Rétablissement dans la schizophrénie et sens de soi

The concept of recovery in mental health, especially in schizophrenia, comes from the encounter between several societal, scientific and therapeutic factors. In its experiential understanding, recovery has to be distinguished from an evolutionary modality of the disease. It refers rather to a personal and singular process which opens to the possibility of satisfying and useful life, and to exit the role of “schizophrenia patient”. This process will appear despite the persistence of symptoms and disorder limitations. A number of qualitative studies describes the recovery process as an experience of personal transformation. However, most theoretical approaches to schizophrenia report this psychopathology to a fundamental, or even more irreversible, disorder of identity. Therefore, we maintain that the paradigm of recovery breaks with these conceptions, by highlighting the patients’ subjective experience, and by attesting the possibility of meaningful identity rearrangements in schizophrenia. The transformations of sense of self will be approached from the angle of narrativity. We will illustrate these identity changes with the results of a qualitative research, which will allow us to identify some psychotherapeutic implications.     

医疗事故鉴定患者创伤后应激障碍的症状及相关因素分析

目的探讨委托医疗事故鉴定患者创伤后应激障碍(posttraumatic stress disorder,PTSD)症状及相关因素。方法采用创伤后应激障碍清单(PCL-C)、状态-特质焦虑问卷(state-trait anxiety inventory,STAI)、抑郁自评量表(self-rating depression scale,SDS)、艾森克个性问卷(eysenck personality questionnaire,EPQ)对委托医疗事故鉴定154例PTSD的发生率及症状相关性进行评价。结果本研究收回有效问卷151份,以50分作为分界值,PTSD发生率为21.19%(32/151,PTSD组)。鉴定为事故组的PTSD发生率高于无事故组及终止鉴定组(P0.05),事故组闯入性症状、高警觉性及PCL-C总分均高于其他两组(P0.05)。PTSD组闯入性症状、高警觉性、回避症状及PCL-C总分均高于非PTSD组(P0.05);患者中女性较男性有更多的闯入性再体验症状及高警觉性,男性患者更多表现为回避症状(P0.05)。回归分析显示,焦虑、抑郁状态及神经质是PTSD发生的重要预知因素。结论委托医疗事故鉴定患者PTSD的发生率高,症状明显,对其心理影响大;抑郁、焦虑状态、神经质是PTSD发生的危险因素,需及时干预。     

Training and teaching of vagus nerve stimulation surgery: Worldwide survey and future perspectives

ObjectiveVagus nerve stimulation (VNS) therapy has been used for more than two decades to treat drug resistant epilepsy and depression and most recently received FDA approval for stroke rehabilitation. Expanding indications will renew the interest in the technique and increase the number of surgeons to be trained. The aim of this study was to survey surgeons with substantial expertise on optimal teaching and training approaches.MethodsAnonymous forms comprising 16 questions were sent by e-mail to surgeons with substantial expertise. Statistical analyses were used to compare the answers of the most experienced surgeons (>5 years) with the less experienced ones (<5 years).ResultsFully-completed forms were collected from 57 experts from 20 countries. The placement of the helical coils was deemed to be the most difficult step by 36 (63.2%) experts, and the use of optical magnification during this step was deemed necessary by 39 (68.4%) experts. Vocal cord palsy should be largely avoidable with proper surgical technique according to 44 (77.2%) experts. The teaching tool considered the most useful was mentoring (38, 66.7%). The future of VNS surgery teaching was deemed to be in anatomical workshops (29, 50.9%) and surgical simulation (26, 45.6%). Overall, answers did not vary significantly according to experience.ConclusionsVNS surgery should be mastered by actively participating in dedicated practical training courses and by individual mentoring during actual surgery, which is still the best way to learn. This study highlights the need for a formal training course and possible specific accreditation.     

L’enfant autiste et son parent face à l’échec de l’intersubjectivité : une clinique de la narrativité

Aim

This article examines the failure of the processes enabling access to intersubjectivity and to primary subjectivation in the treatment of small children presenting autism, and the consequences thereof in the development of parenting exercised by the mothers and fathers of such children. The psychotherapeutic processes implemented via narrative and testimonial functions during consultations appear necessary to relaunch narrative identity and the capacity for parental reverie.

Autistic children,their parents,and the failures of intersubjectivity: A narrative approach

Aim

This article examines the failure of the processes of access to intersubjectivity and to primary subjectivation in the treatment of young children presenting autism, and the consequences thereof for the development of parenthood. The psychotherapeutic nature of certain narrative and testimonial processes used during parent-child consultations appears as a critical element in the restarting of narrative identity and of the capacity for parental reverie.

