Pub Date : 2024-05-23DOI: 10.1016/j.evopsy.2024.05.002
Objective
Forensic clinical investigation frequently reveals the absence of shame in perpetrators of sexual violence while simultaneously victims seem overwhelmed by shame. We sought to understand this paradox by analyzing the dynamics of the introjection of shame in victims’ identification with the aggressor and of the injection of shame in the aggressor's projective identification with his victim.
Method
We focused on the case of Louis, a dismissed priest, sentenced for pedocriminal behavior. This case is part of a qualitative research project conducted on a population of 14 inmates of a Parisian prison and based on interviews structured around the individual's life story and analyzed with the Interpretative Phenomenological Analysis (IPA) methodology.
Results
We observe that behind Louis's apparent absence of shame, as with many of our research subjects guilty of sexual violence, there is, in fact, a great deal of unconscious shame, first introjected by the victim in the abuse suffered, and later injected in the victim in the abuse committed as a means to unload an unbearable shame.
Discussion
The introjection of the shame of the aggressor by his victim in the dynamic of Ferenczi's identification with the aggressor appears as a complement to the injection of shame by the aggressor into his victim through the dynamic of projective identification: both an ordinary projective identification in the form of a projective reversal of shame, and an operative projective identification in the form of perverse behaviors.
Conclusion
The communicating vessels of shame among perpetrators and victims of sexual violence, between injection and introjection, help us better understand the contagious characteristics of shame in the etiology of sexual violence.
{"title":"Les vases communicants de la honte chez les auteurs de violences sexuelles","authors":"","doi":"10.1016/j.evopsy.2024.05.002","DOIUrl":"10.1016/j.evopsy.2024.05.002","url":null,"abstract":"<div><h3>Objective</h3><p>Forensic clinical investigation frequently reveals the absence of shame in perpetrators of sexual violence while simultaneously victims seem overwhelmed by shame. We sought to understand this paradox by analyzing the dynamics of the introjection of shame in victims’ identification with the aggressor and of the injection of shame in the aggressor's projective identification with his victim.</p></div><div><h3>Method</h3><p>We focused on the case of Louis, a dismissed priest, sentenced for pedocriminal behavior. This case is part of a qualitative research project conducted on a population of 14 inmates of a Parisian prison and based on interviews structured around the individual's life story and analyzed with the Interpretative Phenomenological Analysis (IPA) methodology.</p></div><div><h3>Results</h3><p>We observe that behind Louis's apparent absence of shame, as with many of our research subjects guilty of sexual violence, there is, in fact, a great deal of unconscious shame, first introjected by the victim in the abuse suffered, and later injected in the victim in the abuse committed as a means to unload an unbearable shame.</p></div><div><h3>Discussion</h3><p>The introjection of the shame of the aggressor by his victim in the dynamic of Ferenczi's identification with the aggressor appears as a complement to the injection of shame by the aggressor into his victim through the dynamic of projective identification: both an ordinary projective identification in the form of a projective reversal of shame, and an operative projective identification in the form of perverse behaviors.</p></div><div><h3>Conclusion</h3><p>The communicating vessels of shame among perpetrators and victims of sexual violence, between injection and introjection, help us better understand the contagious characteristics of shame in the etiology of sexual violence.</p></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 3","pages":"Pages 525-537"},"PeriodicalIF":0.6,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0014385524000653/pdfft?md5=213c199f6f0bb14ec8a6770c4e75afbc&pid=1-s2.0-S0014385524000653-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141133956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-17DOI: 10.1016/j.evopsy.2024.04.004
Matthieu Braun (psychiatre, chef de clinique des universités, assistant des hôpitaux de région) , Christophe Chaperot (psychiatre, chef de pôle)
Objective
Public hospitals are necessary for patients with the most severe psychological suffering. Within an institution, the symptoms of some have an impact on the way the group functions, with counter-attitudes, scissionary projections, and so on. Ever since Jean-Étienne Esquirol, we have known that hospitals can be healing in themselves, if they are staffed by “skilled” caregivers. At a time when public hospitals are being restructured, can tools from the field of institutional psychotherapy help to “heal the hospital so that it can heal”, in Hermann Simon's aphorism? We articulate psychopathological knowledge with institutional concepts, in order to reflect on how to care for singularities through collective work.
Method
We present a theoretical-clinical elaboration based on clinical vignettes that attempt to capture the day-to-day practice of a public psychiatric department oriented towards institutional psychotherapy, and the psychotherapeutic care possible, in an institution, for psychotic subjects.
