Pub Date : 2024-02-14DOI: 10.1016/j.evopsy.2024.01.005
Luc Surjous (psychiatre, pédopsychiatre)
Objectives
L’Essai sur quelques problèmes concernant le normal et le pathologique, a medical thesis defended in 1943 by Georges Canguilhem (1905–1995), is certainly the best-known French text on the epistemology of medicine. Canguilhem, then a young philosopher, medical student, and member of the French Resistance, defends the self-determination of the living individual, capable of judging what is normal or pathological – categories subsequently adopted by medicine and physiology – as well as a conception of the medical practice tailored to the singular situation. His argumentation is largely based on the theories of psychiatrists, yet excludes psychopathology from its scope. It is this paradox, little studied until now, that I attempt to resolve in this article.
Methods
I have conducted an extensive study of the texts on psychology and mental care in G. Canguilhem's archives, his recently published complete works, and current academic research.
Results
I propose to return to the two problems presented at the beginning of the Essai: “that of the relationship between science and technology, and that of norms and the normal”. Canguilhem responds to the latter by proposing the concept of vital normativity, which follows on from earlier work on psychology, presented in high school courses in the 1930s and in a Traité de psychologie, never published, which already promoted a subject able to value, to commit, and thus to escape from the determinism of his environment and organism. Regarding the relationship between science and technology, which Canguilhem began to conceptualize at the very end of the 1930s, in his Essai, he proposes a path that reverses that of positivism, moving from clinical practice to science, in which the former is clarified by the latter; however, scientific psychology cannot play a role equivalent to physiology in psychological care. Indeed, Canguilhem considers psychology's claim to objectivity incompatible with the respect for subjectivity that his psychologie réflexive, on the contrary, defends. To conclude, I examine Canguilhem's few writings on psychotherapy, as well as those on psychopharmacology.
Discussion
I discuss the clinical consequences of the inability of scientific psychology to play a role in psychotherapy similar to that of physiology in medicine.
Conclusion
Canguilhem's conception of psychological care is essentially a defense of human dignity, based on a philosophical, not a scientific, theory of the individual.
ObjectivesL'Essai sur quelques problèmes concernant le normal et le pathologique（关于正常与病理的几个问题的论文）是乔治-康吉伦（Georges Canguilhem，1905-1995 年）1943 年通过答辩的医学论文，无疑是法国最著名的医学认识论著作。康吉伦当时还是一名年轻的哲学家、医科学生和法国抵抗运动成员，他为活生生的个体的自我决定权辩护，认为个体有能力判断什么是正常或病理--医学和生理学随后采用了这些分类--以及一种针对特殊情况的医疗实践概念。他的论点主要以精神病学家的理论为基础，但又将精神病理学排除在外。我对 G. Canguilhem 档案中有关心理学和精神治疗的文本、他最近出版的全集以及当前的学术研究进行了广泛的研究。结果 我建议回到《随想录》开头提出的两个问题："科学与技术的关系以及规范与正常的关系"。坎吉拉姆针对后者提出了 "生命规范性 "的概念，这一概念源于他早先的心理学研究，在 20 世纪 30 年代的高中课程和从未出版的《心理学教程》中都有介绍。关于科学与技术之间的关系，康吉雷姆在 20 世纪 30 年代末就开始将其概念化，在他的《随想录》中，他提出了一条与实证主义相反的道路，即从临床实践转向科学，前者通过后者得到澄清；然而，科学心理学在心理治疗中并不能扮演与生理学相同的角色。事实上，康吉伦认为心理学的客观性主张与他的反思心理学所捍卫的对主观性的尊重是不相容的。讨论我讨论了科学心理学无法在心理治疗中发挥类似于生理学在医学中的作用所带来的临床后果。结论康吉伦的心理治疗概念本质上是对人类尊严的捍卫，其基础是关于个人的哲学理论，而非科学理论。
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Pub Date : 2024-02-10DOI: 10.1016/j.evopsy.2024.01.004
Clémence Isaac PhD , Sarah Joanny MSc , Noomane Bouaziz PhD , Marie-Carmen Castillo (Pr) , Dominique Januel (Pr)
Objectives
Cognitive impairments represent a major issue in mental health that remains understudied in clinical practice. This article aims to provide an overview of the literature on cognitive functioning in bipolar disorders. Additionally, its purpose is to highlight potential interventions that promote recovery, particularly within the bipolar “Centers of Expertise” of the Fondation FondaMental network.
Method
We conducted a literature review to explore various aspects related to cognitive issues in bipolar disorders, such as trait-related cognitive impairments, variations throughout the course of the illness, and the assessment and treatment of these cognitive deficits.
