À propos de l’expérience de la torture

The large influx of asylum seekers confronts public mental health services with the suffering resulting from extreme political violence. Among these patients, survivors of torture present a unique clinical profile of which clinicians should be made aware. While certain researchers have proposed useful concepts, the statements of witnesses and the writings of clinicians constitute the point of articulation between theory and practice. In this article, we will attempt to understand the ways in which torture results in psychosis (“a laboratory of psychosis”), notably through the specific and ambiguous role of the imaginary. A specific focus will be dedicated to the processes of humiliation, which illuminate a dialectic between the body and the mind, between the physical wounds and the long-lasting injuries inflicted on the soul; torture causing, intentionally, the possibility of a rupture between the ego and the ideal of the self. Finally, the article will critically examine the role of the therapist; so that clinicians will be able find a favorable resolution to the pathogenic conflicts involved.     

L’hypnose,expérience ecmnésique,ou l’ecmnésie,expérience hypnotique ?

Hypnosis is a therapeutic tool which accompanies medicine since always, in varied forms. One of its characteristics is the core use associated with a technique with induction, which produces a “reviviscence” of the memory different from a simple “Re-memorizing”. This experiment is carried by the neurological phenomenon of synesthesia. A clinical example illustrates this proposal.     

Comment rendre l’éthique accessible aux professionnels impliqués dans la prise en charge de l’enfant atteint de handicap ? Notre expérience en Rhône-Alpes

In France, the Rhône-Alpes Regional Network working on children's reeducation and rehabilitation brings together professionals involved in the care of children and teenagers with disabilities. These professionals are, daily, facing dilemmas that involve therapeutics decisions and the wishes or desires of the child and/or of his family. At first, at the Network's seminar in 2011, two clinical situations described were analysed by the philosopher Catherine Perrotin in the light of ethics. The exchanges that took place then showed the interest of thinking about the clinical situations which are dealt with on the field, with the help of someone from outside. In order to pursue this questioning, the network's ethics committee organised ethical exchanges in a coffee shop, which were called “ethics coffee”. Until now, six “ethics coffees” have taken place in Lyon. Each was built on a topic chosen by the ethics committee and inspired from clinical situations ; they involved a speaker who was invited by the Committee to bring a new light on the chosen topic. These “ethics coffees” became a learning space as well as a space for individual and collective questioning, which enables all professionals of the network to get to know and use tools serving the ethical approach in their daily practice.     

L’expérience des professionnels accompagnant les auteurs de violences sexuelles : revue de littérature

Working with sex offenders can be challenging for professionals. Psychotherapy and counseling involve human and emotional commitment that can be demanding. However, supporting sexual offenders seems to confront professionals to specific difficulties, the most obvious being the violent content of patients’ speech and the professional duty to balance justice and care. Beyond that, it appears essential to understand specifically what is at stake for professionals in this type of work, but for the well-being of caregivers and patients as well, and ultimately for the quality of the therapeutic alliance. The objectives of this article are to conduct a review of the international scientific literature of studies that have explored the experiences of professionals who work with sex offenders, and to draw practical perspectives as well as new lines of research. Quantitative studies have focused on specific traumatic effects of professional practice with sexual offenders: secondary traumatic stress, burnout, vicarious trauma, compassion fatigue. Research has operationalized these different indicators but these concepts have relatively blurred boundaries. Thus, the results do not appear significant on a specific traumatic effect. However, these studies show/prove the existence of a number of symptoms among caregivers – hypervigilance, emotional fatigue, and feeling of depersonalization – highlighting the importance of exploring qualitatively the experience of professionals. Qualitative studies have provided a more comprehensive and nuanced understanding of the phenomenon. They confirm and clarify the negative emotional impact but also underline positive effects, especially a strong sense of social responsibility, in protecting the population from potential violence. Professionals also focus on professional training opportunities offered within this challenging domain. The most important objective would be to find a balance between positive and negative impacts, bringing out the importance of personal coping strategies and professional resources. These results emphasize the role of institutions in assisting professionals, especially in regards to organizing regular and adapted clinical supervision, in order to provide emotional support. This questions the possibility – and the limit? – about taking into account the personal repercussions of the practice in the professional context. It thus appears fundamental to consider and develop specific organizational support for professional practices with a strong emotional impact. Finally, this literature review raises the interest of developing French research on the experiences of professionals who work with sexual offenders, in order to enrich this international vision while exploring the French specificities of this practice.     