Results
Concepts derived from institutional psychotherapy are based on psychoanalytical and phenomenological psychopathologies that are tested in clinical practice: in particular, questions of space, atmosphere, and transference, at the heart of psychopathology. These concepts can be discussed and refined in the light of current research and practice, and support creative care approaches based on the logic of geographical sectors.
Discussion
Institutional tools seem to support caregiving teams in their response to psychological suffering. If they are not the subject of dogmatic positioning, they encourage a therapeutic alliance that is as close as possible to the subjectivity of the players involved, and enable a performative theorization of daily practice.
Conclusion
Joint attention to psychopathology and institutional clinical practice helps to provide individualized care and support for the singularity and subjectivity of the most fragile patients and the teams who work with them.
{"title":"Psychothérapie institutionnelle : ambiances de transferts","authors":"Matthieu Braun (psychiatre, chef de clinique des universités, assistant des hôpitaux de région) , Christophe Chaperot (psychiatre, chef de pôle)","doi":"10.1016/j.evopsy.2024.04.004","DOIUrl":"10.1016/j.evopsy.2024.04.004","url":null,"abstract":"<div><h3>Objective</h3><div>Public hospitals are necessary for patients with the most severe psychological suffering. Within an institution, the symptoms of some have an impact on the way the group functions, with counter-attitudes, scissionary projections, and so on. Ever since Jean-Étienne Esquirol, we have known that hospitals can be healing in themselves, if they are staffed by “skilled” caregivers. At a time when public hospitals are being restructured, can tools from the field of institutional psychotherapy help to “heal the hospital so that it can heal”, in Hermann Simon's aphorism? We articulate psychopathological knowledge with institutional concepts, in order to reflect on how to care for singularities through collective work.</div></div><div><h3>Method</h3><div>We present a theoretical-clinical elaboration based on clinical vignettes that attempt to capture the day-to-day practice of a public psychiatric department oriented towards institutional psychotherapy, and the psychotherapeutic care possible, in an institution, for psychotic subjects.</div></div><div><h3>Results</h3><div>Concepts derived from institutional psychotherapy are based on psychoanalytical and phenomenological psychopathologies that are tested in clinical practice: in particular, questions of space, atmosphere, and transference, at the heart of psychopathology. These concepts can be discussed and refined in the light of current research and practice, and support creative care approaches based on the logic of geographical sectors.</div></div><div><h3>Discussion</h3><div>Institutional tools seem to support caregiving teams in their response to psychological suffering. If they are not the subject of dogmatic positioning, they encourage a therapeutic alliance that is as close as possible to the subjectivity of the players involved, and enable a performative theorization of daily practice.</div></div><div><h3>Conclusion</h3><div>Joint attention to psychopathology and institutional clinical practice helps to provide individualized care and support for the singularity and subjectivity of the most fragile patients and the teams who work with them.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 4","pages":"Pages 625-638"},"PeriodicalIF":0.6,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141058394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-17DOI: 10.1016/j.evopsy.2024.04.005
Objective
This study presents a reflection on the inhabitation of a place and the constitution of a territorial Self,’ in the context of ‘country’ life and work. The hypothesis is then put forward of a possible ‘psychopathology of (de-)territorialization,’ according to which a ‘non-place,’ generator of meaninglessness, may be involved in a suicidal dynamics specifically linked to the territorial dimension of the Self and the impossible inhabitation of a place.
Method
The clinical and psychopathological aspects are examined from the perspective of the link between certain ‘traditional farmers’ and the place where they live, with regard to the reciprocal imprint between psyche and territory.
Results
This exploratory study will provide guidance for clinical research into the suffering of farmers who fall outside the scope of commonly identified ‘psycho-social disorders.’
Discussion
The limitations and impasses induced by dissociative or melancholic processes are related either to a failure of Presence, compromising the construction of a habitable world, i.e. one that can be territorialized, or to the hostility of a world that is resistant to the dynamics of a territorialization process, and therefore unfit to allow us to dwell in it.
Conclusion
These considerations open up an original perspective for qualitative research aimed at understanding the relationships between alteration of the territorial foundations of the Self and suicidal intentionality.