Results
In bipolar disorders, many cognitive disorders may present themselves in different ways; the literature identifies disorders of attention, psychomotor speed, executive functions, memory, emotional and social cognition, and metacognition. These cognitive disorders are present in all phases of the disease with heterogeneity between patients. This heterogeneity does not depend on whether patients have type I or type II bipolar disorders; nor does it depend on depressive, manic, or euthymic phases, although cognitive symptomatology is more intense in the acute phases. Bipolar disorders require treatment, although some treatments can have an influence on cognition, notably antipsychotics, lithium, or more general polypharmacy. The International Society for Bipolar Disorders (ISBD) Targeting Cognition Task Force developed consensual recommendations for clinicians regarding cognitive interventions in bipolar disorders. The recommendations include an objective and subjective assessment of cognition for all patients, regardless of whether partial or complete remission is achieved. Caregivers who are not neuropsychology specialists may, after a short training period, use screening tools such as the “Screen for Cognitive Impairment in Psychiatry” (SCIP) and “Cognitive Complaints in Bipolar Disorders Rating Assessment” (COBRA), and must refer patients for a more complete evaluation if any difficulties emerge. There is also an interest in regularly assessing cognition, in connection with the possibility of neurodegeneration. Indeed, there are several theories about the development of cognitive impairments in bipolar disorders in the literature. One theory suggests that neurodevelopmental factors could influence the occurrence of these disorders. On the contrary, the “neuroprogression model” postulates that allostatic load may disrupt cognitive functioning as part of a longer term degenerative process.
Discussion
The FondaMental network Centers of Expertise provide educational programs as well as interventions adapted to several aspects of psychiatric diseases, notably cognitive impairment. Patients can be provided with a complete cognitive assessment, and then directed towards appropriate the
目的认知障碍是精神健康领域的一个重要问题，但在临床实践中仍未得到充分研究。本文旨在概述有关双相情感障碍认知功能的文献。方法我们进行了一次文献综述，以探讨与双相情感障碍中的认知问题相关的各个方面，如与特质相关的认知障碍、整个病程中的变化以及对这些认知障碍的评估和治疗。结果 在双相情感障碍中，许多认知障碍可能会以不同的方式表现出来；文献指出了注意力、精神运动速度、执行功能、记忆、情感和社会认知以及元认知等方面的障碍。这些认知障碍存在于疾病的各个阶段，患者之间存在异质性。这种异质性并不取决于患者是 I 型还是 II 型双相情感障碍，也不取决于抑郁期、躁狂期或缓解期，尽管认知症状在急性期更为强烈。双相情感障碍需要治疗，但有些治疗方法会对认知产生影响，特别是抗精神病药物、锂盐或更普遍的综合药物治疗。国际双相情感障碍协会（ISBD）认知目标工作组为临床医生制定了有关双相情感障碍认知干预的共识性建议。这些建议包括对所有患者的认知能力进行客观和主观评估，无论患者的病情是部分缓解还是完全缓解。非神经心理学专家的护理人员在经过短期培训后，可以使用 "精神病学认知功能障碍筛查"（SCIP）和 "双相情感障碍认知主诉分级评估"（COBRA）等筛查工具，如果出现任何问题，必须将患者转介到更全面的评估机构。此外，定期评估认知能力还与神经变性的可能性有关。事实上，关于双相情感障碍患者认知障碍的发展，文献中有多种理论。一种理论认为，神经发育因素可能会影响这些疾病的发生。相反，"神经退化模型 "则推测，作为长期退化过程的一部分，异位负荷可能会破坏认知功能。讨论方达精神医学网专家中心提供教育计划和干预措施，适用于精神疾病的多个方面，尤其是认知障碍。中心可为患者提供全面的认知评估，然后指导他们接受适当的治疗。例如，这些中心为躁狂症患者提供认知矫正服务，以实现个人康复为目标。认知矫正是一种社会心理康复治疗，包括通过练习来训练认知功能，目的是制定可用于日常生活的解决问题的策略。这种治疗应能提高患者的生活质量和自主能力。在世界范围内，还缺乏针对情绪障碍患者（包括躁郁症患者）的公认方案。不过，一些研究报告称，认知矫正治疗可以改善患者的认知和功能，尽管这些研究的结果不尽相同。这些研究的一些作者建议，以患者的个人和职业项目为中心，针对不同的心理过程（这些心理过程是功能改善的中介），开发个性化的综合疗法。最近，法国为包括躁郁症在内的情绪障碍患者制定了一项名为 "Eco "的生态认知矫正计划。该计划使用纸张和可操作工具进行认知矫正练习，这些工具专门用于支持将认知技能转移到人们的日常生活中。它由一个心理教育模块组成，该模块可以：发展患者的元认知知识；减少自我鄙视；增加治疗的内在动力。该计划包括三个认知训练模块（注意力、记忆力和执行功能），以及针对特定功能的子模块，练习可在指导课程中进行，也可偶尔在家中进行。模块的讲解顺序以及每个子模块的训练次数都根据每位患者的情况进行调整。练习由十个难度等级组成，让患者发现、发展并推广新的认知策略。
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Pub Date : 2024-02-06DOI: 10.1016/j.evopsy.2024.01.003
Quentin Dumoulin (Psychologue clinicien, Maître de conférences) , Pierre Bonny (Psychanalyste, psychologue clinicien, Maître de conférences)
Objectives
The aim is to examine the psychopathological and sociocultural implications of DID (Dissociative Identity Disorder), in relation to the way in which the epidemic of “multiple personalities” had dissipated by the end of the 20th century.
