Psychic Trauma Disturbs Networks of Meaning and Constitutes a Linguistic Wound

ObjectivesTrauma appears within the discourse of mentally injured people, materializing what we have recently defined as “post-traumatic psycholinguistic syndrome” (SPLIT). Translating unspeakability, flashbacks, and dissociation, this clinical entity associates three significant disturbances: traumatic anomia (missing words, reduction of the elocutionary flow, deictic gestures, etc.); linguistic repetitions (of words and phrases, verbal intrusions, echophrasias, etc.); and phrasal and discursive disorganization (incomplete sentences, tense discordance, dysfluence, lack of logical connectors, etc.). What are the causes of these semiological and psycholinguistic expressions? What are their psychological and/or neuropsychological processes? It is time to come up with a new concept intended to go beyond the previous models in order to better identify people suffering from post-traumatic mental disorders, to better organize and evaluate psychotherapeutic care, and also to help practitioners collaborate more effectively on these first two goals. But how to evoke, affirm, or speak out about the consequences of unspeakability? Nothing is more apparently contradictory than wanting to define the language void. How to account for the fractures of psychic trauma in discourse? Nothing is more uncertain than to try to organize the upheavals, the disorders caused by dissociation in language. Finally, how to specify the reiteration of the trauma using words and sentences without this modeling being dissociative or repetitive? Today, thanks to a psycholinguistic reading, essential dimensions of post-traumatic suffering, hitherto hidden, can be clarified. Why exactly does an event cause trauma in the life of a subject at a given moment in her/his existence? Why is a latency phase structured between the traumatic event and the return of flashbacks under the influence of a re-triggering factor? How to differentiate the notion of dissociation as a normal phenomenon from the so-called traumatic dissociation? How to explain the multiple clinical forms of post-traumatic psychological disorders?MethodsFrom Pierre's clinical history, we chronologically detail the structuring and the consequences of the signified reflection that are constitutive of the psychic trauma: the psycholinguistic tools here help to formulate a new etiopathogenic conception of trauma and its psychological consequences. Then, thanks to Jean's testimony, taking up the retrospective meaning of the clinical analysis from chronic repetition syndrome, we discover the phases of tension regarding signified knowledge, up to the network prior to the traumatic confrontation. Finally, illustrated by Karima's disorder, beyond depersonalization, we explain that the analysis of the disturbances of a singular signified network, and also of an attack on its familial and societal bases, testifies to individual and collective subjectivities.ResultsComing from the real world, and therefore also from the body, the stimuli made up of signals picked up by our senses combine to compose an event that can be objectified by its temporal, spatial, biological, and physico-chemical coordinates. These elements combine into a unit, which is then interpreted by the mind, which attributes meaning to this event, which has become subjective reality. But when the subject is not sufficiently prepared to be confronted with this meaning that appears to be in extreme contradiction with her/his previous cardinal networks of significations, it makes “too much sense:” this irreconcilable hyper-signified (that we call the traumatic signified) results in post-traumatic dissociation. In other words, it is an impossibility of concordance of a signified with certain systems of prior significations that constitutes the pathogenesis of the trauma; and a situation runs a greater risk of being traumatic when it contradicts, or, moreso, endangers some or all of the subject's cardinal meanings. This unbearable signified reflexively blocks the capacities of significations immediately pre- and post-trauma, then dissociates the psychic functions to varying degrees and intensities. The traumatic signified, rejected, becomes unattainable: the stimuli that led to its formation find themselves confined to the state of flashbacks, each replication of which attempts to cross the barrier of inconceivability. Limiting sensory compounds to their raw states without the possibility of representational integration, associative pathways remain blocked. The signifier is referred to a hypo-signifier confined to the infra-linguistic by its confusion with the referent, the “objective and material” components of the traumatic event. Dissociation is therefore only a symptomatic reaction, secondary to the trauma, which it reinforces once again by limiting any possibility of representing the trauma. This dissociation does not involve forgetting the traumatic signified but “protects” the adjacent networks of meanings from it as much as it “keeps” this hypersignified intact, therefore ultimately “protecting” it as well. The traumatic signified persists somewhere, and even ends up being found everywhere: when the networks of meanings turn out to be globally disturbed, the tightest links remain those of the traumatic hypersignified that ultimately governs all the networks of meanings.DiscussionOur insufficient knowledge prevents us from precisely qualifying the architecture of the signified idiosyncratic networks and their evolutionary capacities; we cannot predict, beforehand, the reaction of an individual confronted with a potentially psychotraumatic situation. For most clinical situations, we affirm that the psychological trauma occurs in a psychically healthy subject, that is, not suffering from any psychiatric illness or any obvious psychopathological conflict. Psychotherapy will make it possible to discover the signified, sometimes ancient, origins of a trauma occurring in a singular subject. How was this subjectivity constructed? Beyond individual subjectivity, the intensity of certain confrontations such as serious attacks or macrosocial catastrophes such as genocide, would seem to lead to psychological wounds in any individual, even at the scale of a population. While, throughout existence, each subject produces a system of significations in connection with a unique psychic construction, the latter persists -- resulting from, and often remaining overseen by, the community essence of a base of signifying networks, which we call “societal subjectivity.” Here, the psychological trauma can correspond to an individual and “common” injury as a failure of a sharing, or of ancestral beliefs anchored in the collective memory, defining the culture. By the collapse of acquired certainties, the cognitive patterns transmitted by education, language, and everything that establishes one's belonging to a society, trauma shakes the networks of individual and group meanings. Horror has a higher traumatogenic risk, because it defeats the fundamentals of humankind, the foundations of a signified network common to a culture, or even to all cultures, to the human condition. This is the case with murder, rape, torture, wars, genocides. Testifying to an instinct for survival stemming from the biological foundations of every living being, the impossibility of “living death” appears to be anchored in our networks of meanings and is manifested by indescribability, traumatic as such: being deserted by the language collides with the condition of speaking. And yet, it remains possible to say something about it… As a path of progressive desocialization, the occasional loss of the community of language, followed by its lasting traumatic ravages, can be appeased by the reestablishment of a speech link, either within the mind of the subject alone, or promoted by the exchange with others, in a psychotherapeutic setting, for example.ConclusionWhere theoretical discourses have sometimes proved divisive, going beyond the symptoms of indescribability and dissociation, psychodynamic practice today offers to unite. Thanks to psycholinguistic listening, phenomena that have never been explained take on meaning: the singularity of traumatic perception, the chronology of disorders including the latency phase, factors that trigger flashbacks, and the diversity of chronic clinical forms. All these post-traumatic symptoms are consequential to a linguistic wound, a difficulty in accessing meaning, the undermining of two dimensions characterizing and constructing the human being. As much as it integrates extralinguistic determinants, if the traumatic signified is undoubtedly not only speech, language appears the optimal way to identify it as such, while in the same movement appeasing it. The traumatic hypersignified is discovered through clinical analysis and psychotherapy, through deferred action, through the attribution of meaning, through the retrospective reconstruction of an unstable “real,” through a changing narration eternally distancing itself from flashbacks… But what precisely are the mechanisms of effective therapies? What are the intersubjective links called for in the discussion between patient and practitioner? Could the operations that we call “psychotherapy” be made up of mobilizations of the networks of meanings by speech acts?     

