pregnance concerning the construction of the normal or manic mediumnistic state. In fact, a certain examination of the mediumnistic trance offers elements and a model for a psychopathological approach to subjective, neurotic or psychotic divisions. This recourse to history is justified by the new upsurge of subjective divisions connected with current New age mediumnistic states.     

Éléments d’introduction à la question du rêve dans la psychose

Many psychotic patients bring into psychotherapy or into psychoanalytic treatment some elements of dreams. Sometimes, psychoanalysts or psychologists are quite embarrassed by these elements: should we interpret them? Should we encourage these patients to associate? For beginning, the author proposes few Freudian references concerning relations between dreams and psychosis. Then, we’ll see how many authors consider the role of dream into psychosis. Therefore, we’ll show the difference between dream and delirium, and we’ll insist on which utilization of his dream the psychotic patient can make. At last, we’ll consider three psychoanalytic concepts: the “umbilicus of dream”, the Real (Réel, in French), and the “semblant” (these two last concepts are lacanian concepts). With these concepts, we’ll apprehend the structure of psychotic dream, his statute, his function, and how it could help us in our profession.     

Les effets psychopathologiques de l’implant cochléaire

The cochlear implant produces a “chaos of sound” where sounds and meanings are dissociated. This experience is similar to a dissociative state which jeopardize the solidity of the personality structure. Based upon a various clinical cases, our research shows that the medical technique of cochlear implant can produce a real amelioration in the case of a depressed patient. Meanwhile, the other result of our research is that there is a gap between the metallic recovered voice of postimplant and the expected one. This gape may activate mental breakdown phenomenon related to mourning. We had been able to produce another data related to the loss of impaired hearing status. Since a disability can contribute to build one's ego, the loss of this disability contribute to the loss of this “surrogate” ego. Our research conclude therefore that in one hand there is a remarkable variety of cochlear implant effects upon neurotic person and on the other hand that psychotic structure, though already recognized or predictable without necessary being diagnosed, must be handled carefully since there is a high risk of both the irruption or aggravation of the psychotic state.     

Politique et délire

The medico-philosophical study of relations between the physical and moral aspects of man developed during a period marked by major revolutionary movements from the end of the XVIIIth century to the middle of the XIXth century. The authors who published texts on delirious forms recognized as such were often influenced by the dramatic episodes of these revolutions. In Pinel's texts, there are several observations of the insane for who the delusions are directly related to political events both in content as well as in genesis. On the contrary, some of the texts of Esquirol and his students tend to indicate that revolutionary convulsions are themselves the result of a kind of collective folly and that it is participation in these movements that constitutes individual mental insanity. The idea of “to be Napoleon” spreads around during the Monarchie de Juillet following the return of the Emperor's ashes; the popular success of this ceremony had transformed the real person into a myth to which the delirious megalomaniac could identify.     

L'élaboration lacanienne de la jouissance Autre

In this study, the author has examined the way in which Lacan has introduced and developed the concept of ‘other than sexually derived pleasure’. In Lacan’s work, the specificity of ‘other than sexually derived pleasure’ or ‘feminine pleasure’ first took the form of an intuition, which later led to further development of the concept. Its logical emergence was made possible by the progressive introduction and examination of the various aspects of the Real, the Symbolic and the Imaginary.