{"title":"Le « Soi territorial » et le suicide des agriculteurs : la solitude en un lieu inhabitable","authors":"","doi":"10.1016/j.evopsy.2024.04.005","DOIUrl":"10.1016/j.evopsy.2024.04.005","url":null,"abstract":"<div><h3>Objective</h3><p>This study presents a reflection on the inhabitation of a place and the constitution of a territorial Self,’ in the context of ‘country’ life and work. The hypothesis is then put forward of a possible ‘psychopathology of (de-)territorialization,’ according to which a ‘non-place,’ generator of meaninglessness, may be involved in a suicidal dynamics specifically linked to the territorial dimension of the Self and the impossible inhabitation of a place.</p></div><div><h3>Method</h3><p>The clinical and psychopathological aspects are examined from the perspective of the link between certain ‘traditional farmers’ and the place where they live, with regard to the reciprocal imprint between psyche and territory.</p></div><div><h3>Results</h3><p>This exploratory study will provide guidance for clinical research into the suffering of farmers who fall outside the scope of commonly identified ‘psycho-social disorders.’</p></div><div><h3>Discussion</h3><p>The limitations and impasses induced by dissociative or melancholic processes are related either to a failure of Presence, compromising the construction of a habitable world, i.e. one that can be territorialized, or to the hostility of a world that is resistant to the dynamics of a territorialization process, and therefore unfit to allow us to dwell in it.</p></div><div><h3>Conclusion</h3><p>These considerations open up an original perspective for qualitative research aimed at understanding the relationships between alteration of the territorial foundations of the Self and suicidal intentionality.</p></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 3","pages":"Pages 550-559"},"PeriodicalIF":0.6,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S001438552400063X/pdfft?md5=9f9c23b67a159e8409146bd44f37267e&pid=1-s2.0-S001438552400063X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141052494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-07DOI: 10.1016/j.evopsy.2024.04.001
Matthieu Braun (Psychiatre, Chef de clinique des universités, Assistant des hôpitaux de région) , Christophe Chaperot (Psychiatre, Chef de pôle)
Objective
Patients suffering from complex psychiatric pathologies require multi-disciplinary care and, in the event of decompensation, may need to be hospitalized. Institutional psychotherapy approaches psychotic, existential, and institutional crises as opportunities for clinical elaboration and the deployment of creativity. The public health crisis linked to the COVID-19 pandemic has prompted us to rethink its effectiveness and its place within pluralistic contemporary practices. It also offered the opportunity for an unprecedented anthropological reading. In this context, is institutional psychotherapy still a machine for producing “innovation”, for creating, or at least revealing, crises in order to overcome them?
Method
Key concepts from the field of institutional psychotherapy can be reexamined in the wake of the public health crisis. In the aftermath of the pandemic, we propose an elaboration of what the pandemic has taught us about day-to-day practice, in a public psychiatric department oriented towards institutional psychotherapy. We will draw on a re-reading of clinical vignettes, interviews with caregivers and patients, and notes taken at department meetings during the pandemic.
Results
The major concepts of institutional psychotherapy may have some limitations, but they can be reinvented by the caregiver–client collective. During a crisis, collective failings and individual symptoms seem to reveal each other. The therapeutic club represents a stage on which to unfold and elaborate both group and individual issues.
Discussion
In this context, the symbolic framework, collectively instituted, and the culture of a department can present operative points of support for continuing care. They “put in crisis” the prejudices and implicit theories of the actors, and support new narratives and new ways of making sense.
Conclusion
In the aftermath of a crisis, the therapeutic club remains a space of conflict and intrigue, at the crossroads of collective and individual health crises.