Method
We begin by tracing the history of dissociative disorder, reviewing the diagnostic criteria of DID (DSM-5 and ICD-11) and comparing them with those of the former MPD (Multiple Personality Disorder) in DSM-III. We then return to the concept of “dissociation” in psychiatry, highlighting some translation difficulties and its plurivocity. Finally, we conclude with a discussion of the issues involved in clinical practice with the patients concerned.
Results
The renaming of dissociative disorder (from MPD to DID) was a response to the forensic controversies of the 1990s. However, this new diagnostic label resolves neither the epistemological issues surrounding dissociation (around the neurosis/psychosis differential diagnosis), nor the question of therapeutic accompaniment. Today, DID is the subject of two opposing interpretations: the psychotraumatic model and the social-cognitive model. Although they present irreconcilable differences and conceptions of the dynamics of psychic disorders, they both emphasize many points in common with regard to DID. The possibility of the cohabitation of different consciousnesses, identities, or personalities is not called into question. Similarly, the issue of trauma is examined by proponents of both models.
Discussion
The success of the DID could thus be partly explained as a return to the initial thesis of subjective division (Freud, Lacan), incompatible with the idea of a strongly unified ego as an ideal of mental health. However, the “loop” logic inherent in the classification of psychological disorders means that DID can be seen as a way for patients to describe some of their symptoms. So, the question is not to determine the superiority of an “explanatory” model of DID, but to examine the dynamics that led the subject to be identified with this diagnosis. In the case presented here, DID is linked to the patient's psychotic experience.
Conclusion
The success of DID is contemporaneous with social questioning around questions of identity. However, the dynamics of the social bond, specific to the development of a new vocabulary, cannot eclipse a certain reality of suffering manifested through dissociative phenomena. The unconscious as an “autre scène” can shed light on the logic of these mechanisms, notably by drawing on the tools of structural diagnosis proposed by Lacanian psychoanalysis. These insights help to define the conditions under which transference-related disorders can be accepted and elaborated for the patients concerned.
方法我们首先追溯解离障碍的历史，回顾 DID（DSM-5 和 ICD-11）的诊断标准，并将其与 DSM-III 中的前 MPD（多重人格障碍）的诊断标准进行比较。然后，我们回到精神病学中的 "解离 "概念，强调一些翻译上的困难及其多元性。最后，我们讨论了相关患者在临床实践中遇到的问题。结果解离障碍的重新命名（从 MPD 到 DID）是对 20 世纪 90 年代法医争议的回应。然而，这一新的诊断标签既没有解决围绕解离症的认识论问题（围绕神经症/精神病的鉴别诊断），也没有解决伴随治疗的问题。如今，对 DID 有两种截然相反的解释：精神创伤模式和社会认知模式。尽管它们在精神障碍的动力学方面存在着不可调和的分歧和概念，但它们都强调了 DID 的许多共同点。不同意识、身份或人格共存的可能性没有受到质疑。因此，DID 的成功在一定程度上可以解释为回到了最初的主观分裂论（弗洛伊德、拉康），这与作为心理健康理想的强烈统一的自我的想法是不相容的。然而，心理障碍分类中固有的 "循环 "逻辑意味着，DID 可以被视为患者描述其某些症状的一种方式。因此，问题不在于确定 DID "解释 "模式的优越性，而在于研究导致受试者被确定为这一诊断的动力。在本文介绍的病例中，DID 与患者的精神病经历有关。然而，新词汇发展所特有的社会纽带动力，并不能掩盖通过分离现象所表现出的某种现实痛苦。作为 "另一个场景 "的无意识可以揭示这些机制的逻辑，特别是通过借鉴拉康精神分析提出的结构诊断工具。这些洞察力有助于为相关患者界定在何种条件下可以接受和阐述与移情相关的失调。
{"title":"Le Trouble Dissociatif de l’Identité (TDI), du nouveau dans la division subjective ?","authors":"Quentin Dumoulin (Psychologue clinicien, Maître de conférences) , Pierre Bonny (Psychanalyste, psychologue clinicien, Maître de conférences)","doi":"10.1016/j.evopsy.2024.01.003","DOIUrl":"10.1016/j.evopsy.2024.01.003","url":null,"abstract":"<div><h3>Objectives</h3><p>The aim is to examine the psychopathological and sociocultural implications of DID (Dissociative Identity Disorder), in relation to the way in which the epidemic of “multiple personalities” had dissipated by the end of the 20th century.</p></div><div><h3>Method</h3><p>We begin by tracing the history of dissociative disorder, reviewing the diagnostic criteria of DID (DSM-5 and ICD-11) and comparing them with those of the former MPD (Multiple Personality Disorder) in DSM-III. We then return to the concept of “dissociation” in psychiatry, highlighting some translation difficulties and its plurivocity. Finally, we conclude with a discussion of the issues involved in clinical practice with the patients concerned.</p></div><div><h3>Results</h3><p>The renaming of dissociative disorder (from MPD to DID) was a response to the forensic controversies of the 1990s. However, this new diagnostic label resolves neither the epistemological issues surrounding dissociation (around the neurosis/psychosis differential diagnosis), nor the question of therapeutic accompaniment. Today, DID is the subject of two opposing interpretations: the psychotraumatic model and the social-cognitive model. Although they present irreconcilable differences and conceptions of the dynamics of psychic disorders, they both emphasize many points in common with regard to DID. The possibility of the cohabitation of different consciousnesses, identities, or personalities is not called into question. Similarly, the issue of trauma is examined by proponents of both models.