Pub Date : 2025-03-27DOI: 10.1016/j.evopsy.2025.02.004
Patrick Chemla (Psychiatre honoraire des hôpitaux, psychanalyste)
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Pub Date : 2025-03-26DOI: 10.1016/j.evopsy.2025.02.005
Jérémie André Doctorant (MD) (Médecin chef de clinique) , Régis Marion-Veyron (Maître d’enseignement et de recherche clinicien, Responsable de l’unité de psychiatrie de liaison, département des policliniques, Unisanté)
Objectives
Narcissism is distinguished from other contemporary psychiatric terms in that it refers both to a body of clinical and empirical research and to one of the most popular myths in our culture. The objective of this article is, on the one hand, to explore the nature of the link between the myth of Narcissus and narcissism, and on the other hand, from an epistemological perspective, to examine the various current definitions of narcissism.
Methods
Through a literature review, we offer an epistemological perspective on the link between the myth of Narcissus and narcissism, as well as on the various definitions of narcissism in Freudian theories, clinical practice, nosography, the trait model of personality, and everyday language.
Results
The term narcissism was coined in the 19th century to illustrate a clinical condition using the myth of Narcissus. With his seminal essay “On Narcissism: An Introduction”, Freud separated narcissism from the myth of Narcissus. In doing so, he provided an object of interest for 20th-century clinicians, who developed clinical theories of narcissism, seeking to define the function and etiology of behavior identified as narcissistic. With the publication of the DSM-III and the rise of psychological research on personality traits, a new perspective on narcissism emerged, focusing on describing and differentiating behaviors rather than explaining them. The use of narcissism in everyday language draws freely from these different conceptions, employing heuristic shortcuts and analogies.
Discussion
We distinguish three different uses of narcissism: an analogical use, primarily aimed at illustrating a clinical situation or behavior with the myth; a theoretical/clinical use, seeking to explain the nature of narcissistic behavior; and a descriptive use, focused on defining and differentiating narcissism from related disorders or traits. These three uses coexist and are the source of much confusion. The methodological differences between theoretical and descriptive approaches directly influence the very definition of narcissism, as illustrated by the notion of narcissistic vulnerability.
Conclusion
This article clarifies the complex interactions between the myth and narcissism, which contribute both to the richness of the concept and the difficulty in defining it. Nearly two thousand years before the Alternative Model of Personality Disorder in the DSM-5, which places identity disturbances and relational difficulties at the core of personality disorders, Ovid had already intuited that self-ignorance and the inability to love others could lead to great suffering.
{"title":"Le narcissisme, entre mythologie et psychopathologie","authors":"Jérémie André Doctorant (MD) (Médecin chef de clinique) , Régis Marion-Veyron (Maître d’enseignement et de recherche clinicien, Responsable de l’unité de psychiatrie de liaison, département des policliniques, Unisanté)","doi":"10.1016/j.evopsy.2025.02.005","DOIUrl":"10.1016/j.evopsy.2025.02.005","url":null,"abstract":"<div><h3>Objectives</h3><div>Narcissism is distinguished from other contemporary psychiatric terms in that it refers both to a body of clinical and empirical research and to one of the most popular myths in our culture. The objective of this article is, on the one hand, to explore the nature of the link between the myth of Narcissus and narcissism, and on the other hand, from an epistemological perspective, to examine the various current definitions of narcissism.</div></div><div><h3>Methods</h3><div>Through a literature review, we offer an epistemological perspective on the link between the myth of Narcissus and narcissism, as well as on the various definitions of narcissism in Freudian theories, clinical practice, nosography, the trait model of personality, and everyday language.</div></div><div><h3>Results</h3><div>The term narcissism was coined in the 19th century to illustrate a clinical condition using the myth of Narcissus. With his seminal essay “<em>On Narcissism: An Introduction</em>”, Freud separated narcissism from the myth of Narcissus. In doing so, he provided an object of interest for 20th-century clinicians, who developed clinical theories of narcissism, seeking to define the function and etiology of behavior identified as narcissistic. With the publication of the DSM-III and the rise of psychological research on personality traits, a new perspective on narcissism emerged, focusing on describing and differentiating behaviors rather than explaining them. The use of narcissism in everyday language draws freely from these different conceptions, employing heuristic shortcuts and analogies.