Vieillissement et maltraitance : une maltraitance peut en cacher une autre

This article analyses two current problems emphasized by the media: ageing and elder-abuse. We tried to understand starting from a clinical case, Rosaline (95 years old), how conscious and unconscious representations of this patient and her daughter could lead to a severe conflict with sharp consequences in their family life. The psychic drives constituting our identity as well as our death and life drives may interact in such situation, provoking some behaviour quite improper. A case of elder abuse in order to demonstrate its complexity, bringing out the difficult task of the caregivers facing the other's ageing process. Our professional activity as psychologists lead as in our clinical analyse of such conflictual relationships to vouch for the absolute respect and dignity of every person implicated in these difficult situations in every consultation of our institution.     

Analyse clinique au cours d’une marche simple et avec une double tâche chez une population de sujets âgés ambulatoires consultant en gériatrie

Introduction

Gait and balance often change with age. Few studies are available on gait analysis in the elderly. In our work, we have focused on slow walking and variation in pace. Since first introduced by Lundlin, the dual-task paradigm has been largely used to test for the risk of falls and to better understand the link between mild cognitive decline and variation in gait. To our knowledge, very few clinical data are available on the gait changes observed in the elderly in the dual-task situation. In this study, we compared changes in gait and balance between the simple task and the dual-task situation in a 10-m walk test conducted in community-dwelling old people.

Methods

Eighty-nine subjects attending a geriatric outpatient clinic (age 80.76 ± 2.82 years) were included in our protocol. Gait, balance and posture were systematically evaluated during a simple and dual-task 10-m walk using a specific 11-item clinical scale. Gait speed was noted.

Results

Few differences were found in the dual-task walk, only reduced speed, more stops during the walk and less compliance with instructions. These results were correlated with the Mini Mental Status (MMS) score. Systematic clinical analysis failed to identify any links with age, the MMS, the UPDRS, the Tinetti scale or gait speed except for the variables freezing, increased sustention polygon and ataxia.

Discussion

This kind of study appears to offer an attractive analytical approach but would require a more pertinent choice of variables for cognitive evaluation and a more exhaustive set of MRI criteria. Nonetheless, clinical gait analysis could improve our understanding of the consequences of mild cognitive impairment and aging.     

Samu social : relances psychanalytiques en réponse à une analyse sociologique. Notes pour une clinique de l’habiter

From analyses and criticisms presented in P. Gaboriau and D. Terrolle's book “Homeless people: Criticism of ready-made ideas”, the author develops three points that constitute a psychoanalytical revival brought to emergency social (SAMU social) clinical practice. The questions of causality, the ideal of integration, and illusion are considered to end in the proposal for a clinical approach to the dwelling (in a lacanian sense) as it relates to the so-called homeless.     

La psychiatrie en milieu pénitentiaire : chronique d’une pratique psychiatrique au centre pénitentiaire de Bordeaux-Gradignan

We will start with a presentation of the prison population, followed by a review of aggravating factors for situations, which would be perceived as banal. We are confronted with the interface between, on the one hand, a rigid judicial and penitentiary structure and, on the other hand, according to the type of new inmates, can take many faces both from a clinical and a criminological viewpoint. The fact that new specialized bodies have been added (SMPR) and are still developing (UHSA) confirms the idea that prison cannot accommodate a specific psychopathological sample of our society which is then sent to a further exclusion-generating structure. As a result, prison is increasingly seen, as a factor for repetitive offending that is too often limited to a medical approach. The multiplication of legal texts centred around law-and-order is the expression of the current trend to push health professionals to go beyond their role of care.     

Les dérivés conscients des mécanismes de défense au questionnaire de Bond (DSQ 40) : stabilité ou variabilité entre une situation non anxiogène et une situation anxiogène

Introduction

The aim of this research was to test the stability or variability of conscious by-products of defense mechanisms, evaluated with the Bond Defense Style Questionnaire (DSQ 40) so as to integrate them as transactional variables of stress in the model of Lazarus and Folkman.

Participants

One hundred and sixty-one college girls (first-year students in a French university) engaged in psychology studies participated in this research. They participated in two collective sessions: a first session took place in November in a non-stressful situation, and a second session during the January examination week.

