In Analysis最新文献

The psychological dynamics involved in work-related suicidal behaviour are generally neglected or obscured, in favour of an exclusive focus on critical social contexts and poor working conditions. In the field of agricultural work, these conditions, which affect a majority of farmers, are undoubtedly a source of “ill-being”, but do not specifically account for suicidal behaviour. Social anomie and organisational problems are linked to specific drives and mental mechanisms, such as identification and turning against one's own person, mobilised in a “melancholic process” likely to shed more light on the suicidal dynamic. Based on situations encountered in the world of agriculture, and broadening certain perspectives opened up by work psychodynamics, this article proposes a reflection that attempts to correlate socio-organisational processes and mental processes based on movements of psychic unbinding, coextensive with the expression of the death drive.

Context

There have been significant advances in organizational and administrative practices of modern psychiatric institutions. These advances have allowed their capitalization in the therapeutic use of social sub-systems and the interaction between staff and patients, in inpatient hospital programs. The therapeutic use of the interaction between patients and personnel is the essence of contemporary psychiatric divisions: this is what truly distinguishes modern psychiatric services from traditional medical models. However, the enormous gap between these advances and their more universal applications to the contemporary psychiatric hospital is disconcerting.

Objectives

(a) To raise awareness of the differences between a medical and a psychiatric inpatient program; (b) so as to truly appreciate the importance of the therapeutic use of the interaction between personnel and patients; (c) particularly in the context of treating aggressiveness and characterological suicidality in severe personality disorders.

Method

In this study the divergencies between a medical and a psychiatric hospitalization are critically explored along four dimensions: (1) body versus mind; (2) reasons for admissions; (3) pharmacological approaches; and (4) characterological suicidality and aggressiveness in severe personality disorders.

Results

Lamentably, the non-delimited and confusing transposition of traditional and psychiatric models, in inpatient psychiatric programs which do not integrate a comprehensive supraordinate psychotherapeutic framework at the service of their primary tasks, results in the risk of highly restrictive and merely custodial care of patients; unintegrated salads of multiple psychotherapeutic modalities, without a holistic approximation to articulate them; and the mixture of interventions that cancel each other out and could even result iatrogenic for patients and staff. It is precisely in the dimensions of characterological suicidality and aggressiveness, that the overall containment and treatment of suicidal behavior and the rampant infiltration of aggression in severe personality pathology call for a clear demarcation between a medical model and a genuinely psychiatric one.

Interpretations

Contrary to the erroneous prediction of a few decades ago, about the disappearance of the psychiatric hospital, the need of modern psychiatric institutions and psychiatry programs that integrate the achievements and contemporary proposals in mental health and psychotherapeutic sciences is more imperative than ever. This situation will demand an ongoing effort to explore critically our psychiatric practices and to address the enormous challenges represented by the training of staff, professors, and residents in psychiatry, toward the optimal use and advancement of available hospital resources.

Context

Certain clinical encounters can sometimes saturate the clinician's listening, thus causing effects of psychic amazement. Put to the test, a split can occur in listening between disgust and capture by the image. Through this article, we will thus attempt to analyze the psychic stakes of fascination and what this process can reveal in its elaboration.

Aims

This article aims to shed light on the imaginary process of fascination, which can be set in motion during certain clinical encounters in order to apprehend what it actualizes in the transference.

Method

Our research work is based on clinical interviews and on the analysis of the stories of patients encountered. We will present a clinical vignette in this article to inform our research.

Results

This research is based on an analysis of the process of fascination, which is set in motion in the encounter with abjection, with traces of an archaic memory. Faced with instinctual unleashing, the effect of this encounter would produce a threat of narcissistic annihilation and a transference regression.

Interpretation

Our interpretation underlines how fascination can reveal an unconscious truth that is transported in the transference, which should be analyzed afterwards.