</div></div><div><h3>Discussion</h3><div>We distinguish three different uses of narcissism: an analogical use, primarily aimed at illustrating a clinical situation or behavior with the myth; a theoretical/clinical use, seeking to explain the nature of narcissistic behavior; and a descriptive use, focused on defining and differentiating narcissism from related disorders or traits. These three uses coexist and are the source of much confusion. The methodological differences between theoretical and descriptive approaches directly influence the very definition of narcissism, as illustrated by the notion of narcissistic vulnerability.</div></div><div><h3>Conclusion</h3><div>This article clarifies the complex interactions between the myth and narcissism, which contribute both to the richness of the concept and the difficulty in defining it. Nearly two thousand years before the Alternative Model of Personality Disorder in the DSM-5, which places identity disturbances and relational difficulties at the core of personality disorders, Ovid had already intuited that self-ignorance and the inability to love others could lead to great suffering.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 3","pages":"Pages 399-414"},"PeriodicalIF":0.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779371","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 : 2025-03-25DOI: 10.1016/j.evopsy.2025.03.001
Delphine Jacobs (Psychiatre infanto-juvénile, chef de clinique, professeur) , Jean Steyaert (Psychiatre infanto-juvénile, chef de clinique, professeur) , Kris Dierickx (Ethicien, professeur ordinaire) , Kristien Hens (Ethicien, professeur de recherche)
<div><h3>Goal</h3><div>After three quarters of a century of research and clinical experience, autism spectrum disorder (ASD) turns out to be surprisingly heterogeneous in its presentations, causes, and cognitive mechanisms. In light of the varied nature of this diagnosis, it is unclear how the array of (predominantly “basic”) research findings on ASD is translated into information that is meaningful and valuable to parents and clinicians. Few studies are dedicated to detecting the views and experiences of an ASD diagnosis of a child by parents and clinicians, nor to engaging an ethical reflection on their personal perspectives. An ethical reflection on the results of the empirical studies with parents and physicians leads to the formulation of clinical-ethical considerations towards both policy-makers and clinicians concerning the clinical care offered to young children with ASD.</div></div><div><h3>Method</h3><div>We conducted in-depth interviews on how parents and physicians view and experience a young child's ASD diagnosis. Parents were queried longitudinally: before the start of the diagnostic ASD assessment, right after the feedback session at the end of the assessment, and 12 months later. The interviews were analyzed in Nvivo 11 according to the guidelines of Interpretative Phenomenological Analysis.</div></div><div><h3>Results</h3><div>The interviewed parents and physicians addressed ‘psycho-relational’ implications of an ASD diagnosis as much as ‘treatment-oriented’ implications. The psycho-relational ‘exculpatory’ effect was particularly appreciated, which consists in both parents and child being able to exonerate themselves with regard to the child's unusual behavior towards both the parents and other adults. The interviewed parents and physicians often came to view the ASD diagnosis in a pragmatic way, in the light of its usefulness for child, parents, and to a lesser extent, professionals. Twelve months after their child received an ASD diagnosis, the interviewed parents mainly had come to value the ASD diagnosis for two reasons: the access to care it ensured, and the framework it provided allowing them to adapt their interactions with the child because of the ASD diagnosis. The interviewed physicians from their side needed an ASD diagnosis in order to be useful in their clinical practice, particularly in cases where they were able to describe the child toward parents and teachers using phrases such as “he wants to do what is expected from him but is not able to”, and in order to provide appropriate care. Clinicians expressed some doubts about the use of and need for a formal diagnosis. They preferred to establish a descriptive and treatment-oriented profile of the child, a profile of which an ASD diagnosis was sometimes considered to be just one useful part.</div></div><div><h3>Discussion</h3><div>Based on an ethical analysis and reflection, we formulate four clinico-ethical considerations in relations to policy, and four in relatio
{"title":"Le diagnostic de TSA chez les jeunes enfants : une étude clinico-éthique auprès des parents et des praticiens","authors":"Delphine Jacobs (Psychiatre infanto-juvénile, chef de clinique, professeur) , Jean Steyaert (Psychiatre infanto-juvénile, chef de clinique, professeur) , Kris Dierickx (Ethicien, professeur ordinaire) , Kristien Hens (Ethicien, professeur de recherche)","doi":"10.1016/j.evopsy.2025.03.001","DOIUrl":"10.1016/j.evopsy.2025.03.001","url":null,"abstract":"<div><h3>Goal</h3><div>After three quarters of a century of research and clinical experience, autism spectrum disorder (ASD) turns out to be surprisingly heterogeneous in its presentations, causes, and cognitive mechanisms. In light of the varied nature of this diagnosis, it is unclear how the array of (predominantly “basic”) research findings on ASD is translated into information that is meaningful and valuable to parents and clinicians. Few studies are dedicated to detecting the views and experiences of an ASD diagnosis of a child by parents and clinicians, nor to engaging an ethical reflection on their personal perspectives. An ethical reflection on the results of the empirical studies with parents and physicians leads to the formulation of clinical-ethical considerations towards both policy-makers and clinicians concerning the clinical care offered to young children with ASD.