Le traumatisme psychique constitue une blessure du langage par atteinte des réseaux de significations

ObjectivesTrauma appears within the discourse of mentally injured people, materializing what we have recently defined as “post traumatic psycholinguistic syndrome” (SPLIT). Translating unspeakability, revival, and dissociation, this clinical entity associates three significant disturbances : traumatic anomia (missing words, reduction of the elocutionary flow, deictic gestures, etc.); linguistic repetitions (of words and phrases, verbal intrusions, echophrasias, etc.); and phrasal and discursive disorganization (incomplete sentences, tense discordance, dysfluence, lack of logical connectors, etc.). What are the causes of these semiological and psycholinguistic expressions? What are their psychological and/or neuropsychological processes? It is time to come up with a new concept intended to go beyond the previous models in order to better identify people suffering from post-traumatic mental disorders, to better organize and evaluate psychotherapeutic care, and also to help practitioners collaborate more effectively on these first two goals. But how to evoke, affirm, or speak out about the consequences of unspeakability? Nothing is more apparently contradictory than wanting to define the language void. How to account for the fractures of psychic trauma in discourse? Nothing is more uncertain than to try to organize the upheavals, the disorders caused by dissociation in language. Finally, how to specify the reiteration of the trauma using words and sentences without this modeling being dissociative or repetitive? Today, thanks to a psycholinguistic reading, essential dimensions of post-traumatic suffering, hitherto hidden, can be clarified. Why exactly does an event cause trauma in the life of a subject at a given moment in her/his existence? Why is a latency phase structured between the traumatic event and the return of reviviscences under the influence of a re-triggering factor? How to differentiate the notion of dissociation as a normal phenomenon from the so-called traumatic dissociation? How to explain the multiple clinical forms of post-traumatic psychological disorders?MethodsFrom Pierre's clinical history, we chronologically detail the structuring and the consequences of the signified reflection that are constitutive of the psychic trauma: the psycholinguistic tools here help to formulate a new etiopathogenic conception of trauma and its psychological consequences. Then, thanks to Jean's testimony, taking up the retrospective meaning of the clinical analysis from chronic repetition syndrome, we discover the phases of tension regarding signified knowledge, up to the network prior to the traumatic confrontation. Finally, illustrated by Karima's disorder, beyond depersonalization, we explain that the analysis of the disturbances of a singular signified network, and also of an attack on its familial and societal bases, testifies to individual and collective subjectivities.ResultsComing from the real world, and therefore also from the body, the stimuli made up of signals picked up by our senses combine to compose an event that can be objectified by its temporal, spatial, biological, and physico-chemical coordinates. These elements combine into a unit, which is then interpreted by the mind, which attributes meaning to this event, which has become subjective reality. But when the subject is not sufficiently prepared to be confronted with this meaning that appears to be in extreme contradiction with her/his previous cardinal networks of significations, it makes “too much sense:” this irreconcilable hyper-signified (that we call the traumatic signified) results in post-traumatic dissociation. In other words, it is an impossibility of concordance of a signified with certain systems of prior significations that constitutes the pathogenesis of the trauma; and a situation runs a greater risk of being traumatic when it contradicts, or, moreso, endangers some or all of the subject's cardinal meanings. This unbearable signified reflexively blocks the capacities of significations immediately pre- and post-trauma, then dissociates the psychic functions to varying degrees and intensities. The traumatic signified, rejected, becomes unattainable: the stimuli that led to its formation find themselves confined to the state of reviviscences, each replication of which attempts to cross the barrier of inconceivability. Limiting sensory compounds to their raw states without the possibility of representational integration, associative pathways remain blocked. The signifier is referred to a hypo-signifier confined to the infra-linguistic by its confusion with the referent, the “objective and material” components of the traumatic event. Dissociation is therefore only a symptomatic reaction, secondary to the trauma, which it reinforces once again by limiting any possibility of representing the trauma. This dissociation does not involve forgetting the traumatic signified but “protects” the adjacent networks of meanings from it as much as it “keeps” this hypersignified intact, therefore ultimately “protecting” it as well. The traumatic signified persists somewhere, and even ends up being found everywhere: when the networks of meanings turn out to be globally disturbed, the tightest links remain those of the traumatic