Prise en charge de la crampe de l’écrivain : 14 ans d’expérience de la toxine botulique

IntroductionWriter's cramp is a focal dystonia; treatment remains disappointing. We report our 14-year experience with a population of 119 patients aged between 18 and 85 years (average age 43 years).MethodsTreatment was based on botulinum toxin injections (Dysport^®) and physiotherapy. Patients were reviewed every four to six months with clinical and video evaluation by three different observers and subjective analysis of the treatment efficiency by the patient (score of 1 to 3). The post-injection deficit, if present, was also quantified.ResultsIn the group treated with toxin and physiotherapy, cramps improved (score 2 and 3) in 61.6% of patients; a majority of patients (n = 14) reported they were moderately satisfied (score 2). In the group treated with toxin alone, 37.9% of patients were improved (score 2 and 3) with a majority (n = 18) very satisfied reporting normal writing (score 3). Age was not a predictor of therapeutic response. Good results were obtained with injections of the flexor carpi radialis followed by flexor digitorum profundus II and III and the flexor pollicis longus. Seventy-one per cent of injections caused moderate muscle weakness, minimally disabling compared to the benefit of injections. Twenty-seven patients were followed for more than two years and three patients, who had achieved score 3 with excellent response, were followed for 14 years with very efficient repeated injections. If the injections were not effective the first time, we re-assessed the situation and adjusted the injections; we considered that toxin treatment was unsuccessful after three injections without benefit.ConclusionThe choice treatment for writer's cramp remains well-targeted injections of botulinum toxin. Physiotherapy is useful when the toxin injections are ineffective in completely improving writing. This requires close cooperation between the injector, the physiotherapist and the patient.     

Le dévoiement de l’interaction thérapeutique dans l’emprise sectaire. Éléments pour la formation à la prévention

After a reminder of the historical and current framework of clinical practice, and before concluding with a discussion of training in the diagnosis and prevention of sectarian aberrations, it is desirable to emphasize and explain what the contribution of the social psychology of interactions can be to the question. More precisely, it will focus on the pathological interaction, which, under the guise of care, enslaves the patient to a person, a group and an illusory theory. Psychologism, i.e. the tendency to misinterpret phenomena, by alleging psychological discipline, is not outside the scope of this field of sectarian influence. Any training in the prevention of sects for health professionals must examine this problem from the point of view of the pathogenic interactions at the origin of these aberrations.     

Accompagner les professionnels de santé dans la révélation de l’erreur : de la révélation à soi à la révélation à l’autre

Error disclosure is now an ethical and professional obligation for health professionals and seeks to improve quality and safety in healthcare. Literature has highlighted the numerous benefits of error disclosure and several authors have described the options for handling this situation. However, it is not quite that simple to be honest and open and follow a protocol that instructs professionals to explain, support and apologise in situations where they are subject to criticism. While the many personal, institutional and social factors that hinder open disclosure have been identified, little attention has been paid to the obstacles associated with the psychological impact of disclosure, thereby limiting the debate on how professionals might be supported in their efforts to cope with error disclosure. The psychological impact of error on professionals is a well-established fact. Physicians are “second victims” likely to be emotionally affected by medical error. Emotional distress, anger, isolation, fear, guilt and shame can be intense, suggesting that, far from being an isolated act in professional practice, a medical error is a life event that modifies the psychological balance of a professional. Studies in the humanities have shown how work shapes individuals’ identities. The choice to heal and care for is indicative of the ideals related to professionals’ life histories, cultures, family models and representations of health and disease. Work and, more specifically, recognition at work from their peers, patients and relatives enables health professionals to support their ideals and establish a coherent identity, and to belong to a workgroup. The error foreshadows a rupture which plunges the professional and the team in a state of vulnerability that rules out the professional's or the team's possibility to be part of a process of disclosing the error. In these conditions, a policy of security of care also involves a guarantee of the caregiver's and the team's psychological security. The term psychological security was developed by the psychoanalysis who emphasised the individual's need to evolve in a “sufficiently good” protective environment that allows him/her to contain his/her emotions, while giving the individual the possibility to express and discuss them. This space implies a relation of trust between individuals. Trust refers to the idea that the individual can trust someone, it is based on the capacity to create relations. It is only through trust that the professional will be able to open him/herself to others and construct a space where the errors and the doubts that he/she has in the context of work are shared. But if trust is essential, it is also dangerous because it implies accepting the risk of being dependent on those considered as trustworthy and the risk that they will not live up to the professional's expectations. As a consequence, the professional will only have trust when he/she has evaluated the possibility of cooperation and more precisely, as stated by Hardin, a cooperation in which the professional's interests are “encapsulated interests”, in other words the interests of others. Therefore, this cooperation depends on each member of the team seeing his/her interests as being partially those of the others. Cooperation within a service reveals the relations of trust between the professionals and shows the relations of dependence that each one maintains with the others for the good administration of care. Thus the creation of relations of cooperation between the team members proves to be an important indicator to determine the professional's possibility to adhere to a process of disclosing the error. This approach shows that professionals must address multiple rather than single disclosures: to the self, and to others (colleagues, hierarchy, patients and families) who will mobilise specific knowledge, emotions and psychological defences. To avoid cases where disclosure takes on dimensions as tragic as the actual errors committed, it is important to pay attention to the psychic state of healthcare professionals by offering a space of free expression that enables them to better understand their feelings and gain a sense of support in order to restore their ideals and professional identities. Finally, it's important to emphasize that disclosure also depends on the preservation or restoration of the relations of cooperation within the team. Disclosure cannot be prescribed, it must emerge within a workgroup who allows the error to be thought over, communicated and shared. In this context, disclosure becomes a group rule that is known to all. A health professional who feels sufficiently supported might, in turn, support a patient and/or his/her relatives and engage in meaningful disclosure.     

