Le traumatisme psychique constitue une blessure du langage par atteinte des réseaux de significations

ObjectivesTrauma appears within the discourse of mentally injured people, materializing what we have recently defined as “post traumatic psycholinguistic syndrome” (SPLIT). Translating unspeakability, revival, and dissociation, this clinical entity associates three significant disturbances : traumatic anomia (missing words, reduction of the elocutionary flow, deictic gestures, etc.); linguistic repetitions (of words and phrases, verbal intrusions, echophrasias, etc.); and phrasal and discursive disorganization (incomplete sentences, tense discordance, dysfluence, lack of logical connectors, etc.). What are the causes of these semiological and psycholinguistic expressions? What are their psychological and/or neuropsychological processes? It is time to come up with a new concept intended to go beyond the previous models in order to better identify people suffering from post-traumatic mental disorders, to better organize and evaluate psychotherapeutic care, and also to help practitioners collaborate more effectively on these first two goals. But how to evoke, affirm, or speak out about the consequences of unspeakability? Nothing is more apparently contradictory than wanting to define the language void. How to account for the fractures of psychic trauma in discourse? Nothing is more uncertain than to try to organize the upheavals, the disorders caused by dissociation in language. Finally, how to specify the reiteration of the trauma using words and sentences without this modeling being dissociative or repetitive? Today, thanks to a psycholinguistic reading, essential dimensions of post-traumatic suffering, hitherto hidden, can be clarified. Why exactly does an event cause trauma in the life of a subject at a given moment in her/his existence? Why is a latency phase structured between the traumatic event and the return of reviviscences under the influence of a re-triggering factor? How to differentiate the notion of dissociation as a normal phenomenon from the so-called traumatic dissociation? How to explain the multiple clinical forms of post-traumatic psychological disorders?MethodsFrom Pierre's clinical history, we chronologically detail the structuring and the consequences of the signified reflection that are constitutive of the psychic trauma: the psycholinguistic tools here help to formulate a new etiopathogenic conception of trauma and its psychological consequences. Then, thanks to Jean's testimony, taking up the retrospective meaning of the clinical analysis from chronic repetition syndrome, we discover the phases of tension regarding signified knowledge, up to the network prior to the traumatic confrontation. Finally, illustrated by Karima's disorder, beyond depersonalization, we explain that the analysis of the disturbances of a singular signified network, and also of an attack on its familial and societal bases, testifies to individual and collective subjectivities.ResultsComing from the real world, and therefore also from the body, the stimuli made up of signals picked up by our senses combine to compose an event that can be objectified by its temporal, spatial, biological, and physico-chemical coordinates. These elements combine into a unit, which is then interpreted by the mind, which attributes meaning to this event, which has become subjective reality. But when the subject is not sufficiently prepared to be confronted with this meaning that appears to be in extreme contradiction with her/his previous cardinal networks of significations, it makes “too much sense:” this irreconcilable hyper-signified (that we call the traumatic signified) results in post-traumatic dissociation. In other words, it is an impossibility of concordance of a signified with certain systems of prior significations that constitutes the pathogenesis of the trauma; and a situation runs a greater risk of being traumatic when it contradicts, or, moreso, endangers some or all of the subject's cardinal meanings. This unbearable signified reflexively blocks the capacities of significations immediately pre- and post-trauma, then dissociates the psychic functions to varying degrees and intensities. The traumatic signified, rejected, becomes unattainable: the stimuli that led to its formation find themselves confined to the state of reviviscences, each replication of which attempts to cross the barrier of inconceivability. Limiting sensory compounds to their raw states without the possibility of representational integration, associative pathways remain blocked. The signifier is referred to a hypo-signifier confined to the infra-linguistic by its confusion with the referent, the “objective and material” components of the traumatic event. Dissociation is therefore only a symptomatic reaction, secondary to the trauma, which it reinforces once again by limiting any possibility of representing the trauma. This dissociation does not involve forgetting the traumatic signified but “protects” the adjacent networks of meanings from it as much as it “keeps” this hypersignified intact, therefore ultimately “protecting” it as well. The traumatic signified persists somewhere, and even ends up being found everywhere: when the networks of meanings turn out to be globally disturbed, the tightest links remain those of the traumatic hypersignified that ultimately governs all the networks of meanings.DiscussionOur insufficient knowledge prevents us from precisely qualifying the architecture of the signified idiosyncratic networks and their evolutionary capacities; we cannot predict, beforehand, the reaction of an individual confronted with a potentially psychotraumatic situation. For most clinical situations, we affirm that the psychological trauma occurs in a psychically healthy subject, that is, not suffering from any psychiatric illness or any obvious psychopathological conflict. Psychotherapy will make it possible to discover the signified, sometimes ancient, origins of a trauma occurring in a singular subject. How was this subjectivity constructed? Beyond individual subjectivity, the intensity of certain confrontations such as serious attacks or macrosocial catastrophes such as genocide, would seem to lead to psychological wounds in any individual, even at the scale of a population. While, throughout existence, each subject produces a system of significations in connection with a unique psychic construction, the latter persists – resulting from, and often remaining overseen by, the community essence of a base of signifying networks, which we call “societal subjectivity.” Here, the psychological trauma can correspond to an individual and “common” injury as a failure of a sharing, or of ancestral beliefs anchored in the collective memory, defining the culture. By the collapse of acquired certainties, the cognitive patterns transmitted by education, language, and everything that establishes one's belonging to a society, trauma shakes the networks of individual and group meanings. Horror has a higher traumatogenic risk, because it defeats the fundamentals of humankind, the foundations of a signified network common to a culture, or even to all cultures, to the human condition. This is the case with murder, rape, torture, wars, genocides. Testifying to an instinct for survival stemming from the biological foundations of every living being, the impossibility of “living death” appears to be anchored in our networks of meanings and is manifested by indescribability, traumatic as such: being deserted by the language collides with the condition of speaking. And yet, it remains possible to say something about it... As a path of progressive desocialization, the occasional loss of the community of language, followed by its lasting traumatic ravages, can be appeased by the reestablishment of a speech link, either within the mind of the subject alone, or promoted by the exchange with others, in a psychotherapeutic setting, for example.ConclusionWhere theoretical discourses have sometimes proved divisive, going beyond the symptoms of indescribability and dissociation, psychodynamic practice today offers to unite. Thanks to psycholinguistic listening, phenomena that have never been explained take on meaning: the singularity of traumatic perception, the chronology of disorders including the latency phase, factors that trigger reviviscences, and the diversity of chronic clinical forms. All these post-traumatic symptoms are consequential to a linguistic wound, a difficulty in accessing meaning, the undermining of two dimensions characterizing and constructing the human being. As much as it integrates extralinguistic determinants, if the traumatic signified is undoubtedly not only speech, language appears the optimal way to identify it as such, while in the same movement appeasing it. The traumatic hypersignified is discovered through clinical analysis and psychotherapy, through deferred action, through the attribution of meaning, through the retrospective reconstruction of an unstable “real,” through a changing narration eternally distancing itself from reviviscences. But what precisely are the mechanisms of effective therapies ? What are the intersubjective links called for in the discussion between patient and practitioner? Could the operations that we call “psychotherapy” be made up of mobilizations of the networks of meanings by speech acts?     