Instruments

Two questionnaires were used twice in this experiment: (a) the Anxiety State Questionnaire of Spielberger (STAI-Y) which evaluates the anxiety-state and anxiety-traits; (b) the DSQ 40, which estimates 20 conscious by-products of defense mechanisms and distinguishes three factors corresponding to the mature, neurotic and immature styles according to the factorial analyses of Guelfi and al.

Hypotheses

Two hypotheses were formulated: (a) a first hypothesis postulates that an examination situation increases the State Anxiety score; (b) a second hypothesis postulates a variability of defense mechanisms assessed by Bond's questionnaire (DSQ 40). It verified that the scores of the Bond defensive style questionnaire are significantly different in the two sessions.

Results

The mean state-anxiety score is higher in the second session. The great majority of students are described as more anxious during the week of examinations than during the previous month. The first hypothesis is then validated. The situation of evaluation of the university performance appears as a situation more stressful than the courses period. The three defense mechanism factors vary in a significant way from the first to the second session. In the second session the scores in mature and neurotic defense mechanisms increased significantly whereas the average scores in immature defense mechanisms decreased significantly. The majority of the 20 defense mechanisms are not stable between both situations. Indeed, 17 conscious by-products of defense mechanisms differ significantly in both sessions and only three defense mechanisms show a certain stability. Eleven defensive styles (55 %) decreased, six increased (30 %) and three remained stable (15 %). The instability of conscious by-products of defense mechanisms between the two sessions was confirmed by correlations analyses.

Discussion

The results show that the instability between situations is not limited to three categories of defenses (mature, neurotic and immature): 17 out of 20 mean scores in defense styles differed significantly. Conscious by-products of defense mechanisms are, indeed, influenced by situational factors.     

Thérapie comportementale et cognitive avec suivi intrahospitalier au service des urgences et liaison en psychiatrie

In our experience a significant proportion of patients attending the emergency service of psychiatry in an general hospital in France, for a period of 3 to 10 days, can benefit from a couple of cognitive behavior therapy (CBT) sessions. An ambulatory follow-up will complete the therapy (with a total of 12 to 20 sessions). The CBT can be beneficial in different conditions : suicide attempts, addictions, pharmacopsychosis, thymic and anxious disorders, behavior disorders, etc. This specific approach is not indicated in chronic, severe disorders needing pluridisciplinary care and a rather long psychotherapy. The benefits of starting an in-patient CBT are : 1) the crisis experienced by the patient is a strong motivation to seek a psychological support. The rapid initiation of a brief therapy such as CBT will meet the patient’s request; 2) the therapist and the nurses can observe the hospitalized patient in a realistic situation; 3) various tasks of exposure can be accomplished in the presence of the therapist, outside the office; 4) rapid benefit with probable reduction of recurrence (especially for suicide attempts and depression); 5) to promote the psycho-educative approach and to assess the efficiency or lack of support of the relatives; 6) in chronic patient with a rupture of care, to restore a therapeutic project, by frequent and interactive exchanges; 7) last but not least, to informe about CBT, usually unkonwn or poorly known, while the patient evokes the failure of another type of therapy in the past.     

Décrochage du sens moral au sein des forces armées en milieu opérationnel : une approche constructive

Despite the international ratification of Geneva Conventions, which define rules to protect people in situations of war, violence beyond the law of armed conflict is not uncommon. Fairly regularly, the subject makes the headlines. A notable example is the recent publication of confidential informations by Wikileaks. What is at stake is the coherence of UN mandates to western armies. This coherence contributes to the preservation of mental balance of military forces.     

Le Cannabis en France au xix siècle : une histoire médicale

This text draws a history of cannabis (hashish) in xixth century France, based on the study of medical, pharmaceutical and psychiatric texts. First is recalled the state of knowledge concerning cannabis at the beginning of the century. Are distinguished the geographical origins of such a knowledge, with paths leading from India, Near-East and North Africa until mid-xixth century. The work of the alienist Joseph Moreau de Tours (1804–1884) is then exposed, as well as the preceding contributions of Alexandre Brierre de Boismont (1787–1881). The travel of Moreau in Orient is evoked, and the cultural context of Romanticism. The acceptance of Moreau's book of 1845 by contemporary medical readers is commented. This book gives a general theory concerning mental illness, and a proposal for curing such illnesses with cannabis. The subsequent history of cannabis, considered as a medical remedy in the second half of xixth century is drawn as rise and fall of therapeutical hopes. The role of French chemists for the extraction of active principles is detailed, focused on the 1848 cholera epidemic. Cannabis as a psychiatric treatment after 1845 is specially analysed. Cannabis will then be progressively considered as a poison, responsible of public health problems. From the 1870 years is outlined a new nosographical category: toxic psychoses, among which “folies hachichiques” (cannabic madnesses). A brief sketch is drawn, of cannabis considered as a tool for psychological investigation at the beginnings of scientific psychology, with Charles Richet. At the end of xixth century is built the new frame of drug addictions (toxicomanias), in which cannabis addiction will take place. Psychiatry will then be involved in the treatment not only of the consequences but of the psychological causes of drug consumption. The role played by medicine in the diffusion of cannabis use in Occident is finally underlined.     

