{"title":"Les vases communicants de la honte chez les auteurs de violences sexuelles","authors":"","doi":"10.1016/j.evopsy.2024.05.002","DOIUrl":"10.1016/j.evopsy.2024.05.002","url":null,"abstract":"<div><h3>Objective</h3><p>Forensic clinical investigation frequently reveals the absence of shame in perpetrators of sexual violence while simultaneously victims seem overwhelmed by shame. We sought to understand this paradox by analyzing the dynamics of the introjection of shame in victims’ identification with the aggressor and of the injection of shame in the aggressor's projective identification with his victim.</p></div><div><h3>Method</h3><p>We focused on the case of Louis, a dismissed priest, sentenced for pedocriminal behavior. This case is part of a qualitative research project conducted on a population of 14 inmates of a Parisian prison and based on interviews structured around the individual's life story and analyzed with the Interpretative Phenomenological Analysis (IPA) methodology.</p></div><div><h3>Results</h3><p>We observe that behind Louis's apparent absence of shame, as with many of our research subjects guilty of sexual violence, there is, in fact, a great deal of unconscious shame, first introjected by the victim in the abuse suffered, and later injected in the victim in the abuse committed as a means to unload an unbearable shame.</p></div><div><h3>Discussion</h3><p>The introjection of the shame of the aggressor by his victim in the dynamic of Ferenczi's identification with the aggressor appears as a complement to the injection of shame by the aggressor into his victim through the dynamic of projective identification: both an ordinary projective identification in the form of a projective reversal of shame, and an operative projective identification in the form of perverse behaviors.</p></div><div><h3>Conclusion</h3><p>The communicating vessels of shame among perpetrators and victims of sexual violence, between injection and introjection, help us better understand the contagious characteristics of shame in the etiology of sexual violence.</p></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 3","pages":"Pages 525-537"},"PeriodicalIF":0.6,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0014385524000653/pdfft?md5=213c199f6f0bb14ec8a6770c4e75afbc&pid=1-s2.0-S0014385524000653-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141133956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthieu Braun (psychiatre, chef de clinique des universités, assistant des hôpitaux de région) , Christophe Chaperot (psychiatre, chef de pôle)
{"title":"Psychothérapie institutionnelle : ambiances de transferts","authors":"Matthieu Braun (psychiatre, chef de clinique des universités, assistant des hôpitaux de région) , Christophe Chaperot (psychiatre, chef de pôle)","doi":"10.1016/j.evopsy.2024.04.004","DOIUrl":"10.1016/j.evopsy.2024.04.004","url":null,"abstract":"<div><h3>Objective</h3><div>Public hospitals are necessary for patients with the most severe psychological suffering. Within an institution, the symptoms of some have an impact on the way the group functions, with counter-attitudes, scissionary projections, and so on. Ever since Jean-Étienne Esquirol, we have known that hospitals can be healing in themselves, if they are staffed by “skilled” caregivers. At a time when public hospitals are being restructured, can tools from the field of institutional psychotherapy help to “heal the hospital so that it can heal”, in Hermann Simon's aphorism? We articulate psychopathological knowledge with institutional concepts, in order to reflect on how to care for singularities through collective work.</div></div><div><h3>Method</h3><div>We present a theoretical-clinical elaboration based on clinical vignettes that attempt to capture the day-to-day practice of a public psychiatric department oriented towards institutional psychotherapy, and the psychotherapeutic care possible, in an institution, for psychotic subjects.</div></div><div><h3>Results</h3><div>Concepts derived from institutional psychotherapy are based on psychoanalytical and phenomenological psychopathologies that are tested in clinical practice: in particular, questions of space, atmosphere, and transference, at the heart of psychopathology. These concepts can be discussed and refined in the light of current research and practice, and support creative care approaches based on the logic of geographical sectors.</div></div><div><h3>Discussion</h3><div>Institutional tools seem to support caregiving teams in their response to psychological suffering. If they are not the subject of dogmatic positioning, they encourage a therapeutic alliance that is as close as possible to the subjectivity of the players involved, and enable a performative theorization of daily practice.</div></div><div><h3>Conclusion</h3><div>Joint attention to psychopathology and institutional clinical practice helps to provide individualized care and support for the singularity and subjectivity of the most fragile patients and the teams who work with them.