Du cri sans appel à la restauration du transfert

Goals

To explore the scream through its relationship to voice, speech and silence, the link to the Other, and its function in the psychotic subject, the effects in the listener. To place its position in the specific drive circuit and on the silence-speech axis developed by M. Poizat. To present the absence of closure of the invocation drive in a psychotic patient and the possibilities offered by the wet wraps used in packing therapy in the renewal of contact, which is the basis of the transferential relationship.

Method

This is the study of a clinical situation in a psychotic patient in a psychiatric institution, whose frequent inconsolable screams and whose tendency to provoke rejection from caregivers led to the use of a therapeutic device of unusual magnitude. The analysis focuses on the patient's manifestations of vocal jouissance produced in different environments and on the effects of packing therapy conducted in a context of institutional psychotherapy.

Results

Vocal phenomena in this psychotic patient, such as whispering and aphonia, will appear a few days after the beginning of the packing therapy. I hypothesize that they resemble the patient's frequent unconsolable cries, and I situate them, alongside silence, opposite to speech, thus revealing the structural lack of symbolism. If this patient's unconsolable scream is a life force inscribed in the body, its repetition and its effects align him with something deathly, the risk of automation and rejection by others. The scream, coupled or not with suffocation, would also be a valuable indicator of the anxiety that arises in the passage into a new environment, especially when the latter is made up of a desirous otherness. Thanks to the packing therapy, the therapeutic work invites the patient to speak and leads him to reinvest in the living and institutional collective; and the screams will lessen in intensity. The daily packing program allowed for an increased proximity with caregivers, and with the patient feeling more present, no longer abandoned, and that he is someone. If the restoration of transference is favorable and brings a noticeable improvement quickly, other transferential movements will require therapeutic rearrangement. Important and sensitive points in the course and continuation of the therapy that could not be observed are the analysis of the caregiving team's countertransference and, in counterpoint to work carried out by healthcare professionals, the role of the peers in work with alterity.

Discussion

Packing is a therapeutic choice whose benefits are positive for this highly motivated patient, facilitating a reinvestment of speech and a turning away from a deathly horizon to reconnect with life. A system of lesser magnitude in terms of frequency, duration, and personnel would not have allowed such a positive transferential movement, counteracting the psychological and relational degradation. However, a music therapy could be a complementary dedicated means to move from the unconsolable scream to speech. In addition, the melancholy dimension of the patient seems to be shared with his parents and in particular with the central figure of the father. Taking inspiration from J.-M. Vivès's reflections on the place of the voice in filiation, our patient's scream and its related manifestations – whispering, broken voice, throat out of voice – could be a vocal form that could not have been obscured, in the absence of the gift of symbolic castration.

Conclusion

This study should support caregiving teams’ work with psychotic patients, focusing in particular on: the identification of various forms of repetitive vocal jouissance – pure scream, whispering, aphony – that are oriented towards the obliteration of speech and that signal an unfallen objet-voice, while the caregivers’ desire for the patient to access speech acts is experienced as unbearable by the latter; the analysis of countertransference relating to screams, which risks compromising the serenity and process of psychotherapeutic work; the detection of anxiety by screams and suffocation during changes in environment; the use of packing, a technique based on a corporal mediation to establish the transferential relationship.