</p></div><div><h3>Discussion</h3><p>The success of the DID could thus be partly explained as a return to the initial thesis of subjective division (Freud, Lacan), incompatible with the idea of a strongly unified ego as an ideal of mental health. However, the “loop” logic inherent in the classification of psychological disorders means that DID can be seen as a way for patients to describe some of their symptoms. So, the question is not to determine the superiority of an “explanatory” model of DID, but to examine the dynamics that led the subject to be identified with this diagnosis. In the case presented here, DID is linked to the patient's psychotic experience.</p></div><div><h3>Conclusion</h3><p>The success of DID is contemporaneous with social questioning around questions of identity. However, the dynamics of the social bond, specific to the development of a new vocabulary, cannot eclipse a certain reality of suffering manifested through dissociative phenomena. The unconscious as an “autre scène” can shed light on the logic of these mechanisms, notably by drawing on the tools of structural diagnosis proposed by Lacanian psychoanalysis. These insights help to define the conditions under which transference-related disorders can be accepted and elaborated for the patients concerned.</p></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 2","pages":"Pages 299-321"},"PeriodicalIF":0.6,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139814275","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 : 2024-02-02DOI: 10.1016/j.evopsy.2024.01.002
Norbert Godon (Artiste, conférencier)
{"title":"Dessins de courbes gaussiennes représentant les probabilités de résultats obtenus en lançant deux, trois, quatre et cinq dés","authors":"Norbert Godon (Artiste, conférencier)","doi":"10.1016/j.evopsy.2024.01.002","DOIUrl":"https://doi.org/10.1016/j.evopsy.2024.01.002","url":null,"abstract":"","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 1","pages":"Pages 163-166"},"PeriodicalIF":0.6,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139738717","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 : 2024-01-30DOI: 10.1016/j.evopsy.2023.12.001
Clément Fromentin (psychiatre, psychanalyste) , Olivier Douville (psychologue, psychanalyste, Maître de conférences des Universités)
Objective
The aim of this article is to offer an overview of the notion of sublimation in Lacan's teaching. More specifically, the aim is to approach the notion of sublimation not from the point of view of artistic creation, but from the point of view of its function in love relationships. Lacan uses the category of courtly love in particular to highlight this dimension.
Method
This work is based on a study of Freud's and Lacan's developments of the notion of sublimation and the amorous encounter. Following a review of the historical principles of courtly love, we will successively address the question of love at first sight in Freud, the articulation of the notions of sublimation and idealization, Lacan's developments on ecstatic love and its distinction from narcissistic love, the conception of the Thing, and finally the distinction between two types of sublimation distinguished by Lacan in 1969: that which is accomplished via the object to reach the woman, the other which is accomplished via the drive, the prototype of which is the work of art.
Results
Lacan bases his version of sublimation on a distinction between instinct and drive, which tends not towards an object but towards das Ding. This field of the Thing, which lies beyond the regulation of the pleasure principle, designates that of jouissance, which is electively targeted by sublimation. This forbidden jouissance constitutes a void around which creation is constituted.
Discussion
The object that plays a primordial role in sublimation is never reduced to a narcissistic object of imaginary idealization, but instead relates to a process directed towards the real of the unattainable Thing. Sublimation in love allows us to conceive that there is no desexualization of the drive.
Conclusion
Courtly love plays on this double articulation, which allows desire to address itself to a signifying being, based on a poetic linguistic creation, but which also authorizes the exercise of a transgressive jouissance, in relation to the partner's body.