Le dilemme du réfugié

The experiences of trauma, displacement, and forced migration faced by refugees raise profound questions about the relationship of self and community. This article explores some ways in which the intrapsychic dynamics of refugees' suffering and remembering interact with the larger social dynamics of refugee communities and host societies. The narrative construction of the self constitutes the pivot between the realms of the social and the psychological and rests on cultural meta-narratives. In Euro-American folk psychology two of the meta-narratives or concepts of the self can be compared in terms of their root metaphors: the adamantine self, characterized by its integrity, coherence, autonomy, self-definition, self-determination and self-control; and the transactional self, characterized by its fluidity, sensitivity to context, deference to authority, multivocality, deference and yielding to or accommodating others. These two accounts of the self shape how we view people who have suffered wrenching transformations of their worlds through violence, dislocation and loss. The changes produced through the therapeutic process can be understood as the development of a form of dialogue that is at once, within and without, personal and transcendental, rooted in communal tradition and in the open confrontation of the face of the other. The ethics of storytelling has its necessary counterpart in the ethics of listening, of witnessing and taking part in the creation of community through copresence.     

山楂结块体外凝结、离解的实验研究

目的:探讨山楂结块形成的机制,以指导预防和治疗。方法:配制以胃蛋白酶为基本液的模拟胃液,对60个山楂糊团和500g山楂糊进行酸凝实验。使用6％和8％浓度的碳酸氢钠溶液对酸凝后的山楂糊团、山楂糊做碱离解试验。设搅拌、非搅拌组和清水对照组作对比。结果:酸凝实验:山楂团硬度增加。清水对照组山楂团硬度明显低于酸凝组。散放入模拟胃液中的山楂糊相互接触处发生凝结,形态仍呈不规则片块状。碱离解实验:6h后碳酸氢钠溶液中均出现酸碱中和现象。非搅拌组:结块表面有碎屑脱落,至第10天碳酸氢钠溶液和清水中的结块均未自行碎解。搅拌组:搅拌时有较多碎屑脱落。第3天,1个结块碎解。至第10天,20个结块全部碎解。清水对照组:仅1个结块在第8天碎解。结论:山楂团酸凝后硬度增大。散放入的山楂糊酸凝后形态仍呈不规则片块状。碱溶液通过酸碱中和可使山楂结块表面松解,无外力作用时不能使结块碎解。     

Reticulocyte counts before and after exercise: Trained vs. sedentary

Summary Reticulocyte count comparisons were made on ten trained and ten sedentary college males before and immediately after heavy exercise and following 15 min of recovery. No significant differences occurred within or between groups; in fact, all means were within the normal range. Previous findings were discussed. It was concluded that a physiologically significant increase in reticulocytes does not occur as a result of exercise or training and therefore can not be a mechanism for increased maximal oxygen uptake.     

Binding of influenza viruses to sialic acids: reassortant viruses with A/NWS/33 hemagglutinin bind to alpha2,8-linked sialic acid

We have examined the specificity of binding of A/NWS/33 hemagglutinin (HA), exploring the effects of fucosylation, changing the Gal-GlcNAc linkage between the second and third sugars, and binding affinity for alpha2,8-linked sialic acid. The HA of A/NWS/33(HA)-Tokyo/67(NA) (NWS-Tok, H1N2) virus binds to 3'-linked sialyllactose with 10-fold higher affinity than 3' sialyllactosamine and 3-fold higher affinity than 6' sialyllactosamine. The P227H mutation in A/NWS/33(P227H)(HA)-A/Memphis/31/98(NA) (NWS-Mem/98, H1N2) results in sevenfold lower affinity for 3' sialyllactose, but binding to 6' sialyllactosamine is unchanged. The apparent switch from 3' to 6' specificity is solely due to a loss of Siaalpha2,3 binding. Fucosylation of the third sugar and changing the linkage between second and third sugars had little effect on binding by NWS-Tok, but marked effects on A/NWS/33(P227H)(HA)-tern/Australia/G70c/75(NA) (NWS-G70c, H1N9) and NWS-Mem/98. NWS-Tok, NWS-G70c, and NWS-Mem/98 bind to alpha2,8-bisialic acid with high affinity. NWS-Mem/98 can also bind to alpha2,8-trisialic acid, but with lower affinity. Together, these data show that alpha2,8-linked sialic acid, fucosylation of the third sugar, and linkage between the second and third sugars could play important roles in allowing efficient virus binding to its host cell. The finding that influenza viruses have the potential to bind to alpha2,8-linked sialic acid is a new influenza virus-receptor interaction pathway.     

Effects of sodium and GTP on the binding kinetics of [3H]diprenorphine in NG 108-15 cell membranes

Summary Equilibrium binding isotherms of [³H]diprenorphine in membranes from NG 108-15 cells are consistent with a homogenous population of binding sites. Upon addition of Na⁺, Mg²⁺ and GTP, only a 2-fold reduction in affinity with a minor decrease in the number of sites is observed. Dissociation curves of [³H]diprenorphine, however, are clearly biphasic: in the absence of Na⁺, Mg²⁺ and GTP, 80% of the bound ligand dissociates slowly with at _1/2 of 100 min, and only 20% rapidly (t _1/2 4.5 min). In the presence of Mg²⁺, nearly all the binding is found in the slowly dissociating form. Upon the addition of either Na⁺ or GTP, 20–30% of the binding dissociates more rapidly. The rate constant of the rapidly dissociating form generated by Na⁺, however, is 2.5 times greater than that induced by the presence of GTP. Thus, the addition of both, Na⁺ and GTP, converts about 80% of the receptor into a very fast dissociating form (t _1/2 1.7 min).Exposure of intact cells to pertussis toxin (10 ng/ml) or treatment of membranes with N-ethyl maleimide (500 M), strongly reduces the proportion of the slowly dissociating component. Following these treatments, the effect of GTP is reduced or abolished, but that of Na⁺ remains unaffected.We conclude from these data that the effects of Na⁺ and GTP are not only distinct in site but also in mechanism of action and that there are three forms of opioid receptors that can be differentiated by their kinetic properties. The slowly dissociating receptor form requires a functional N unit.     