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 4","pages":"Pages 625-638"},"PeriodicalIF":0.6,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141058394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Le « Soi territorial » et le suicide des agriculteurs : la solitude en un lieu inhabitable","authors":"","doi":"10.1016/j.evopsy.2024.04.005","DOIUrl":"10.1016/j.evopsy.2024.04.005","url":null,"abstract":"<div><h3>Objective</h3><p>This study presents a reflection on the inhabitation of a place and the constitution of a territorial Self,’ in the context of ‘country’ life and work. The hypothesis is then put forward of a possible ‘psychopathology of (de-)territorialization,’ according to which a ‘non-place,’ generator of meaninglessness, may be involved in a suicidal dynamics specifically linked to the territorial dimension of the Self and the impossible inhabitation of a place.</p></div><div><h3>Method</h3><p>The clinical and psychopathological aspects are examined from the perspective of the link between certain ‘traditional farmers’ and the place where they live, with regard to the reciprocal imprint between psyche and territory.</p></div><div><h3>Results</h3><p>This exploratory study will provide guidance for clinical research into the suffering of farmers who fall outside the scope of commonly identified ‘psycho-social disorders.’</p></div><div><h3>Discussion</h3><p>The limitations and impasses induced by dissociative or melancholic processes are related either to a failure of Presence, compromising the construction of a habitable world, i.e. one that can be territorialized, or to the hostility of a world that is resistant to the dynamics of a territorialization process, and therefore unfit to allow us to dwell in it.</p></div><div><h3>Conclusion</h3><p>These considerations open up an original perspective for qualitative research aimed at understanding the relationships between alteration of the territorial foundations of the Self and suicidal intentionality.</p></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 3","pages":"Pages 550-559"},"PeriodicalIF":0.6,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S001438552400063X/pdfft?md5=9f9c23b67a159e8409146bd44f37267e&pid=1-s2.0-S001438552400063X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141052494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthieu Braun (Psychiatre, Chef de clinique des universités, Assistant des hôpitaux de région) , Christophe Chaperot (Psychiatre, Chef de pôle)
{"title":"La psychothérapie institutionnelle à l’épreuve des crises. Une réflexion clinique au cœur d’un service de psychiatrie publique au décours de la crise sanitaire liée à la COVID-19","authors":"Matthieu Braun (Psychiatre, Chef de clinique des universités, Assistant des hôpitaux de région) , Christophe Chaperot (Psychiatre, Chef de pôle)","doi":"10.1016/j.evopsy.2024.04.001","DOIUrl":"10.1016/j.evopsy.2024.04.001","url":null,"abstract":"<div><h3>Objective</h3><div>Patients suffering from complex psychiatric pathologies require multi-disciplinary care and, in the event of decompensation, may need to be hospitalized. Institutional psychotherapy approaches psychotic, existential, and institutional crises as opportunities for clinical elaboration and the deployment of creativity. The public health crisis linked to the COVID-19 pandemic has prompted us to rethink its effectiveness and its place within pluralistic contemporary practices. It also offered the opportunity for an unprecedented anthropological reading. In this context, is institutional psychotherapy still a machine for producing “innovation”, for creating, or at least revealing, crises in order to overcome them?</div></div><div><h3>Method</h3><div>Key concepts from the field of institutional psychotherapy can be reexamined in the wake of the public health crisis. In the aftermath of the pandemic, we propose an elaboration of what the pandemic has taught us about day-to-day practice, in a public psychiatric department oriented towards institutional psychotherapy. We will draw on a re-reading of clinical vignettes, interviews with caregivers and patients, and notes taken at department meetings during the pandemic.</div></div><div><h3>Results</h3><div>The major concepts of institutional psychotherapy may have some limitations, but they can be reinvented by the caregiver–client collective. During a crisis, collective failings and individual symptoms seem to reveal each other. The therapeutic club represents a stage on which to unfold and elaborate both group and individual issues.</div></div><div><h3>Discussion</h3><div>In this context, the symbolic framework, collectively instituted, and the culture of a department can present operative points of support for continuing care. They “put in crisis” the prejudices and implicit theories of the actors, and support new narratives and new ways of making sense.</div></div><div><h3>Conclusion</h3><div>In the aftermath of a crisis, the therapeutic club remains a space of conflict and intrigue, at the crossroads of collective and individual health crises.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 4","pages":"Pages 611-624"},"PeriodicalIF":0.6,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141043753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"L’inquiétante étrangeté du handicap mental","authors":"","doi":"10.1016/j.evopsy.2024.03.002","DOIUrl":"10.1016/j.evopsy.2024.03.002","url":null,"abstract":"<div><h3>Objectives</h3><p>This article aims to bypass the epistemological impasses produced by the contemporary development of the concept of disability – a concept formed in close relation with the societal context and with questions of human rights, more than with a nosographic and clinical problematic - and more precisely with regard to mental disability, a clinical entity whose classification history is particularly difficult, and yet at the heart of the edification of psychiatry since the 19th century. In studying this trajectory, we aim to demonstrate the interest of psychoanalysis's theoretical-clinical approach.