</div></div><div><h3>Method</h3><div>We conducted in-depth interviews on how parents and physicians view and experience a young child's ASD diagnosis. Parents were queried longitudinally: before the start of the diagnostic ASD assessment, right after the feedback session at the end of the assessment, and 12 months later. The interviews were analyzed in Nvivo 11 according to the guidelines of Interpretative Phenomenological Analysis.</div></div><div><h3>Results</h3><div>The interviewed parents and physicians addressed ‘psycho-relational’ implications of an ASD diagnosis as much as ‘treatment-oriented’ implications. The psycho-relational ‘exculpatory’ effect was particularly appreciated, which consists in both parents and child being able to exonerate themselves with regard to the child's unusual behavior towards both the parents and other adults. The interviewed parents and physicians often came to view the ASD diagnosis in a pragmatic way, in the light of its usefulness for child, parents, and to a lesser extent, professionals. Twelve months after their child received an ASD diagnosis, the interviewed parents mainly had come to value the ASD diagnosis for two reasons: the access to care it ensured, and the framework it provided allowing them to adapt their interactions with the child because of the ASD diagnosis. The interviewed physicians from their side needed an ASD diagnosis in order to be useful in their clinical practice, particularly in cases where they were able to describe the child toward parents and teachers using phrases such as “he wants to do what is expected from him but is not able to”, and in order to provide appropriate care. Clinicians expressed some doubts about the use of and need for a formal diagnosis. They preferred to establish a descriptive and treatment-oriented profile of the child, a profile of which an ASD diagnosis was sometimes considered to be just one useful part.</div></div><div><h3>Discussion</h3><div>Based on an ethical analysis and reflection, we formulate four clinico-ethical considerations in relations to policy, and four in relatio","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 2","pages":"Pages 321-331"},"PeriodicalIF":0.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090356","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 : 2025-03-25DOI: 10.1016/j.evopsy.2025.02.002
Philippe Drweski (Psychologue clinicien, Maître de conférences)
Objectives
This article proposes a reflection on the impacts of exile and immigration on therapeutic work with certain patients. I observe that the dynamics of transference, due to often traumatic histories, are marked by a variety of phenomena: projective identification, acting out, and operational thinking. Based on this observation, I propose an adjustment to the framework through the creation of a tool I call a “group in transition.” This initiative integrates several elements, including the sensory dimension and transitional objects that facilitate connections between the present and the past, and between the subject's current location and their country of origin. The objective is to facilitate associative processes that have been disrupted by various life events encountered by these populations through sensory transference.
Method
The method employed is participant observation of a group established with immigrant subjects.
Results
The results indicate that this type of group facilitates the establishment of a transference dynamic through a series of elements: the multicultural group, sensory mediation, and transitional objects. The multicultural aspect allows for the representation of otherness within the group, facilitating its elaboration. Sensory experiences promote regression, granting access to certain parts of the psyche that are challenging to reach due to trauma. Lastly, the transitional object helps to link temporalities (the past and the present) and spaces (here and elsewhere), which are often split, allowing for entry into the subjects’ histories. Thus, this group acts as a vector for the elaboration of questions of identity. The identity question manifests in several ways: the first corresponds to a nostalgic elaboration signifying a genuine process of disengagement. However, we also observe the presence of narcissistic defenses embodied within the group through splits concerning culture, triggering rejection responses. Lastly, another occurrence corresponds to a form of depressive collapse.
Discussion
These results prompt me to question certain elements of the “group in transition,” such as its very brief duration (3 months) and the group dimension itself. It seems that while the group supports the psychic apparatus for some, it can also potentially serve as a source of collective resistances through a number of alliances structured by culture and religion. These defenses appear to obscure the traumatic dimensions, which are markedly absent from the sessions. The question of the group's duration is perhaps worth exploring, as it may hinder certain processes, particularly in relation to the elaboration of loss.
