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Projective tests are a valuable tool for understanding the dynamics of psychological functioning and for accounting for the adjustments and rearrangements that take place. The time of adolescence, with the processes that accompany it, represents a moment of choice for a certain number of renegotiations (identity and identification in particular), which occur under the aegis of the issues of psychic transmission between the generations. In this context, this article proposes to apprehend the traces of traumatic transmissions in the current encounter with adolescents engaged in violent sexual acts. Using the Rorschach and the TAT, a certain number of indicators of these unconscious transmissions between generations emerge, in terms of identity and identificatory aspects, thought processes and the representation of origins. The highlighting of these indicators, based on the projective tests, contributes to the clinical identification of what, in the background of violent sexual acts, remains in suffering and causes suffering from the point of view of symbolization potential. Beyond that, the projective tests confirm their quality of relaunching symbolization processes, based on a scripting of the representations in the projective space. [ABSTRACT FROM AUTHOR]

Winnicott's concept of trauma is entirely related to the vicissitudes of the early psychic parent-infant relationship in which the mother's role is fundamental for the development of the newborn's psyche, at the beginning and subsequently. Early trauma is caused by psychic transmissions that emanate through the mother's affective states of mind towards her fetus. The earlier that psychic trauma occurs in the nascent psyche, the more severe the impact on the individual's mental health. The author outlines Winnicott's key concepts and highlights his perspective on psychoanalysis as a therapeutic treatment for all levels of psychic trauma. [ABSTRACT FROM AUTHOR]

Babies born prematurely are frequently prone to developmental disorders, which are all the more severe in babies of low gestational age. However, medium prematurity also generates its own set of difficulties, including sensory, motor, cognitive, behavioral, relational and emotional disorders. It is essential to gain a better understanding of the developmental trajectory of these children and its various ups and downs, in order to support their development as early as possible., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

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Résumé Objectifs Dans ce texte, il s’agit d’établir un lien possible entre le développement d’un psychotraumatisme chez certains sujets et la constitution, dans l’enfance, d’un savoir faisant de la mort un pur anéantissement, par lequel le sujet disparaît non seulement dans sa chair, mais aussi et surtout de la pensée de ses proches. En effet, ce savoir constitué dans l’enfance viendrait empêcher qu’advienne un processus psychique majeur : le travail sur la mort. Or, ce travail psychique, qui accompagne la découverte de la mort comme étant universelle et irréversible, constituerait une matrice fondamentale pour tout traitement psychique ultérieur des traumas, souvent envisagés comme rencontre avec le « réel de la mort », dans la mesure où il permet au sujet de s’inscrire dans une continuité qui dépasse les limites de sa seule existence. Il s’agit donc, dans ce texte, d’étudier à la fois l’importance de ce travail infantile sur la mort, les conséquences psychiques de son échec et la constitution, parfois, d’un savoir précoce sur une mort-silence, susceptible d’être actualisé lors d’un événement traumatogène ultérieur. Méthode Dans un premier temps, c’est à partir du travail psychothérapique avec deux enfants de 4 et 4,5 ans que sont présentées les différentes étapes du travail infantile sur la mort, et les processus inconscients qui le caractérisent. Puis, dans un second temps, l’évocation de deux patientes (préadolescente et adulte) permet d’appréhender les conséquences psychiques de l’échec de ce travail. Parallèlement, sont questionnées les formations psychiques singulières (position identificatoire, figures temporelles) qui accompagnent la constitution d’un savoir sur une mort sans parole ni mémoire. Résultats Face à la découverte de la mort et de ses réalités, le travail sur la mort conduit paradoxalement l’enfant à un renforcement de son sentiment de continuité d’exister. Il s’agit notamment pour lui de retraverser la position dépressive venant accompagner ce deuil par anticipation. Au final, ce processus lui permet de se situer dans une lignée générationnelle et de constituer la mémoire (la sienne et celle des autres) comme refuge narcissique par-delà la mort. Or, différentes histoires montrent que certains sujets n’ont pu se constituer un tel abri et que la mort s’est imposée à eux comme anéantissement pur, sans que rien de la vie ne puisse survivre à la mort. L’on découvre ainsi que la rencontre avec le « réel de la mort » s’impose à certains sujets comme l’actualisation de cette certitude et par conséquent comme l’assurance de leur propre anéantissement et parfois même comme la confirmation du fait qu’ils sont morts depuis toujours. Discussion À partir de ces différents éléments, on peut s’interroger en premier lieu sur les écueils que rencontre l’enfant dans ce travail sur la mort. En effet, certains ne sont-ils pas contraints de le suspendre face à un entourage qui refuse ou évite (d’autant plus si l’enfant est jeune) de parler de la mort, de sa mort ou qui l’élude par un discours religieux ? Quels effets produisent alors ces interruptions ? Engagent-elles, elles aussi, des scénarii ayant force de certitudes ? Produisent-elles des déformations temporelles ? Enfin, on peut se demander ce qui permet à l’enfant de reprendre ultérieurement ce travail pour le mener à terme ? Il serait également intéressant d’interroger les conditions qui permettent à ce travail de s’engager dans le cadre de la relation transférentielle et s’il ne surgit pas, parfois, dans l’ombre du travail qui accompagne la fin de certaines cures, bien après qu’aient pu être déconstruites les certitudes aliénantes de l’enfance. Conclusion Au fil de ces rencontres cliniques, on voit que le travail infantile sur la mort est avant tout un travail de liaison entre la vie et la mort qui participe de façon majeure au sentiment de continuité d’exister. Se constitue ainsi une matrice qui, par la suite, permettra la remise en route d’un travail de symbolisation, capable de réinscrire la temporalité dans le corps du langage, et conduisant le sujet à retrouver les limites que le trauma avait disloquées. À l’inverse, quand ce travail n’a pas pu avoir lieu, le plus souvent en lien avec une histoire familiale traumatique, se crée la certitude d’une mort qui coïncide avec une chute hors de l’espace psychique de l’autre et donc avec une pure néantisation. C’est l’actualisation de telles certitudes lors de la rencontre du « réel de la mort » qui entraînerait alors le développement d’un psychotraumatisme ; le sujet ayant subi un processus identificatoire intolérable puisqu’il se voit confirmer sa non-existence ou sa mort advenue depuis toujours, qu’elle prenne la forme d’un désinvestissement par l’autre ou, autre exemple, celle d’un meurtre. Aims This paper sets out to explore the possible link between the development of psychotrauma in certain subjects and the formation, during childhood, of a “knowledge” staging death as a complete annihilation, whereby the subject not only disappears in the flesh, but also and above all in the thoughts of those close to him. This “knowledge” formed in childhood could prevent the advent of an essential psychic process, which is work on death. This psychic process, which often accompanies the discovery that death is universal and irreversible, can be seen as a fundamental matrix for all future processing of trauma, often envisaged as being encounters with the “reality of death”, since they enables the subject to position him or herself in a continuity that extends beyond his or her own existence. Thus we set out to study the importance of this work on death in childhood, the psychic consequences of failure in this area, and the possible early birth of a knowledge of death that is “silenced”, but liable to re-emerge at the time of a later traumatic event. Methods First, on the basis of psychic work with two children aged four and four and a half we present the different stages in work with children on death, and the unconscious processes arising. Second, the cases of two female patients, one adolescent and one adult, make it possible to apprehend the psychic consequences when the above process fails. Alongside, we also explore particular psychic configurations (positions of identification, temporal figures) that accompany the formation of knowledge about death that is neither put into words nor remembered. Results In the context of the discovery of death and its realities, paradoxically, work on death gives the child a stronger feeling of continuing existence. The task for the child is to return through the depressive phase that will accompany this mourning by anticipation. Ultimately, this process enables the child to position him or herself in the generational lineage, and to form a memory (his and that of others) as a narcissistic refuge beyond death. Different personal narratives show that certain subjects are unable to build themselves a refuge of this sort, and that death appears to them as sheer annihilation, with nothing of life surviving death. Thus the encounter with the reality of death takes the form, for some subjects, of a reinstatement of this certainty, and thus the assurance of their own annihilation, and sometimes the confirmation that they have always been dead. Discussion On the basis of these different elements, we can first of all consider the setbacks that the child will encounter in work on death. Indeed, some are required to renounce, under pressure from those around him or her, who refuse or avoid (especially if the child is young) talking about death, or who elude it via religious discourse. What are the effects of interruptions of this sort ? Do they also lead to scenarios that stage certainties ? Do they produce temporal distortions ? And what can later enable the child to return to this work, to see it out ? It would also be worthwhile exploring the conditions enabling this work to be undertaken in a transference relationship. It possible that sometimes, within the scope of the work accompanying the end of certain cures, it will re-emerge, well after the deconstruction of the alienating certainties of childhood has occurred. Conclusion In these clinical encounters, we can see that work on death with children is above all work on the links between life and death, which make a major contribution to the feeling of continuity of existence. Thus a matrix forms, and it will later enable the triggering of a process of symbolization, restoring the temporality to language, and enabling the subject to redefine the boundaries that the trauma has upset. Conversely, when this work cannot occur, most often as a result of a traumatic family history, we see the formation of the certainty of a death coinciding with the fall from the psychic space of the other, and thus with sheer annihilation. It is the re-emergence of these certainties at the time of an encounter with the reality of death that can lead to psychotrauma. The subject has undergone an intolerable identification process – since his or her non-existence, or the notion that he or she has always been dead, is confirmed – whether it takes the form of withdrawal of the other, or even the form of murder. [ABSTRACT FROM AUTHOR]