Soins psychiques et somatiques des sujets en grande précarité : une épreuve de corps

The clinical study of precariousness shows that the psyche and the somatic are no longer mediatized by the discourse of the Other. This absence of otherness projects the subjects that experience it in an unassimilable real. Unable to identify themselves with their body and their image, they cannot feel their physical degradation and their pathology. This leads to the assumption that a divided body is the object of a negation delirium. Nowadays, new medical technologies and mainly medical imaging divide the patient's body in separate units, blocking the access to the fantasized body. Through the socially excluded, this article poses the question of the impact of an increasing objectivization of the medical profession.     

Comportement et activités extra-scolaires : une étude en vie quotidienne de l’échec et de la réussite scolaire

Objectives

In light of its high prevalence and important consequences for future opportunities, academic failure is a major preoccupation of the French educational system. Difficulties at school are associated with later social and professional exclusion and may have an important psychological impact on students, notably concerning self-esteem. However, while the majority of research concerning academic difficulties has been conducted at school or within educational contexts, there is a growing literature demonstrating its association with extracurricular activities. The study of daily life activities poses several problems for the researcher in that students may not accurately recall specific behaviors or correctly report their frequency when assessed retrospectively over long time delays. In order to understand the daily life experiences of students outside of school, this investigation therefore used the Experience Sampling Method in order to collect information at several times throughout the day concerning the environments, activities and routines of students.

Materials and methods

All students and their parents provided written informed consent to participate. Students were selected from ten junior high schools in Southwest France, including five traditional schools and five ‘education priority’ schools based on low academic performance in the school district. Within each type of school, 65 students were selected for being in academic difficulty (defined as having scores below 50% on national evaluations of both French and Math) and 66 were selected for being in academic success (defined as having scores above 80% in these same subjects). Following recruitment into these groups, students were trained in how to complete electronic interviews for a 1-week period using a personal digital assistant (PDA). This device was then programmed to provide three signals a day after school between 6 pm and 9 pm, and five signals a day on the weekend between 10 am and 9 pm. At each signal, the PDA administered an electronic interview asking the students to describe at that given moment their geographic location, social environment, and specific activities. At the end of the 1-week period, the PDAs were returned and data were analyzed using multilevel modeling using a Bonferroni correction for multiple comparisons.

Results

Students in the academic difficulty and success group did not differ by sex, maternal language, country of birth, or by type of school. However, students in the academic success group more often had fathers with higher career or professional status. Concerning daily life experiences, students in academic difficulty were more likely to be spending time in academic or commercial locations, more likely to be with domestic animals or with persons other than family and friends. These students were also more likely to be ‘doing nothing’, and less likely to be performing sustenance or leisure activities. However, students in the academic difficulty group were more likely be doing school work, and several differences were also observed in the structure of these daily life routines across days.

Conclusions

Using an ambulatory monitoring protocol, daily life activities and environments were recorded in real-time and in natural contexts among students experiencing either difficulty or success. The findings demonstrating greater passivity, fewer leisure activities, and fewer moments spent with family for students in academic difficulty may indicate that less structured or unsupervised time schedules should be examined for its potential role in academic difficulty. While students in difficulty were also more often in academic settings and likely to being doing school work, these seemingly paradoxical findings are likely to reflect the academic tutoring or other intentional strategies to cope with such difficulties. Future research should consider extracurricular activities and contexts when investigating risk and protective factors associated with academic performance.     