</p></div><div><h3>Method</h3><p>We analyze the evolution of psychiatric and psychoanalytical conceptions of mental disability. We discuss them and identify avenues of reflection for the psychoanalytically oriented clinical and therapeutic work we do with young disabled patients and their parents.</p></div><div><h3>Results</h3><p>Mental disability is placed in the historical dynamic of the attempts to classify it: idiotism, idiocy, mental debility, mental or intellectual disability, etc. Its proven or strongly assumed organic etiology originally marginalized, and continues to marginalize, certain modes of clinical thinking and psychic treatments, of which the psychoanalytical approach is one.</p></div><div><h3>Discussion</h3><p>We discuss and differentiate between the concepts of “mental” and “psychic” and the ambiguity of their meanings. The “mentally handicapped” subject, when reduced to their neuronal aetiology, is considered from a deficit perspective, which relegates the investigation of psychic life to the background or even renders it superfluous. Following in the footsteps of D. Widlöcher, we point out that Kraepelin's thinking, which made the therapeutic indication dependent on the supposed aetiology, is now outdated. We therefore emphasize the individual differences in the relationship that develops between the young disabled person and his or her family, and in the interaction between their psyches. The effects of the birth of a disabled child on the construction of the feeling of parenthood, the bond of filiation, and parental narcissism are thus understood within the dynamics of interactions, both real and <em>fantasized</em>, which necessarily differ according to the subjects, parents and children. More specifically, we consider J. Laplanche's “fundamental anthropological situation” as a heuristic model for thinking about the psychic life of the child with a disability and the infantile sexuality that constitutes it, in adult-child interaction, as in everyone else. We hypothesize that the parental encounter with a child presenting a handicapping pathology is likely to send some parents back to their own “uncanniness,” that is to say, to the disturbing return of a repressed or primitive way of thinking abandoned a long time ago, coming from their own “internal foreign land.” This internal irruption is likely to lead t","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 3","pages":"Pages 538-549"},"PeriodicalIF":0.6,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140781266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Héloïse Haliday (Maître de conférences en psychologie clinique et psychopathologie)
{"title":"Reassessing the usefulness of “contact” in psychiatry. From the Praecox Gefülh to a typification tool for pathological forms of human existence","authors":"Héloïse Haliday (Maître de conférences en psychologie clinique et psychopathologie)","doi":"10.1016/j.evopsy.2024.03.003","DOIUrl":"10.1016/j.evopsy.2024.03.003","url":null,"abstract":"<div><h3>Objectives</h3><p>The clinician who adopts a psychoanalytic approach in a psychiatric context often regards the encounter between two individuals as an interplay of subjectivities, whose mode of being-in-the-world is shaped by their unique historical experiences. Despite some psychoanalytic authors exploring the concept of “contact”, it has often been reduced to its similarity with transference and countertransference, with little attention given to its distinctive qualities. This limits psychoanalysis in its ability to conceptualize an unmediated, preverbal encounter between two individuals. In this article, we argue that the dimension of “contact” cannot be equated with transference, and that it constitutes a vital tool for diagnosing and guiding therapy for various clinical conditions commonly encountered in psychiatry.</p></div><div><h3>Method</h3><p>This article is based on theoretical considerations. We first worked on the history of the concept of contact, then of <em>Praecox Gefühl</em> in the works of H.C. Rümke, to which we added the findings of current studies on the relevance of <em>Praecox Gefühl</em> in the diagnosis of schizophrenia and the study of the works of the great phenomenological psychiatrists. In so doing, we aimed to show that contact could be a tool of great use for psychiatric diagnosis, insofar that it allows for a typification of the forms of existence of different patients.</p></div><div><h3>Results</h3><p>H.C. Rümke's investigation of the concept of <em>Praecox Gefühl</em> highlights the unique mode of contact observed in schizophrenia. It is distinct from the feeling of strangeness and involves an intuitive observation of a perceived distance within the clinical relationship. Given that many psychiatric pathologies can cause patients to withdraw from the shared world, we suggest that the notion of <em>Praecox Gefühl</em>, beyond its original designation of the clinician's experience of schizophrenic dissociation and the particularities of the schizophrenic mode of being-in-the-world, may be applicable to other pathologies studied in psychiatric phenomenology. We propose four main forms of contact: the loss of vitality in schizophrenia, the untraceable authenticity of the hysteric, the impossible fluidity in the melancholic, and the failure of anchorage in mania. By approaching contact as a fractal form that reveals the entire mode of the subject's being-in-the-world, this typifying approach goes beyond a purely semiological or etiological reflection and can be diagnostically useful in guiding therapeutic efforts to enhance the subject's capacity to truly engage with others.