Conclusion
The difficulties encountered in the clinical setting lead me to imagine new tools to address the challenges of clinical practice with exiled and migrant populations. The “group
{"title":"Dispositif « groupe de passage » auprès de patients exilés et migrants : intérêts et limites","authors":"Philippe Drweski (Psychologue clinicien, Maître de conférences)","doi":"10.1016/j.evopsy.2025.02.002","DOIUrl":"10.1016/j.evopsy.2025.02.002","url":null,"abstract":"<div><h3>Objectives</h3><div>This article proposes a reflection on the impacts of exile and immigration on therapeutic work with certain patients. I observe that the dynamics of transference, due to often traumatic histories, are marked by a variety of phenomena: projective identification, acting out, and operational thinking. Based on this observation, I propose an adjustment to the framework through the creation of a tool I call a “group in transition.” This initiative integrates several elements, including the sensory dimension and transitional objects that facilitate connections between the present and the past, and between the subject's current location and their country of origin. The objective is to facilitate associative processes that have been disrupted by various life events encountered by these populations through sensory transference.</div></div><div><h3>Method</h3><div>The method employed is participant observation of a group established with immigrant subjects.</div></div><div><h3>Results</h3><div>The results indicate that this type of group facilitates the establishment of a transference dynamic through a series of elements: the multicultural group, sensory mediation, and transitional objects. The multicultural aspect allows for the representation of otherness within the group, facilitating its elaboration. Sensory experiences promote regression, granting access to certain parts of the psyche that are challenging to reach due to trauma. Lastly, the transitional object helps to link temporalities (the past and the present) and spaces (here and elsewhere), which are often split, allowing for entry into the subjects’ histories. Thus, this group acts as a vector for the elaboration of questions of identity. The identity question manifests in several ways: the first corresponds to a nostalgic elaboration signifying a genuine process of disengagement. However, we also observe the presence of narcissistic defenses embodied within the group through splits concerning culture, triggering rejection responses. Lastly, another occurrence corresponds to a form of depressive collapse.</div></div><div><h3>Discussion</h3><div>These results prompt me to question certain elements of the “group in transition,” such as its very brief duration (3 months) and the group dimension itself. It seems that while the group supports the psychic apparatus for some, it can also potentially serve as a source of collective resistances through a number of alliances structured by culture and religion. These defenses appear to obscure the traumatic dimensions, which are markedly absent from the sessions. The question of the group's duration is perhaps worth exploring, as it may hinder certain processes, particularly in relation to the elaboration of loss.</div></div><div><h3>Conclusion</h3><div>The difficulties encountered in the clinical setting lead me to imagine new tools to address the challenges of clinical practice with exiled and migrant populations. The “group","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 2","pages":"Pages 219-231"},"PeriodicalIF":0.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090546","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 : 2025-03-11DOI: 10.1016/j.evopsy.2025.02.003
Frédéric Tordo (Docteur en psychologie clinique, chercheur associé au CRPMS) , Thomas Rabeyron (Psychologue clinicien, Professeur de psychopathologie et psychologie clinique au CRPPC)
Objectives
This article analyzes certain forms of contemporary subjective configurations influenced by the anthropological context marked by the growing hybridization between the psyche and digital technology. More specifically, it examines the development and use of psychic prostheses as compensatory mechanisms in response to processes of desubjectivation and identity erasure.
Methods
The clinical case of Catharina, a young female hospitalized in a psychiatric service, is analyzed through a psychoanalytic framework. This case study explores the psychic dynamics at play in borderline subjectivation issues, particularly the mechanisms of dependence on digital prostheses and their impact on identity construction.
Results
Catharina's psychic functioning is characterized by an experience of self-erasure and a dependence on digital prostheses developed to ensure a form of narcissistic continuity.
Discussion
While these prostheses help regulate the psychic economy, they reinforce mechanisms of splitting and dissociation. They also lead to a delegation of certain psychic functions—particularly reflexivity—to the technological environment. This externalization, though providing an illusion of mastery and continuity, weakens the subjectivation process by hindering the mature and autonomous development of symbolic functions.
Conclusion
The clinical study of borderline subjectivation issues in the digital age thus highlights the exacerbated suffering of contemporary subjects, faced with the dissolution of traditional frameworks of identity and narcissism. In psychotherapeutic work with such patients, particular attention must be given to transferential dynamics marked by experiences of emptiness and annihilation, while focusing on reviving symbolic capacities as a counterpoint to the reifying and alienating use of psychic prostheses.