{"title":"La psychothérapie institutionnelle à l’épreuve des crises. Une réflexion clinique au cœur d’un service de psychiatrie publique au décours de la crise sanitaire liée à la COVID-19","authors":"Matthieu Braun (Psychiatre, Chef de clinique des universités, Assistant des hôpitaux de région) , Christophe Chaperot (Psychiatre, Chef de pôle)","doi":"10.1016/j.evopsy.2024.04.001","DOIUrl":"10.1016/j.evopsy.2024.04.001","url":null,"abstract":"<div><h3>Objective</h3><div>Patients suffering from complex psychiatric pathologies require multi-disciplinary care and, in the event of decompensation, may need to be hospitalized. Institutional psychotherapy approaches psychotic, existential, and institutional crises as opportunities for clinical elaboration and the deployment of creativity. The public health crisis linked to the COVID-19 pandemic has prompted us to rethink its effectiveness and its place within pluralistic contemporary practices. It also offered the opportunity for an unprecedented anthropological reading. In this context, is institutional psychotherapy still a machine for producing “innovation”, for creating, or at least revealing, crises in order to overcome them?</div></div><div><h3>Method</h3><div>Key concepts from the field of institutional psychotherapy can be reexamined in the wake of the public health crisis. In the aftermath of the pandemic, we propose an elaboration of what the pandemic has taught us about day-to-day practice, in a public psychiatric department oriented towards institutional psychotherapy. We will draw on a re-reading of clinical vignettes, interviews with caregivers and patients, and notes taken at department meetings during the pandemic.</div></div><div><h3>Results</h3><div>The major concepts of institutional psychotherapy may have some limitations, but they can be reinvented by the caregiver–client collective. During a crisis, collective failings and individual symptoms seem to reveal each other. The therapeutic club represents a stage on which to unfold and elaborate both group and individual issues.</div></div><div><h3>Discussion</h3><div>In this context, the symbolic framework, collectively instituted, and the culture of a department can present operative points of support for continuing care. They “put in crisis” the prejudices and implicit theories of the actors, and support new narratives and new ways of making sense.</div></div><div><h3>Conclusion</h3><div>In the aftermath of a crisis, the therapeutic club remains a space of conflict and intrigue, at the crossroads of collective and individual health crises.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 4","pages":"Pages 611-624"},"PeriodicalIF":0.6,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141043753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1016/j.evopsy.2024.04.002
Kelly Poracchia (Psychologue clinicienne), Mohammed Ham (Professeur de psychopathologie psychanalytique et psychanalyste)
Aims
In melancholy, the subject experiences a fundamental disillusionment, marked by a breakdown of investments, which signals a ruin of the imagination. This flaw in the field of illusion implies an alteration of the relationship to the ideal, and the position of the subject is dominated by disbelief. Through this article, the authors question the way in which creation can create an illusion of the relationship with reality by capturing the subject from a nostalgic position.
Method
From a psychoanalytic reference, the authors first propose to analyze the subjectivizing dynamic of the illusion insofar as it supports the singular fiction and ensures a function of treating the original distress. Nostalgia is thus thought of as carrying illusions and is considered in its metapsychological status as an imaginary materialization of the lost object. The authors propose certain questions concerning the way in which the creation would capture the subject in a nostalgic relationship with the lost object, which would thus allow an illusion of the relationship with reality. A clinical case report is also presented in order to deepen the elaborations proposed in this article.
Results
Emerging on the edge of the void, the repetition of an act of creation seems to open the subject to a space of illusions within which the traces left by the object in its loss can resonate in the subject. The work of creation fills the void in the heart of the speaking being and inspires nostalgic regret that aspires to treat loss in a poetic way. The creation lends a voice to express the irreversible loss that animates the subject, and gives substance to the cry left suspended in melancholy. The creative process therefore seems caught up in a movement of nostalgic embalming, which exhumes the remains of the lost object and commemorates its loss.
Discussion
Although the nostalgic position can be thought of as a fantasmatic materialization of the object and can provoke a libidinal fixation of the subject to a lure object, which thus eclipses any external investment, the approach to nostalgia also seems to protect it from melancholic annihilation of desire.
Conclusion
By displaying a nostalgic position through an act of creation, inexpressible melancholic remorse gives way to ineffable nostalgic regret.