{"title":"La sublimation amoureuse","authors":"Clément Fromentin (psychiatre, psychanalyste) , Olivier Douville (psychologue, psychanalyste, Maître de conférences des Universités)","doi":"10.1016/j.evopsy.2023.12.001","DOIUrl":"https://doi.org/10.1016/j.evopsy.2023.12.001","url":null,"abstract":"<div><h3>Objective</h3><p>The aim of this article is to offer an overview of the notion of sublimation in Lacan's teaching. More specifically, the aim is to approach the notion of sublimation not from the point of view of artistic creation, but from the point of view of its function in love relationships. Lacan uses the category of courtly love in particular to highlight this dimension.</p></div><div><h3>Method</h3><p>This work is based on a study of Freud's and Lacan's developments of the notion of sublimation and the amorous encounter. Following a review of the historical principles of courtly love, we will successively address the question of love at first sight in Freud, the articulation of the notions of sublimation and idealization, Lacan's developments on ecstatic love and its distinction from narcissistic love, the conception of the Thing, and finally the distinction between two types of sublimation distinguished by Lacan in 1969: that which is accomplished via the object to reach the woman, the other which is accomplished via the drive, the prototype of which is the work of art.</p></div><div><h3>Results</h3><p>Lacan bases his version of sublimation on a distinction between instinct and drive, which tends not towards an object but towards das Ding. This field of the Thing, which lies beyond the regulation of the pleasure principle, designates that of jouissance, which is electively targeted by sublimation. This forbidden jouissance constitutes a void around which creation is constituted.</p></div><div><h3>Discussion</h3><p>The object that plays a primordial role in sublimation is never reduced to a narcissistic object of imaginary idealization, but instead relates to a process directed towards the real of the unattainable Thing. Sublimation in love allows us to conceive that there is no desexualization of the drive.</p></div><div><h3>Conclusion</h3><p>Courtly love plays on this double articulation, which allows desire to address itself to a signifying being, based on a poetic linguistic creation, but which also authorizes the exercise of a transgressive jouissance, in relation to the partner's body.</p></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 1","pages":"Pages 61-74"},"PeriodicalIF":0.6,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139737909","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 : 2024-01-24DOI: 10.1016/j.evopsy.2024.01.001
Christophe Chaperot (Psychiatre, psychanalyste)
{"title":"L’homme Freud dans son temps. À propos de… « La psychanalyse dans le monde du temps de Freud. Chronologie » de Olivier Douville","authors":"Christophe Chaperot (Psychiatre, psychanalyste)","doi":"10.1016/j.evopsy.2024.01.001","DOIUrl":"10.1016/j.evopsy.2024.01.001","url":null,"abstract":"","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 2","pages":"Pages 412-415"},"PeriodicalIF":0.6,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139633352","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 : 2024-01-23DOI: 10.1016/j.evopsy.2023.11.005
Sylvain Missonnier
Objectives
This research focuses on the work of Arthur Conan Doyle and his famous detective Sherlock Holmes, considered a true secular myth. His worldwide fame is exceptional. The detective plays with the boundary between reality and fiction to establish himself deeply and durably in individual and collective psychic surreality. Paradoxically, the Scottish physician Arthur Conan Doyle had very little literary regard for his famous hero, and much preferred his other novels: “My lowest works cast into the shadows that of which I am most proud.” In 1893, he murdered his creation in issue 36 of The Strand Magazine, where he published “The Final Problem.” Doyle received countless letters from outraged readers insulting him and demanding the rebirth of the hero.
Method
As part of a clinical psychopathological reflection on Doyle's creative work, this paradox is explored here through an analysis of the links between Sherlock Holmes and John Watson.
Result
The strategic role of the inseparable chronicler-narrator John Watson in this detective fiction is seen both as a mirror of Doyle's creative anaclitism and as a constant support for Sherlock Holmes’ deployment of his observational skills and the mastery of his indexical logic. The consulting detective's iconoclastic method is seen as characteristic of anaclitic creativity.
Discussion
This picture of an intersubjective framework between the detective and Watson's “presence-support,” conducive to crisis resolution, does not leave the psychoanalytically-oriented clinician unmoved.
Conclusion
In literature, the “body of work” is not always where the author consciously wishes it to be! Doyle's unwitting self-writing is a source of inspiration for the clinician.
{"title":"La fiction détective chez Conan Doyle : une création anaclitique ?","authors":"Sylvain Missonnier","doi":"10.1016/j.evopsy.2023.11.005","DOIUrl":"10.1016/j.evopsy.2023.11.005","url":null,"abstract":"<div><h3>Objectives</h3><p>This research focuses on the work of Arthur Conan Doyle and his famous detective Sherlock Holmes, considered a true secular myth. His worldwide fame is exceptional. The detective plays with the boundary between reality and fiction to establish himself deeply and durably in individual and collective psychic surreality. Paradoxically, the Scottish physician Arthur Conan Doyle had very little literary regard for his famous hero, and much preferred his other novels: “My lowest works cast into the shadows that of which I am most proud.” In 1893, he murdered his creation in issue 36 of <em>The Strand Magazine</em>, where he published “The Final Problem.” Doyle received countless letters from outraged readers insulting him and demanding the rebirth of the hero.</p></div><div><h3>Method</h3><p>As part of a clinical psychopathological reflection on Doyle's creative work, this paradox is explored here through an analysis of the links between Sherlock Holmes and John Watson.</p></div><div><h3>Result</h3><p>The strategic role of the inseparable chronicler-narrator John Watson in this detective fiction is seen both as a mirror of Doyle's creative anaclitism and as a constant support for Sherlock Holmes’ deployment of his observational skills and the mastery of his indexical logic. The consulting detective's iconoclastic method is seen as characteristic of anaclitic creativity.</p></div><div><h3>Discussion</h3><p>This picture of an intersubjective framework between the detective and Watson's “presence-support,” conducive to crisis resolution, does not leave the psychoanalytically-oriented clinician unmoved.</p></div><div><h3>Conclusion</h3><p>In literature, the “body of work” is not always where the author consciously wishes it to be! Doyle's unwitting self-writing is a source of inspiration for the clinician.</p></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 1","pages":"Pages 75-85"},"PeriodicalIF":0.6,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632562","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 : 2024-01-18DOI: 10.1016/j.evopsy.2023.12.004
Nicolas Dissez (Psychiatre et Psychanalyste) , Édouard Bertaud (Psychologue Clinicien et Psychanalyste)
Objectives
The Freudian notion of repetition compulsion is marked, in its inaugural conception, by a negative connotation, that of a return of the same, which does not give the measure of the multiple facets of this register. Raising repetition to the rank of one of the four fundamental concepts of psychoanalysis, Lacan uses Kierkegaard's text entitled “La reprise” to point out the renewal, of fecundity that the movement towards repetition can induce. This article aims at underlining how much the creative dimension of repetition finds a particularly vivid illustration in the field of music, a domain that makes regular and varied use of the term “reprise”.