{"title":"Le sujet contemporain et ses prothèses : du vécu de néantisation à la recherche de réflexivité","authors":"Frédéric Tordo (Docteur en psychologie clinique, chercheur associé au CRPMS) , Thomas Rabeyron (Psychologue clinicien, Professeur de psychopathologie et psychologie clinique au CRPPC)","doi":"10.1016/j.evopsy.2025.02.003","DOIUrl":"10.1016/j.evopsy.2025.02.003","url":null,"abstract":"<div><h3>Objectives</h3><div>This article analyzes certain forms of contemporary subjective configurations influenced by the anthropological context marked by the growing hybridization between the psyche and digital technology. More specifically, it examines the development and use of psychic prostheses as compensatory mechanisms in response to processes of desubjectivation and identity erasure.</div></div><div><h3>Methods</h3><div>The clinical case of Catharina, a young female hospitalized in a psychiatric service, is analyzed through a psychoanalytic framework. This case study explores the psychic dynamics at play in borderline subjectivation issues, particularly the mechanisms of dependence on digital prostheses and their impact on identity construction.</div></div><div><h3>Results</h3><div>Catharina's psychic functioning is characterized by an experience of self-erasure and a dependence on digital prostheses developed to ensure a form of narcissistic continuity.</div></div><div><h3>Discussion</h3><div>While these prostheses help regulate the psychic economy, they reinforce mechanisms of splitting and dissociation. They also lead to a delegation of certain psychic functions—particularly reflexivity—to the technological environment. This externalization, though providing an illusion of mastery and continuity, weakens the subjectivation process by hindering the mature and autonomous development of symbolic functions.</div></div><div><h3>Conclusion</h3><div>The clinical study of borderline subjectivation issues in the digital age thus highlights the exacerbated suffering of contemporary subjects, faced with the dissolution of traditional frameworks of identity and narcissism. In psychotherapeutic work with such patients, particular attention must be given to transferential dynamics marked by experiences of emptiness and annihilation, while focusing on reviving symbolic capacities as a counterpoint to the reifying and alienating use of psychic prostheses.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 3","pages":"Pages 431-441"},"PeriodicalIF":0.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779373","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 : 2025-03-08DOI: 10.1016/j.evopsy.2025.02.001
Isabelle Hubinet (Psychothérapeute, psychologue du travail)
<div><h3>Goals</h3><div>To explore the scream through its relationship to voice, speech and silence, the link to the Other, and its function in the psychotic subject, the effects in the listener. To place its position in the specific drive circuit and on the silence-speech axis developed by M. Poizat. To present the absence of closure of the invocation drive in a psychotic patient and the possibilities offered by the wet wraps used in packing therapy in the renewal of contact, which is the basis of the transferential relationship.</div></div><div><h3>Method</h3><div>This is the study of a clinical situation in a psychotic patient in a psychiatric institution, whose frequent inconsolable screams and whose tendency to provoke rejection from caregivers led to the use of a therapeutic device of unusual magnitude. The analysis focuses on the patient's manifestations of vocal jouissance produced in different environments and on the effects of packing therapy conducted in a context of institutional psychotherapy.</div></div><div><h3>Results</h3><div>Vocal phenomena in this psychotic patient, such as whispering and aphonia, will appear a few days after the beginning of the packing therapy. I hypothesize that they resemble the patient's frequent unconsolable cries, and I situate them, alongside silence, opposite to speech, thus revealing the structural lack of symbolism. If this patient's unconsolable scream is a life force inscribed in the body, its repetition and its effects align him with something deathly, the risk of automation and rejection by others. The scream, coupled or not with suffocation, would also be a valuable indicator of the anxiety that arises in the passage into a new environment, especially when the latter is made up of a desirous otherness. Thanks to the packing therapy, the therapeutic work invites the patient to speak and leads him to reinvest in the living and institutional collective; and the screams will lessen in intensity. The daily packing program allowed for an increased proximity with caregivers, and with the patient feeling more present, no longer abandoned, and that he is someone. If the restoration of transference is favorable and brings a noticeable improvement quickly, other transferential movements will require therapeutic rearrangement. Important and sensitive points in the course and continuation of the therapy that could not be observed are the analysis of the caregiving team's countertransference and, in counterpoint to work carried out by healthcare professionals, the role of the peers in work with alterity.</div></div><div><h3>Discussion</h3><div>Packing is a therapeutic choice whose benefits are positive for this highly motivated patient, facilitating a reinvestment of speech and a turning away from a deathly horizon to reconnect with life. A system of lesser magnitude in terms of frequency, duration, and personnel would not have allowed such a positive transferential movement, counteracting the psychological a