{"title":"L’illusion nostalgique : d’une poétique du regret comme traitement de la perte","authors":"Kelly Poracchia (Psychologue clinicienne), Mohammed Ham (Professeur de psychopathologie psychanalytique et psychanalyste)","doi":"10.1016/j.evopsy.2024.04.002","DOIUrl":"10.1016/j.evopsy.2024.04.002","url":null,"abstract":"<div><h3>Aims</h3><div>In melancholy, the subject experiences a fundamental disillusionment, marked by a breakdown of investments, which signals a ruin of the imagination. This flaw in the field of illusion implies an alteration of the relationship to the ideal, and the position of the subject is dominated by disbelief. Through this article, the authors question the way in which creation can create an illusion of the relationship with reality by capturing the subject from a nostalgic position.</div></div><div><h3>Method</h3><div>From a psychoanalytic reference, the authors first propose to analyze the subjectivizing dynamic of the illusion insofar as it supports the singular fiction and ensures a function of treating the original distress. Nostalgia is thus thought of as carrying illusions and is considered in its metapsychological status as an imaginary materialization of the lost object. The authors propose certain questions concerning the way in which the creation would capture the subject in a nostalgic relationship with the lost object, which would thus allow an illusion of the relationship with reality. A clinical case report is also presented in order to deepen the elaborations proposed in this article.</div></div><div><h3>Results</h3><div>Emerging on the edge of the void, the repetition of an act of creation seems to open the subject to a space of illusions within which the traces left by the object in its loss can resonate in the subject. The work of creation fills the void in the heart of the speaking being and inspires nostalgic regret that aspires to treat loss in a poetic way. The creation lends a voice to express the irreversible loss that animates the subject, and gives substance to the cry left suspended in melancholy. The creative process therefore seems caught up in a movement of nostalgic embalming, which exhumes the remains of the lost object and commemorates its loss.</div></div><div><h3>Discussion</h3><div>Although the nostalgic position can be thought of as a fantasmatic materialization of the object and can provoke a libidinal fixation of the subject to a lure object, which thus eclipses any external investment, the approach to nostalgia also seems to protect it from melancholic annihilation of desire.</div></div><div><h3>Conclusion</h3><div>By displaying a nostalgic position through an act of creation, inexpressible melancholic remorse gives way to ineffable nostalgic regret.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 3","pages":"Pages 457-467"},"PeriodicalIF":0.6,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141052567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-30DOI: 10.1016/j.evopsy.2024.03.005
Philippe Veysset (Professeur agrégé de philosophie)
<div><h3>Goals</h3><div>By extending the analysis of a case identified by Ludwig Binswanger, the Jürg Zünd case, using a philosophical reading inspired by phenomenology, we strive to show that the patient – this is what gives meaning to his disorder – attempts to display the relevance (failure of reason) as well as the limits (reason remains operative) of a doctrine that was made familiar to him by his psychiatrist: existential analysis, notably its representation of space and language. This aims to illustrate the dangers posed by too insistent a dialogue between patient and caregiver when this patient is associated with diagnosis and therapy. Finally, it is a question of better marking the remaining gap between the practical field and the experiential field. The patient has renounced the rationality of her actions but continues to subscribe to that of her experience, the only means of “proof” remaining to her.</div></div><div><h3>Method</h3><div>Extend the psychiatrist's analysis by establishing a correspondence between the symptoms of the illness and the validations/refutations of this same analysis. The main danger of the analysis carried out here is a hyper-rationalization of mental disorder, but if, in the mental disorder, no element of reason remains, no psychiatry can see the light of day either. It is, however, clear that the simple failure of reason cannot be enough to put the scientific exploitation of mental disorder into perspective. We can therefore only follow the author in his frequent references to the fundamental texts of phenomenology. We could say that our analysis is experimental in nature.</div></div><div><h3>Results</h3><div>An in-depth analysis of the case shows that there is indeed a link between the patient's system of attitude and behavior and a desire to test the relevance of the phenomenological analysis applied by the caregiver to the patient.</div></div><div><h3>Discussion</h3><div>In the third <em>Critique</em>, known as <em>the Faculty of Judgment</em>, Kant strives to restore to a reason invalidated in its pure use a path, a field of sensitive expression that, spanning understanding and language, allows this reason to “say itself”, but this behavior is in turn struck by impotence, due to its antinomic structure. Only the body, left out of Kantian analysis, allows reason to find its balance because it is already in itself penetrated, corseted, steeped in reason, but also, by the same token, crushed by this reason, a reason which, by overwhelming the only means of expression that remains to it, overinvests this body and makes itself inaudible again. It will therefore be necessary to return the body to itself, free it from the influence of reason, reify it and, at the same time, allow to reappear what, perhaps, remains in the man of reason: madness, weak reason inhabiting a weakened body. To contradict reason is to speak it out loud, in the experience of its almost although never quite definitive loss, suspended as i
