L'expérience du corps vécu dans la paranoïa

The concept of Paranoia is almost synonymous with a certain “interpretative” style, whether it refers to emotionally disturbed or frankly manic states. This intellectualization, which is to a large extent a result of the psychopathological matrix from which Paranoia issued has in fact limited comprehension of the latter, in particular as regards the two following aspects: on the one hand, the distinction between a “sectorial” manic state that nevertheless has a marked confiscatory effect on the person's entire existence and a “network-associated” delirium that remains compatible with a certain social integration; and on the other hand, the marginalization of the hypochondria that is frequently observed in these patients and which may include a possible accusatory component (e.g. laying the blame on the therapist and associated structures for inadequate treatment) or a “neurosis” that sometimes replaces the patient's passionate or delirious attitude for a period of time. The phenomenological concept of the “opaque body” provides a certain reply to these questions: it shows that the body plays major role in Paranoia, as it represents the constitutive limit of the “truth” the paranoid subject seeks, and it also acts as a transmitter of signals - both mimico-gestural and verbal - through which the patient attempts to circumvent such a limit. The marginal role assumed by hypochondria then alters to become one of the body's possible means of physical expression of Paranoia; it does not manifest itself as an “other” illness that sometimes replaces the former, but rather as a continuation of the paranoid state including a reversal of roles, with the patient acting as persecutor and the therapist becoming the object of persecution. Thus one could qualify as Paranoia any pathological interpretative situation characterized by the persistence of an “opaque body”; and exclude the type of situations in which the body has become transparent to the patient's intuition as it has to the hallucinations of the paranoid subject.     

Le contingentement de la jouissance dans la paraphrénie

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

Hypothesis: grandiosity and guilt cause paranoia; paranoid schizophrenia is a psychotic mood disorder; a review

Delusional paranoia has been associated with severe mental illness for over a century. Kraepelin introduced a disorder called "paranoid depression," but "paranoid" became linked to schizophrenia, not to mood disorders. Paranoid remains the most common subtype of schizophrenia, but some of these cases, as Kraepelin initially implied, may be unrecognized psychotic mood disorders, so the relationship of paranoid schizophrenia to psychotic bipolar disorder warrants reevaluation. To address whether paranoia associates more with schizophrenia or mood disorders, a selected literature is reviewed and 11 cases are summarized. Comparative clinical and recent molecular genetic data find phenotypic and genotypic commonalities between patients diagnosed with schizophrenia and psychotic bipolar disorder lending support to the idea that paranoid schizophrenia could be the same disorder as psychotic bipolar disorder. A selected clinical literature finds no symptom, course, or characteristic traditionally considered diagnostic of schizophrenia that cannot be accounted for by psychotic bipolar disorder patients. For example, it is hypothesized here that 2 common mood-based symptoms, grandiosity and guilt, may underlie functional paranoia. Mania explains paranoia when there are grandiose delusions that one's possessions are so valuable that others will kill for them. Similarly, depression explains paranoia when delusional guilt convinces patients that they deserve punishment. In both cases, fear becomes the overwhelming emotion but patient and physician focus on the paranoia rather than on underlying mood symptoms can cause misdiagnoses. This study uses a clinical, case-based, hypothesis generation approach that warrants follow-up with a larger representative sample of psychotic patients followed prospectively to determine the degree to which the clinical course observed herein is typical of all such patients. Differential diagnoses, nomenclature, and treatment implications are discussed because bipolar patients misdiagnosed with schizophrenia are severely misserved.     

Travail psychanalytique, transfert et maniement du transfert dans la cure des personnes diagnostiquées « psychose » ou « schizophrénie »

The possibility of a psychoanalytic treatment or cure in the case of a psychotic patient is the controversial subject of many discussions. We are reminding in this paper Freud's different positions about this subject, in order to show his ambivalence. We examine further the hypotheses and techniques that are proposed by several schools of psychoanalysis and we show how the technical rules of the treatment are resulting mainly of theses hypotheses concerning the etiology and the pathology. The technical rules are inducing a particular position of the analyst, which is different for each school. We assume that these postures are not excluding each other, but they are reflecting particular “moments” of the treatment, or specific “techniques” which are more or less appropriated for each category, we explicit different postures and we match they with these proposed by Freudian, Lacanian or Kleinian authors. The imaginary transference is the one described by Freud in “An Outline of Psychoanalysis”. It represents the transfer on the analyst's person of an early significant figure (imago). We argue the idea that the initial transference of a psychotic person is a transfer of “functions”, as in the R-scheme described by Lacan. The symbolic transference involves the language, i.e. the working out of a delusion. The real transference is the contrary of the neurotic process of “uncovering” the object: it is the one, which grasp the object into the discourse. We argue the idea that there is a possibility of structural mutations between psychosis and neurosis. The structure is conceived as a preferential pattern of relationship (transference) at a “m” moment.     

La Folie à deux, une entité confuse

The history of the nosographical entity of “Folie à deux”, its semiology and its taxonomy since the xix^th Century. The developments of the entity and its supposed refinement, display only a difficulty seizing the characteristics of the “Folie à deux”. To speak about the “folie à deux”, it is above all to speak about the delusion and about its structure. It is a matter of seeing the impasse in which psychiatry falls when it cannot envisage the delusion in a different way, the nosography remains anchored in an exceeded and inaccurate phenomenology, which does not contain all the extent of the phenomenon and which distorts the clinical observation, and comes to the point of fixing the entity's shape and semiology according only to the points of view of a psychiatrist. The method of the psychiatric diagnosis, as for the observation of the delusion, “is obliterated by a naive reference to reality”, as underlined by Maleval. These questionings come to shake the structure of this entity raised since 1873, and interrogate us about the current events of its diagnosis and the validity of its semiology. From Legrand du Saulle up to the contributions of de Clérambault and Lacan, it is a matter of clearing a passage towards other perspectives of a nosographic entity in evolution.     