Sevrage tabagique chez les patients fumeurs VIH : expérience de la consultation de tabacologie de l’HEGP à Paris

Introduction

There is a particular need among HIV-infected patients to stop smoking because of the risk of smoking-related complications and the high prevalence of cigarette smoking among them. Only a few studies have focused on this population in real-world settings.

Étude de l’impact de la grossesse sur les comportements alimentaires à travers l’utilisation du questionnaire SCOFF

Pregnancy has often been considered as a period of profound changes (physical, psychological) in women. This is also a period during which previous psychological issues rise to surface and current issues have the potential to get worse or better. Eating behaviors and attitude to body weight are very important in women's life and in certain periods of life, like adolescence and pregnancy, a source of concern. It has been proved that women with a prior history of dieting have been found to be more likely concerned during pregnancy when previous ED can either improve or be revealed. Pregnancy is a time that precipitates or exacerbates problematic eating behaviors. This article aims at giving an overview of articles of the literature on this topic. Eating behavioral changes and bodily changes are presented as a result of pregnancy. Our aim is to evaluate the impact of the pregnancy on pregnant women's eating behaviors. In order to evaluate eating behavioral changes, we used the SCOFF questionnaire which is composed of 5 questions. This questionnaire which, at first, is a tool of screening of the TCA, also allowed us to have a global vision of the eating behaviors of the pregnant women. Two hundred and eighty-five women, recruited at the obstetric unit, answered. First results revealed a major concern for food among pregnant women. Pregancy and motherhood may be feared for negative consequences such as loss of control of their appetite, and weight. There are few changes which concern their body satisfaction, between before and during the pregancy.     

Approche qualitative de l’éprouvé au Jardin de Soins. Une étude exploratoire en Psychiatrie de l’Adulte

In Adult Psychiatry, the Healing Garden seems today an innovative therapeutic mediation aimed likely take part in the recovery of severe patients. The therapeutic effect would depend on several bound mechanisms, in keeping with our fundamental relation with the natural environment and socio-relational purposes supported by a nonintrusive support of low complexity. Formal scientific clinical studies began in psychiatry in reactive disorders. We want to consolidate the clinical impressions accumulated in practice care in the suffering hospitalized adult of a severe pathology, through a pilot study of a qualitative type using the content analysis of interviews in a short form. The method consists of exploring elements of their comments through a feedback of personal experiences within a small group of patients to identify recurring and shared issues. Then, a structural synthesis of central elements of described experience aims at understanding the patient unique experience meanwhile and perceive the meaning for them. We began the investigation with 7 patients. The clinical evaluation was based on a semi structured interview lasting 20–30 minutes with the help of an interview guide collecting experience. The personal experience of the patient once re-written has been analyzed. The first step of qualitative data confirms the assumption of a device of care supporting the process of recovery, the benefit in a reduction of perception of symptoms of the disease, the impression to get back on their feet, the interest of a differently perceived relation with caregivers, the advantage of a resumption of the power to act, and the recognition of the importance of the support from others. Therefore patients state a re-start of their physical or psychic energy. It can be understood with the support of the group as well as the direct effects of the vegetal, or more, with discovering new possibilities to enable them to rebound back into daily life. Then, they can describe that whenever the caregiver goes to the same level as the patient in charge, and that he agrees to be taught and surprised by what the other knows, he restores on a making-together method a failing self-esteem. This feeling of self-efficiency, highlighted by human interaction with a newly renamed caregiver, enables people to get past feeling stigmatized even if this feeling is unfortunately deeply buried in the person. If the feeling of worthlessness and impossibility to change give way to a slightest action, a dynamic settles down. It enables the patient to get aware that it can act and influence on its environment, like the others. As a result, the feeling of inadequacy decreases and even the slightest result enable to recover self-confidence thanks to a positive environment. It doesn’t take much for them to realize they can act and widen their experience to other areas of their lives. The feeling of the ability to act by themselves comes back. Finally the relationship with others seems a key element in the Healing Garden. It can be shared between peers, between caregivers and patients, between the relationships of these people with the rest of society. The matter is the acceptance of its own abilities even if they are diminished. This perspective cannot be separated from the above mentioned elements: The achievement is team work and overtake individual boundaries. It allows the patient. It is the feedback of society over creation and work performed. The feeling of self-efficiency created by the pride they can feel is reward and may lead to other achievement. To conclude, we propose to consider the thematic emergence of the experience of the concept of vitality as spring action in the real in front of others as echo in a psychopathologic tradition dedicated to the existential comprehension of disorders. The implementation of a healing garden in the psychiatric fields comes as a response of our survey and sustains the patients differently. The originality is in that patients acquire resources from the environment, in a dynamic recovery. So we suggest offering this mediation as soon as possible to curb the spread of their illness. We would like to see this pilot survey taking part in structuring relevant dimensions and new researches.