Evolution Psychiatrique最新文献

{"title":"Science et soin du psychisme dans l’œuvre de Georges Canguilhem","authors":"Luc Surjous (psychiatre, pédopsychiatre)","doi":"10.1016/j.evopsy.2024.01.005","DOIUrl":"10.1016/j.evopsy.2024.01.005","url":null,"abstract":"<div><h3>Objectives</h3><p><em>L’Essai sur quelques problèmes concernant le normal et le pathologique</em>, 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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>I propose to return to the two problems presented at the beginning of the <em>Essai</em>: “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 <em>Traité de psychologie</em>, 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 <em>Essai</em>, 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 <em>psychologie réflexive</em>, on the contrary, defends. To conclude, I examine Canguilhem's few writings on psychotherapy, as well as those on psychopharmacology.</p></div><div><h3>Discussion</h3><p>I discuss the clinical consequences of the inability of scientific psychology to play a role in psychotherapy similar to that of physiology in medicine.</p></div><div><h3>Conclusion</h3><p>Canguilhem's conception of psychological care is essentially a defense of human dignity, based on a philosophical, not a scientific, theory of the individual.</p></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 2","pages":"Pages 357-376"},"PeriodicalIF":0.6,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139877713","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":"Prises en charge de la symptomatologie cognitive dans les troubles bipolaires","authors":"Clémence Isaac PhD ,&nbsp;Sarah Joanny MSc ,&nbsp;Noomane Bouaziz PhD ,&nbsp;Marie-Carmen Castillo (Pr) ,&nbsp;Dominique Januel (Pr)","doi":"10.1016/j.evopsy.2024.01.004","DOIUrl":"10.1016/j.evopsy.2024.01.004","url":null,"abstract":"<div><h3>Objectives</h3><p>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.</p></div><div><h3>Method</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Discussion</h3><p>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","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 2","pages":"Pages 399-411"},"PeriodicalIF":0.6,"publicationDate":"2024-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139874858","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 Trouble Dissociatif de l’Identité (TDI), du nouveau dans la division subjective ?","authors":"Quentin Dumoulin (Psychologue clinicien, Maître de conférences) ,&nbsp;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}

{"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}

{"title":"La sublimation amoureuse","authors":"Clément Fromentin (psychiatre, psychanalyste) ,&nbsp;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}

{"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}

{"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}

{"title":"The reprise in the musical field. About the creative dimension of the repetition compulsion","authors":"Nicolas Dissez (Psychiatre et Psychanalyste) ,&nbsp;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}

{"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}

{"title":"Autisme et médiation thérapeutique musicale immersive : l’espace comme composante du timbre","authors":"Frédéric Vinot (Maître de Conférences HDR en Psychologie Clinique) ,&nbsp;Michel Pascal (Professeur en composition de musique électroacoustique) ,&nbsp;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}