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?     

L’espace de la santé mentale : un paysage discursif et clinique en remaniement

Objectives

This paper introduces some epistemology about mental health developments and how it leads to reconsider the landscape of clinical practices.

Une psychiatrie sans esprit ?

Philosophy of Mind is currently one of the most prolific fields of research in philosophy and has witnessed a progressive hybridization with cognitive science. It focuses on fundamental questions to neuroscience and psychiatry, such as the nature of mental states and cognitive processes, or the relationships between mental states and the world. Anticipating the accumulation of experimental data from neuroscience, it provides a framework for the generation of theories in cognitive science. Philosophy of mind has thus laid the foundations of the conceptual space within which cognitive sciences have spread: a large part of contemporary theories in cognitive science result from a hybridization of conceptions forged by philosophers of mind and data produced by neuroscientists. Yet contemporary psychiatry is still reluctant to feed on the philosophy of mind, other than through the fragments that emerge from neuroscience. In this paper, we describe the evolution of contemporary philosophy of mind, and we detail its contributions around three central themes for psychiatry: naturalization of mind, mental causality, and subjectivity of mental states. We show how philosophy of mind provide the conceptual framework to link different levels of explanation in psychiatry: from biological to functional, from neurophysiology to cognition, from matter to mind.     

Psychanalyse et pharmacopsychologie

ObjectiveAlthough it is easy to portray psychoanalysis and psychopharmacology as separate and contradictory approaches of the psychic phenomena, the aim of this paper is to highlight that the two disciplines have shared a common historical context, some epistemological traits, and even some theoretical alliance at their very beginnings and during the 20th century.MethodsIn order to achieve this objective, the article re-examines through an historical perspective both Emil Kraepelin's very first experimental project of a genuine “pharmacopsychology”, and Sigmund Freud's invention of “metapsychology”, which were formed almost simultaneously. Through an in-depth analysis of the main texts in the Freudian and the Kraepelinian corpus (some of which have not been translated into French), we analyze the theoretical frameworks of the two so-called “fathers” of modern psychiatry, as well as their complex interactions. This leads to explore, as a second step, why Freud himself envisioned with hopeful optimism the coming era of psychopharmacology, and why psychoanalysis initially expressed a positive attitude towards the burgeoning influence of pharmacological psychiatry.ResultsStrikingly, before the shift in our field from the subjectivity-oriented psychiatry to the more scientific model of the biological psychiatry, metapsychology and pharmacopsychology have grown side by side, with many unintended mutual synergies. This is especially true during the 1950s, when psychoanalysts had come to dominate the whole psychiatric field at the same time as psychopharmacology had begun its revival, thanks to the chlorpromazine discovery. The historical examination of this symbiotic relationship existing for a limited time between the two fields leads to understand how and why they interacted together, both from a practical and theoretical points of view.DiscussionAlthough some psychoanalysts simply acknowledged that the new pharmacological medications were indispensable for helping difficult patients make use of psychotherapy, and advocated therefore the integration of psychological and biological treatment modalities, many others intended to offer in addition some psychoanalytic hypothesis for the pharmacological effects, and proposed the metapsychology as a useful explanatory tool for examination of drug effects upon the psychic apparatus. More interestingly, psychoanalytical framework has also contributed to highlight the many oft-neglected clues that speak powerfully to the influence of psychological and interpersonal factors in psychopharmacology. Because the pure pharmacology of drugs can hardly account for all the clinically observable effects, psychoanalysts have invited to acknowledge some extra-pharmacological factors, like the nature of the patient's relationship to the physician and their attitude toward the drug that may play a crucial role in psychiatric treatment outcome.ConclusionsMany interactions encourage a breaking down of barriers, in order to emphasize the psychology of psychopharmacology, and to specify the therapeutic effects that are connected with the use of psychotropic drugs beyond their pharmacologic specificity. Further research needs today to be done – related to patients’ expectancies, treatment preferences, drugs’ prescientific representations, etiological beliefs, and their positive or adverse effects on therapeutic alliance and outcomes – to better understand how nonpharmacologic aspects of medications play a crucial role in psychiatric treatment. This could help to clarify the modalities of the psychological and biological treatments association.     