Psychiatrie et prison : une histoire parallèle

Psychiatry and prison have a complex parallel history. It starts at the end of eighteenth century with a radical distinction between crime and mental illness. Since that time, one can see an evolution more and more clearly. Insanity and criminality are brought together in a same study by criminological theories (phrenology, criminal anthropology…). Despite the fact that the criticism of asylums and prisons has taken an unexpected level during the twentieth century, the more recent evolution in France is to punish the criminal mentally defective. It's hard to for see the future of this gradual acculturation.     

Coping et qualité de vie dans la sclérose en plaques et la maladie de Parkinson : une réflexion clinique

Objective

In neurological disorders, such as multiple sclerosis (MS) and Parkinson’ s disease (PD), psychological and adaptive processes have not been extensively investigated, it has, however, been demonstrated that they have a great impact on “quality of life” (QoL). Interestingly, even though these two diseases affect people of different ages, both of them have a substantial impact on mood and QoL. In these two diseases, the authors objective was to analyse the style of coping in relation with the QoL taking depression and anxiety into account.

Methods

Two hundred and seventy MS and PD subjects were seen for a semistructured interview in order to collect sociodemographic and clinical information, after which there was an assessment of their mental and cognitive states using: the Mini International Neuropsychiatric Interview (MINI), the Montgomery and Asberg Depression Rating Scale (MADRS), the Depressive Mood Scale (EHD), the Hamilton Anxiety scale (HAMA) and the Frontal Assessment Battery (FAB). Then, all subjects completed three self-report questionnaires; two about coping strategies: the Ways of Coping Checklist (WCC), the Coping with Health, Injuries and Problems scale (CHIP), and one about QoL: the SEP 59 for MS and the French version of PDQ-39 for PD.

Results

The studies show that the psychosocial dimension of QoL is preserved in the two diseases studied. They also demonstrated that in MS and PD the two factors associated with a poor QoL are depression and emotion-focused coping strategies. Furthermore, these variables are highly dependent on the clinical courses in MS and motor signs in PD. However, the MS patients tended to be more irritable and to lose the control of their emotions more easily than PD patients.

Discussion

The report discusses the importance, first, of identifying these manifestations in patients with MS or PD and, second, of offering patients interventions tailored to the characteristics of each disorder. The authors propose some examples of psychotherapy, which could be used with neurological patients. The studies show that it is also important to work with MS and PD patients on both the expression and the management of their emotions in connection with their diseases.     

Adhésion au traitement prescrit et traits de personnalité dans une population de patients atteints de schizophrénie