hypersignified that ultimately governs all the networks of meanings.DiscussionOur insufficient knowledge prevents us from precisely qualifying the architecture of the signified idiosyncratic networks and their evolutionary capacities; we cannot predict, beforehand, the reaction of an individual confronted with a potentially psychotraumatic situation. For most clinical situations, we affirm that the psychological trauma occurs in a psychically healthy subject, that is, not suffering from any psychiatric illness or any obvious psychopathological conflict. Psychotherapy will make it possible to discover the signified, sometimes ancient, origins of a trauma occurring in a singular subject. How was this subjectivity constructed? Beyond individual subjectivity, the intensity of certain confrontations such as serious attacks or macrosocial catastrophes such as genocide, would seem to lead to psychological wounds in any individual, even at the scale of a population. While, throughout existence, each subject produces a system of significations in connection with a unique psychic construction, the latter persists – resulting from, and often remaining overseen by, the community essence of a base of signifying networks, which we call “societal subjectivity.” Here, the psychological trauma can correspond to an individual and “common” injury as a failure of a sharing, or of ancestral beliefs anchored in the collective memory, defining the culture. By the collapse of acquired certainties, the cognitive patterns transmitted by education, language, and everything that establishes one's belonging to a society, trauma shakes the networks of individual and group meanings. Horror has a higher traumatogenic risk, because it defeats the fundamentals of humankind, the foundations of a signified network common to a culture, or even to all cultures, to the human condition. This is the case with murder, rape, torture, wars, genocides. Testifying to an instinct for survival stemming from the biological foundations of every living being, the impossibility of “living death” appears to be anchored in our networks of meanings and is manifested by indescribability, traumatic as such: being deserted by the language collides with the condition of speaking. And yet, it remains possible to say something about it... As a path of progressive desocialization, the occasional loss of the community of language, followed by its lasting traumatic ravages, can be appeased by the reestablishment of a speech link, either within the mind of the subject alone, or promoted by the exchange with others, in a psychotherapeutic setting, for example.ConclusionWhere theoretical discourses have sometimes proved divisive, going beyond the symptoms of indescribability and dissociation, psychodynamic practice today offers to unite. Thanks to psycholinguistic listening, phenomena that have never been explained take on meaning: the singularity of traumatic perception, the chronology of disorders including the latency phase, factors that trigger reviviscences, and the diversity of chronic clinical forms. All these post-traumatic symptoms are consequential to a linguistic wound, a difficulty in accessing meaning, the undermining of two dimensions characterizing and constructing the human being. As much as it integrates extralinguistic determinants, if the traumatic signified is undoubtedly not only speech, language appears the optimal way to identify it as such, while in the same movement appeasing it. The traumatic hypersignified is discovered through clinical analysis and psychotherapy, through deferred action, through the attribution of meaning, through the retrospective reconstruction of an unstable “real,” through a changing narration eternally distancing itself from reviviscences. But what precisely are the mechanisms of effective therapies ? What are the intersubjective links called for in the discussion between patient and practitioner? Could the operations that we call “psychotherapy” be made up of mobilizations of the networks of meanings by speech acts?     

Game-XP: Action Games as Experimental Paradigms for Cognitive Science

Why games? How could anyone consider action games an experimental paradigm for Cognitive Science? In 1973, as one of three strategies he proposed for advancing Cognitive Science, Allen Newell exhorted us to “accept a single complex task and do all of it.” More specifically, he told us that rather than taking an “experimental psychology as usual approach,” we should “focus on a series of experimental and theoretical studies around a single complex task” so as to demonstrate that our theories of human cognition were powerful enough to explain “a genuine slab of human behavior” with the studies fitting into a detailed theoretical picture. Action games represent the type of experimental paradigm that Newell was advocating and the current state of programming expertise and laboratory equipment, along with the emergence of Big Data and naturally occurring datasets, provide the technologies and data needed to realize his vision. Action games enable us to escape from our field's regrettable focus on novice performance to develop theories that account for the full range of expertise through a twin focus on expertise sampling (across individuals) and longitudinal studies (within individuals) of simple and complex tasks.     