Thermodynamics and kinetics of t-butylbicyclophosphorothionate binding differentiate convulsant and depressant barbiturate stereoisomers acting via GABAA ionophores

The temperature dependence of [³⁵S]-t- butylbicyclophosphorothionate (TBPS) binding to the convulsant sites of the GABA_A receptor complex was studied in membrane preparations of rat forebrain. Although specific [³⁵S]TBPS binding was maximal around 20° C, the rate constants of dissociation decreased monotonously between 37°C and 2° C. The displacing potencies of the convulsant S(+) enantiomer of 1-methyl-5-phenyl-5-propyl-barbituric acid (MPPB) (IC₅₀ = 1250 ± 30 M) and the depressant R(–) MPPB (IC_5O = 310 ± 5 M) did not show significant changes between 19° C and 37° C. Therefore barbiturate binding seems to be driven by entropic, rather than enthalpic changes. An excess of MPPB enantiomers elicited accelerated and polyphasic dissociations of [³⁵S]TBPS as compared to the monophasic dissociation by TBPS. Arrhenius analysis was applied to the measurable initial rate constants of dissociation. Arrhenius plots were linear between 2° C and 37° C. Activation parameters were similar when [³⁵S] TBPS dissociation was triggered by the convulsants TBPS and S(+) MPPB. It can be attributed to similar conformations of the closed ionophore complex. In contrast, the depressant R(–) MPPB strongly decreased the activation energy of TBPS dissociation from the open ionophore ternary complex.In whole-cell patch-clamp experiments R(–) MPPB, but not S(+) MPPB, elicited chloride currents in rat primary cortical cultures with an EC₅₀ value of 560 ± 30 M and a Hill coefficient of 2.9 ± 0.2. These currents were similar to those elicited by GABA and blocked by TBPS. A kinetic scheme is proposed for the dissociation of TBPS and to explain the different effects of MPPB enantiomers. Submillimolar R(–) MPPB is supposed to bind to (about three) barbiturate sites on GABA_A-ionophores and to open them in a cooperative manner to result in a decreased activation energy for accelerated displacement of convulsant binding.     

On the Dimensionalities of the Dissociative Experiences Scale (DES) and the Dissociation Questionnaire (DIS-Q)

Abstract

The dimensionalities of the Dissociative Experiences Scale (DES) and the Dissociation Questionnaire (DIS-Q) have been explored by factor analysis by a number of investigators. The general claim is that both scales are multidimensional. However, we argue that, in both cases, this ap parent multidimensionality is a form of range restriction that arises because some symptoms are more common than other symptoms. As a result, the resulting subscales derived from the multifactor solutions are so highly intercorrelated as to be incapable of meaningful discriminant validity. The current findings support a more parsimonious single factor solution for both scales.     

The Language of Dissociation

ABSTRACT

Three case studies of inner-city elementary school children illustrate the connection between speech-language disorders and dissociative disorders in children who have known or suspected trauma histories. The role of speech language pathologists in identifying and responding to dissociative symptoms in children is explored. Lack of adequate training concerning the impact of trauma and scarce literature on the communication profiles of dissociative children contributes and greatly impacts the diagnosis, referral, and treatment of these children. The case studies demonstrate how unusual speech and language symptoms and awareness of dissociative features may aid in identifying trauma-related problems and instituting effective treatment. Grounding techniques and specific language interventions can assist children in acquiring the vocabulary needed for communicating both their daily experiences and traumatic histories. The nature of the relationship between dissociation and communication disorders is explored, and the importance of future research, interdisciplinary collaboration, and trauma training in the speech-language curriculum is emphasized.     

Development of Dissociation: Examining the Relationship Between Parenting,Maternal Trauma and Child Dissociation

SUMMARY

While many studies have demonstrated relationships between trauma and dissociation, relatively little is known about other factors that may increase children's risk for developing dissociative symptoms. Drawing on betrayal trauma theory and Discrete Behavioral States frameworks, the current study examined the contributions of maternal factors (including mothers' dissociation, betrayal trauma experiences, and inconsistent parenting) to children's dissociation. Seventy-two mother-child dyads completed self-report questionnaires. Maternal dissociation was found to relate positively to maternal betrayal trauma history. Additionally, both mothers' and children's betrayal trauma history were found to significantly predict children's dissociation. Implications for the intergenerational transmission of betrayal trauma and dissociation are discussed.