Résumé Tous les traumatisés psychiques ne viennent pas demander une psychothérapie. L’angoisse alors les amène à ne vouloir rien savoir de ce qui leur est arrivé. Aussi, dans un premier temps peut-il être judicieux de ne pas leur demander leur avis et de favoriser leur entrée dans le transfert. La névrose traumatique porte bien son nom, contrairement à ce que pensent les rédacteurs du DSM : le traitement passe par la mise en pause de la névrose qui a permis l’incrustation de la scène traumatique. L’entrée dans le transfert a lieu à l’occasion des soins immédiats ou post-immédiats (les debriefings). Le cours de la psychothérapie prend schématiquement deux directions. La première : le récit de l’événement est ressassé mais subit peu à peu des modifications qui signent le travail de l’inconscient sur les images de l’effraction. Dans la deuxième, rapidement il n’est plus question de l’événement traumatique, mais sur la base de sa culpabilité névrotique, le sujet s’extrait peu à peu de l’orbe du trauma. Il fait alors souvent appel à ces figures d’identification mises en situation œdipienne : horrible fusion dans un espace « maternel » et/ou meurtre du père. Dans l’un et l’autre cas, on voit disparaître soit progressivement, soit sans même que le sujet et le thérapeute en soient avertis, le syndrome de répétition. Traumatic neuroses are a clinical entity which manifests and develops as a result of psychological trauma. Since their first description by Oppenheim in 1889, they have posed a problem with the specificity of care they required. The answer to that question, that of treatment depended primarily on the concept with which the author had already of psychic trauma. Shell shock considered primarily as a stress disorder, was first described by the British military psychiatrists at the time of the First World War. It was this psychophysiological concept that prevailed in this line of thought which led to the diagnosis of “post-traumatic stress disorder” (PTSD). The proposed treatments aimed to reduce or to eradicate the symptoms by acting directly on them by cognitive-behavioral techniques, hypnosis, “EMDR”, etc. At the same time, another school of thought, initiated by Freud and his students, defended the idea that the psychological trauma resulted from an encounter with the “reality of death”. Freud's successors clarified that the traumatic event took place when the Ego of the subject was completely absorbed by his efforts of repression. (“Fenichel”), that is to say, presented neurosis transference, hysterical or obsessive. This corresponds to what we learned from clinical and psychotherapies which we had brought to patients presenting with a traumatic neurosis. These psychotherapies are not “cure types of psychoanalysis” but they use the concepts of psychoanalysis in particular on the issue of transference. We will use the metaphorical schemas of the psychic apparatus proposed by Freud to try to understand the link between the traumatic image which broke in and what Freud calls “the lost object”. This “lost object” is a myth constituted over the early days of the nursling's life: there would be an object capable to fully satisfy the subject, appearing to show nothing missing. More the structure of the subject is neurotic, that is to say, the more it is dissatisfied with the objects of his desire, stronger the longing for the mythical lost object will be. And it is in this place that comes to lodge the traumatic image purveyor of a paradoxical enjoyment even if it pays a fear of annihilation as infants. In biogenic law, with the acquisition of language, the fear of annihilation and pleasure suffer repression (primal repression). We understand more now that there may be a therapeutic effect on the neurotic structure grace of transference. In transferring, the patient sends a message towards a subject (the therapist) seemingly to know. That is to say, he has the desire to inform the therapist of his thoughts with as little censorship as possible, and in doing so, he informs himself, consciously and unconsciously in its own psychic content conscious and unconscious. The motor of this work is the unconscious guilt resulting from having faced the real of death, which is the subject of an anthropological censure. Oedipal guilt pre-conscious or conscious is induced by the previous primary conviction. At the end of this journey that involves the data of the Oedipus complex, the mythical lost object loses its appeal. The traumatic image will possibly disappear, the traumatic event is no longer something that is repeated but a more memory, the subject feels relieved of the trauma as well as the lost object. Three progress-reports of psychotherapy illustrate the theoretical points. [ABSTRACT FROM AUTHOR]