Mélancolie délirante et paranoïa : diagnostic différentiel

Objectives

In this paper, the author proposes to separate delirious melancholy and paranoia, locating in these two psychoses the common points and points which are able to distinguish them clearly.

Methodology

We present the delirious melancholy according to the psychiatrist H. Ey's theory, then – with psychoanalytical approach, according notably to Lacan – we will underline three important points of reference: relationships with “fault”, with the “object”, and finally with the “Other” (Lacan).

Results

These three points will lead us to the melancholic self-accusation and to the paranoiac accusation, to the position of “exception”, and to delirious common themes.

Discussion and conclusion

Finally, we attempt to ascertain – as Freud formulated about paranoiac delirium – whether melancholic delirium could also be a “tentative of (self) cure”.     

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.     

La personnalité schizoïde : l’apport original de Fairbairn

Adopting the term “schizoid personality”coined by Kretschmer, in 1940 Fairbairn attempted to determine the underlying mechanisms connected with this type of personality. He extends this term, which covers in a transnosographic manner a number of states characterized by attitudes of all-powerfulness, detachment, and the individual's focus on his internal reality. These states demonstrate a difficulty in integrating certain parts of the personality, which remain split.Fairbairn considers that this condition results from a fixation which develops at the early oral stage. He then outlines the four characteristics involved: 1) the tendency to focus on a partial object; 2) the predominance of taking over giving in the libidinal attitude; 3) the incorporation or internalization factor in the subject's libidinal behavior, 4) the emptiness of the object. In fact, emptying the mother's breast after feed may upset the infant to such a degree that he believes that he has destroyed it. At a more object-relations level, the infant who thinks that he lacks love believes that his own love is destructive.His article, written in 1940, raises a number of questions: Fairbairn emphasizes the oral aspects in patients who could be considered obsessive, but who are more likely to be borderline cases. The fragility of the early oral relationship leads to the development of a narcissistic behavior pattern which remains in isolation. Taking into account the corporal aspect, Fairbairn's text then considers the beginnings of the construction of a possible internal world. He postulates that this interior space could then become more complex, and distanced from the survival mechanism of these individuals, almost as if his theory was aimed at constructing a psychic interior for these subjects and at “restimulating their auto-eroticism” (Widlöcher).     

Georges Lantéri-Laura clinicien

The author presents the general conceptions of the french psychiatrist Georges Lantéri-Laura (1930-2004) about the semiology and the nosography of mental disorders: comparison with other medical specialities; connexions between semiology, clinical knowledge and theoretic models; part of “expérience vécue”, of relation and of laboratory investigations; historical anteriority of illnesses relatively to clinical signs and symptoms; notion of syndrome; criticism of “monosymptomatic” disorders and of “atheoretic” classifications (like DSM-IV). Then he restores his discontinuous periods in the history of psychiatry, based on the three successive “paradigms” of alienation, illnesses and mental structures, their “crisis” and their legacy in the clinical practice nowadays. He after evokes Georges Lantéri-Laura's inquiries and contributions about several clinical concepts (hallucinations, Clérambault's “mental automatism”, delusion, Chaslin's “discordance”), in perspective with the works of Henri Ey, about the criticism of others (sexual perversions or paraphilias) and about the relations between acute and chronic mental disorders. At last he resumes his analysis of a clinical knowledge contingent, which depends on several heterogeneous models, in perspective with etiopathogeny, theories and psychiatric specificity.     

Déconstruire Kraepelin : considérations historiques sur la nosologie kraepelinienne

Objectives

In the case of Kraepelin, we still need to debunk a myth. This is all the more important as psychiatry still lives in a “Kraepelinian world”. The article invites psychiatrists to understand the full extent of this myth, through which Kraepelin, the so called “father of modern psychiatry”, is at the same time one of the most famous nouns in the history of psychiatry, and one of its most ignored figures. There is still a need to re-evaluate what Kraepelin really said.

Method

The article therefore invites us to revise one by one some of the main clichés that overload any speech on Kraepelin. Thus, it considers successively: a) a discussion on the early development of Kraepelin's directions for psychiatric research ; b) a reassessment of the influence of the Wundtian psychology experimental framework, and the epistemic role it played in the first years of Kraepelin's research; c) a critical re-reading of Kraepelin's concept of “natural disease entities”, and its “clinical method”.

Results

Finally, through this return to Kraepelin's works, the article invites us to deconstruct the Kraepelinian episteme.

Discussion

Thus, under the apparent unity of his overall project, an essential hiatus is pointed out in the Kraepelinian text, as if a break were separating the ideal of his project (to discover true natural mental disease) and its carrying out – as if the Kraepelinian natural disease model was always maintained de jure, and never reached de facto.

Conclusions

More research still needs to be conducted to re-examine the role of myth of the Kraepelinian methodology in the epistemology of modern psychiatry.     

« Drapeaux rouges » : quand s’alarmer, quel examens demander ?

The diagnosis of Parkinson's disease (PD) requires ruling out other causes of parkinsonism. Among various “other” causes of parkinsonism, neurodegenerative causes or “atypical parkinsonism” are the most difficult to diagnose. Most common diseases are “synucleinopathies”: multiple system atrophy and dementia with Lewy bodies and “tauopathies”: progressive supranuclear palsy and corticobasal degeneration. Unexpected or atypical signs and symptoms for PD, also called “red flags” along with absent or poor or short-lived levodopa response may be a clue for the diagnosis. Some tests may also support the diagnosis, among them, structural (MRI) and functional brain imaging, autonomic function tests and urodynamics, oculographic recordings and neuropsychological work-up, are the most useful.