Schizophrenia — a category error

According to conventional psychiatry, the schizophrenic is a ‘patient’ helplessly in the grip of an ‘illness’ that ‘causes’ him to display abnormal social behaviour, much as a patient with diabetes displays abnormal carbohydrate metabolism. In fact, however, schizophrenic behaviour is conduct, not ‘symptom’. Persons called ‘schizophrenic’ do not lack the capacity to make moral decisions: on the contrary, they exaggerate the moral dimensions of ordinary acts, displaying a caricature of decision-making behaviour. “The last thing that can be said of a lunatic”, writes Gilbert K. Chesterton, “is that his actions are causeless. If any human acts may loosely be called causeless, they are the minor acts of a healthy man; whistling as he walks; slashing the grass with a stick; kicking his heels or rubbing his hands.” Chesterton² then delivers this stunning aphorism about madness: “The madman is not the man who has lost his reason. The madman is the man who has lost everything except his reason.”I agree. I believe that whatever small truth might lurk in the biological and psychological ‘explanations’ of schizophrenia, such accounts are largely false- for the same reason that the schizophrenic's ‘delusive’ explanations of the world about him are false: both accounts serve to disguise certain unbearably painful truths about human existence. In my opinion⁸, being schizophrenic (in the sense of schizophrenia as mental disease) is a career, just as being a psychiatrist is a career. We are now prevented from seeing this because officially ‘schizophrenia’ is the name of a psychosis and ‘psychiatry’ is the name of a profession. But names are only labels. Conventional psychiatry refuses to scrutinize schizophrenia as a name and insists that because it is the name of a disease, the thing it names is a disease. That reasoning is not worthy of further criticism.Except when used in the highly restricted sense of a name for an as yet undiscovered brain disease, schizophrenia is not a medical but a moral problem. Bleuler's great predecessor, that famous physician of the soul, has warned: “For what shall it profit a man, if he shall gain the whole world, and lose his own soul?” Jesus understood that the man who loses his soul loses everything — except his reason! That is why the poets used to call madmen “lost souls” or the “living dead”. Accordingly, such persons need spiritual regeneration (or generation) — something that theologians no longer respect and therapists refuse to recognize.The void between the spiritual and material realms has plagued mankind for millennia. In the past, men tried to fill that void with theological fables. Today they try to fill it with therapeutic fables. Among these fables, the theories and treatments of schizophrenia are among the most popular.     

Das Lachen im Psychodrama

This article in the journal “Zeitschrift für Psychodrama und Soziometrie” explains what laughing is about and what function it has in the psychodramatic process. Laughing plays a decisive role for Morenos therapeutic acting as well as for his world view. Just as he himself was a humourist, psychodramatics should also be humourists. Then they can help to make todays social process of acceleration seem ridiculous.     

Avarice et psychopathologie. À propos de L’Avare de Molière : persécution et compensation

ObjectivesFrom the pathological avarice of Harpagon in the play L’Avare (by Molière), we’ll show that this symptom has allowed Harpagon not to sink into madness, not to “derail” or “get out of the groove” (according to the etymology of the word “delusion”). The objective is therefore to report on the value of “preventive locums” (“suppleances”, according J. Lacan), or some of the so-called “compensation” symptoms.MethodologyThe article begins with a short review of the literature on the question of avarice in its relations to psychopathology. Then we will see all the elements that allow us to see the character of Harpagon not only as a domestic tyrant but as a true “persecuted-persecutor”. The theft of the famous “cassette” will shake deeply the psychic world of Harpagon. At this moment we see the emergence of delusion. This will be an opportunity to ask ourselves: what could avarice have been for Harpagon until then?ResultsAlways Harpagon is known as an unpleasant character, not only greedy, but also dry, hard, tyrannical, wary, proud, suspicious… Our study lead us to consider Harpagon's greed - the accumulation of his money, its gold, its “cassette” – as a means to fill a bottomless pit, a “chasm” that it is constantly about filling, and a cumulation that it is mainly about avoiding cutting. This can be deduced in part by his reactions to the loss of his “cassette-object” which really causes him to decompensate: paranoia, melancholic and claim, retribution elements…DiscussionThe discussion focuses on two interrelated points: the elements of persecution present in Harpagon, and the function of its pathological avarice in maintaining a state of relative stability. In particular, the importance of the “cassette-object” to Harpagon will be discussed; as its madness is triggered by its theft.ConclusionL’Avare is a comedy that somebody call “dark”. The character of Harpagon can be read and interpreted very differently: comical and/or ridiculous, or tragic, carried away by its pathological avarice. To take it seriously, to the letter, the play reveals all the importance that this avarice has for the precarious balance of the character, in other words it has for Harpagon a very special function, that of “support” for its existence. We see that an event related to being robbed, dispossessed, will come to falter his relationship to reality and to life itself, since Harpagon in his madness goes so far as to think of suicide.     

