Traumatisme et psychanalyse : comment passer de l’excitation à la mise en représentation ?

Objectives

This article develops the psychoanalytical theories of trauma in Freud's work and that of other psychoanalysts. The author will show the place of traumatism prior to language acquisition and its specificities. We will propose a method of treatment, group therapy.

Freud's theory

Usually traumatism designates a psychological impact of events, which are painful for a person and his life. This term is over-used in common language. Actually in France “trauma” usually results in immediate intervention of psychological treatments. In psychoanalytical theory, the notion of trauma is at the heart of Freud's work. This notion has varied greatly from 1905 to 1931. Many psychoanalysts work on the place of trauma in self-development. But in this article, we will examine the work of only two other authors: Ferenczi and Winnicott. These psychoanalysts work on “narcissic damage”. This problem corresponds to the absence of an adequate response from the object to a stressful situation and constitutes a mutilation of the self. The conception of trauma has many meanings: the first theory is that of the overwhelming of the defense mechanism of the subject and the other is repressed memory in relationship to theories of sexuality. The second theory is that trauma interrupts the self-continuity. In this situation, the subject clings to perceptive sensations. There is an interruption in the cycle of representation. It is not possible to use the representation mechanism. Actually many children who turn to child psychiatrists have pasts filled with traumas. There have not constructed transitional areas, which would permit them to create psychological spaces differentiating the imaginary from the real. For other children, however, the notion of trauma is difficult to recognize in their own lives.

Clinical case

Here, the author will present an observation of a child who had a trauma at the age of 8 months. His trauma was very precocious, occurring at a time prior to the child's language acquisitions and he didn’t have the skills to express his emotion. In therapy groups, he is able to remember the sound of the American ambulance siren, and with this sound, he expresses this psychological disorganization with great anxiety. It is probably the only memory he has been able to keep of this extremely traumatic experience. This analysis will show that the only memory of the child is an auditory one.

Conclusion

The author concludes with the interest of group's therapies permitting the emotional expression through play rather than through language. When there are group therapies, the children are going to have a certain excitation, and they feed off of each other; this group dynamic helps to transform the excitation into representation. The group therapies enable the children to reconstruct their pasts and repress the trauma. This therapy results in an associative representation: the children live emotional experiences and they translate these emotions into images (figurability). Then they arrive at a representation with a scenario and exceptionally at verbalization.     

Évolution du spasme du sanglot à court terme et effet de la thérapie mère–enfant. Étude prospective

The aim of the study was to investigate the evolution of BHS at the short-term psychotherapy mother–child.     

De l’intégration à la scolarisation des handicapés : regards sur 30 années de collaboration école–psychiatrie

Thirty years have passed since the establishment of two French laws regarding the schooling of disabled children and adolescents (1975–2005). This article proposes a critical examination of the expressions used in the two texts since they reflect the mentality of each period; followed by an analysis of the progression and pitfalls of the laws from the angle of the users (parents and children) and the professionals. The author relies on her 30 years of experience in the public domain of pedopsychiatry to provide a diachronic analysis of the school–pedopsychiatric relationships since the instigation of the Regional Commission for Specialised Education (Commission départementale de l’éducation spécialisée [CDES]) and the setting up of Houses for the disabled (Maison de personnes handicapées [MDPH]).     

« Qui suis-je ? » Quelques spécificités du discours sur soi à l’adolescence chez les sujets à haut potentiel intellectuel

Objective

Students are considered intellectually gifted when their intellectual quotient (IQ) scores on scales such as the Wechsler Intelligence Scale for Children (e.g., WISC IV) are 130 or higher. The socio-emotional development of these intellectually gifted students and, more specifically, the development of their self-concept, are of growing interest among today's parents, teachers, practicing psychologists and directors of institutions. This research apprehends some characteristics of the discourse of self among French gifted high school teenagers who have spent their scholarship in heterogeneous classes (i.e. in “ordinary” classes).

Methods

Our sample include 84 gifted high school students (Intelligence Quotient more or equal to 130), whose age ranges from 13 to 18 years old (M = 15.5; σ = 1.0). These high school students are compared with 84 “mainstream” high school students (who have never been identified as gifted from an Intelligence Quotient greater than or equal to 130 and who have never skipped classes) on various criteria: gender, family (sociocultural background and information about siblings) and scholarship situation (the class they are in, if they have already repeated a class or not, average school marks). Each of these teenagers has produced a text in response to the question “Who am I?”.

Results

We present here the results of the lexicometric analysis (Alceste software, version 4.7) performed on all the collected textual data. The lexicometric analysis of the corpus made up of texts written by gifted and non-gifted adolescents in response to the question “Who am I?” made it possible to identify a discourse specific to gifted adolescents. Gifted adolescents adopted a reflexive discourse by which they questioned their own identity and the general construction of identity as well as other wider themes such as happiness, difference, relations with others, etc. The existential questions frequently attributed to gifted adolescents were thus found here. The atypical intelligence of a gifted adolescent, with its extreme richness and complexity, gave the young person an incredible lucidity, a sharp analysis of things, people and himself. This intelligence enabled a fine analysis of all environmental elements. This way of being in the world, constantly in search of meaning, seemed to create a permanent and diffuse anxiety, one which could not be calmed by certitudes: the beginning of every answer appeared to indefatigably lead to new questions, new interrogations, new anxieties. None of the three classes, however, was significantly associated with non-gifted adolescents. These results lead us to moderate the idea that the representations of self of gifted adolescents are very different from those of non-gifted young people. Beyond the characteristics related to the status of gifted versus mainstream teenagers, the speech of self is linked to gender, age, sociocultural background and educational attainment of adolescents.