Method
This article takes up themes deployed in a series of conferences during the academic year 2021/2022 at the École Pratique des Hautes Études en Psychopathologie, associating musicians – Vincent Ségal – psychoanalysts -Marc Morali, Corinne Tyszler, Olivier Douville- and music lovers, Mario Choueiry, and leaving a large place to musical listening. This study, beyond a reading of the repetition as an expression of the death pulsion, studies the way in which we can hear and put to work this Freudian notion through its manifestation in the musical register. It is a question here of exploring the question of repetition in the sphere of popular music but also in jazz and classical music in order to apprehend its articulation with the very movement of creation.
Results
In so-called popular music, and mainly in rock music, the cover consists, not in imitating but in proposing a version, more or less faithful or distant, of an original piece. Listening to this cover causes a particular satisfaction in the listener who can identify it. Usually considered as a tribute to the pioneers or the mark of a debt towards the elders, the cover version is however above all an attempt, impregnated with hostility, to erase the origin. This is how covers come to not only supplant the original pieces but also to repress them, to make them totally forgotten. Jazz is also attached to covering standards, not only as a necessary learning exercise, but as a way for those who try to impose their own style and thus gain recognition. The cover of standards can be the occasion to make hear the blind spot of a piece of origin or to make resurface a trait of identity unknown to itself. Within the context of classical music, the progression of a work is also regularly done through the repetition of a theme that always knows how to renew itself through slight displacements. Finally, the contemporary repetitive music pushes, perhaps to its height, this creativity inherent to the effects of the repetition.
Discussion
Pleasure, repression, origin, hostility, imitation and identification: these terms are closely linked to psychoanalysis, which only uses the concept of “repetition”. It is however usual to hear oneself on the divan
{"title":"The reprise in the musical field. About the creative dimension of the repetition compulsion","authors":"Nicolas Dissez (Psychiatre et Psychanalyste) , Édouard Bertaud (Psychologue Clinicien et Psychanalyste)","doi":"10.1016/j.evopsy.2023.12.004","DOIUrl":"10.1016/j.evopsy.2023.12.004","url":null,"abstract":"<div><h3>Objectives</h3><p>The Freudian notion of repetition compulsion<span> is marked, in its inaugural conception, by a negative connotation, that of a return of the same, which does not give the measure of the multiple facets of this register. Raising repetition to the rank of one of the four fundamental concepts of psychoanalysis, Lacan uses Kierkegaard's text entitled “La reprise” to point out the renewal, of fecundity that the movement towards repetition can induce. This article aims at underlining how much the creative dimension of repetition finds a particularly vivid illustration in the field of music, a domain that makes regular and varied use of the term “reprise”.</span></p></div><div><h3>Method</h3><p>This article takes up themes deployed in a series of conferences during the academic year 2021/2022 at the École Pratique des Hautes Études en Psychopathologie, associating musicians – Vincent Ségal – psychoanalysts -Marc Morali, Corinne Tyszler, Olivier Douville- and music lovers, Mario Choueiry, and leaving a large place to musical listening. This study, beyond a reading of the repetition as an expression of the death pulsion, studies the way in which we can hear and put to work this Freudian notion through its manifestation in the musical register. It is a question here of exploring the question of repetition in the sphere of popular music but also in jazz and classical music in order to apprehend its articulation with the very movement of creation.</p></div><div><h3>Results</h3><p>In so-called popular music, and mainly in rock music, the cover consists, not in imitating but in proposing a version, more or less faithful or distant, of an original piece. Listening to this cover causes a particular satisfaction in the listener who can identify it. Usually considered as a tribute to the pioneers or the mark of a debt towards the elders, the cover version is however above all an attempt, impregnated with hostility, to erase the origin. This is how covers come to not only supplant the original pieces but also to repress them, to make them totally forgotten. Jazz is also attached to covering standards, not only as a necessary learning exercise, but as a way for those who try to impose their own style and thus gain recognition. The cover of standards can be the occasion to make hear the blind spot of a piece of origin or to make resurface a trait of identity unknown to itself. Within the context of classical music, the progression of a work is also regularly done through the repetition of a theme that always knows how to renew itself through slight displacements. Finally, the contemporary repetitive music pushes, perhaps to its height, this creativity inherent to the effects of the repetition.</p></div><div><h3>Discussion</h3><p>Pleasure, repression, origin, hostility, imitation and identification: these terms are closely linked to psychoanalysis, which only uses the concept of “repetition”. It is however usual to hear oneself on the divan","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 1","pages":"Pages e1-e10"},"PeriodicalIF":0.6,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139635093","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 : 2024-01-13DOI: 10.1016/j.evopsy.2023.10.005
Goals
The objective of this article is to question gender-affirming therapies at the theoretical and clinical levels. They are, in fact, presented in the DSM-5-TR as the only possible therapies for gender dysphoria; we demonstrate that this is questionable from the point of view of the interaction between medical activity and clinical practice with the subject, as well as from the point of view of the evolution of psychopathological models of treatment of gender-related issues, particularly with regard to psychoanalytic data (diagnoses, associated processes and therapies).