Résumé La rencontre du cinéma et de la psychiatrie, et à l’origine plus exactement du cinéma et de la psychanalyse, n’est pas une rencontre ordinaire : « Si la psychiatrie n’avait pas existé, les films auraient dû l’inventer. Et d’une certaine manière, ils l’ont fait. » Kon Ichikawa, cinéaste japonais né en 1915, mort en 2008, découvert en 1960 au festival de Cannes lorsqu’il reçoit le prix du Jury pour son film Kagi ( L’étrange obsession ), a réalisé deux films magnifiques, récits impitoyables de la Seconde Guerre mondiale, La harpe de Birmanie et Les feux dans la plaine , qui nous permettent d’illustrer le dialogue entre création cinématographique et psychopathologie, en particulier autour du traumatisme et de ses conséquences. “If psychiatry had not existed, the movies would have had to invent it. And in a sense they did”, wrote Irving Schneider in the foreword to the excellent book by Krin and Glen Gabbard, Psychiatry and the Cinema . For this session of the Société Médico-Psychologique focusing on Cinema and Psychiatry, opportunistically “delocalized” at the misfit theatre called Le Brady, we wanted to present two masterpieces of the Japanese director Kon Ichikawa. These two powerful war stories, The Burmese Harp and Fires on the Plain illustrate the fascinating dialogue between movies and psychiatry, specifically in this case around war trauma and its consequences. “While Ozu depicted the consequences of war on contemporary 1950 Japan, Ichikawa remained stuck on the last weeks of agony of 1945… Ozu's films begin where those of Ichikawa end”, wrote Serge Kaganski in the Inrocks in 1994, when the Parisian public was able to discover Kon Ichikawa's movies. Of course, we could have chosen to rather “psycho”-analyze Godzilla, this terrible monster awaken from his deep prehistoric sleep by the Bikini atomic explosions and appearing for the first time on Japanese screens in 1954 as a metaphor of the horror of Hiroshima and Nagasaki, and as a subtle criticism of the US presence in Japan, nine years after the end of the war. We should not forget that King Kong against Godzilla (1962) directed by Inoshiro Honda was part of the Brady unconventional program. Kon Ichikawa was discovered by the majority of the Occidental public in 1960, when he received in Cannes the Jury's Prize for his film Kagi ( The strange obsession ) together with Antonioni for L’Avventura while the Palme d’Or was awarded to Fellini for La Dolce Vita . Kon Ichikawa, Japanese filmmaker (1915–2008) began his career as a cartoonist. Considered as the tenant of a rather commercial school, Ichikawa directed numerous films, more than fifty, not all always well received by the critics. However, we concur with Max Tessier who in his book Images of the Japanese cinema , states “to see several of his films, you realize that there is in some of his movies a true Ichikawa's ‘eye’, mix of black humor and cinematographic entomology” (indeed Ichikawa depicts some of his main characters as helpless insects), and a very recognizable aesthetic, especially in his films in cinemascope. His first films were satirical comedies, scratching the moral conventions of the Japanese cinema. Then came more drama and deep movies, especially three masterpieces, two great war films, The Burmese Harp in 1956, Fires on the Plain in 1959 and Kagi ( The strange obsession ) presented and awarded at the Cannes festival in 1960. The characters painted by Ichikawa are not the typical “heros” but individuals lost in a quest of an absurd goal, often isolated, like the two soldiers of his two war films, The Burmese Harp and Fires on the Plain . In Les Carabiniers , Jean-Luc Godard reminds us the true nature of war: (in war…) “there is no victory, there are only flags and men falling”. In these two war films, Ichikawa is far from lecturing us, and far from an alleged exaltation of the values of feudal Japan like what was reproached to his first film by the US censorship. Kon Ichikawa personal aesthetic develops on screen an almost clinical vision of the traumatic destinies of two Japanese soldiers, caught in chaos, lost in the middle a disorganized mass of soldiers. Interestingly, we would suggest to watch these two movies in a row, as they are at the same time so similar and so different, like a kind of construct in mirror, the second prolonging the first in a vertiginous horror. They are quite similar in the sense that they are both depicting the destiny of an anti-hero, a Japanese soldier defeated at the end of the Second World War. But they differ totally aesthetically, to the classical academic format of Buddhist meditation of The Burmese Harp , responds the crude cinemascope format of the Fires on the Plain , using the black and white to emphasize the horror, the unspeakable, the unbearable, making in my opinion Fires on the Plain one of the greatest war movies. This cinematographic artwork reflects the true creative qualities of Kon Ichikawa i.e. the Ichikawa's eye… The Burmese Harp is his last work before switching to cinemascope, which was introduced relatively late in Japan, only in 1957. The classic cinematographic format throughout the film instils a slow pace that drives Mizushima the musician soldier in his journey towards Buddhism. Taken prisoner with what remains of his company, Mizushima is sent by his commanding officer, at the request of the British allied forces, to convince a few soldiers isolated in a cave of the futility of their resistance in front of the British guns. Mizushima manages to reach these survivors but they consider him a traitor, honor ordering them to die in battle but not surrender. Mizushima will only be saved from their violence by the British bombs. Only survivor to rise, he finally collapsed under the Burmese sun. This is his first step of his initiatory journey to Buddhism, that has somewhat been announced by Ichikawa portraying the soldier Mizushima with unusual artistic qualities. The second step is the encounter with a monk who will help him to survive and heal. Finally, Mizushima, considered dead by his comrades, becomes a monk to save the souls of his fellow soldiers, and decides to stay in Burma to give burial to all the dead Japanese soldiers whose bodies cover the beaches and woodland of Burma, and thus to cleanse the shame of the war. In contrast to this Buddhist fable, Fires on the Plain also shows defeated Japanese soldiers exiled this time in the Philippines, and again, through an anti-hero, the soldier Tamura, expelled from his unit because of his tuberculosis, but not sick enough to be admitted to the military hospital, and finally isolated in a mass of wandering soldiers with no goal. By adapting one of the masterpieces of the literature of war, the Fires (Nobi) of Shôhei Ooka, Ichikawa subtly uses the cinemascope to depict with absolute darkness the horror, the deprivation, the degradation, and the unspeakable. In Fires on the Plain , rain and mud, light and shadow exhibit an incredible cinematographic beauty, even when the horror is such that it could become gore, especially when Tamura discovers the true nature of monkey meat that his comrades pretend eating, or when the same Tamura witnesses the murder of a tyrannical sergeant by the young soldier forced to kill “monkeys”, murder followed by strange cannibalistic ritual by this young soldier on the body of his commanding officer. We will not make any psychopathological analysis of the two soldiers depicted by Ichikawa, but we recommend you to see The Burmese Harp and Fires on the Plain , to let you choose to be either a psychiatrist or an entomologist to analyze the destinies of Mizushima, the soldier/bonze and Tamura, cannibal against his will. Let's conclude with Samuel Fuller, who served in the First US Infantry Division during World War II, the famous Big Red One (and who actually directed the eponymous film): “War is barbarous, cannibalistic, barbaric as The Burmese Harp and cannibalistic as Fires on the Plain …” [ABSTRACT FROM AUTHOR]

Résumé Neuf cents cas de syndrome de stress post-traumatique (SSPT) ont été identifiés en dix ans au sein de l’armée française (2013). Pour les traiter, le service de santé des armées a développé un parcours de soins continu depuis la zone de combat jusqu’au retour en France. Mais cette prise en charge globale peut être interrompue partiellement ou complètement si le sujet quitte l’institution, ou s’il souhaite ne pas consulter un médecin militaire par crainte d’une appréciation défavorable sur son aptitude. Les policiers, pompiers, diplomates et personnels des ONG sont également exposés au traumatisme psychique au cours de leur engagement. La prise en charge du syndrome de stress post-traumatique devient de facto interministérielle. Ainsi un centre de référence interministériel sur le SSPT et le stress opérationnel piloté par le ministère de la Défense pourrait proposer une réponse structurée et adaptée avec un maillage territorial de professionnels militaires et civils spécialisés et bien au courant des incidences tant de maintien dans l’armée que de réinsertion dans le monde civil. Nine hundred cases of post-traumatic stress disorder syndrome (PTSD) have been identified these last ten years within the French army corps (2013). This pathology described since Antiquity, was the object of famous works by military psychiatrists (Barrois, Crocq, Lebigot). The various armed conflicts of the last years saw the fighters suffering from psychic wounds further to the fights. For their treatment, a psychic trauma plan builds a way to military care starting from the battle zone. This consideration of the PTSD by the Ministry of Defense is essential in the process of acceptance of the wound by the soldier and in his (her) process of reconstruction. Indeed it gives a sign of gratitude and solidarity to the wounded person. But, this global treatment can be partially or totally interrupted if the subject leaves the army or if he or she wishes to quit and his family wants him to quit the military institution, fearing an unfavorable valuation of his aptitude. In this case, the soldier and his family can be made a break by symptoms which can appear years after the initial trauma, not knowing towards which healthcare professional they can be addressed. Policemen, firemen, diplomats, customs officers, staff of the NGO can, during their functions, be exposed to a traumatic event. The current event demonstrates unfortunately that the exposure in the trauma can take place as much on the national territory as abroad, and thus concern a very important number of people belonging to very different circles. The civil offer of care is heterogeneous and not always visible for a not warned public. Every ministerial structure develops its own model of care. Yet the “Livre blanc” (White book) 2013 on the Defense and the National Security recommends a solidarity and a commitment for all the military and civil staffs who make a commitment in the service of the State. The treatment of PTSD becomes de facto interministerial, and both a civil and a military matter. In fact, managing crises requires multidisciplinary competences. Therefore, an interministerial PTSD reference Center under the guidance of the Ministry of Defense would be a very well structured and adapted response to the issue, with an territorial implantation of military and civil specialized professionals well knowing incidences of maintaining in the army or reinserting in the civil word. This center would be federative of an innovative approach to assure the continuity of treatments. It would allow to develop a common doctrine on the psychic trauma from the exchanges of experts. [ABSTRACT FROM AUTHOR]