Conclusion

Taking account of gifted teenagers’ speech of self allows understanding more accurately their experiences and how they integrate or not giftedness to their identity. In addition, the comparison of results obtained on samples of gifted adolescents to those obtained with non-gifted adolescents with similar sociobiographical sheds light on the characteristics of self-representations of gifted adolescents. Finally, the recognition of the heterogeneity of this population (and the identification of variables that might explain it) encourages to take them into account and to adapt solutions to their teenagers’ profiles.     

Quel est l’intérêt de la radiographie du thorax dans le diagnostic d’une pneumonie de l’enfant en 2011 ?

According to the French national health authority guidelines, the diagnosis of childhood pneumonia is based on clinical suspicion and radiological confirmation. The chest radiography is an expensive procedure, and potentially deleterious by its radiating character. We have attempted to clarify its diagnostic value in community acquired pneumonia in children through a literature review using the Pubmed search engine with the following keywords: “pneumonia, child, radiograph”. Conclusion: The indication of chest radiography in severe pneumonia achieved unanimity among the various scientific societies. In contrast, in mild forms, tendency of the available data is to not recommend the routine use of chest radiography; further randomised and prospective studies are necessary to confirm this trend. Finally, because of the frequency of atypical presentations in children, chest radiography retains all its usefulness in the etiologic diagnosis of fever of unknown origin.     

Prendre soin du bébé et de sa famille : une expérience de recherche–action en périnatalité

Objective

Authors present a clinical research led in France (area Lorraine in the east of the country) where several towns are associated with children presenting severe language delay. This language delay appears to be linked to a low socioeconomic context. Public psychiatry hospital and services of maternal and child protection (medical and social service called “Protection maternelle et infantile” in France) are associated to contribute at better infant development using home based assessment and intervention by a clinical psychologist. Objective is to show that home observations can reduce language delay in this population.

Methods

Forty-nine families have been studied and have benefited of psychological accompaniment. This clinical group has been compared with a control group of 42 families living in the same area but without accompaniment. Each family in clinical group have benefited from 23 sessions of home observation from pregnancy to 24 months. Sessions began two months before birth and stopped at 48 months. Several tools are used: clinical scales evaluation; psychometric test for assessment of psychomotor skills, oral language; mother-infant interactions studied with video. Qualitative analysis of parents–infant interactions and statistic comparisons (clinical group vs. control group) are used to analyze the development of the children from birth to 48 months.

Results

Toddlers of clinical group that have benefited of home observation and care at home by clinician psychologist present at 2 years old less developmental language disorder and development of psychomotor skills is better than control group. This research led at family's home shows that the intervention of clinician psychologist permits the parents to take care spontaneously of the baby, this promotes play activities and narrative verbal exchange. This research suggests that prevention of severe language delay can be easily led with home based assessment and intervention. These first results indicate the prospects for the continuation of this action research of primary prevention.     

Diagnostic du trouble de personnalité borderline à l’adolescence : revue francophone

Borderline personality disorder (BPD) is a frequent and severe pathology. Although BPD is mostly diagnosed in adults, evidence shows that it can also be adequately diagnosed in adolescents. However, several obstacles seem to prevent this diagnosis from being made on patients younger than 18. Aside from the fact that drawing a line between borderline personality features and the transitional adolescent turmoil could be complicated, some health professionals are reluctant to make a diagnosis that stigmatizes their patients, especially the youngest ones. However, being able to identify and treat BPD during this developmental stage would reduce many adverse outcomes in the long run. Achieving early detection requires reliable and valid tools to screen and diagnose BPD in adolescents. The aim of this article is not only to review studies reporting on difficulties to diagnose BPD in adolescents but also to highlight some realistic solutions. We explain in detail how BPD symptoms manifest during adolescence. We also present the tools currently available to assess and diagnose this pathology in adolescents.     

Épreuves fonctionnelles respiratoires de l’enfant de 3 à 5 ans : quel matériel,quelles mesures ?

Lung function testing in children 3 to 5 years of age is possible using equipment and techniques suitable for this age group. The use of different techniques will depend on the child's ability as well as on the technician's skill to use specific techniques. This review will detail the techniques that are easily available for routine lung function assessment in private practice or in hospital laboratory.     

Difficultés diagnostiques du trouble de conversion à l’adolescence : étude mixte qualitative et clinique autour du parcours de soin d’une jeune fille de 15 ans

IntroductionThe diagnosis of conversion disorder causes many difficulties in children and adolescents. As a diagnosis of exclusion, it implies diagnostic procedures that are often long and costly. The objective is to describe the difficulties encountered by health professionals in the diagnostic process when faced with an atypical neurological symptom.MethodA mixed study combining a case study and a thematic qualitative study based on semi-directed interviews with the physicians who managed the patient of the case study.ResultsThe case study highlighted the difficulties of articulation with psychiatry. The thematic analysis revealed four main difficulties: 1) specific patients with a complex picture that lead to diagnostic difficulties in emergency; 2) specific parents with a strong demand for a precise diagnosis despite an ambivalence towards psychiatric illness; 3) a specific physio-psycho-pathology that can be difficult to explain to patients and families due to a lack of knowledge among somatic physicians; 4) a feeling of failure and doubt with regard to these complex pictures leading to difficulties in positioning the patients.ConclusionPatients with conversion disorders require time, listening and reflection. This temporality is not compatible with the emergency context, often reinforced by the pressure of worried parents. The lack of specialized training in mental health and interdisciplinarity and the stigmatization of psychiatric diagnostic hypotheses hinder care and can lead to serious consequences in the short and long term.