{"title":"Du cri sans appel à la restauration du transfert","authors":"Isabelle Hubinet (Psychothérapeute, psychologue du travail)","doi":"10.1016/j.evopsy.2025.02.001","DOIUrl":"10.1016/j.evopsy.2025.02.001","url":null,"abstract":"<div><h3>Goals</h3><div>To explore the scream through its relationship to voice, speech and silence, the link to the Other, and its function in the psychotic subject, the effects in the listener. To place its position in the specific drive circuit and on the silence-speech axis developed by M. Poizat. To present the absence of closure of the invocation drive in a psychotic patient and the possibilities offered by the wet wraps used in packing therapy in the renewal of contact, which is the basis of the transferential relationship.</div></div><div><h3>Method</h3><div>This is the study of a clinical situation in a psychotic patient in a psychiatric institution, whose frequent inconsolable screams and whose tendency to provoke rejection from caregivers led to the use of a therapeutic device of unusual magnitude. The analysis focuses on the patient's manifestations of vocal jouissance produced in different environments and on the effects of packing therapy conducted in a context of institutional psychotherapy.</div></div><div><h3>Results</h3><div>Vocal phenomena in this psychotic patient, such as whispering and aphonia, will appear a few days after the beginning of the packing therapy. I hypothesize that they resemble the patient's frequent unconsolable cries, and I situate them, alongside silence, opposite to speech, thus revealing the structural lack of symbolism. If this patient's unconsolable scream is a life force inscribed in the body, its repetition and its effects align him with something deathly, the risk of automation and rejection by others. The scream, coupled or not with suffocation, would also be a valuable indicator of the anxiety that arises in the passage into a new environment, especially when the latter is made up of a desirous otherness. Thanks to the packing therapy, the therapeutic work invites the patient to speak and leads him to reinvest in the living and institutional collective; and the screams will lessen in intensity. The daily packing program allowed for an increased proximity with caregivers, and with the patient feeling more present, no longer abandoned, and that he is someone. If the restoration of transference is favorable and brings a noticeable improvement quickly, other transferential movements will require therapeutic rearrangement. Important and sensitive points in the course and continuation of the therapy that could not be observed are the analysis of the caregiving team's countertransference and, in counterpoint to work carried out by healthcare professionals, the role of the peers in work with alterity.</div></div><div><h3>Discussion</h3><div>Packing is a therapeutic choice whose benefits are positive for this highly motivated patient, facilitating a reinvestment of speech and a turning away from a deathly horizon to reconnect with life. A system of lesser magnitude in terms of frequency, duration, and personnel would not have allowed such a positive transferential movement, counteracting the psychological a","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 2","pages":"Pages 233-246"},"PeriodicalIF":0.6,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090547","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 : 2025-03-03DOI: 10.1016/j.evopsy.2024.12.001
Luc Surjous (Psychiatre, Pédopsychiatre)
Introduction
Philippe Pinel's Traité médico-philosophique de l’aliénation mentale (1800) is considered the foundational act of French psychiatry. Since the 1960s, it has been the subject of remarkable studies. Focusing on the difference between the two editions of the Traité regarding moral treatment, this article explores the contemporary issues raised by Pinel's work.
Method
Following the successive stages of Pinel's medical career: in Paris before his time at the Bicêtre hospital as a translator and a popularizer of medical literature with limited clinical experience, at Bicêtre where he met Pussin, and finally at La Salpêtrière where he was widely known. I study the evolution of his scientific medical project and his attempts to extend it to cover the question of insanity and, in particular, moral treatment. The two editions of the Traité reflect this evolution.
Result
Influenced by English texts on the efficacy of moral treatment of insanity, Pinel discovered it practiced at Bicêtre by Pussin and his wife. He writes about this effectiveness and presents its principles in the first edition of his Traité. These remained equivocal, combining gentleness and firmness, and cautiously encouraging the distraction of the insane. The second edition presents the result of the rationalized application of these principles at La Salpêtrière, in line with their initial scientific ambitions. Principles of moral treatment have become unequivocal and aim to act directly on the disease in spite of the patient: importance of the “single center of authority,” distraction imposed by sewing workshops, baths, and a “calculated” environment. I hypothesize that this systematization denatures the origins of the moral treatment, which consists of: 1/ the moral therapist's identification of a “rest of reason” in the lunatic; 2/ guiding the skillful, pragmatic application of social practices well identified at the time: reasonable consent to a just law and distraction in an emotional refuge, which reinstitute the alienated individual as an agent.
Discussion
I place my work in the continuity and updating of the work of G. Swain and M. Gauchet, resituated among the major interpreters of Pinel's work.