Richard III : du préjudice à la revendication

ObjectivesThis article sets out to explore the revengeful, retribution logic of Shakespeare's Richard III.MethodsThe method consists in a review of the literature (critical essays, psychiatric and psychoanalytic writings) on this historical play so as to define the central issue. This well-known figure of Shakespearean drama leads us to explore the question of perceived grievances and litigious or querulous paranoia (see Sérieux & Capgras, Clérambault, Lacan, etc) underpinning demands for one's for rights. On this point it is useful to recall the distinction between querulous delusion and interpretation delusion.ResultsMoving from the initial wrong or grievance sustained to a feeling of injustice and then on to the hateful claims precipitating the character into his criminal course, Richard III provides all the clinical components that enable this tragedy to be read in the light of querulous paranoia. The querulant – who sees himself as a victim of the Other – following in from the initial wrong, throws himself body and soul into obtaining reparation (the querulous paranoid subject can be summed up as “reparation is owed to me”). The trajectory chosen by Richer III takes him from being “deformed, unfinished, sent before my time into this breathing world” to “being determined to be a villain” by removing anyone standing in his way to the throne – or suspected of doing so.DiscussionThus the central element at the outset is the wrong or prejudice sustained (“I that am curtailed of this fair proportion”) that demands retribution at all costs. Richard III, deformed from birth, accuses the Other (“dissembling Nature”, his mother) and wants that Other to pay what is owing, thus inflicting on others the initial injustice. His bloodthirsty, destructive frenzy, his murderous enterprise devoid of any form of empathy, regret, or guilt, the details provided on his childhood and youth, his relationships with the law and with others all contribute to making Richard III above all a querulant or a persecuted persecutor with illusions of grandeur. Thus the central element in the discussion relates to the harm or prejudice sustained – damage that can also be encountered in other forms of psychosis, such as melancholy. The prejudice is interpreted and processed differently according to the person, and in particular according to whether the subject relates the wrongdoing to himself or accuses the Other of being responsible. For Richard III, the Other must be subjected to crime and punishment.ConclusionThe dark figure of Richard III, however terrible, criminal, and full of hate he may be, is even so not indifferent to us, and not without echoes for us. Freud analyzed him in this manner in 1916. In fact, any subject carries within him some sort of feeling of injustice, any subject “has the right” to lay claim to some form of harm or prejuduce, and in a way we are all, on a small scale, querulous subjects. But Richard II shows us in a sense that according to the type of clinical profile to which we belong, the harm or prejudice and the resulting claims for retribution take on very different forms. The morbid claims for retribution by Richard III suggest an egocentric querulous aranoia, or perhaps egocentric querulous psychosis where an “idealism of justice” (Dide) predominates: the subject is intent on justice being done to him.     

Les « Gueules Cassées », d’une génération à une autre : approche sociologique et psychopathologique des blessures de guerre

ObjectivesIn the context of present-day “asymmetric warfare”, it is becoming more and more difficult to find a response to the crucial question: “For whom, and for what, are we prepared to die?” In action far from his homeland, today's soldier has to work hard to make sense of his mission. Legitimacy is eroded by the fact that alternating states of war and peace change all the time, placing him at the mercy of an inconstant public opinion. More than any other entity, “Gueules Cassées” embody the horror of war, and the violence that we try to keep from seeing and seek to forget. How does one survive when one's body has lost its protective cover, when it unveils the shapelessness of flesh, a face that is indistinguishable from an animal's? How does one get back one's individuality when the only visible part of one's body, inaccessible even to oneself, becomes something monstrous?PatientsIn 1921, after the First World War, three horribly disfigured French soldiers founded an association to come to the aid of fellow comrades. They proposed an original way to support those who had sacrificed their faces for their country. They chose to give them back a social existence, something to build on, an attentive look. More than one hundred years later, their story is still applicable to the new generations injured in combat. We propose to analyze two real-life stories of disfigured soldiers during recent conflicts. They make us seek to understand the effects bodily injuries have on the psychological reality and to illuminate the process of “alterisation”. The evidence presented by “Gueules Cassées” forces one to question the theory that comprises the basic principle of identity in human beings, and to rethink the paradigm of alterity.ResultsFollowing this initial phase of reparation to the physical wounds, comes a much slower narcissistic reconstruction which requires a long period of work, in front of the mirror, under the scrutiny of others, and sometimes through a phase of symbolic identification: being one of the “Gueules Cassées”, “being a soldier with a scar, a war wound”… The support offered by the group, the right to dignity and reparation allows the wounded soldier to subscribe to a new type of recognition, the one offered by a new alterity. In fact, those most disfigured, after long years of “reconstruction”, have asked for more as the trauma went way beyond that of just their appearance. They asked to once again inhabit a society touched by amnesia. “To be a witness of”, is to get back some legitimacy and to make sense of the injury.ConclusionThe “Broken Faces” we met have tried to forge new ties with their kind, to pass on their experience. Entering into an “ethnic group” with common features has the effect of “symbolic transplant”, of recognition, and gives back an identity to the broken face.     

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.     

De l’identité numérique vers la personnalité connectée,du diagnosticien augmenté vers le soignant virtuel : quels enjeux pour la psychologie et la psychiatrie du futur ?