{"title":"Jürg Zünd : voir/faire voir l’espace","authors":"Philippe Veysset (Professeur agrégé de philosophie)","doi":"10.1016/j.evopsy.2024.03.005","DOIUrl":"10.1016/j.evopsy.2024.03.005","url":null,"abstract":"<div><h3>Goals</h3><div>By extending the analysis of a case identified by Ludwig Binswanger, the Jürg Zünd case, using a philosophical reading inspired by phenomenology, we strive to show that the patient – this is what gives meaning to his disorder – attempts to display the relevance (failure of reason) as well as the limits (reason remains operative) of a doctrine that was made familiar to him by his psychiatrist: existential analysis, notably its representation of space and language. This aims to illustrate the dangers posed by too insistent a dialogue between patient and caregiver when this patient is associated with diagnosis and therapy. Finally, it is a question of better marking the remaining gap between the practical field and the experiential field. The patient has renounced the rationality of her actions but continues to subscribe to that of her experience, the only means of “proof” remaining to her.</div></div><div><h3>Method</h3><div>Extend the psychiatrist's analysis by establishing a correspondence between the symptoms of the illness and the validations/refutations of this same analysis. The main danger of the analysis carried out here is a hyper-rationalization of mental disorder, but if, in the mental disorder, no element of reason remains, no psychiatry can see the light of day either. It is, however, clear that the simple failure of reason cannot be enough to put the scientific exploitation of mental disorder into perspective. We can therefore only follow the author in his frequent references to the fundamental texts of phenomenology. We could say that our analysis is experimental in nature.</div></div><div><h3>Results</h3><div>An in-depth analysis of the case shows that there is indeed a link between the patient's system of attitude and behavior and a desire to test the relevance of the phenomenological analysis applied by the caregiver to the patient.</div></div><div><h3>Discussion</h3><div>In the third <em>Critique</em>, known as <em>the Faculty of Judgment</em>, Kant strives to restore to a reason invalidated in its pure use a path, a field of sensitive expression that, spanning understanding and language, allows this reason to “say itself”, but this behavior is in turn struck by impotence, due to its antinomic structure. Only the body, left out of Kantian analysis, allows reason to find its balance because it is already in itself penetrated, corseted, steeped in reason, but also, by the same token, crushed by this reason, a reason which, by overwhelming the only means of expression that remains to it, overinvests this body and makes itself inaudible again. It will therefore be necessary to return the body to itself, free it from the influence of reason, reify it and, at the same time, allow to reappear what, perhaps, remains in the man of reason: madness, weak reason inhabiting a weakened body. To contradict reason is to speak it out loud, in the experience of its almost although never quite definitive loss, suspended as i","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 1","pages":"Pages 97-120"},"PeriodicalIF":0.6,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-25DOI: 10.1016/j.evopsy.2024.03.004
Dario Alparone PhD et Doctor Europaeus (Maître de conférences associé en psychologie clinique et psychopathologie à l’Université de Bretagne Occidentale, UFR Lettres et Sciences Humaines, Département de Psychologie. Doctor en criminologie psychanalytique, psychologue clinicien.) , Giorgia Tiscini (Psychologue, psychanalyste, Professeur en psychologie clinique et psychopathologie à l’Université de Rennes 2, France, Vice-Directeur du laboratoire Recherches en psychopathologie et psychanalyse (RPpsy))
Objective
This article aims to demonstrate the relevance of the concept of guilt in understanding the depressive syndrome, particularly in melancholic psychosis, in the phenomenological and psychoanalytic approaches to psychopathology. It does so by comparing Lacan's and Heidegger's approaches to subjectivity and existence.
Method
Through a bibliographic and conceptual analysis of the notions of guilt and melancholy in the phenomenological and psychoanalytic traditions, and using two clinical vignettes from the scientific literature, we highlight the significance of the concept of guilt in understanding melancholic psychosis.
Result
There is a possible parallel between Lacanian psychoanalysis and Heidegger's Daseinanalysis on the concept of guilt. It can be interpreted as the expression of the rejection of the unconscious but also as an expression of authentic existential projectuality of Dasein. This opens up several conceptual and methodological questions at the theoretical and clinical levels.
Discussion
Guilt could then be a clinical indicator of the subject's rejection of the unconscious, which in melancholic psychosis manifests as a totalizing identification with the waste-object, without other existential possibilities, without “lack.” From the perspective of existential analysis, the abnormal guilt of the melancholic could thus be understood as a form of foreclosure of Being.
Conclusion
Guilt in psychopathology can vary depending on the specific subjective conditions observed in clinical settings. In the case of melancholy, guilt is an indicator of the stagnation of the subject in relation to their existential possibilities. The existential inertia of the melancholic can be interpreted as a very current ontology of waste.