Conclusion
The evolution of moral treatment in Pinel's work illustrates the temptations and risks involved in substituting rational treatment for reasonable care.
{"title":"Philippe Pinel et le secret des Anglais","authors":"Luc Surjous (Psychiatre, Pédopsychiatre)","doi":"10.1016/j.evopsy.2024.12.001","DOIUrl":"10.1016/j.evopsy.2024.12.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Philippe Pinel's <em>Traité médico-philosophique de l’aliénation mentale</em> (1800) is considered the foundational act of French psychiatry. Since the 1960s, it has been the subject of remarkable studies. Focusing on the difference between the two editions of the <em>Traité</em> regarding moral treatment, this article explores the contemporary issues raised by Pinel's work.</div></div><div><h3>Method</h3><div>Following the successive stages of Pinel's medical career: in Paris before his time at the Bicêtre hospital as a translator and a popularizer of medical literature with limited clinical experience, at Bicêtre where he met Pussin, and finally at La Salpêtrière where he was widely known. I study the evolution of his scientific medical project and his attempts to extend it to cover the question of insanity and, in particular, moral treatment. The two editions of the <em>Traité</em> reflect this evolution.</div></div><div><h3>Result</h3><div>Influenced by English texts on the efficacy of moral treatment of insanity, Pinel discovered it practiced at Bicêtre by Pussin and his wife. He writes about this effectiveness and presents its principles in the first edition of his <em>Traité</em>. These remained equivocal, combining gentleness and firmness, and cautiously encouraging the distraction of the insane. The second edition presents the result of the rationalized application of these principles at La Salpêtrière, in line with their initial scientific ambitions. Principles of moral treatment have become unequivocal and aim to act directly on the disease in spite of the patient: importance of the “single center of authority,” distraction imposed by sewing workshops, baths, and a “calculated” environment. I hypothesize that this systematization denatures the origins of the moral treatment, which consists of: 1/ the moral therapist's identification of a “rest of reason” in the lunatic; 2/ guiding the skillful, pragmatic application of social practices well identified at the time: reasonable consent to a just law and distraction in an emotional refuge, which reinstitute the alienated individual as an agent.</div></div><div><h3>Discussion</h3><div>I place my work in the continuity and updating of the work of G. Swain and M. Gauchet, resituated among the major interpreters of Pinel's work.</div></div><div><h3>Conclusion</h3><div>The evolution of moral treatment in Pinel's work illustrates the temptations and risks involved in substituting rational treatment for reasonable care.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 3","pages":"Pages 480-499"},"PeriodicalIF":0.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779276","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 : 2025-02-25DOI: 10.1016/j.evopsy.2025.01.006
Florestan Delcourt (Psychologue, doctorant en psychologie)
{"title":"Jusqu’où peut-on savoir ce que veut dire je vais mal ou je vais mieux en santé mentale ? À propos de… « Storying Mental Illness and Personal Recover » sous la direction de Dorthe Kirkegaard Thomsen","authors":"Florestan Delcourt (Psychologue, doctorant en psychologie)","doi":"10.1016/j.evopsy.2025.01.006","DOIUrl":"10.1016/j.evopsy.2025.01.006","url":null,"abstract":"","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 3","pages":"Pages 545-559"},"PeriodicalIF":0.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779281","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 : 2025-02-19DOI: 10.1016/j.evopsy.2025.01.008
Jennifer Mertz (Psychologue clinicienne) , Marie-Frédérique Bacqué (Professeur en psychopathologie)
Objective
The person's wishes at the end of their life bring a variety of relational and psychological issues into question. French law allows for Deep and Continuous Sedation Maintained Until Death (SPCMD) under certain conditions. The question then arises of the accuracy of a medical decision in its deontological and ethical dimensions.
Method
We present the request to die of Ms. M., a patient suffering from bipolar disorder treated for several years and a cancer for which treatments have been stopped. This clinical case study highlights the work of reflection around the question of supporting a person whose refractory existential suffering is associated with mental depression.
Results
The request for SPCMD is not admissible within the framework of the Claeys-Leonetti law, as it does not meet the criterion of a short-term lethal prognosis. We offer psychodynamic supportive psychotherapy to the patient. The psychological support undertaken invites us to read the psychological processes that emerge in the meeting space between Ms. M. and a clinical psychologist with a psychoanalytic orientation.
Discussion
The therapeutic listening device specific to the function of the clinical psychologist allows for a space of speech where it is possible to return to what had not been said until then, in this final time of a final accomplishment of a speech act that strengthens and soothes family ties and Ms. M.’s relationship with herself.