Épistémologie psychanalytique : une épistémologie aux frontières

ObjectivePsychoanalysis and epistemology raise multiple questions, and provoke debate and lively controversies. Without wishing to take up the old debate on the scientific nature of psychoanalysis, we wish to question its place in a contemporary epistemology, an epistemology of research, rather than one of science. We propose to think about psychoanalytic epistemology on the borders: between the theoretical and the clinical, between research and the practice of the cure, but also in dialogue with other hybrid disciplines such as psychiatry.MethodStarting from the observation that progress in scientific disciplines such as physics has led to the abandonment of the illusion of a universal theory of knowledge and to the shattering of the affirmation of epistemology's unique conception, we study the specificities of psychoanalytic epistemology as well as current conceptions of epistemology in science, research, and evaluation. We are interested in metapsychology as a Freudian epistemology, as well as in its limits and the criticisms it raises.ResultsPsychoanalysis carries a specific form of knowledge based on the hypothesis of the unconscious. It is a hybrid object with a hypercomplex causality that mixes nature, culture, and the clinic. Thinking about its epistemology roots us in the processual logic of the notion of epistemological obstacle, as opposed to epistemological impasse. The liveliness of psychoanalytical epistemology rests both on its confrontation with clinical practice, and with the progress of other sciences such as the chaos sciences, which open up to non-linear causalities and take dissipative structures into account. The epistemology of research in psychoanalysis requires compromise but also makes “border work” possible; here, a metapsycho-epistemological gap is put to work.DiscussionThe possibility of a psychoanalytical epistemology is not unanimously accepted. The best-known skeptic is perhaps K. Popper, whose proposals on the criteria of scientificity were ultimately refuted by epistemologists of the physical sciences. Scientific models’ lack of uniqueness makes the exclusive recourse to the experimental model based on the triptych observation-hypothesis-verification obsolete from an epistemological point of view. Its epistemological specificity lies in its method, which articulates the theory of unconscious processes with a transference-based clinical practice, making it a regional epistemology. The epistemology of psychoanalysis is situated at the borders of the natural and the cultural, the individual and the intersubjective, science and fiction, hermeneutics and phenomenology, clinical practice and research. Its multiple borders are, according to the times and the theoretical choices, more or less open or even porous, more or less closed or even impassable.ConclusionPsychoanalysis's epistemological stakes reflect the contemporary evolution from an epistemology of science to an epistemology of research and therefore of evaluation. The hypercomplex nature of the human psyche and of psychic facts makes the transposition of epistemic models from other sciences inadequate. The border position of psychoanalytic epistemology cannot be limited to a form of causalist and theoretical originality; it is first and foremost rooted in the specificity of its method, which is itself on the border between practice and theory. The processual part of psychoanalysis as a theory, but also as a therapy, is essential and thus opens to a questioning of the transmission of psychoanalytic epistemology to the field of research, to the sciences as a whole. The wager of the transmissibility of the epistemology of psychoanalysis remains a challenge but we consider that thinking about it as a dialogue – that is, a confrontation with and an opening-up to other disciplines – is necessary in this between compromise and border work.     

L’abord phénoménologique de l’épistémologie de la psychiatrie,selon Georges Lantéri–Laura

ObjectiveThe article aims to give an account of the construction, by G. Lantéri–Laura, philosopher and historian of psychiatry, of a phenomenology of psychiatry dedicated to the critical elucidation of its foundations, inseparable from the concrete approach of its history, apprehended with the methods of structuralism.MethodThe stages of this construction are summarized and connected to the path of their author, while paying tribute to him and his work.ResultsThis phenomenology of the psychiatric fact privileges the study of the sign and its effects of meaning, and requires the clarification of the conditions of its production, including the knowledge and the know-how that it supposes. Extending the work of E. Minkowski thanks to the principles of structuralism, G. Lantéri–Laura considers the structure of the semiotics of psychiatry and makes numerous contributions to its semiology, notably of language. Considering the investigation of its praxis to be inseparable from its history, he forges a periodization of it in various paradigms, in conformity with T. Kuhn's epistemology and with C. Lévi–Strauss's conception of history.DiscussionLantéri–Laura links this phenomenology with an approach to subjectivity that keeps Husserl's vow of evidence, but without rejecting the unconscious, thus resisting the hegemonic and totalizing tendency of any psychopathology through the rigorous elucidation of the semiotics of psychiatry and the emphasis put on the regional, plural, and historical characters of its epistemology.ConclusionG. Lantéri–Laura has proposed a phenomenological epistemology of psychiatry, inseparable from the three dimensions of semiotics, subjectivity, and its history.     

Perceptual Pragmatism and the Naturalized Ontology of Color

This paper considers whether there can be any such thing as a naturalized metaphysics of color—any distillation of the commitments of perceptual science with regard to color ontology. I first make some observations about the kinds of philosophical commitments that sometimes bubble to the surface in the psychology and neuroscience of color. Unsurprisingly, because of the range of opinions expressed, an ontology of color cannot simply be read off from scientists’ definitions and theoretical statements. I next consider two alternative routes. First, conceptual pluralism inspired by Mark Wilson's analysis of scientific representation. I argue that these findings leave the prospects for a naturalized color ontology rather dim. Second, I outline a naturalized epistemology of perception. I ask how the correctness and informativeness of perceptual states is understood by contemporary perceptual science. I argue that the detectionist ideal of correspondence should be replaced by the pragmatic ideal of usefulness. I argue that this result has significant implications for the metaphysics of color.