{"title":"Tristesse et mélancolie comme conséquence de la culpabilité : le Schuldigsein entre phénoménologie et psychanalyse","authors":"Dario Alparone PhD et Doctor Europaeus (Maître de conférences associé en psychologie clinique et psychopathologie à l’Université de Bretagne Occidentale, UFR Lettres et Sciences Humaines, Département de Psychologie. Doctor en criminologie psychanalytique, psychologue clinicien.) , Giorgia Tiscini (Psychologue, psychanalyste, Professeur en psychologie clinique et psychopathologie à l’Université de Rennes 2, France, Vice-Directeur du laboratoire Recherches en psychopathologie et psychanalyse (RPpsy))","doi":"10.1016/j.evopsy.2024.03.004","DOIUrl":"10.1016/j.evopsy.2024.03.004","url":null,"abstract":"<div><h3>Objective</h3><div>This article aims to demonstrate the relevance of the concept of guilt in understanding the depressive syndrome, particularly in melancholic psychosis, in the phenomenological and psychoanalytic approaches to psychopathology. It does so by comparing Lacan's and Heidegger's approaches to subjectivity and existence.</div></div><div><h3>Method</h3><div>Through a bibliographic and conceptual analysis of the notions of guilt and melancholy in the phenomenological and psychoanalytic traditions, and using two clinical vignettes from the scientific literature, we highlight the significance of the concept of guilt in understanding melancholic psychosis.</div></div><div><h3>Result</h3><div>There is a possible parallel between Lacanian psychoanalysis and Heidegger's <em>Daseinanalysis</em> on the concept of guilt. It can be interpreted as the expression of the rejection of the unconscious but also as an expression of authentic existential projectuality of <em>Dasein</em>. This opens up several conceptual and methodological questions at the theoretical and clinical levels.</div></div><div><h3>Discussion</h3><div>Guilt could then be a clinical indicator of the subject's rejection of the unconscious, which in melancholic psychosis manifests as a totalizing identification with the waste-object, without other existential possibilities, without “lack.” From the perspective of existential analysis, the abnormal guilt of the melancholic could thus be understood as a form of foreclosure of Being.</div></div><div><h3>Conclusion</h3><div>Guilt in psychopathology can vary depending on the specific subjective conditions observed in clinical settings. In the case of melancholy, guilt is an indicator of the stagnation of the subject in relation to their existential possibilities. The existential inertia of the melancholic can be interpreted as a very current ontology of waste.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 1","pages":"Pages 85-95"},"PeriodicalIF":0.6,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140785648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1016/j.evopsy.2024.03.002
Objectives
This article aims to bypass the epistemological impasses produced by the contemporary development of the concept of disability – a concept formed in close relation with the societal context and with questions of human rights, more than with a nosographic and clinical problematic - and more precisely with regard to mental disability, a clinical entity whose classification history is particularly difficult, and yet at the heart of the edification of psychiatry since the 19th century. In studying this trajectory, we aim to demonstrate the interest of psychoanalysis's theoretical-clinical approach.
Method
We analyze the evolution of psychiatric and psychoanalytical conceptions of mental disability. We discuss them and identify avenues of reflection for the psychoanalytically oriented clinical and therapeutic work we do with young disabled patients and their parents.
Results
Mental disability is placed in the historical dynamic of the attempts to classify it: idiotism, idiocy, mental debility, mental or intellectual disability, etc. Its proven or strongly assumed organic etiology originally marginalized, and continues to marginalize, certain modes of clinical thinking and psychic treatments, of which the psychoanalytical approach is one.
Discussion
We discuss and differentiate between the concepts of “mental” and “psychic” and the ambiguity of their meanings. The “mentally handicapped” subject, when reduced to their neuronal aetiology, is considered from a deficit perspective, which relegates the investigation of psychic life to the background or even renders it superfluous. Following in the footsteps of D. Widlöcher, we point out that Kraepelin's thinking, which made the therapeutic indication dependent on the supposed aetiology, is now outdated. We therefore emphasize the individual differences in the relationship that develops between the young disabled person and his or her family, and in the interaction between their psyches. The effects of the birth of a disabled child on the construction of the feeling of parenthood, the bond of filiation, and parental narcissism are thus understood within the dynamics of interactions, both real and fantasized, which necessarily differ according to the subjects, parents and children. More specifically, we consider J. Laplanche's “fundamental anthropological situation” as a heuristic model for thinking about the psychic life of the child with a disability and the infantile sexuality that constitutes it, in adult-child interaction, as in everyone else. We hypothesize that the parental encounter with a child presenting a handicapping pathology is likely to send some parents back to their own “uncanniness,” that is to say, to the disturbing return of a repressed or primitive way of thinking abandoned a long time ago, coming from their own “internal foreign land.” This internal irruption is likely to lead t
