Camille Veit (Psychologue clinicienne, Docteure en psychologie, Maîtresse de conférences en psychopathologie clinique)
{"title":"Les pavés du dire, ou quand la rue se fait réseau soignant","authors":"Camille Veit (Psychologue clinicienne, Docteure en psychologie, Maîtresse de conférences en psychopathologie clinique)","doi":"10.1016/j.evopsy.2024.05.004","DOIUrl":"10.1016/j.evopsy.2024.05.004","url":null,"abstract":"<div><h3>Goals</h3><div>“I am a housed homeless person”. This statement says something about the experience of constructing an address – a term whose polysemy is immediately obvious in the context of therapeutic practices with people who frequent or have frequented the street. Under certain conditions, how can the street become a constellation of care?</div></div><div><h3>Method</h3><div>The street is considered here from the perspective of institutional psychotherapy, Lacanian psychoanalysis, and phenomenology. I take a retrospective look at a clinical case, providing insights into, on the one hand, the creation of “spaces of habitability” (de Certeau) and, on the other, the “shared caregiving function” (Tosquelles). I discuss the clinical implications of these findings, as well as their impact on support and accommodation services for the unhoused.</div></div><div><h3>Results</h3><div><em>The</em> street doesn’t exist: this is a prerequisite for any possible practice with whoever stays, lives, or makes use of the street. Thus, there is no “street” that can be essentialized: it is constantly made and unmade by those who cross it and inhabit it. The uses of the street – the ways in which it is inhabited – are considered on a case-by-case basis. A distinction between circulation, homelessness, and wandering is then sketched out, based on the concept of “pedestrian enunciation” (Michel de Certeau).</div></div><div><h3>Discussion</h3><div>Dwelling is always an attempt at dealing with dreams, ideals, and the impossible. <em>Inhabitable spaces</em> are created between shelters, homes, displacements, and circulations. From a clinical perspective, taking these singular ways of living into account is a prerequisite for any possible encounter. Sometimes, this encounter has therapeutic or even psychotherapeutic effects.</div></div><div><h3>Conclusion</h3><div>In light of the above, clinicians should be mindful of adopting a unanimously militant stance, a theoretical withdrawal, charitable kindness, or a desire to rehabilitate at all costs. These slippages are inevitably revealed as such in the interstices of a practice that should be polyphonic.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 4","pages":"Pages 639-650"},"PeriodicalIF":0.6,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141402708","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}
Elise Pelladeau (Maître de conférences HDR en psychologie clinique et psychopathologie)
{"title":"« La semaine prochaine, je serai sorti ». La psychothérapie à l’épreuve du temps en milieu carcéral","authors":"Elise Pelladeau (Maître de conférences HDR en psychologie clinique et psychopathologie)","doi":"10.1016/j.evopsy.2024.05.003","DOIUrl":"10.1016/j.evopsy.2024.05.003","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this article is to describe the way in which the announced release from prison precipitates the work of linking in the final stages of psychotherapeutic work, and to illustrate the transferential modalities involved. More specifically, we examine the fates and functions of what we propose to call a “hallucinatory temporality” in psychotherapy, at the dawn of the announcement of release from prison.</div></div><div><h3>Method</h3><div>To illustrate our ideas, we will use the case of Joël, who has been detained in custody for armed robbery, and is in a state of legal recidivism. This patient was receiving weekly psychotherapy in prison and had been seen in a care unit in the few months prior to his release.</div></div><div><h3>Results</h3><div>In this article, we wanted to illustrate the way in which release from prison, as a negative of the shock of imprisonment, can affect the subject's fantasy life, between anticipation and impulse realization.</div></div><div><h3>Discussion</h3><div>The defenses mobilized by Joël during the interview seemed to us to be particularly relevant in the way in which they pressed on the drive in the service of the rise in tension, thus producing an effect of reversal from the passive pole to the active pole, even in the time of the session. This temporality, over-invested in its risk thresholds between getting out and staying in, seemed to us to draw artificial contours like so many fantasmatic stopping points to force the representational system in favor of a hallucinatory circulation with masturbatory <em>functions.</em></div></div><div><h3>Conclusion</h3><div>If, from the perspective of Roussillon's work cited above, we conceive of symbolization as an experience of subjectivation through domination, it is easy here to see how the ramparts of the therapeutic setting can act as a hallucinatory crossroads, at the tempting moment of dreaming, or at least trying to “hallucinate” the way out. The support of this hallucinatory space – from temporal circularity to fantasmatic temporality – seems to us to benefit from the inter-holding put to work and described by Ciavaldini, even in its transferential manifestations in the session. Beyond the session, as “beyond the wall”, would thus put to the test the solidity of the psychic rampart fashioned by a path other than that of domination.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 4","pages":"Pages 651-660"},"PeriodicalIF":0.6,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141391722","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}
Isabelle Orrado (Psychanalyste, Post-doctorante en psychologie, Université de Brasilia, Brésil) , Jean-Michel Vives (Psychanalyste, Professeur de psychologie clinique et pathologique, Université Côte d’Azur, France)
