L’inquiétante étrangeté du handicap mental

Objectives

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.

Method

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.

Results

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.

Discussion

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point out that Kraepelin's thinking, which made the therapeutic indication dependent on the supposed aetiology, is now outdated.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 fantasized, 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 to a re-elaboration of the parent's fantasies, re-launching the child's drive dynamics. In other clinical configurations, it may prompt the parent to use drastic defenses aimed at freezing his or her own and the child's drives, with the effect of hindering the child's efforts to translate enigmatic messages and their desire to understand, and inhibiting the creativity of a psychic life based on auto-erotic dynamics.

Conclusion

Psychoanalytic understanding, listening, and clinical treatment of the mentally handicapped patient is based on the fundamental recognition of the infantile, i.e. of an unconscious, an unconscious infantile sexuality; the psychoanalytic approach allows for, in certain configurations that may have frozen, inhibited, or repressed the child's psychic life, a revitalization of the drives.