ObjectivesWho have we become, as citizens, patients, practitioners? How do the means of communication and the computerization of our society, its digitization, modify and integrate our identities? Can we assume that artificial intelligence will soon have a more accurate understanding of the human being from whom it will have emancipated itself?Materials and methodsWe move from lexicology to try to grasp, from the point of view of philosophy, a contemporary identity that is moving towards the notion of a “digital identity” whose normal or pathological psychological incidents lead to what we define as “the digital personality.” Then, laying the foundations for a contemporary psychology of identity, we consider how current “psychology” and “psychiatry” view the patient's “personality” and, in turn, how they define themselves from the point of view of “the patient,” or, inversely, from the point of view of the “online practitioner” or “connected researcher.”ResultsIn exchange for its “free” use, the Internet user's action on Web 2.0 produces content and feeds databases, whether this is declared or not. Users’ privacy is lost, as “their” data no longer belongs to them; and citizens’ identity is broken down into digital media functions: a site for meeting friends, a dating platform, a blog about hobbies or travel, etc. At the same time, digital identity is made up of an other-self, including a part of artificial intelligence that provides capacity for its own existence. Rather than two parallel, differentiable entities, real or augmented, a “realistic-virtual” hybrid identity is born. What are the normal or pathological consequences for humans? Postmodern societal trends emerging from or finding expression in the digital can lead to an exacerbation of previously existing personality traits, or even symptoms, in a given individual. At the same time, it happens that the modern means of communication become an aid to experience the world, to increase self-esteem, to dream favorably about one's fantasies, to confide more easily in “strangers,” etc. But in all cases, in the subject suffering, or not suffering, prior to his overexposure, from a neuropsychiatric disease or a psychopathological disorder, it now turns out to be scientifically documented that the increased numerical confrontation induces massive neuropsychic damage (weakening working memory, attention and concentration skills, skills in constructing sophisticated cognitive operations, etc.). On the psychopathological level, rather than the terminology of “identity disorder” or a notion of “co-identities,” the term “identity elusive" seems to us to best account for this mutation of the “me” where the border between reality and virtualities is shrinking: dissociation prevails. The postmodern human and its connected objects become one, but this “uniformity” appears to be made up of a patchwork of identifying confetti more or less joined together, without a real overall harmonization. The common personality is marked by hyperexpressiveness and hyperemotivity, to the detriment of the possibility of controlling affects and the development of introspective capacities. Against the risk of a vacuum, a contra-phobia tends to develop through the smartphone, by the object itself, by the possibility of constantly contacting relatives if necessary, and in return always remaining “available,” which fuels a form of addicting self-centeredness. The result of these developments, for society in general, is a weakening of language skills, and thus of reflection, including in the clinical and scientific space.DiscussionFor the areas of psychology and psychiatry, two developments are currently associated: a desire for “objectivity-scientificity” and a digitization of the patient–caregiver relationship. On the side of “science,” objective “factual” medicine is increasingly interested in pathology at the expense of the suffering subject, confusing sign and symptom, sliding down to a molecular level, far below the patient, towards psychiatry or postclinical psychology. Whether we want to promote it or destroy it, on the side of the clinician or the researcher, “subjectivity” has become a fashionable signifier in the field of mental health. This current return of the “subjective” thrives on a kind of fear of subjectivity present since the end of World War II, which had led American nosography towards the “objectives” of the DSM (Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association since 1952). But rather than a verifiable and/or invariable knowledge concerning a particular psychic disorder, the changes and the relativity of nosographic entities from one version of the manual to another provides us with a mirror image of the subjectivity of an era, which we propose to call “societal subjectivity.” As much as it is a product of our time, the bio-digital revolution will probably impose itself in a future edition of nosography: the diagnostic validity should be increased by the precise definition of biological and/or neuroradiological markers, if these participate in building an etiopathogenic theory of observed psychic phenomena. This orientation remains in its infancy, however: in addition to the tiny number of identified biomarkers, and above all, those that are usable in daily practice, their causal or consequential links with symptoms or with the morbid process remain most often uncertain, inasmuch as they are diverse and interrelated. The neuroscience researcher aims to measure and analyze a multitude of data, integrating, in particular, mimicry and emotions authenticated by thermal camera; movements of body segments and gaze dynamics recorded by sensors; the standardization of voices and speeches for computer software analysis of prosody, used signifiers, syntax… all of which is integrated into a digital phenotyping of suffering. Will we soon be able to speak, replacing the psychologist or the psychiatrist, of an “augmented diagnostician?”.ConclusionDoes it currently appear risky to trust an entirely virtual therapist… an experiment already launched more than 50 years ago! The human being is a “being of meaning,” yet, according to the model of trauma, the emergence of the all-digital can lead to a “collapse of meaning,” generating a tendency to personality dissociation. Granting the reestablishment of the links between emotions, affects, behaviors, and cognitions, spoken language attenuates dissociation, then makes it disappear. Guided by the practitioner, this therapeutic word is sometimes qualified as “maieutics,” from the name of the science of childbirth: it builds thought synchronously to its essence, and an awareness of it, rather than nondisclosure, would account for it secondarily. It is a causal reinterpretation of a meaning understood or rather “attributed” singularly by the subject, after the fact: the past revisited in the present moment creates a synthesis, and chance is transformed into fate. The speaking subject re-elaborates her/his story towards a semantic reconstruction, a densification of her/his networks of signification. Reclaiming one's being by the creation of a discourse, of veridical as well as fictional meanders, narration, even poetization, offers the punctual illusion of a better coherence, always relative, illusory… Therapeutic speech and discourse about such speech–these are still being made, unfinished, uncertain, and alive. These are the characteristics of what we could a “post-psychotherapy,” that is, a psychotherapy and not a re-educational technique whose objectives would be fixed and known in advance. The notions of facts and reality are secondary here, not in the sense of the objective, nor even of the subjective, but of the second degree, then of other successive or overlapping degrees that require intellectual effort. Moving towards appeasement, if we wanted to bring the reflection to its paroxysm, we could advance that it would be enough to give “any meaning,” whatever it may be. This would apply both to the patient and to the practitioner, without each party's meaning necessarily being the same: a testimony to a formally invalid intersubjective construction.     