Method
Our method combines an analysis of the literature and two clinical cases. First, we study diagnostic developments from transsexualism to gender dysphoria in the field of psychopathology and psychoanalysis. Next, we present two clinical cases of patients who have considered or initiated a transition. Then, we study the medical activity involved in gender-affirming care, based on Canguilhem's theses.
Results
The DSM-5-TR has a reductive and contradictory conception of dysphoria: it implicitly locates the cause and the solution in the social environment, without taking into account the interaction with the patient. Psychoanalytic theories have, on the contrary, maximized the potential of this interaction, thus making it possible to argue the psychotherapeutic interest of gender reassignment (or affirmation), but also to demonstrate its limits, in particular by taking into account the subjective position of the subject in its psychic structure.
Discussion
Reassignment presents itself as a normativation of dysphoria by medical treatments. However, normativation must rather be understood as the process by which subjects establish gender norms that are specific to them and which allow them to treat their dysphoria, by making specific use of medical reassignment protocols. Due to the interaction between subject and environment, normativation is not an adaptation to external or social reality, but implies that the latter is also modified by the former.
Conclusion
We cannot therefore subscribe to the thesis of the DSM-5-TR according to which dysphoria has only one possible predefined, systematic, and general treatment. The internal clinical dimension of medical activity assumes that the suffering of patients precedes the formalization that can be made of it, and that medical tools are designed and applied secondarily to a diversity of psychopathological configurations. This is also what the cases and the history of the ideas and practices presented demonstrate. The standardization of patients applies to their environment including therapies, which therefore should be modified and diversified.
{"title":"Les thérapies d’affirmation de genre : activité médicale et normativation du sujet","authors":"","doi":"10.1016/j.evopsy.2023.10.005","DOIUrl":"10.1016/j.evopsy.2023.10.005","url":null,"abstract":"<div><h3>Goals</h3><p>The objective of this article is to question gender-affirming therapies at the theoretical and clinical levels. They are, in fact, presented in the DSM-5-TR as the only possible therapies for gender dysphoria; we demonstrate that this is questionable from the point of view of the interaction between medical activity and clinical practice with the subject, as well as from the point of view of the evolution of psychopathological models of treatment of gender-related issues, particularly with regard to psychoanalytic data (diagnoses, associated processes and therapies).</p></div><div><h3>Method</h3><p>Our method combines an analysis of the literature and two clinical cases. First, we study diagnostic developments from transsexualism to gender dysphoria in the field of psychopathology and psychoanalysis. Next, we present two clinical cases of patients who have considered or initiated a transition. Then, we study the medical activity involved in gender-affirming care, based on Canguilhem's theses.</p></div><div><h3>Results</h3><p>The DSM-5-TR has a reductive and contradictory conception of dysphoria: it implicitly locates the cause and the solution in the social environment, without taking into account the interaction with the patient. Psychoanalytic theories have, on the contrary, maximized the potential of this interaction, thus making it possible to argue the psychotherapeutic interest of gender reassignment (or affirmation), but also to demonstrate its limits, in particular by taking into account the subjective position of the subject in its psychic structure.</p></div><div><h3>Discussion</h3><p>Reassignment presents itself as a normativation of dysphoria by medical treatments. However, normativation must rather be understood as the process by which subjects establish gender norms that are specific to them and which allow them to treat their dysphoria, by making specific use of medical reassignment protocols. Due to the interaction between subject and environment, normativation is not an adaptation to external or social reality, but implies that the latter is also modified by the former.</p></div><div><h3>Conclusion</h3><p>We cannot therefore subscribe to the thesis of the DSM-5-TR according to which dysphoria has only one possible predefined, systematic, and general treatment. The internal clinical dimension of medical activity assumes that the suffering of patients precedes the formalization that can be made of it, and that medical tools are designed and applied secondarily to a diversity of psychopathological configurations. This is also what the cases and the history of the ideas and practices presented demonstrate. The standardization of patients applies to their environment including therapies, which therefore should be modified and diversified.</p></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 3","pages":"Pages 477-496"},"PeriodicalIF":0.6,"publicationDate":"2024-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139638424","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 : 2024-01-11DOI: 10.1016/j.evopsy.2023.11.004
Frédéric Vinot (Maître de Conférences HDR en Psychologie Clinique) , Michel Pascal (Professeur en composition de musique électroacoustique) , Virginie Cayla (Psychologue Clinicienne)
Objectives
The aim of this article is to highlight the clinical effects of an immersive music device used as a therapeutic mediator with autistic children. As musical immersion is based on the hypothesis that space is a component of timbre, the aim is to bring together in a novel way two major problematic issues in autism: space and voice. To do this, post-Freudian and Lacanian psychoanalytical references are mobilized and discussed.