Schizophrenia is one of the most important public health problems. It is a common, tragic and devastating mental illness that typically strikes young people when they are maturing into adulthood. Among schizophrenic out-patients, 24-63% of patients are non compliant as they failed to take the correct drug in the correct dosage. Clinical experience had demonstrated the existence of several groups of patients, some who comply with the medical regimen and others who do not adhere to treatment. Some of the factors that had been linked to poor compliance included low socio-economic status, unstable lifestyle, general negative attitudes towards one’s predicament, cognitive strategies and patient’s personal and psychological characteristics. As such, several studies have shown that three personality dimensions are particularly important for understanding schizophrenia which are extraversion, neuroticism and peculiarity. The aim of this study is to search for the possible association between personality traits or cognitive strategies and compliance to treatment in a sample of adult patients with schizophrenia. Eighty-three patients were screened for suitability for inclusion into the study. Patients who fulfilled the following criteria were recruited: aged 18 and more, who received a diagnosis of schizophrenia (Axis I DSM-IV), without severe cognitive impairment, without a diagnosis of personality disorder (Axis II DSM-IV), consulting their psychiatrist for a period of one year after dismissal of their psychiatric ward and having given their written informed consent. The final study sample consisted of 50 out-patients adults, 35 males and 15 females, age 19-59 years. After inclusion, patients were divided into two groups (Compliant-C and Non Compliant-NC) on the basis of their compliance to treatment. Mean age for the two groups is, respectively, 34.59 ± 9.62 and 27.29 ± 7.93. Compliance to treatment was measured by indirect methods such as the impression of the treating psychiatrist, interviewing patients, therapeutic outcome, counting the number of tablets remaining in a patient’s supply and objective criteria such as presence to medical and staff appointments or ending the follow-up. Personality traits were measured by the Rorschach Test, scored and interpreted according to Exner’s Comprehensive System. This psychological measure was selected for its ability to differentiate state and trait personality variables and its sound validity when used in the manner for which it was designed and intended. The selected trait variables in the Rorschach are: P < a + 1, which identifies tendencies to be passive and deferential in social situations; HVI index, which indicates a cautious, distant and mistrustful orientation to people ; EB which shows a cognitive style of decision making; Lambda > 0.99 which identifies a lack of adequate openness to experience and tendencies to view one’s world with an overly narrow focus of attention; and Fr + rF, associated with narcissistic marked tendencies to overvalue personal worth. The selected defense mechanisms in the Rorschach are: the intellectualization index (2AB + Art + Ay) used to keep emotion at a distance and minimize their impact. Denial (MP > MA) defines a predilection for escapist fantasy and prevents the impact of an unpleasant reality. Patients were contacted during their hospitalization period by the medical chief of staff who described the study in details. After they had consented, participants received the Rorschach test, before leaving the hospital. The Rorschach protocols have been scored by two Senior Rorschach practitioners. On the selected variables their scoring agreement percentage was 100%. Rorschach protocols were assigned to the C and NC groups by the end of the scoring process and once the medical team had finished the inclusion into the two groups (C and NC). The two Rorschach practitioners had worked single-blind on the set of Rorschach protocols. Group differences in Rorschach variables at the end of one year of medical follow-up were examined by using the χ² test. The significance level was set at P < 0.05. Results have shown that the C and NC groups differ significantly on the basis of schizophrenia subtypes. The Paranoid type (295.30) is more frequent in the C group whether the Disorganized type (295.10) is more frequent in the NC group (χ²= 12.16, P < 0.001). Compliant schizophrenic patients use significantly, more frequently the intellectualization defense mechanism (χ² = 6.17, P < 0.012). Non compliant patients appear to have significantly more marked narcissistic traits and tendencies to overvalue personal worth (χ² = 8.79, P < 0,003). These observations support the idea that paranoid delusions, even if persecutory, do not alter pervasively the ability of maintaining genuine relationships with some others, such as the treating psychiatrist, for instance. In Disorganized type patients, the orientation to people is overall disturbed, the interest in the therapeutic alliance more superficial and fragile. Due to narcissistic traits and tendencies to overvalue personal worth, non compliant patients display a sense of grandiosity and entitlement which distort the genuine perception of personal needs and that of their psychological states. Intellectualization acts as cognitive coping strategy aiming to mute the intensity of emotions and safeguard against distress. Shifting emotional experience to a cognitive level allows the schizophrenic patient to acknowledge his needs for medical therapy even if he does not recognize himself as being ill. The research presented here comprises a 1-year prospective study designed to test some associations between personality factors and compliance to treatment. The degree to which schizophrenic patients comply with the advice of health workers depends, among other factors, on their stable personality traits and coping mechanisms. Continued study of the links between personality traits and compliance to treatment in this population as well as regular psychological assessment of these patients may identify which therapeutic approaches are best for which patients. There is increasing interest in the role of psychological mechanisms in compliance behavior formation after the onset of illness and these models may also be useful in thinking about events before onset.     

Alliance thérapeutique et engagement : une réflexion sur l’éthique de la prise en charge des patients suicidants en psychothérapie psychanalytique

The ethical questions involved in the treatment of patients who have attempted suicide will be addressed here on the basis of two contradictory positions, which appear in codes of deontology. On one hand, we find individual freedom and protection of the person; on the other, professional secret and shared secret. The reflection, developed along the lines of psychoanalytical theory, is enriched by contributions from crisis management. It is illustrated by means of clinical situations taken from clinical practice in the domain of suicide prevention. What is revealed is the fact that suicide does not correspond, in the case of our patients, to the exercise of freedom and as a consequence, it requires us to intervene. Suicide attempts are often associated with pathologies in which we can find a life history marked by separations, abandonments and trauma, corresponding to a failure of the environment which the treatment must be careful not to reproduce. This implies that, between the contradictory terms evoked above, we make the choice of protection of the person and of shared secret. As concerns the analytically based psychotherapeutic framework, the guidelines of traditional neutrality for the analyst, whose value remains complete, must be redefined toward a more interventionist counter-transferential position.     