History of Guillain-Barré syndrome

1916: birth in Paris of a modest syndrome presented to a weekly meeting of the Société Médicale by Georges Guillain, Jean-Alexandre Barré and André Strohl. 1981: glorification of the syndrome as a world event in Santa Inez Valley at the International Conference held under the auspices of the Kroc Foundation. This is indeed a long way from a few clinicians and internists to the representatives of all branches of the Neurological Sciences for "la radiculo-névrite avec dissociation albumino-cytologique à évolution spontanément régressive "studied in two soldiers of the Vth French Army. Every neurologist from clinician to researcher currently knows this model of inflammatory and demyelinating diseases of the peripheral nervous system and the pros and cons of cellular vs humeral immunity which are presumed to be its pathophysiological process. What is less known is "la petite histoire" i.e. that of men and events which surrounded its birth and growth to being an entity. Why did André Strohl disappear? Who were L. Duménil and O. Landry? Should we say Guillain-Barré?, Landry-Guillain-Barré?, Duménil-Landry-Guillain-Barré? Unexpected or poorly known facts are not lacking in this story the last of which being that most references to that most French syndrome are to be found in English and American books.     

Can Strategic Ignorance Explain the Evolution of Love?

People's devotion to, and love for, their romantic partners poses an evolutionary puzzle: Why is it better to stop your search for other partners once you enter a serious relationship when you could continue to search for somebody better? A recent formal model based on “strategic ignorance” suggests that such behavior can be adaptive and favored by natural selection, so long as you can signal your unwillingness to “look” for other potential mates to your current partner. Here, we re‐examine this conclusion with a more detailed model designed to capture specific features of romantic relationships. We find, surprisingly, that devotion does not typically evolve in our model: Selection favors agents who choose to “look” while in relationships and who allow their partners to do the same. Non‐looking is only expected to evolve if there is an extremely large cost associated with being left by your partner. Our results therefore raise questions about the role of strategic ignorance in explaining the evolution of love.     

Putnam,Merritt, and the Discovery of Dilantin®

In the first part of this essay, the “common wisdom” about Putnam and Merritt's contributions to the treatment of epilepsy was summarized (Rowland, 1982). Based on the history that has been presented here, how true are these “wisdoms”? Putnam and Merritt did devise “a simple and reliable method to test drugs of anticonvulsant effect” and they did show “that anticonvulsant effects in cats accurately predicted effects in humans,” but others before them had done these same things. Dilantin, contrary to common wisdom, was not the first anticonvulsant drug to be tested in animals before it was given to human subjects; at least a year before, Cobb and his co-workers had done the same thing using vital dyes. However, Dilantin did represent the first time an anticonvulsant tested in animals was subsequently studied in a large series of patients. Nor were Putnam and Merritt the first to show that “anticonvulsant and sedative effects of drugs could be separated.” Potassium borotartrate, ketogenic diet, ketone bodies, and vital dyes were anticonvulsive without necessarily being sedative. However, Putnam and Merritt were probably the first to make so explicit a statement to this effect. It may well have been this particular statement—and the fact that it was so well heard by other researchers—that represented their greatest achievement. In Kuhn's theory of scientific revolutions, the great step forward may not be so much the accumulation of evidence that the existing paradigm is not a feasible one, but rather the use of this evidence to form a new model or paradigm which is then accepted by normal science in such a fashion that the results prove to be productive. This, it would seem, is what Putnam and Merritt did. From it came their own major discovery, Dilantin, which, in Rowland's words, remains “a mainstay of treatment” for epilepsy up to the present time, and which “opened the way to the development of other anticonvulsant drugs.”     