{"title":"Élever la bizarrerie à la dignité du style. Pour une éthique de l’accompagnement des patients autistes","authors":"Isabelle Orrado (Psychanalyste, Post-doctorante en psychologie, Université de Brasilia, Brésil) , Jean-Michel Vives (Psychanalyste, Professeur de psychologie clinique et pathologique, Université Côte d’Azur, France)","doi":"10.1016/j.evopsy.2024.04.003","DOIUrl":"10.1016/j.evopsy.2024.04.003","url":null,"abstract":"<div><h3>Objectives</h3><div>This article aims to identify how the analytical framework can lead an autistic subject to create an artisanal solution that allows him to enter the world.</div></div><div><h3>Method</h3><div>The Lacanian theoretical conceptualization is based on clinical observations collected during the treatment of a young autistic boy.</div></div><div><h3>Results</h3><div>We argue that engaging in therapeutic work with an autistic patient can offer him a potential environment – which we distinguish from potential space – in which his particular quirks can be elevated to the dignity of a style that the autistic child will himself shape and that will allow him a certain social bond.</div></div><div><h3>Discussion</h3><div>We qualify the therapeutic space offered by the analytical framework as a potential environment, which we define as the coordinates of the encounter set up by the clinician bringing into existence a <em>Stimmung</em> from which the child can experience his or her instinctual movements. <em>Stimmung</em> is to be understood as the phenomenological quality of the potential environment, simultaneously including tuning, invocative address, disposition, and atmosphere, i.e. a possible relationship with the Other. Clinical intervention would allow the child not to represent himself in this potential environment – which is the nature of potential space –, but to present himself to the world. It is the clinician's responsibility to bring into existence an Other who can isolate and put into circulation the subject's oddity – which could be considered a failure – bringing forth a singularizing sign and elevating it to the dignity of style that the autistic child will shape.</div></div><div><h3>Conclusion</h3><div>The style, thus obtained, corresponds to the possibility of a singular enunciative position – inscribing a presence in the world by tempering the weight of the subject –, which, in autism, always requires a certain amount of tinkering in order to arrive at a solution.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 1","pages":"Pages 59-69"},"PeriodicalIF":0.6,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141142888","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":"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}
Philippe Veysset (Professeur agrégé de philosophie)
{"title":"Jürg Zünd : voir/faire voir l’espace","authors":"Philippe Veysset (Professeur agrégé de philosophie)","doi":"10.1016/j.evopsy.2024.03.005","DOIUrl":"10.1016/j.evopsy.2024.03.005","url":null,"abstract":"<div><h3>Goals</h3><div>By extending the analysis of a case identified by Ludwig Binswanger, the Jürg Zünd case, using a philosophical reading inspired by phenomenology, we strive to show that the patient – this is what gives meaning to his disorder – attempts to display the relevance (failure of reason) as well as the limits (reason remains operative) of a doctrine that was made familiar to him by his psychiatrist: existential analysis, notably its representation of space and language. This aims to illustrate the dangers posed by too insistent a dialogue between patient and caregiver when this patient is associated with diagnosis and therapy. Finally, it is a question of better marking the remaining gap between the practical field and the experiential field. The patient has renounced the rationality of her actions but continues to subscribe to that of her experience, the only means of “proof” remaining to her.</div></div><div><h3>Method</h3><div>Extend the psychiatrist's analysis by establishing a correspondence between the symptoms of the illness and the validations/refutations of this same analysis. The main danger of the analysis carried out here is a hyper-rationalization of mental disorder, but if, in the mental disorder, no element of reason remains, no psychiatry can see the light of day either. It is, however, clear that the simple failure of reason cannot be enough to put the scientific exploitation of mental disorder into perspective. We can therefore only follow the author in his frequent references to the fundamental texts of phenomenology. We could say that our analysis is experimental in nature.</div></div><div><h3>Results</h3><div>An in-depth analysis of the case shows that there is indeed a link between the patient's system of attitude and behavior and a desire to test the relevance of the phenomenological analysis applied by the caregiver to the patient.</div></div><div><h3>Discussion</h3><div>In the third <em>Critique</em>, known as <em>the Faculty of Judgment</em>, Kant strives to restore to a reason invalidated in its pure use a path, a field of sensitive expression that, spanning understanding and language, allows this reason to “say itself”, but this behavior is in turn struck by impotence, due to its antinomic structure. Only the body, left out of Kantian analysis, allows reason to find its balance because it is already in itself penetrated, corseted, steeped in reason, but also, by the same token, crushed by this reason, a reason which, by overwhelming the only means of expression that remains to it, overinvests this body and makes itself inaudible again. It will therefore be necessary to return the body to itself, free it from the influence of reason, reify it and, at the same time, allow to reappear what, perhaps, remains in the man of reason: madness, weak reason inhabiting a weakened body. To contradict reason is to speak it out loud, in the experience of its almost although never quite definitive loss, suspended as i","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 1","pages":"Pages 97-120"},"PeriodicalIF":0.6,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}