Soubresauts face aux contraintes handicapantes de l’âge. Valences capacitaires/déficitaires du corps chez des danseurs seniors

ObjectiveIn the Western artistic field, dancers are particularly challenged by the phenomenon of bodily aging and the expectations of the public.MethodHow can dancers respond to often contradictory requirements, sometimes to the extent of blurring the linear and causal logics of the capacity and deficit attributes of the body? When the body is caught up in the decline related to age and the onset of debilitating constraints, how can they take on the choreographic proposals made to older artists, unless it is as “one-off” performers, in spite of age? How can one detect certain self-healing virtues attributed to dance, akin to the effects of dance therapy and far removed from the constraints of medication, within the prerogatives of care/cure?ResultsThe bio-physical abilities and limitations of the living body affect certain choreographic requirements, while the receptiveness of the media towards mature dancing bodies remains ambivalent. Dancers – professionals and amateurs – are put to the test. The successive jolts – bodily failings and the conscious emergence of another form of expressiveness – suggest the need to reconsider the capacitance/deficit of the body in the light of these dancers’ personal experiences and self-esteem, and of societal repercussions.DiscussionTo continue to dance is to support the soul and the body; it is often an opportunity for self-care and resilience; it maintains or induces social integration by activating feelings of usefulness and pride, which revive failing self-esteem after a frequent phase of withdrawal, partially resulting from a real handicap or a handicap amplified by the imagination.ConclusionThe assumed decadence of the mature body paradoxically constitutes an undeniable and specific asset in the eyes of some contemporary choreographers, who draw on these dancers’ physiological and structural changes and their long-standing acquaintance with the body.     

Bruised Witness: Bernard Spilsbury and the Performance of Early Twentieth-Century English Forensic Pathology

This article explores the status, apparatus and character of forensic pathology in the inter-war period, with a special emphasis on the ‘people’s pathologist’, Bernard Spilsbury. The broad expert and public profile of forensic pathology, of which Spilsbury was the most prominent contemporary representative, will be outlined and discussed. In so doing, close attention will be paid to the courtroom strategies by which he and other experts translated their isolated post-mortem encounters with the dead body into effective testimony.Pathologists built a high-profile practice that transfixed the popular, legal and scientific imagination, and this article also explores, through the celebrated 1925 murder trial of Norman Thorne, how Spilsbury’s courtroom performance focused critical attention on the practices of pathology itself, which threatened to destabilise the status of forensic pathology. In particular, the Thorne case raised questions about the interrelation between bruising and putrefaction as sources of interpretative anxiety. Here, the question of practice is vital, especially in understanding how Spilsbury’s findings clashed with those of rival pathologists whose autopsies centred on a corpse that had undergone further putrefactive changes and that had thereby mutated as an evidentiary object. Examining how pathologists dealt with interpretative problems raised by the instability of their core investigative object enables an analysis of the ways in which pathological investigation of homicide was inflected with a series of conceptual, professional and cultural difficulties stemming in significant ways from the materiality of the corpse itself.This article presents early findings of a larger study of twentieth-century English homicide investigation which focuses on the interaction between two dominant forensic regimes: the first, outlined in part here, is a body-centred forensics, associated with the lone, ‘celebrity’ pathologist, his scalpel and the mortuary slab; the second is a ‘forensics of things’ centred on the laboratory and its associated technologies of trace analysis (hair, blood, fibres), deployed in closed technician-dominated spaces and in the regimentally managed crime scene. Future work will seek to illuminate the shifting landscape of English forensics by following the historical interplay between these two powerful investigative models.     

Individual testimonies to nursing care after the atomic bombing of Hiroshima in 1945

Aim:  The aim of the present research is to clarify the nursing care conducted just before and after the atomic bombing of Hiroshima in 1945.
Methods:  Five surviving nurses, who were registered nursing staff at that time in Hiroshima, offered to participate in this research. Individual interviews were conducted in order to obtain the information concerning the nursing activities in the disaster-stricken areas. The collected information was collated with the documents with regard to the atomic bombing in Hiroshima, and compared with the current studies concerning nursing in disaster.
Findings:  The five nurses who participated in the study made it clear that, from the day of the bombing, nursing care activities changed moment by moment according to the condition of the radiation victims, the stricken areas and the relief systems. Under these circumstances, the nurses tried to help the victims of the bombing by devising anything useful for nursing care.
Conclusion:  The research participants left their messages, pointing out that nurses' mental attitude to those in front of them as patients is one of the most important things to keep in mind following any major disaster.     

Sexual Science and Sexual Forensics in 1920s Germany: Albert Moll as (S)Expert

Using court records involving the expert testimony of the Berlin sexologist Albert Moll, my article demonstrates that during the early 1920s a shift in the ‘epistemologies of justice’ concerning the adjudication of sex crimes took place within German courtrooms. Namely, presiding judges considered a greater number of sexual acts as punishable, despite no change in the laws themselves. Central to my argument is the role of expert testimony in practice and its critical reception. By focusing upon the rhetorical strategies presented by attorneys, judges and expert witnesses (as well as defendants themselves and their relatives), it illustrates the functions of expert and tacit knowledge in court, which were often not mutually exclusive. Moll’s stature also enabled him to translate his scientific–medical expertise into state support for his testimonies, as well as the rebuilding of an international community of sexological authorities. It was only under Moll’s leadership that the First International Sexology Congress could take place in 1926, an event that marked the apex of his prestige.     

现实动机作案与责任能力的关系

目的：探索司法精神医学鉴定中现实动机作案者与责任能力之间的关系。方法：分析78例现实动机作案者的责任能力。结果：除24例无精神病外，其余54种有各种精神障碍的作案者中有31例评定为限制责任能力，23例评定为完全责任能力，无1例能完全免除责任能力。结论：动机论适合于司法精神鉴定实践，现实动机作案者，不论其精神状态如何，均不能完全免除刑事责任。