Trouble psychotique partagé ou trouble délirant induit ? Étude d’un cas clinique

Can a delusional idea be contagious? This question may seem paradoxical when we know that the very definition of delirium correspond to “an erroneous belief (…) maintained despite the very generally shared opinion” (DSM4) and so implies that peers do not share the beliefs expressed by the subject. However, cases of collective delirium have been described for many years, and have been the subject of numerous scientific publications since the 19th century. Among them, an entity emerged : “folie à deux”, in which a primary active subject could induce his delusions to a secondary subject, more vulnerable, said induced and passive. In 1877, Lasègue and Falret first introduced the term “folie à deux” and proposed the diagnostic criteria. They describe nine essential criteria among which, three would be the sine qua non conditions that can allow the outbreak of a delirium shared by two. They are the presence of an active element of superior intelligence, the existence of a common life between the two individuals, sufficiently long and intimate and a “closed and isolated” environment. These criteria were subsequently supplemented to arrive at the current definitions of induced delusional disorder (ICD10) and shared psychotic disorder (DSM4). This rare disorder has been the subject of numerous publications. However, these publications were often divided over both its epidemiology, its diagnostic criteria, and the specific treatment to be offered. The two recent definitions resulting from current classifications can also illustrate this dichotomy on certain criteria, beyond the very semantics which here oppose the terms “induced delusional” and “shared psychosis”. Moreover, this disorder has the particularity to question its real existence as it is currently challenged in the new classifications of the DSM V and ICD 11. We can therefore see that if the subject fascinates, it divides. What is it really? Can a delirium really be transmitted? Can a psychosis really be shared? And if so, is one of the two definitions more suitable to describe this disorder? What future can we imagine for this pathology? During the hospitalization of a patient for a “délire à deux”, concerning two persons from two different families sharing a delirium of filiation, we observed the current issues around this disorder and we asked ourselves which treatment to administer to these patients. The hospitalization took place over two stages: the first stage to understand the disorder, the second one to treat it. À family interview was conducted in the presence of the dyad of patients, to explore the interactional elements together, and establish the diagnosis. A preliminary step essential to therapeutic work on the question of loyalty and differentiation. This clinical case recalls the value of an integrated approach based on the systemic epistemology, both for the diagnostic phase than during therapeutic support. The objective of this work is to study, through an atypical clinical case and a review of recent literature, the different diagnostic, therapeutic and evolutionary perspectives of this particular pathology.     

Breaking the Silence,or Who Says Shut Up?

Abstract

In place of the question “Can we talk?” this article explores what keeps us from speaking, and also from listening, to voices that through time and across cultures have broken the silences in our midst. By highlighting the relational capacities that are with us practically from birth (including our ability to register the obvious and give voice to our experience), I draw on girls’ voices across a range of settings to articulate the tension we face when, paradoxically, a sacrifice of voice becomes the price of having relationships. Why have #MeToo and Time’s Up taken us by surprise when in fact most of us knew what was going on? Why did the Parkland School activists strike us as so articulate when in truth they were naming the obvious? As a culture, we have granted sexual license to powerful men and valued guns more than children. Women’s silence and men’s violence are the mainstays of this patriarchal order. By breaking silence, women, along with the men who have joined them, are leaving the confines of patriarchy. By interrogating the voice that says shut up, they are contesting those invested in perpetuating a culture that values honor over love and life.     

The analyst, the transference, and the representational world.

Viewing the phenomenon of transference within the metapsychological context of the representational world, and the shapes of the important past and present object representations in it, has a clarifying value. Any new approach to what Freud characterized as “the almost inexhaustible topic of transference”¹ is justified because of the central position it holds in the analytic treatment process. The basic idea presented in this paper is that transference can be viewed in terms of the changing shapes of the object representation of the analyst as he is formed and transformed in the representational world during the course of the analysis. These changes are affected by the regression during analysis, the influences of the patient's important past object and self representations which are laid down in his representational world (particularly in the unconscious part of it), the interventions of the analyst, and other occurrences during the course of the analysis.The term “transference” has been defined in a variety of ways. I will use the definition of Sandler et al.²—“a special illusion which develops in regard to the other person, one which, unbeknown to the subject, represents, in some of its features, a repetition of a relationship towards an important figure in the person's past … this is felt by the subject, not as a repetition of the past, but as strictly appropriate to the present and to the particular person involved.”The term transference has also been described in terms of the transference neurosis, the externalization of the superego, projections of the id or aspects of the patient's own self-representation onto the analyst, “character” transferences, the “basic” or “primary” transference of the working alliance, “ready-made” transferences, acting-out of transference, and so on. Some of these will be dealt with in this paper.     

Au nom de la raison neurobiologique

Problem

Neurobiology, adorned with the most recent discoveries of the molecular biology, the genetics and the cognitive sciences, is present everywhere: In the report of the man with his body, with his intellectual faculties, with his perception of others and himself. Our social conducts, morality and our affects would be governed by neuronal substrata. Are things so simple?

Fetal growth in the offspring of epileptic women: results of an Italian multicentric cohort study

An historical cohort study of the association between maternal epilepsy, anticonvulsant drugs and fetal growth was carried out among 47 hospitals collaborating in the Italian Multicentric Registry on Birth Defects (IPIMC). Birth weight, head circumference and body length were studied in 164 babies of epileptic women and compared to 185 controls. Seventy-nine epileptic women were treated by monotherapy, 59 by polytherapy and 26 took no anticonvulsant during pregnancy. An intrauterine growth retardation and a smaller head circumference was observed among babies of epileptic women. No effect was evident for body length. When specific anticonvulsant therapies were taken into account, only phenobarbital showed an effect on birth weight and head circumference; a reduction in head circumference was observed also in the babies of untreated epileptic women. The other antiepileptics (carbamazepine and valproic acid) showed no influence on the outcome considered. The observed effects on fetal growth can be interpreted as a result of an interaction between the effect of the maternal disease and that of the anticonvulsants.     

La « maison » en psychanalyse. Cliniques du seuil

Introduction

Apprehending the issue of “the house” using a psychoanalytical approach opens the way to addressing such notions as “boundary” or “home”. How can the discovery of the unconscious help to revisit the preexisting categories of the familiar and the foreign? Does psychoanalysis accomodate “a home of one's own”? What would be the Freudian conception of the home?