Method
After a technical presentation of the immersive device and an explanation of the spatial and aesthetic characteristics of the works played on it, the authors describe the clinical case of an 11-year-old autistic child and identify the different stages of the relationship. The initially observed effects of containment were quickly limited, and the child almost rejected the system. It was only during a work based on different spatializations of a voice that the child was able to reengage with the device and with the relationship with the caregiver as “a double,” going so far as to invent games that included him. To shed light on the subjectivizing effects of these sessions, the authors first recall the specific relationship that the autistic subject has with the voice as an “a object,” relying in particular on the notion of “delocalization of the voice,” which is active in all devices for distancing the timbre, the latter being understood as one of the names of the Real of the voice. The article goes on to describe in detail the spatial characteristics of the work to which the child was so sensitive in renewing his relationship with the other. After analysis, the work in question turns out to be composed not of a single unified or unifying space, but of several sound spaces, sometimes broadcast simultaneously.
Results
The notion of the delocalization of the voice is then confronted with the fact that the work of immersive music can offer much more than a simple point of delocalization of the voice in the same space: it offers the experience of several simultaneous sound spaces, which we call a “delocalization of the delocalization of the voice,” making it possible to relieve the autistic subject of what Lacan called the “real weight of the subject” implied by the voice object.
Discussion
The article raises several points for discussion: firstly, immersive musical works should not be considered as recreating a realistic sound environment (of the virtual reality type), but rather as proposing impossible sound spaces. In this respect, there are both aesthetic and ethical issues at stake in the clinical use that can be made of these immersive musical devices. Moreover, the construction of autistic space is not just a matter of the gaze but also of the voice in its impulsive dimension. Finally, the “delocalization of the delocalization” of the voice would enable the autistic subject to experience the atopic part of it, i.e. its
{"title":"Autisme et médiation thérapeutique musicale immersive : l’espace comme composante du timbre","authors":"Frédéric Vinot (Maître de Conférences HDR en Psychologie Clinique) , Michel Pascal (Professeur en composition de musique électroacoustique) , Virginie Cayla (Psychologue Clinicienne)","doi":"10.1016/j.evopsy.2023.11.004","DOIUrl":"10.1016/j.evopsy.2023.11.004","url":null,"abstract":"<div><h3>Objectives</h3><p>The aim of this article is to highlight the clinical effects of an immersive music device used as a therapeutic mediator with autistic children. As musical immersion is based on the hypothesis that space is a component of timbre, the aim is to bring together in a novel way two major problematic issues in autism: space and voice. To do this, post-Freudian and Lacanian psychoanalytical references are mobilized and discussed.</p></div><div><h3>Method</h3><p>After a technical presentation of the immersive device and an explanation of the spatial and aesthetic characteristics of the works played on it, the authors describe the clinical case of an 11-year-old autistic child and identify the different stages of the relationship. The initially observed effects of containment were quickly limited, and the child almost rejected the system. It was only during a work based on different spatializations of a voice that the child was able to reengage with the device and with the relationship with the caregiver as “a double,” going so far as to invent games that included him. To shed light on the subjectivizing effects of these sessions, the authors first recall the specific relationship that the autistic subject has with the voice as an “a object,” relying in particular on the notion of “delocalization of the voice,” which is active in all devices for distancing the timbre, the latter being understood as one of the names of the Real of the voice. The article goes on to describe in detail the spatial characteristics of the work to which the child was so sensitive in renewing his relationship with the other. After analysis, the work in question turns out to be composed not of a single unified or unifying space, but of several sound spaces, sometimes broadcast simultaneously.</p></div><div><h3>Results</h3><p>The notion of the delocalization of the voice is then confronted with the fact that the work of immersive music can offer much more than a simple point of delocalization of the voice in the same space: it offers the experience of several simultaneous sound spaces, which we call a “delocalization of the delocalization of the voice,” making it possible to relieve the autistic subject of what Lacan called the “real weight of the subject” implied by the voice object.</p></div><div><h3>Discussion</h3><p>The article raises several points for discussion: firstly, immersive musical works should not be considered as recreating a realistic sound environment (of the virtual reality type), but rather as proposing impossible sound spaces. In this respect, there are both aesthetic and ethical issues at stake in the clinical use that can be made of these immersive musical devices. Moreover, the construction of autistic space is not just a matter of the gaze but also of the voice in its impulsive dimension. Finally, the “delocalization of the delocalization” of the voice would enable the autistic subject to experience the atopic part of it, i.e. its","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 2","pages":"Pages 267-282"},"PeriodicalIF":0.6,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139538250","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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