{"title":"L’inquiétante étrangeté du handicap mental","authors":"","doi":"10.1016/j.evopsy.2024.03.002","DOIUrl":"10.1016/j.evopsy.2024.03.002","url":null,"abstract":"<div><h3>Objectives</h3><p>This article aims to bypass the epistemological impasses produced by the contemporary development of the concept of disability – a concept formed in close relation with the societal context and with questions of human rights, more than with a nosographic and clinical problematic - and more precisely with regard to mental disability, a clinical entity whose classification history is particularly difficult, and yet at the heart of the edification of psychiatry since the 19th century. In studying this trajectory, we aim to demonstrate the interest of psychoanalysis's theoretical-clinical approach.</p></div><div><h3>Method</h3><p>We analyze the evolution of psychiatric and psychoanalytical conceptions of mental disability. We discuss them and identify avenues of reflection for the psychoanalytically oriented clinical and therapeutic work we do with young disabled patients and their parents.</p></div><div><h3>Results</h3><p>Mental disability is placed in the historical dynamic of the attempts to classify it: idiotism, idiocy, mental debility, mental or intellectual disability, etc. Its proven or strongly assumed organic etiology originally marginalized, and continues to marginalize, certain modes of clinical thinking and psychic treatments, of which the psychoanalytical approach is one.</p></div><div><h3>Discussion</h3><p>We discuss and differentiate between the concepts of “mental” and “psychic” and the ambiguity of their meanings. The “mentally handicapped” subject, when reduced to their neuronal aetiology, is considered from a deficit perspective, which relegates the investigation of psychic life to the background or even renders it superfluous. Following in the footsteps of D. Widlöcher, we point out that Kraepelin's thinking, which made the therapeutic indication dependent on the supposed aetiology, is now outdated. We therefore emphasize the individual differences in the relationship that develops between the young disabled person and his or her family, and in the interaction between their psyches. The effects of the birth of a disabled child on the construction of the feeling of parenthood, the bond of filiation, and parental narcissism are thus understood within the dynamics of interactions, both real and <em>fantasized</em>, which necessarily differ according to the subjects, parents and children. More specifically, we consider J. Laplanche's “fundamental anthropological situation” as a heuristic model for thinking about the psychic life of the child with a disability and the infantile sexuality that constitutes it, in adult-child interaction, as in everyone else. We hypothesize that the parental encounter with a child presenting a handicapping pathology is likely to send some parents back to their own “uncanniness,” that is to say, to the disturbing return of a repressed or primitive way of thinking abandoned a long time ago, coming from their own “internal foreign land.” This internal irruption is likely to lead t","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 3","pages":"Pages 538-549"},"PeriodicalIF":0.6,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140781266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-09DOI: 10.1016/j.evopsy.2024.03.003
Héloïse Haliday (Maître de conférences en psychologie clinique et psychopathologie)
Objectives
The clinician who adopts a psychoanalytic approach in a psychiatric context often regards the encounter between two individuals as an interplay of subjectivities, whose mode of being-in-the-world is shaped by their unique historical experiences. Despite some psychoanalytic authors exploring the concept of “contact”, it has often been reduced to its similarity with transference and countertransference, with little attention given to its distinctive qualities. This limits psychoanalysis in its ability to conceptualize an unmediated, preverbal encounter between two individuals. In this article, we argue that the dimension of “contact” cannot be equated with transference, and that it constitutes a vital tool for diagnosing and guiding therapy for various clinical conditions commonly encountered in psychiatry.
Method
This article is based on theoretical considerations. We first worked on the history of the concept of contact, then of Praecox Gefühl in the works of H.C. Rümke, to which we added the findings of current studies on the relevance of Praecox Gefühl in the diagnosis of schizophrenia and the study of the works of the great phenomenological psychiatrists. In so doing, we aimed to show that contact could be a tool of great use for psychiatric diagnosis, insofar that it allows for a typification of the forms of existence of different patients.
Results
H.C. Rümke's investigation of the concept of Praecox Gefühl highlights the unique mode of contact observed in schizophrenia. It is distinct from the feeling of strangeness and involves an intuitive observation of a perceived distance within the clinical relationship. Given that many psychiatric pathologies can cause patients to withdraw from the shared world, we suggest that the notion of Praecox Gefühl, beyond its original designation of the clinician's experience of schizophrenic dissociation and the particularities of the schizophrenic mode of being-in-the-world, may be applicable to other pathologies studied in psychiatric phenomenology. We propose four main forms of contact: the loss of vitality in schizophrenia, the untraceable authenticity of the hysteric, the impossible fluidity in the melancholic, and the failure of anchorage in mania. By approaching contact as a fractal form that reveals the entire mode of the subject's being-in-the-world, this typifying approach goes beyond a purely semiological or etiological reflection and can be diagnostically useful in guiding therapeutic efforts to enhance the subject's capacity to truly engage with others.
Discussion
Our paper focuses on the relationship between contact and what clinicians commonly refer to as an “encounter.” It is important to recognize that contact is not always equivalent to an encounter, and that assuming otherwise risks overlooking the possibility that certain relational modalities could act
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