</p></div><div><h3>Discussion</h3><p>Our paper focuses on the relationship between contact and what clinicians commonly refer to as an “encounter.” It is important to recognize that contact is not always equivalent to an encounter, and that assuming otherwise risks overlooking the possibility that certain relational modalities could act","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 2","pages":"Pages e11-e20"},"PeriodicalIF":0.6,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0014385524000367/pdfft?md5=44a757aa9606a84ee786afcd2973b8ad&pid=1-s2.0-S0014385524000367-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140778437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Odette Chesnot (Art-thérapeute, Docteur en psychologie clinique, Membre de la Société Medico-Psychologique, Fondatrice de l’Association libanaise des victimes du terrorisme, Consultante à l’UNODC (Office des Nations Unis contre la drogue et le crime)) , Silke Schauder (Professeure de psychologie clinique et psychopathologie à l’UPJV, Co-responsable de la spécialité Arts-plastiques Art-thérapie à l’Université Paris Cité, Psychologue clinicienne, art-thérapeute, Membre de la SFPE-AT et du groupe de recherche sur les processus de création Pandora)
{"title":"Aspects scientifiques et cliniques des médiations thérapeutiques : quelle prise en soin pour les victimes de l’explosion du port de Beyrouth ?","authors":"Odette Chesnot (Art-thérapeute, Docteur en psychologie clinique, Membre de la Société Medico-Psychologique, Fondatrice de l’Association libanaise des victimes du terrorisme, Consultante à l’UNODC (Office des Nations Unis contre la drogue et le crime)) , Silke Schauder (Professeure de psychologie clinique et psychopathologie à l’UPJV, Co-responsable de la spécialité Arts-plastiques Art-thérapie à l’Université Paris Cité, Psychologue clinicienne, art-thérapeute, Membre de la SFPE-AT et du groupe de recherche sur les processus de création Pandora)","doi":"10.1016/j.evopsy.2024.02.001","DOIUrl":"10.1016/j.evopsy.2024.02.001","url":null,"abstract":"<div><h3>Objectives</h3><div>After reviewing current research in art therapy, this article discusses the therapeutic effectiveness of clay workshops in cases of individual or collective traumas. Specifically, it advocates for the interest and specific indication of this method, which promotes health-generating creative processes. How do these processes facilitate identity reconstruction and psychological repair for the victims?</div></div><div><h3>Method</h3><div>In a clay workshop, 10 group sessions, spread over a year, were offered to four women and four men who survived the explosion on August 4th, 2020, at the port of Beirut. Using a case study involving the analysis of a patient's artistic productions, the psychic processes facilitated by this type of therapy were highlighted. Determining inclusion in the group, clinical progress was assessed using Traumaq, which provides a comprehensive evaluation of clinical aspects related to trauma, such as anxiety, depression, memory disorders, and difficulties regaining a sense of security. Administered at the beginning, midway, and at the end of treatment, the PCL-5 Post-traumatic Stress Disorder Checklist aimed at identifying different trauma characteristics, allowing for a quantitative assessment of the patient's clinical evolution. Finally, six individual sessions, combined with the analysis of productions in the group workshop, provided qualitative elements necessary for a clinical understanding of the patient.</div></div><div><h3>Results</h3><div>Notably, symbolization through clay and the independence of art therapy from language skills were highlighted as key factors in helping heavily traumatized individuals overcome mutism, depression, and shock. Thus, resorting to non-verbal expression allowed patients to avoid re-traumatization through an immediate narrative of the explosion. Their PCL-5 scores significantly decreased at the end of treatment, indicating an important clinical improvement. Heightened self-esteem and the return of the ability to relate to others were observed, supporting the patients’ desire to recommit to new projects.</div></div><div><h3>Discussion</h3><div>Emotional and behavioral reactions such as avoidance, hypervigilance, dysphoria, and flashbacks in the patient were alleviated through the secure, relaxing, and sensory experience of working with clay. In the workshop, the group dimension emerged strongly, demonstrating the importance of sharing the experience of both the medium and the traumatic event.</div></div><div><h3>Conclusion</h3><div>These encouraging results invite further research into creative processes in art therapy. By expanding the studied cohorts, diversifying the media and the evaluative tools used, and by extending the indication to other pathologies, the effectiveness of art therapy will be even better demonstrated.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 4","pages":"Pages 661-678"},"PeriodicalIF":0.6,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278051","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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