Conclusion
The request to die is thus presented as the unconscious revealer of psychological processes neglected by medical decision-making.
{"title":"Psychothérapie et réflexion éthique d’une équipe de soins palliatifs confrontée à la demande de mourir d’une patiente bipolaire","authors":"Jennifer Mertz (Psychologue clinicienne) , Marie-Frédérique Bacqué (Professeur en psychopathologie)","doi":"10.1016/j.evopsy.2025.01.008","DOIUrl":"10.1016/j.evopsy.2025.01.008","url":null,"abstract":"<div><h3>Objective</h3><div>The person's wishes at the end of their life bring a variety of relational and psychological issues into question. French law allows for Deep and Continuous Sedation Maintained Until Death (SPCMD) under certain conditions. The question then arises of the accuracy of a medical decision in its deontological and ethical dimensions.</div></div><div><h3>Method</h3><div>We present the request to die of Ms. M., a patient suffering from bipolar disorder treated for several years and a cancer for which treatments have been stopped. This clinical case study highlights the work of reflection around the question of supporting a person whose refractory existential suffering is associated with mental depression.</div></div><div><h3>Results</h3><div>The request for SPCMD is not admissible within the framework of the Claeys-Leonetti law, as it does not meet the criterion of a short-term lethal prognosis. We offer psychodynamic supportive psychotherapy to the patient. The psychological support undertaken invites us to read the psychological processes that emerge in the meeting space between Ms. M. and a clinical psychologist with a psychoanalytic orientation.</div></div><div><h3>Discussion</h3><div>The therapeutic listening device specific to the function of the clinical psychologist allows for a space of speech where it is possible to return to what had not been said until then, in this final time of a final accomplishment of a speech act that strengthens and soothes family ties and Ms. M.’s relationship with herself.</div></div><div><h3>Conclusion</h3><div>The request to die is thus presented as the unconscious revealer of psychological processes neglected by medical decision-making.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 2","pages":"Pages 290-301"},"PeriodicalIF":0.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090551","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 : 2025-02-14DOI: 10.1016/j.evopsy.2025.01.010
Thomas Rabeyron (Professeur de psychologie clinique)
Aim
Transference is a fundamental concept in analytical practices and theories, whose modeling can be refined through insights from other disciplines such as cognitive neurosciences.
Method
We show how this concept can be connected to various findings from cognitive neurosciences, offering a fresh perspective on conceptualizing the dynamics of transference.
Results
Connections between transference and connectionist theories, distinctions between implicit and explicit memory, certain properties of self-organized networks such as pattern completion, studies in social cognition on experimental transference, and recent work on brain synchronization using hyperscanning techniques are presented and examined in dialogue with psychoanalytic metapsychology.
Discussion
Numerous points of convergence emerge between these disciplines, helping to build a model of the mind supported by elements from diverse but complementary methodological fields.
Conclusion
The elements presented in this work underscore the relevance of the psychoanalytic conceptual modeling of transference, emphasizing its essential importance in any psychotherapeutic work.
{"title":"Le transfert entre neurosciences et psychanalyse","authors":"Thomas Rabeyron (Professeur de psychologie clinique)","doi":"10.1016/j.evopsy.2025.01.010","DOIUrl":"10.1016/j.evopsy.2025.01.010","url":null,"abstract":"<div><h3>Aim</h3><div>Transference is a fundamental concept in analytical practices and theories, whose modeling can be refined through insights from other disciplines such as cognitive neurosciences.</div></div><div><h3>Method</h3><div>We show how this concept can be connected to various findings from cognitive neurosciences, offering a fresh perspective on conceptualizing the dynamics of transference.</div></div><div><h3>Results</h3><div>Connections between transference and connectionist theories, distinctions between implicit and explicit memory, certain properties of self-organized networks such as pattern completion, studies in social cognition on experimental transference, and recent work on brain synchronization using hyperscanning techniques are presented and examined in dialogue with psychoanalytic metapsychology.</div></div><div><h3>Discussion</h3><div>Numerous points of convergence emerge between these disciplines, helping to build a model of the mind supported by elements from diverse but complementary methodological fields.</div></div><div><h3>Conclusion</h3><div>The elements presented in this work underscore the relevance of the psychoanalytic conceptual modeling of transference, emphasizing its essential importance in any psychotherapeutic work.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 2","pages":"Pages 207-218"},"PeriodicalIF":0.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090539","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}
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