Résumé Objectif L’article étudie la clinique du traumatisme selon une approche différentielle, plus particulièrement dans les situations de catastrophes humaines (attentats terroristes, massacres, génocides), dont la spécificité et la portée sont précisées par rapport aux catastrophes naturelles. Méthode L’auteur s’appuie sur la littérature concernant le traumatisme. Après avoir resitué la notion de trauma pour Charcot, puis Freud et Ferenczi, les définitions du traumatisme psychique sont précisées à partir d’auteurs contemporains : Maria Torok, Claude Nachin, Pierre Benghozi, Guy Briole, Olivier Douville, etc. Les notions classiques de clivage et de dissociation sont abordées, ainsi que celles plus récentes de « révisionnisme psychique » et d’« en-deuil catastrophique ». Résultats Le trauma a partie liée avec l’accident et plus encore avec la catastrophe, surtout si elle concerne la mise à mort barbare d’autres humains. Ces réalités conduisent à s’interroger sur la haine et le meurtre. Les grandes guerres mondiales, les pratiques de la torture et les génocides ont bouleversé notre façon de considérer la mort, notamment du fait de la mutilation irréversible des corps. Accueillir et écouter les êtres humains aux prises avec les effets dévastateurs durables des catastrophes amène l’auteur à constater l’existence d’un « principe d’intégrité », complétant les principes de plaisir et de réalité posés par Freud : intégrité comme vœu et comme processus, non comme instinct de conservation ou de repli sur soi, non comme fixation défensive ou comme fantasme de totalité ; intégrité, encore, comme désir d’éthique, aussi du fait que le sujet se situe comme appartenant au genre humain. Sont alors explorées les possibilités thérapeutiques qui découlent du repérage de ces notions dans le cadre de la cure psychanalytique et de l’accueil empathique du praticien. La symptomatologie de l’après-coup traumatique et les voies thérapeutiques qui se présentent à lui confirment la pertinence du concept de « principe d’intégrité ». Discussion L’approche et la démarche de la psychanalyse, à l’écoute de la singularité du sujet, se démarquent des protocoles comportementalistes, notamment du debriefing. Les notions traditionnelles du corpus psychanalytique demandent aussi à être complétées par des éléments qui découlent de la clinique contemporaine, notamment en situation de catastrophe. Conclusion Une clinique différentielle du choc traumatique et de ses effets ultérieurs peut garantir l’accueil personnalisé du sujet en souffrance et la reprise de ses processus de subjectivation. Objective The paper examines the clinical characteristics of trauma using a differential approach, particularly in human disaster situations (terrorist attacks, slaughter, genocide), and their specificity compared to natural disasters is explored. Method The author draws on the specialized literature on trauma. After reviewing the notion of trauma in Charcot, Freud and Ferenczi, definitions of mental trauma are drawn from contemporary authors: Maria Torok, Claude Nachin Pierre Benghozi Guy Briole, Olivier Douville, etc. The conventional notions of cleavage and dissociation are discussed, as well as the more recent concepts of “psychological revisionism” and “catastrophic mourning.” Results Trauma is closely linked to accidental occurrences and even more to disaster, especially where it concerns the barbaric killing of other humans. These realities raise questions on hatred and murder. The world wars, torture and genocide have changed our way of looking at death, particularly as a result of the irreversible mutilation of bodies. Experience confronting and listening to people struggling with the devastating effects of disasters leads the author to posit the existence of an “integrity principle”, completing the pleasure principle and reality principle posed by Freud: integrity seen as both a wish and a process, not as an instinct for self-preservation or withdrawal, nor as a defensive fixation or a fantasy of totality; integrity rather as an ethical desire, linked to the fact that the subject is positioned as belonging to the human race. Consideration is then given to the therapeutic possibilities arising from the identification of these concepts in the context of the psychoanalytic cure and an empathetic approach by the practitioner. The post-traumatic symptom profiles and the resulting therapeutic strategies confirm the relevance of this new concept of an “integrity principle.” Discussion The psychoanalytical approach, lending an ear to the subject's singularity, is quite distinct from behavioral protocols, including “debriefing”. Classic notions from the psychoanalytic corpus need to be supplemented by elements stemming from contemporary practice, particularly in disaster situations. Conclusion Differential studies on traumatic shock and its aftermath can enable a personalized approach to the distressed subject and the resumption of the individual's “subjectivation” process. [ABSTRACT FROM AUTHOR]

Résumé À partir du matériel issu d’une recherche sur le cancer gynécologique, les auteurs proposent de comparer deux passations du Thematic Apperception Test, entourant l’événement majeur et actuel de la réalité externe que représente le passage aux traitements de la maladie grave. Les épreuves projectives apprécient l’armature immuable de la structure psychique et sont également sensibles aux aspects actuels de ce que vit le patient. Elles déterminent le poids de l’événement, c’est-à-dire l’effraction de la réalité externe sur le fonctionnement psychique du sujet. Ainsi, partant de la distinction acquise entre l’invariabilité de l’organisation et les mouvements inhérents aux retentissements d’un événement actuel sur l’organisation psychosomatique, l’analyse clinique et projective appréciera les modalités de traitement de l’événement actuel en termes d’aménagements défensifs, d’évolution des représentations et de la progression des affects. L’étude met spécifiquement au jour le repérage des identifications féminines et l’apparition de modalités limites de fonctionnement pour traiter l’angoisse. The material of research on gynecological cancer allows authors to compare two sessions of the Thematic Apperception Test. They surround the major and current event of external reality that are treatments for serious disease. Projective tests show the immutable structure of psychic functioning and are also sensitive to current aspects of what lives the patient. They determine the importance of the event, i.e. the break of psychic functioning of the subject by the external reality. Thus, starting from this distinction, the clinical analysis and projective appreciate the treatment modalities of the current event in terms of defensive arrangements, evolution of representations and progression affects. The study shows specifically female identifications and occurrence borders modalities to treat anxiety. [ABSTRACT FROM AUTHOR]

Résumé Quelle(s) psychothérapie(s) doit-on proposer aux sujets psychotraumatisés ? Sont référencées aujourd’hui plusieurs centaines de méthodes psychothérapiques qui réservent bien des différences ! Différentes théories et techniques psychothérapiques concourent à ce qu’il est commun d’assembler sous le même vocable de « psychothérapie », pratique basée sur une relation interpersonnelle afin de soigner une maladie, de résoudre un trouble, d’apaiser une inadaptation ou une souffrance. Afin de discuter leurs mécanismes d’action, nous exposerons les offres de soins les plus répandues en psychotraumatologie (psychothérapies comportementales et cognitives, Eye Movement Desensitization and Reprocessing , psychothérapies psychodynamiques). Si des « Écoles » vendent parfois des pratiques contradictoires, en fait, des principes et techniques communs semblent en réalité partagés par ses trois orientations psychothérapiques. Which psychotherapy(ies) for psychotraumatised subjects? Today is referenced hundreds of psychotherapeutic approaches that hold many differences! Different theories and psychotherapeutic techniques contribute to what is common to assemble under the same term of “psychotherapy” practices based on an interpersonal relationship to cure illnesses, to resolve a disorder, to appease maladjustment or suffering. We will present the most common cares offered by psychotraumatology: the cognitive and behavioral psychotherapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR) and psychodynamic psychotherapies before discussing their mechanisms of action. If “schools” sometimes sell contradictory practices, in fact, common principles and techniques are actually shared by three psychotherapeutic orientations. [ABSTRACT FROM AUTHOR]

Résumé Le clinicien amené à suivre des patients souffrant des conséquences d’un trauma, abordera avec la critique nécessaire les actuelles recommandations de bonnes pratiques qui sont basées sur le postulat d’efficacité comparative de psychothérapies considérées comme hermétiques les unes des autres alors que l’évaluation scientifique des psychothérapies a de longue date mis en évidence leurs principes thérapeutiques communs. Dans le deuxième article de ce dossier, nous exposons puis nous discutons les recommandations de bonnes pratiques anglophones et francophones pour les confronter à l’évaluation scientifique des psychothérapies en termes d’efficacité comparative et d’adaptation à la pratique clinique effective. The experienced clinician psychotraumatology discuss with the necessary critical current recommendations of good practices that are based on the comparative effectiveness of psychotherapies postulate considered sealed from each other so that the scientific assessment of psychotherapy has long highlighted their common therapeutic principles. In the second article of this issue, we present and we discuss the recommendations for good English and French practices to confront the scientific evaluation of psychotherapies in terms of comparative effectiveness and adaptation to actual clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Posttraumatic stress disorder (PTSD) is a severe psychiatric disorder following exposure to a traumatic event. It is rarely diagnosed alone. High comorbidity has been observed between PTSD and other psychiatric disorders., Objectives: The purpose of this work is to evaluate the prevalence of latent PTSD in a population followed in a service of psychiatry and to describe the associated factors., Materials and Methods: It is a descriptive cross-sectional study of 300 patients treated for psychiatric disorders, using a hetero-questionnaire containing sociodemographic data, personal and family history, clinical and therapeutic data, and characteristics of the traumatic event. The MINI was used to screen for PTSD and assess suicidal risk., Results: Exposure to a traumatic event is reported by 46.7% of patients, and PTSD by 19.7%. The suicidal risk is 47.7% in the presence of this comorbidity. An ESPT is significantly associated with a schizoaffective disorder and significant suicidal risk. The recentness of the traumatic event, the presence of a state of acute stress and the absence of family psychological support are significantly associated with the occurrence of PTSD., Conclusion: A significant number of patients with a psychiatric disorder have undiagnosed PTSD, thus explaining their clinical deterioration. Screening and treatment of the underlying PTSD would help to improve their management., (Copyright © 2021. Published by Elsevier Masson SAS.)

