Géographie et psychose : territoire et perte du corps commun

Faced with the observation of clinical stalemate that may cause psychotic subject's speech, the authors suggest an alternative methodology based on the report of the subject to its own geography and its faculty of “territorialisation”. Based on arguments coming from ethology and phenomenology, they suggest an epistemological reflection of the act for the practice of clinical psychology with psychotic patients. These acts consisting the refrain, the social adjustment, the emotional regulation or even the relational intuition are witnesses stating that the central problem of psychosis is within the broad spectrum and complex of the loss of common sense and common body.     

La Scientologie : un délire systématisé inspiré par les Études sur l’hystérie, de Breuer et Freud

Was Lafayette-Ronald Hubbard, the famous founder of the Church of Scientology, psychotic? From this question, we have tried to rethink the analysis of this sect. We approached the scientologist doctrine in the Freudian way, that is as a “recovery attempt” – like the delirious, which enabled Hubbard to treat, through his writings, the teeming elementary psychotics phenomena, which harassed him. The study of his first “philosophical” book, Dianetics: The modern science of mental health, will show us, in a quasi-experimental way, the intense work of the delirious, which enabled him to put back together his broken-down universe, to inject sense into the sluggishness resulting from his psychotic decompensation, and finally to reintegrate the social tie. Scientology's writings will then reveal to us their hidden source: Studies on hysteria, by J. Breuer and S. Freud, which had strongly inspired Hubbard. Through a comparative analysis of these two texts, we will show how Hubbard managed to adapt hysteria's etiology into the way of his own psychotic experience, so as to include it inside his delirious system.     

The psychotic mummified hand: An unusual hand injury complication

The authors report the case of a patient with psychotic symptoms secondary to a posttraumatic stress disorder following a work-related hand injury. The somatic presentation was a “mummified” hand neglected for several years in a splint without any care. The psychiatric analysis concluded that this was part of a delusion of persecution expressing a conflict against the patient's employer and insurance company. Surgical treatment was limited to a hand cleaning with hardware removal. Despite 3 years of antipsychotic medication the patient was still suffering from delusion and the hand remained neglected at the last follow-up.     

Certitude anticipée du passage à l'acte

Acting takes place at a time when the subject's act literally puts down in reality the logical necessity of a loss. The loss is equal to attesting a signification which has been achieved - the subject being altered to a “fallen object” and imposing on the Other a loss of his enjoyment. This can only be established while reaching an anticipated certainty answering the question : ‘What am I for the Other?’. It goes along with the downfall of the subject, contrary to the principle of altering afterward which is at play in Fantasy. Committing suicide illustrates this decision and so, after Lacan, entails the alteration of the subject through the act. An examplary clinical case (the “case of Marie” by D. Lagache) which is revisited here allows us to ascertain clinically the coordinates of the subject's resorting to act. Studying teenagers' suicides (in increasing numbers and a current illustration of the general feeling of discomfort) on the one hand and on the other the martyrs of idealized political causes will throw a new light on psychopathological cases whose reasons are not made the clearer for a sociological approach which is too often the only point of reference used.     

Réflexions sur la fréquence, l’organisation et les facteurs prédictifs des homicides psychotiques : à propos de trois observations avec mutilation corporelle

The statistically positive correlation between severe mental disorders and physical violence has now been firmly established by international studies. In Europe, about 10% of homicides are committed by psychotic patients who may re-offend. Three medicolegal observations of homicides with bodily mutilation are presented. The first concerns a 31-year-old schizophrenic man who killed a passer-by in the street when in a state of paranoid delusion with themes of homosexual rape and persecution. The crime was committed in two separate phases: first, emotional violence and then, a few hours later, operational utilitarian violence with amputation of the victim's hands. The second case concerns a 21-year-old man suffering from paranoid schizophrenia associated with an antisocial personality disorder. During the night, he assassinated two women who worked in a psychiatric unit, one of whom was decapitated while still alive. Although living freely in the community, the patient acted with premeditation and method under the influence of ideas of persecution and cosmic supernatural terror. The third case concerns a 30-year-old man who had been forcibly hospitalized in a psychiatric unit for delusional disorder of persecution with paranoiac personality disorder. During a period of weekend leave, he killed his own mother in the family home in a totally disorganized emotional moment of acting out, then cut off her leg and threw it out of the window. Six years beforehand, he had already killed a prison inmate who was sharing his cell. In the first two cases, the patients’ behavior was partially or totally organized despite delusional motives of paranoid type. In the light of these three dramas and a litterature review, the main psychopathological predictors of physical violence committed by psychotic patients are discussed: severe psychotic episode, persecutory delusional beliefs, comorbidity with substance abuse (alcohol, cannabis) and personality disorders, little or no antipsychotic treatment, and poor therapeutic compliance. In France, it appears mandatory to apply a rigorous procedure for evaluating the dangerousness of severe mental patients and violent criminals.     

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.     

Psychothérapies des psychoses : entre histoire et évaluation

Historically, the psychotherapy of the psychoses was bound to the psychoanalysis in the questions around the possibility of transfer at the psychotics then in the developments of the psychoanalytical technique and in the use of against transfer. The development of medicines and the formalization of the other psychotherapeutic techniques (family, cognitive and behavioural psychotherapies) advanced the necessary coordination of the care to go of an exclusive psychotherapy centred on a type of treatment towards an integrative psychotherapy. The model dominating at present notably in the USA is a psychosocial model which uses the medicinal treatment, the family psychotherapy and the psychotherapeutic techniques of type TCC. The objective of this care is to limit relapses and consequences of the negative symptoms which pull isolation. The future of the psychotherapies of the psychoses articulates the evaluative dimension to be able to define real therapeutic integrative strategies and the individual dimension where the meeting with a subject is in the heart of the therapeutic device and where the psychoanalysis keeps all its interest.     

La fuite des événements dans les suicides maniaco-dépressifs

We propose to consider manic-depressive suicide not as an act but as an event, or rather as the result of a series of events in flight. The main idea is that bipolar disorders are not the differential symptoms of manic-depressive psychosis (MDP). But rather the delirium of death, the cotardization of desire, the flight of ideas, and especially the flight of events leading to the unconscious destruction of the subject. To present our theory on this subject, we must quickly evoke the new concepts we have formalized concerning the clinic of MDP, namely manic foreclosure, delirium of death, white factors, altruistic anxieties, psychic ruins and, of course, flight of events. In the diagnosis of MDP, there may well be medical data, why not, since this psychic disturbance produces real effects in the somatic, even if it is not an obligation that there should be. However, that it may have some effects in the somatic, does not mean that the MDP and the disorders attached to it depend, or come, ultimately, from an organic disorder that should be treated medically. The manic experience shows us the very singular relation of the subject to the language. It turns out that some over-evaluated or over-represented signifiers begin to have a very heavy weight against which the subject develops a frenzied and privileged ban. This is what Binswanger calls the flight of ideas, by which the subject does not shun his delusional ideas, but it is the ideas themselves and the overvalued signifiers that begin to flee by themselves. Now, the flight of events is a fourth form of psychopathological expression, in addition to delirium, hallucination and passages to the act, which I have observed in many cases of MDP and which I have formalized in several works. These events may come from the life of the mother or father and both, independently, but especially from earlier generations whose affective value is, like in a cascade, by the parent-child relationship. The inter-subjective event is the space in which the unconscious of several subjects can manifest themselves in a synchronous way and, as such, they can be shared and assimilated diachronically. In the case of a subject in whom the delirium of death fails, in whom negative hallucinations abound, but with an inhibition of the act, it is possible that the inter-subjective events in flight carry out the destruction of his life for him.