Le destin de la projection paranoïaque à l’aube d’une décompensation somatique : mouvements transférentiels et analyse projective

Our review of the literature supports on the psychoanalytical theories about the concepts of transference, counter transference and projection. For our analysis, we privilege Sigmund Freud's works resumed by Michel Neyraut as for the definition which they propose of the transference, understood as a displacement on “the person of the doctor” and repetition of the unconscious feelings of a primary's object relation. In the psychotherapy frame, the transference massive can express itself with strength (freely or at the price of resistances) thanks to the identification and to the projection (of love or hatred). When a negative transference that Thierry Bokanoswki translates into terms of hatred of the transference and the hatred in the transference is at stake, it is well-to-do to understand that the counter transference is affected… But the question is: How? This process which adorned us inseparable of the transference, is understood by Sandor Ferenczi and Paul Denis as an obstacle to be overcome by the therapist to reach better the psychic life of his patient thanks to their relation. Runner of the psychoanalytic considerations according to which one counter transference is a brake for the good progress of the psychotherapy but also a lever allowing the psychic elaboration and the creation of sense, we chose to register the dynamic of the transference in the clinic of the serious illness to better encircle the echoes of physical burglaries and the psychic impact of binding treatments. Besides, it generally admitted that the trauma of the somatic achievement reveals an unconscious raw engendering various psychopathologic demonstrations. The term of projection comes to illustrate this idea of a psychic disorganization and its consequences. The various psychoanalytical meanings the concept of projection and the discovery of a dialectic organizing perception/projection of any projective situation including a medium participated in the elaboration of the paradigms of the projective psychology, characterized by its theoretical and clinical transversally. Beyond the analysis of the transference and counter transference movements thanks to clinical consultations, we also chose to use Rorschach and TAT and the psychoanalytic interpretation inspired by the university of Paris 5 method. Our research appears under the form of a clinical case report built following the meeting with a patient at the beginning of dialysis. Loïc, 60 years old, reached by two severe somatic pathologies taken care medically: diabetes treated by insulin and a renal insufficiency treated by dialysis. Our clinical and projective study shows in what the projection appearing in its relationships to the transference, forms an eminently effective strategy to counteract the obvious disorganization generated by the chronic diseases from which Loïc suffers. The exploratory perspective of this research joined of our previous works, by highlighting the interest of the analysis of the transference and counter transference in medical context. Although the projection was profitable to the patient, it not less nevertheless remained expensive on the side of the clinician-researcher who, became persecutor object only because of being a “learned woman”, had to compose with the feminine maternal persecutive transference which was attributed to her. The transference movements and the paranoiac projections nevertheless allowed Loïc to support the event of disease in what put temporarily the therapist in trouble.     

Architecture,théorie du soin en psychiatrie et politique. De la forme au sens

When evoking the insane asylum, Esquirol wrote in 1822 : “In the hands of a skillful physician it is the most powerful agent against mental illnesses”, he did not refer only to the architectural space arrangement of the asylum but to its global conception of the care environment, and this notion of care environment is more complex than it seems. The significant link he introduced could lead to confuse that which belongs to care and that which depends on the environment in which it is given. Moreover, history shows this subtle exchange between psychiatry and architecture. Within the research of the therapeutic impact that an ideal society could have on mental illness, the link between moral treatment and the architecture of the classical asylum is well known as is that between the village hospital with institutional psychotherapy. But, on the other hand, who remembers that the debate between Marxism and psychoanalysis within psychiatry had important repercussions on the architectural and environmental modalities provided to care for the mentally ill ?     

Aspects psychopathologiques de l’exercice physique intensif chez l’enfant et l’adolescent : mise au point à partir d’une situation clinique

Physical activity is related to beneficial effects mental health in children and adolescents. However, intensive training may be associated with both physical and psychological negative aspects. This article provides a clinical report and a review of psychopathological symptoms in young elite athletes. A particular focus is laid on eating disorders, risk-taking behaviors like substance abuse and/or doping, as well as on emotional disturbances and overtraining syndrome. Familial and social pressures may be inappropriate, causing physical or psychological distress. The implications of the reviewed data are discussed in terms of prevention and future challenges for research in sports psychiatry.     

Transsexualisme et Rorschach : une revue de la littérature

The Rorschach test appears as the main projective method used to investigated the personality of sex reassignment candidates. We shall first look at studies testing, the hypothesis of troubled background. In a second time, we will analyze the hypothesis of independent issue. Finally, we will present the few follow up studies built up with the Rorschach test.