Résumé Cadre théorique Le harcèlement psychologique dans les institutions scolaires est un phénomène mal connu en France, en dépit de sa médiatisation et de ses effets délétères : des symptômes réversibles du traumatisme jusqu’aux passages à l’acte suicidaires. Nous avons été confrontés à la difficulté de définir le harcèlement psychologique. En quelques mots, nous pourrions qualifier ce processus d’agressions psychologiques, construit sur un lien sadomasochiste, alimenté par une communication teintée de perversion. L’installation d’un climat de terreur peut être rapide et créer chez les victimes des sentiments de crainte, d’humiliation, de honte, de culpabilité. Nous avons tenté de lire le harcèlement psychologique en milieu scolaire de manière plus clinique, sous l’angle des théories psychanalytiques du traumatisme, de l’adolescence et du groupe. Paradoxalement, le groupe peut tant représenter un lieu de protection et une voie de valorisation narcissique pour les adolescents, qu’être source de danger pour certains adolescents vulnérables. Méthodologie Nous discutons ici le cas d’Alexandra, seize ans, qui a été victime de harcèlement psychologique au collège pendant plusieurs mois. Nous l’avons rencontrée trois fois dans le contexte d’une recherche clinique sur le sujet. Grâce aux entretiens effectués, nous avons pu recueillir les sentiments et le vécu de la jeune femme. Les éléments cliniques recueillis lors du dernier entretien, un an et demi après les faits, nous mènent sur la voie d’effets négatifs toujours actuels du trauma psychique (évitement comme principal mécanisme de défense pour lutter contre le trauma). Réflexions Notre analyse nous a permis de discuter l’existence d’une névrose traumatique (syndrome de stress post-traumatique) et de sa gravité, particulièrement lorsqu’elle émerge au moment de l’adolescence. Perspectives Ce cas clinique illustre les conséquences psychiques d’un trauma réel chez des adolescents victimes de harcèlement et la nécessité d’envisager trois types de solutions : la prévention, la reconnaissance de la situation et de la souffrance de l’adolescent, le suivi psychologique. Background School bullying is a phenomenon badly known in France, in spite of its mediatization and of its noxious effects: to reversible symptoms of the traumatism up to the suicidal acting out. Despite of the difficulty to find a good definition of it, it could be considered as some repeated psychological aggressions, based on a perversely communication. The installation of a terror climate can be fast, and can create on the victims a real fear feeling, or even shame and culpability. We tried to define school bullying thanks to psychoanalytical theories of trauma, adolescence and group. In fact, group can represent a protection place and a valorization way for adolescents, but it also can be a real danger. Methods We chose to discuss the case of Alexandra, a sixteen-year-old adolescent, who has been a school bullying victim during a lot of months. We met her three times, in the context of psychological interviews. The clinical informations collected during the last interview show that the negative traumatic effects are still present in her psychical life (avoidance as the principal defense mechanism to fight the trauma effect). We tried to relate with her how she lived bullying, and what are her feelings today when she rethinks about that. This helped us to analyze what and if they were efficient or not. Reflexions Our analysis of psychical consequences of bullying for Alexandra has permit us to discuss the existence of a real traumatic neurosis next to this situation. The fact that it arises during the adolescence period is really worrying because it associates to all the corporal and psychical anxieties that can be related to this process. Perspectives This clinical case can illustrate a lot of school bullying situations, and how much the psychical consequences can be important and create a real trauma for the adolescent's victims, and, in this way, the necessity of considering three solutions: the prevention, the recognition of the situation and the suffering of the teenager, the psychotherapy. [ABSTRACT FROM AUTHOR]

Résumé En août 2013, à l’acmé de la crise syrienne, l’État français décide de la mise en place d’une structure médicochirurgicale à destination des réfugiés syriens, positionnée au sein du camp de Za’atari en Jordanie, à quelques kilomètres de la frontière syrienne. Face à l’évidence des blessures psychiques de cette population meurtrie, endeuillée et en exil, l’urgence médico-psychologique prendra le pas sur l’aspect chirurgical. Ainsi, le dispositif évoluera, permettant la mise en place d’un binôme psychiatre/psychologue. L’opération « Tamour » est atypique car elle place l’action du Service de Santé au profit des réfugiés au centre de sa mission, et non pas dans sa mission régalienne de soutien des Forces. Les problématiques psychiques des réfugiés syriens sont certes en lien direct avec les vécus traumatiques liés aux horreurs d’une guerre civile (torture, viols, exécutions, bombardements sur des zones d’habitation), mais également à la précarité et à la violence de la vie au long cours sur un camp de réfugiés de plus de 140 000 personnes. Cela vient questionner ce qui fait régulation de la loi, et l’inscription du symbolique face à la perte de l’ancrage dans une société jusque-là structurante et organisatrice. Nous développerons par ailleurs le travail particulier réalisé avec les enfants par des biais de médiation, distincts des prises en charge destinées aux adultes. Enfin, une attention particulière sera portée sur le vécu des personnels du détachement militaire, désarmés et sans ennemi, dépossédés de leur idéal guerrier, se risquant ainsi à une difficile identification aux statuts d’assiégés et d’exilés des réfugiés syriens. In August 2013, in the acme of the Syrian crisis, the French State decides on the implementation of a medical surgical structure bound for the Syrian refugees, positioned within the camp of Za’atari in Jordan, a few kilometers away from the Syrian border. In front of the obvious fact of the psychic wounds of this bruised, saddened population and in exile, the medicopsychologic urgency will override the surgical aspect, so the device will evolve allowing the implementation of a binomial psychiatrist/psychologist. The operation “Tamour” is atypical because it places the action of the Health service for the benefit of the refugees in the center of its mission, and not in its kingly mission of support of the armed forces. The psychological problems of the Syrian refugees are in direct link with the related traumatic experiences of the civil war horrors (torture, rape, executions, bombing raids), but also with the insecurity and violence of life in the long course on a refugee camp of more than 140,000 people. We will also develop the particular work with children through mediations, distinct from the support for adults. Finally, particular attention will be paid on the experience of the military detachment, disarmed and without enemy, dispossessed of their warrior ideal, risking a difficult identification with the exiles statute of Syrian refugees. [ABSTRACT FROM AUTHOR]

Résumé La problématique du deuil normal ou pathologique fait l’objet d’une multitude de publications. Au sein de cette pléthore éditoriale, un seul sujet manque à l’appel : le psychothérapeute lui-même, pourtant instigateur de ces études. La mort du thérapeute viendra interroger le patient sur le sens de la vie, le réel de la mort, la possibilité d’obtenir un socle de soutien durable. Une relation thérapeutique qui s’établit depuis de nombreuses années et au sein de laquelle le praticien a été l’archiviste et le dépositaire des secrets les plus intimes ne peut s’interrompre brutalement sans souffrance. Le deuil du thérapeute peut être « compliqué » c’est-à-dire inhabituel, avec une souffrance marquée et persistante. Le deuil peut aussi être « pathologique », avec le déclenchement d’une pathologie physique ou mentale, par définition absente avant le décès mais classiquement retenue a posteriori comme latente et témoignant d’une vulnérabilité préalable, vulnérabilité pour laquelle le sujet avait peut-être engagé une thérapie. Les patients devront être reçus individuellement et rapidement pour l’annonce du décès. Cette annonce permettra une évaluation du tableau psychopathologique latent et des défenses psychiques qui pourraient être opérantes. Dans tous les cas, un second rendez-vous sera proposé et une invitation à un groupe de parole remise. Une question cardinale est de savoir si les patients peuvent se rendre aux obsèques de leur thérapeute. Nous partageons cette idée car elle limite la capacité de déni et demeure un rite social opérant qui canalise les passions. Également, la possibilité d’un groupe de parole joignant patients et soignants permettra de partager ces craintes et de dissiper les malentendus. À l’échelon individuel, la poursuite de la psychothérapie intégrera nécessairement cet événement récent de confrontation à la possibilité de la mort. L’événement traumatogène du deuil pourra être en lui-même réinscrit dans la trajectoire du sujet via une perspective thérapeutique qui permettra de « faire son deuil » et de poursuivre les soins déjà engagés. Alors que la mort brutale de son thérapeute a fréquemment été vécue dans une absence du dire, l’acceptation de la fatalité et du néant s’établira sur une production du sujet. Introduction The world of medicine, hospitals, is in close contact with and is interested in death; many practitioners deny it and attempt to avert it themselves. Much research deals with the reaction of patients in the face of their own death or that of a family member or a friend. The problem of normal and pathological bereavement has been the subject of numerous publications. Within this editorial superabundance, one subject is missing: the psychotherapist, often the instigator of these studies. The death of the therapist, sudden or expected, is a difficult issue for their patients as well as their colleagues and certainly for the therapist themselves. This death, always sudden, will surely lead the patient to question the meaning of life, the reality of death, the possibility of obtaining lasting support. This question of denial of the death of the aging and ill psychiatrist is undoubtedly ingrained in the history of the father of psychoanalysis who, suffering from a particularly painful post-smoking neoplasia, continued to smoke and see his patients until the day he died. Let us suppose that the psychiatrist had an unconscious mind; within it he may therefore be persuaded of the absence of possibility of his own death and live in the present of immortality. It is thus how Freud lived, like everybody he thought. Thus, structural elements of the analytical treatment increase this feeling of immortality. Clinical findings A therapeutic relationship established over several years and for which the practitioner was the archivist and the guardian of the most intimate secrets, to prepare a better future, cannot be interrupted suddenly without suffering. The mourning of the therapist can be complicated that is to say unusual with a marked and persistent suffering; or pathological triggering a physical or mental pathology by definition absent before the death but traditionally retained afterwards as latent and evidence of a prior vulnerability, vulnerability for which the subject had undertaken the therapy. The risk of anaclitic depression or even melancholic breakdown is to be feared. A psychotic decompensation can occur in the face of bereavement and when the secondary treatments are stopped lead to a medical escheatment. Acting out suicide or self-harm can bring into question the relationship between the therapist and the patient through the spectrum of pain and death. Of course the reaction of the subject can be strictly foreseeable due to the inter-subjective relationship uniting the protagonists. How can the patient therefore move on to another therapist and will this procedure necessarily be therapeutic? Guidelines A non psychotraumatic announcement must be made to the patients to pre-empt a fortuitous discovery via another patient or the press, which requires good reactivity on the part of the medical team. The patients must be seen individually quite quickly to announce the death in person. It is a good idea for the patient to be seen by a doctor they already know, for example having met them when their referring therapist was absent. This announcement will enable an evaluation of the latent psychopathological picture and the psychic defences, which may or not be operative. The follow-up will depend on each clinical situation after looking very carefully at the anamnesis, detailing the psychiatric examination and evaluating the patient's reaction to the announcement of the tragedy. In any case, a second appointment will be proposed and the subject will be invited to join a therapy group. A cardinal question is to know if the patients can go to their therapist's funeral. We share this idea as it limits the capacity of denial and remains an operative social ritual which channels emotions. This event should be managed by the medical team and will retain a therapeutic value. Also, the possibility of group therapy bringing together patients and medical staff will enable them to share their fears and dispel any misunder [ABSTRACT FROM AUTHOR]

Résumé Avec l’augmentation de l’espérance de vie et du nombre de démences, la question clinique de l’état de stress post-traumatique (ESPT) chez la personne âgée est un enjeu majeur de santé publique. Un ESPT se structure ou se restructure au cours du grand âge selon plusieurs déclinaisons psychodynamiques. La présentation somatisée de l’ESPT est une dimension cardinale de la demande de soins chez le patient âgé : si une blessure organique traumatique majore le risque de structuration traumatique, une nouvelle maladie physique peut être la cause d’un ESPT de novo ou faire ressurgir les douleurs psychiques psychotraumatiques anciennes. La clinique de l’ESPT chez la personne âgée possède des spécificités : les reviviscences s’émoussent au cours du temps au profit de l’hypervigilance et des stratégies d’évitement. Ces dernières sont au premier plan du « syndrome post-chute », syndrome envisagé comme un tableau psychotraumatique spécifique de la personne âgée, qu’elle évolue vers un processus de vieillissement normal ou démentiel. Face à une situation potentiellement traumatogène, l’intégrité des capacités cognitives est primordiale pour assurer une résolution psychique non pathologique. Mais si les troubles cognitifs intégrant le processus normal de vieillissement favorisent les expressions psychotraumatiques, réciproquement l’ESPT est le lieu d’affaiblissement des fonctions cognitives. Des stress récents ou prolongés précéderaient une évolution démentielle dans 80 % des cas en jouant le rôle de facteurs déclencheurs ou facilitateurs. Réciproquement, le diagnostic d’ESPT est plus facilement caractérisable lors d’un syndrome démentiel. Loin d’une banalisation ou d’une vision fataliste des troubles psychotraumatiques de la personne âgée, nous avons souhaité dégager des perspectives de recherche. Il est nécessaire de valider des outils psychométriques permettant d’évaluer l’ESPT chez des sujets souffrant d’altérations cognitives comorbides non directement reliées au trouble anxieux. À un stade de démence évoluée, il reste toutefois difficile d’établir un diagnostic d’ESPT, d’autant que la mémoire émotionnelle est secondairement touchée. Ou plutôt, il s’agit d’une autre clinique qu’il conviendrait d’explorer. With the increase in life expectancy and dementia, the clinical question of post-traumatic stress disorder (PTSD) in the elderly is a major public health issue. PTSD is structured or restructured in old age according to several psychodynamic variants, which can be a reaction to a psychic trauma that is presented de novo; PTSD can also develop at a young age to later become chronic in old age. PTSD can thus be diagnosed very remotely, in time, from the event that was once the cause. The clinical presentation of PTSD is not constant but fluctuates over time: Following the apogee during the acute phase, the psychotraumatic symptoms decrease for a few years or even decades before increasing again at the start of old age. If traumatic or stressful life events that occur during old age can be isolated from a previously structured PTSD, the themes of the suffering experienced within the life history overlap. The symptoms of PTSD can evolve through absence, fluctuating over time to be updated in the elderly person through an organic pathology, sensory deficiency disorders, a cognitive decline or an institutionalization. Over time, the specific symptoms (reexperiencing, avoidance and hypervigilance) decrease in favor of nonspecific symptoms (asthenia, depression, use of psychoactive substances). The somatic presentation of PTSD is a fundamental aspect of the request for treatment in elderly patients: A somatic illness can lead to a PTSD de novo or cause old psychological psychotraumatic pain to reappear. With age the revivifications wane in favor of hypervigilance and avoidance strategies. The latter are at the forefront of “post-fall syndrome”, a syndrome considered as a psychotraumatic picture specific to the elderly person that develops into a normal aging process or dementia. In the face of a potentially traumatogenic situation, the integrity of the cognitive abilities is primordial to ensure a non-pathological psychological resolution. The difficulty in inhibiting traumatic memories will lead to their update. Likewise, PTSD is the locus of a decline in cognitive functions: recent or prolonged stress precedes the development of dementia in 80% of cases, playing the role of a triggering factor or facilitator. As revivifications are expressed more clinically due to neurocognitive disorders, it can be feared that the appearance or the exacerbation of a latent PTSD is the sign of the onset of dementia. Hypocampal atrophy with relative conservation of the amygdala is a biological support for dementia such as PTSD: pathological compensatory mnemic mechanisms could be at work here favoring productions that do not reflect real memories but thoughts guided by semantic knowledge. The absence of possibility of symbolizing death beyond life can fix thoughts on an ancient, unresolved confrontation where this death has already imposed itself. Far from a trivialization or a fatalistic vision of psychotraumatic disorders in elderly people, we wished to highlight research prospects, which open up the way to multidisciplinary questions notably including anthropological determinants. A dementia process can associate, at clinical level, hypo- and hypermnesic affections. It is thus fitting to assert the interest of considering dementia not only from a deficiency point of view but also according to its productive aspects. At an advanced stage of dementia it is difficult to establish a diagnosis of PTSD, all the more so as the emotional memory is affected. [ABSTRACT FROM AUTHOR]

Résumé: Tout au long de la grossesse, la femme enceinte va pré-investir puis investir le futur enfant, le sentir, le ressentir, se le représenter, puis le voir, le regarder, le montrer. À mesure que la femme enceinte ressent l’enfant qu’elle porte, son récit et ses fantasmes le concernant se font riches et voluptueux. L’étayage corporel est important et par l’introduction de l’échographie, il va alors pouvoir s’appuyer sur cette image, sur ce regard porté au-delà de la peau, tant dans le processus d’investissement du bébé, qu’au niveau des représentations qui en sont les signes. Un processus de création psychique vient alors soutenir le processus de ű création biologique Ƈ et, pas à pas, l’enfant est là, dans sa réalité, au-delà du ventre maternel. L’image échographique aide donc à la fantasmatisation, dans un travail de création psychique, mais parfois, elle peut aussi mener au gel de cette même fantasmatisation, à ű l’arrêt sur image Ƈ de ce travail de création devenu prisonnier d’une folie maternelle mortifère. En effet, du côté de la destructivité, de la désintrication pulsionnelle, l’image échographique peut se fétichiser et devenir traumatique, comme cela sera montré dans le cas d’une patiente appelée Marie. [ABSTRACT FROM AUTHOR]

Résumé: Nombre de sujets dits « névrosés » se sont précipités eux-mêmes au-devant de leur évènement traumatique. Dans la névrose si le mécanisme traumatique est immuable, c’est la thématique subjectivée de l’évènement qui va toucher l’intimité de la structure. Mais le réel est présent au sein de la structure névrotique comme témoignage du refoulé originaire causé par l’apparition du langage. Au cours du trauma, ce réel est directement confronté au sujet, rendant brièvement perméable l’extérieur et l’intérieur de son être. Le réel exposé du dehors fait écho au réel interne en créant un trajet de résonance, même temporaire, qui les relie en fixant une faiblesse sans cesse revisitée. Le traumatisme psychique est caractérisé par la répétition qui accapare le sujet à son insu. Cette répétition est présente au cours des cauchemars et ecmnésies mais elle consacre également un télescopage biographique qui fait l’essence même du trauma. Le retour d’un évènement traumatique éclate de l’écho et de la résonance entraînés par une autre situation de vie qui appelle l’initiale de manière directe ou plus symbolisée. L’évènement qui avait fait trauma n’est alors authentifié à l’évidence que dans un second, voire un troisième temps, traduisant une suite d’évènements liés qui se dirigent vers les reviviscences. On peut parler d’après-coups secondaires, voire tertiaires. Cette répétition de confrontations réelles interroge la pulsion traumatophilique au-devant de laquelle le sujet se précipite : la rencontre traumatique s’établit comme la réalisation d’un désir inconscient qui s’ancre au plus intime de l’être, via l’originaire, en touchant à la pulsion de mort. Si un signifiant du destin pousse à la mauvaise rencontre, le trauma serait-il chargé de sens ? La psychothérapie nécessitera un engagement actif du sujet qui loin de se dédouaner de la scène traumatique va produire du sens en se détachant d’une position purement passive au cœur du drame auquel il prit parti. Seule cette quête d’un sens permettra au sujet de continuer à produire plutôt que de se retourner définitivement vers la mort réelle. [ABSTRACT FROM AUTHOR]

Abstract: Our contribution of posttraumatic psychosis comes within that prospect in reference to the semiologies of traumas generated by extreme situations such as the victims of World Trade Center of New York (September 2001) or the hostage taking in North Ossetia (September 2004). Four sets of themes lead us to suggest a traumatic psychosis when the person shows symptoms of a neurotic psychic structure. (1) There''s no traumatic psychic inscription of the event. Sideration (Stuporous confusion symptoms) or panic flight (Hallucinations or acute delirious fits) often illustrates this first clinical aspect. (2) Psychic processes tend to ignore the pleasure/displeasure principle. They are governed by compulsion to repeat and the invasion of affects of pain. (3) The models of neurosis and psychic conflict are not efficient to manage the quota of affect and the drive influence. It would be necessary to add the appearance of temporary fits of mental confusion, self-destructive and autolysis behaviours. The reference of a DSM-IV type seems to be inadequate to convey the implemented posttraumatic stakes. If trying to soothe the symptoms is undeniably important, psychic disorganizations that generate a semiology that is essentially present in the symptomatology of the psychoses cannot be ignored. Our proposal posttraumatic psychosis is supported by five main syndromic classes. (1) The symptoms are often temporary delirious fits (delirious ideas or perceptions of a persecutory, cenesthetic or hypochondriac nature), mental confusions (oneiroïd state, anxiety and stupor), phases of depersonalisation and derealization, sever death pangs experiences, serious physical disorders, divides close to schizophrenic-type dual personalities. (2) The adhesiveness marks the impossibility for the victims to keep away from a trauma. The objects are bound, persecuting and adhesive. (3) Traumatic temporality imposes a factual and current omnipresence of the trauma. It destroys the temporal projections of the patient as well as an anamnestic reconstruction. (4) The traumatic body is not that the hysterical neurosis conversions. The somatic semiology marks operational-type functioning. (5) Traumatic compliance doesn’t work on the level of facilitations that lead the formation of symptoms. The identity structure appears disorganised by the dismantling of the primary psychic envelopments. Four theorical considerations support our contribution. (1) Pictographic inscription. The severe traumatism does not produce the polarity necessary to the process of self-fathering described by P. Aulagnier in connecting with original processes. Traumatic adhesiveness splits the necessary mediation and distance spaces for the emergence of representation processes. (2) Pain affect. The pain affect generated reminds of baby''s first distress experiences, primitive agonies and anaclitic collapses; the narcissistic contract is broken and the patient lives without a secure base or a sufficiently good and supporting psychic container (D.W. Winnicott). (3) Anxiety status. The anxiety is not of neurotic nature but truly annihilating. It is often similar to anxieties caused by catastrophes, psychoses due melancholy or more archaic anxieties that have been observed in hebephrenic pathologies. (4) Body dismantling. The trauma results in mute somatizations that cannot be symbolised (M. Bertrand, 2005). They appear in sensory outward signs such as dermatosis, pruritus, diarrhoas, haemorrhagic periods or persistent headaches for example. These severe forms of trauma confirm the unconscious traumatolytic aim of victim''s psychological destruction. Suicidal dimension seems to be the ultimate recourse not to sink into insanity and to keep a subjective position in front of the figures of cruelty. [Copyright &y& Elsevier]

Abstract: The media relieve daily the traumatic events, which take place worldwide as in closer of the everyday life of the spectators. This overbid of images joins in a context where political, judiciary, media and medical logic are forced to coexist. The spectacularisation of the distress and the suffering invades all the space and leads to the stigmatization of the persons involved in this type of event in a specific human category, that of the victims so fast sanctuarised that sacrificed on the scene of the ratings. Our comment aims at understanding better the stakes bound to the evolution of the media culture and its repercussions both with the subjects directly involved in the traumatic event and towards the spectators. [Copyright &y& Elsevier]

Abstract: The purpose of this study is to research the elements indicative of traumatic experience in adoptive parents’ accounts of the period of their first encounters with their child, in situations of international adoption. A review of trauma narratives aims to evaluate which characteristics in the structure of the account are more frequently described for traumatized subjects than for non traumatized subjects. These characteristics are called «traumatic marks» in this study. Among the ten accounts collected, five present traumatic marks in their structure, such as absorption in the scene, reduction of references to inner experience, incoherence, or the intrusion of a single theme. In nine of the ten interviews, one finds potentially traumatic experiences at the level of content, i.e. experiences likely to bring about fright and psychic effraction. Principally concerned are the divergence between the real child and the imaginary child, the impossibility of relating the lived experiences to the realm of the familiar, and the confrontation, in the course of the adoption process, of a difficult context, likely to hinder the establishment of the ties between parents and child. These results confirm the clinical interest of the account of the adoption to shed light on familial interactions. [Copyright &y& Elsevier]

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Copyright of EMC-Psychiatrie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The participation in an original experiment of multi-field reception of the victims of moral harassing in the work allowed us to verify the aptness and the utility of the so psychoanalytical but classic psychiatric concepts to shine the importance and the gravity of the phenomenon and its consequences. In this particular setting, our understanding of the concepts of perversion, perversity, psychic trauma, post-traumatic states but also on the psychodynamic level: of envy, of elaboration, of depressive position, of potential space, of scapegoat, is enlightened and enriched. These same concepts are essential to set up a psychotherapic attitude adapted to the consequences on the psyche of the victims of this large scale psychopathologic phenomenon. The reflection on this experience allowed us to suggest hypotheses on the socio-cultural determinants their increasing frequency. [ABSTRACT FROM AUTHOR]

In humanitarian contexts where children are exposed to major traumatic events, psychological care is fundamental to enable them to escape psychological and social isolation. A group care system, that also offers time dedicated to drawing, shows how children can find the necessary internal and external resources that will help them to restore their confidence in a possible future., (Copyright © 2020. Published by Elsevier Masson SAS.)

Introduction: As a result of determinants specific to the psychopathological structure of the psychological trauma, psycho-traumatised patients very rarely solicit the health care system directly with a request for treatment centred on their trauma. The medical profession is consulted for non-specific symptoms and complications, which are mainly somatoform, addictions and depressive disorders. After a few epidemiological reminders followed by a discussion concerning contemporary depressive and post-traumatic nosographic features, we define, through our clinical experience collated with the data in the literature, different clinical and etiopathogenic contexts of post-traumatic depression in order to control their therapeutic treatment., Clinical Findings: Burnout post-traumatic depression in response to re-experiencing is the most common: it is a reactive psycho-physiological burnout in response to the emotional distress re-experienced during flashbacks, insomnia, a constant feeling of insecurity and the deleterious consequences of this symptomatology in terms of social adaptation. A common genetic predisposition affecting serotoninergic regulation seems to be a vulnerability marker of both depressive and psychotraumatic symptoms. In this case, SSRI will be effective on sadness. In addition, these antidepressants have been widely prescribed for the first-line treatment of depressive and psychotraumatic symptoms. However, this pharmacological class is often insufficient in relieving autonomic hyperactivity such as re-experiencing which are mediated more by noradrenergic hyperactivity. SNRI such as venlafaxine can be used as a first-line treatment. Post-traumatic depression with psychotic features congruent with mood is dominated by a feeling of incurability; the subject blames himself and feels guilty about the traumatic event and its consequences. Symptoms of denial of identity are sometimes observed: confined by an intense depersonalization, the psycho-traumatised subject evokes that he is "no longer himself" and that his mind "is disconnected". Confronted with the psychological emptiness of the traumatic scene, the psycho-traumatised subject remains devoid of thought as if their mind has left him. In addition to antidepressant therapy, an atypical antipsychotic drug must be prescribed to relieve the melancholic symptoms as well as the concomitant psychotraumatic symptoms. Post-traumatic depression masked by peripheral physical injuries is the result of accidents combining psychological and physical impairment. The physical pain resulting from the accident regularly recalls the drama in the same way as traumatic re-experiencing. Depression masked by this somatic suffering is difficult to diagnose, but the repeated somatic complaints at the forefront of the request for treatment, the breakdown of self-esteem as well as the level of subjective strain due to pain and dysesthesia are all indications. The psychotherapy will focus on the symbolic reconstruction of the organs that have been damaged or destroyed, with the aim of healing the extensive narcissistic impairment. Post-concussive depression is diagnosed following a head trauma, however severe. It is sometimes assigned to neurological lesions and at other times recognised as the expression of a purely psychological reaction. Antidepressant therapy, or possibly trial therapy, is often indicated. The terms traumatic grief and post-traumatic grief are often used synonymously in publications: a conceptual opposition must however been recalled. If the traumatic grief is the result of the loss of an object that holds much psychological importance for the individual, the subject has not however been traumatised by this event and is not suffering and will not suffer from re-experiencing. The therapy will include methods used in the psychotherapeutic treatment of grief; antidepressants are often insufficient. Differently, post-traumatic grief takes shape when the loss of another is concomitant with the confrontation with the reality of the death witnessed in a moment of peri-traumatic dissociation. This grief is often observed following the discovery of the body of a close friend or family member who has committed suicide, or when part of a family has been decimated by an accident whilst the survivors watch their close relations die pending the arrival of the emergency services, or when a military comrade is wounded in combat in front of his partner. The mourning process cannot really begin until the flashbacks cease., Conclusions: Clinical depression or even melancholia, possibly masked by somatic or post-concussive complaints, is often the initial mode of contact with the health care system for the psycho-traumatised subject. The different clinical and etiopathogenic contexts of post-traumatic depression that we have developed in this work use specific therapies which need to be clarified by further research based on this nosography., (Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: After Operation Desert Storm which took place in Iraq from August 1990 to July 1991 involving a coalition of 35 countries and a 700,000 strong contingent of mainly American men, some associations of war veterans, the media and researchers described a new diagnostic entity: the Gulf War Syndrome (GWS)., Literature Findings: GWS seems to be a new disorder which associates a litany of functional symptoms integrating the musculoskeletal, digestive, tegumentary and neurosensory systems. The symptoms presented do not allow a syndrome already known to be considered and the aetiology of the clinical picture remains unexplained, an increasing cause for concern resulting from the extent of the phenomenon and its media coverage. It quickly appears that there is no consensus amongst the scientific community concerning a nosographic description of GWS: where can all these functional complaints arise from? Different aetiopathogenic hypotheses have been studied by the American administration who is attempting to incriminate exposure to multiple risks such as vaccines and their adjuvants, organophosphorous compounds, pyridostigmine (given to the troops for the preventive treatment of the former), impoverished uranium, and the toxic emanations from oil well fires. But despite extremely in-depth scientific investigations, 10 years after the end of the war, no objective marker of physical suffering has been retained to account for the disorders presented. It would appear that the former soldiers are in even better objective health than the civil population whereas their subjective level of health remains low. Within this symptomatic population, some authors have begun to notice that the psychological disorders appear and persist associating: asthenia, fatigability, mood decline, sleep disorders, cognitive disorders and post-traumatic stress disorder (PTSD). Within the nosological framework, does GWS cause functional disorders or somatisation? Finally, 20 years after the end of the fighting, only PTSD has been causally attributed to military deployment., Clinical Findings: Certain functional symptoms of GWS occur during the latent phase of a future reexperiencing syndrome, latent phase which is the locus of nonspecific symptoms. The psychotraumatised subject does not express himself spontaneously and waits to be invited to do so: if the social context does not allow this expression, the suffering can remain lodged in a few parts of the body. How can the inexpressible part of the trauma be recounted, particularly if the social context does not allow it? For civil society, calling into question "the somatic word" of veterans is difficult: why were they sent to face these hardships? What could we learn from these soldiers we do not wish to listen to: the horror of the war, the aggressive impulse of men, and the confrontation with death? Another obstacle to this reflection is the reference to stress as a prevalent aetiopathogenic model of the psychological trauma. A model like this, considering that PTSD is a normal reaction to an abnormal situation, finally discredits the subject and society and disempowers them by freezing them in a passive status of victim., Discussion: However, as GWS affects approximately a quarter of subjects deployed, it is not very likely that all these symptoms are caused by a psychotraumatic reaction. Many veterans suffering from GWS have themselves rejected the diagnosis of PTSD, arguing that they do not suffer repetition nightmares. What the veterans rightly tell us here is that the notions of stress and trauma cannot strictly be superimposed. A subject may have been intensely stressed without ever establishing traumatic flashbacks and likewise; a psychological trauma can be experienced without stress and without fear but in a moment of terror. This clarification is in line with the first criterion of the DSM-IV-TR which necessarily integrates the objective and subjective dimensions as determinants of PTSD. Yet, scientific studies relating to GWS are struggling to establish opposition or continuity links between the objective external exposure (smoke from petrol wells, impoverished uranium, biological agents, chemicals) and the share of inner emotion albeit reactive and characterised by a subjective stress. There were no lack of stress factors for the troops deployed: repeated alerts of chemical attacks, hostility of the environment with its sandstorms and venomous animals, climatic conditions making long hours of backup and static observation difficult, collecting bodies, lack of knowledge of the precise geography of their movements and uncertainty of the duration of the conflict. The military anti-nuclear-bacteriological-chemical uniform admittedly provided protective confinement, shutting out the hostile world from which the threat would come but, at the same time, this isolation increases the fear of a hypothetical risk whilst the internal perceptions are increased and can open the way to future somatisations. In a context like this, the somatic manifestations of anxiety (palpitations, sweating, paresthesia…) are willingly associated with somatised functional disorders to which can also be assigned over-interpretations of bodily feelings according to a hypochondriacal mechanism. The selective attention to somatic perceptions in the absence of mentalisations, the request for reassurance reiterated and the excessive use of the treatment system will be diagnostic indices of these symptoms caused by the stress. Rather than toxic exposure to such and such a substance, the non-specific syndrome called "Gulf War Syndrome" is the result of exposure to the eponymous operational theatre. But if the psychological and psychosomatic suffering occurring in veterans is immutable throughout history, the expression of these difficulties has specificities according to the past cultural, political and scientific context. In the example of GWS, the diffusion of the fear of a pathology resulting from chemical weapons has promoted this phenomenon. In the end, biochemical and biological weapons have not been used on a large scale but the mediatisation of this possibility has led to a deleterious… To spare the bother of a group psychological reflection, the scientific and political authorities chose to investigate the implication of environmental factors in the genesis of the disorder. At individual as well as social level, rather than accept a psychogenic origin, a common defence mechanism is to assign the suffering to an external cause. With the perspective of preventing the risk of diffusion of other unexplained syndromes, which could occur following future armed conflicts, new epidemiological diagnostic models must be defined. The media also has considerable responsibility for the diffusion of epidemic psychological reactions but at the same time, they can inform the population about certain individual or group psychopathological mechanisms., Conclusion: The GWS exists: it is not an "imaginary illness" but a serious public health issue which has led to tens of thousands of complaints and swallowed up millions of dollars. To reply to human suffering, a new nosographic entity can spread through society taking the epidemic expression of a somatised disorder via identification, imitation and suggestion mechanisms. This possibility questions not only mental health but also the sociology and politics. It is necessary to inform the leaders and the general population of the possibility of this type of mass reaction, which can take the shape of a highly contagious complex functional syndrome., (Copyright © 2013. Published by Elsevier Masson SAS.)