Psychotherapeutic treatment of adolescents confronted with a psychotic experience reveals a characteristic feeling of shame. The first hypothesis formulated here addresses the existence of shame in such psychotic individuals based on archaic experience calling into question the Freudian, and classic, conceptual tool of post-Œdipal structural shame. The second hypothesis postulates that in clinical work the expression of shame as an ontological challenge against the Other represents an attempt by the subject to prove his or her existence. Our reflection focuses, through a clinical analysis, on the double occurrence of psychotic experience and a feeling of shame.
Archives de catégorie : ENG – Corps et âmes – 2005 T.23 n°2
Patrick Chaltiel : Families and Psychiatry: How to Reduce Misunderstandings
The encounter between family and caregivers in psychiatry often has negative aspects for both sides from the start. There is fear on the part of the caregivers that the emotional surge of ambivalence and double binds could disturb a diagnostic and therapeutic practice classically founded on separation, while the family fears guilt-arousing accusation of ill-will that have long served to distance it from therapeutic construction. But an integrative “multi-partner therapy,” in which each of the actors involved must discover their own resources and investigate the mechanisms of their own psychic coherence, has clear benefits, both for the patient’s social prognosis and the prevention of secondary pathologies induced by the suffering of the patient’s family. Still, it is necessary to eradicate the prejudices of the past, which are resistant and insidiously persist in poisoning the natural relations between the inevitable protagonists of any coherent treatment aimed at integration and de-stigmatization.
Stephan Wenger : Placing Psychotic Elements into the “World” of the Psychotic
Psychotic manifestations in adolescence can take on a defensive aspect when dealing with psychotic illness, a breakdown (Laufer, M. and M. E.). Fanny presented delusive and hallucinatory activity and her symptoms disappeared after two years of therapy. Psychotherapeutic technique must follow a common thread: the conviction that the delirious and the hallucinatory belong to the internal world of the patient and form part of her narrative about herself; the associative thread of the session makes it possible to suggest that the patient invite psychotic elements into her psychic space or world, thereby putting them into the “world,” which is an identity created by the psychotic person.
Paula Vodickova : Autism and the Pubertal
Puberty compels the autistic subject to do some psychic work, and doing so via corporeity has integrative effects on the psyche. The enigmatic other becomes the target of eroticized demands. The sex drive is diverted to serve the purpose of an identity/narcissist construction. The autistic pubertal finds its denouement in a fetishist reality beyond adolescences.
Nicole Catheline : puberty and psychotic functioning : an inter-generational confusion
The symptomatology of early adolescence (13 to 15 years) raises a number of questions: is this the expression of changes induced by puberty, or should we see in it the seeds of an onset of mental illness (e. g., schizophrenia)? The parents’ reaction to their child’s adolescence seems to be a determining factor in any attempt to answer this question. Indeed, when the child’s puberty too strongly solicits the parents’ own experience of adolescence, inter-generational confusion can set in, weighing upon the process of disengagement from Œdipal bonds and hampering the adolescent’s identity process.
Anne Edan , Sophie Gasser, Laurent Frobert : Angélique and the three bears
The story of a seventeen year-old girl hospitalised for a psychotic breakdown illustrates the importance of preserving a diagnostic opening between psychosis in adolescence and the onset of psychosis, despite the case history and symptoms. The nurse referents were the thread linking different therapeutic spaces, enabling (re)structuring and a return to symbolization.
Gianluigi Monniello : Therapeutic Actions in Psychotherapy with Adolescents
Like other basic psychoanalytical constructions, the theory of therapeutic action is currently undergoing revision, and theorists of different persuasions are suggesting different mechanisms.
In the domain of clinical research, the author argues that psychoanalytical psychotherapy with adolescents enables us to describe both treatment goals, (that is, changes) and technique (that is, the strategies that can help to bring about these changes). Interventions that facilitate change can be placed in one of two categories : those which make use of several transformational aspects of the therapeutic relationship, and those which increase insight and reinforce identity.
In particular, the treatment of an adolescent suffering from personality disorder calls into question the identity of the analyst who is specifically engaged in the process of self-analyzing his own adolescence. The work of recognizing and elaborating this process can prove to be a fundamental therapeutic action.
The description of two clinical vignettes will illustrate the different therapeutic actions that are in play.
François Richard : The Work of Representation and the Psychotic Process
This paper supports the hypothesis that the process of subjectivation resorts to a firmness of personal or artistic style when the subject is threatened by psychotic attacks, especially during adolescence. Thought and representation are then seen to intensify in the subject, but it is difficult to distinguish between the excess of melancholic consciousness, psychotic anxiety, and a type of sublimation that is fascinated by drive chaos. The paper proposes a second hypothesis regarding, inversely, the usefulness of a kind of solitude and of masochistic compromise with object and reality. A moment of psychotic crisis in an adolescent girl with a neurotic problem is presented in terms of how the quest for the distinctiveness of style curbs her breakdown. The paper then analyzes the theatrical work of the playwright S. Kane in detail; indeed, here we find an example of the paradox of a suicide that follows successful representational mastery. Finally, we discuss Freud’s ideas about masochistic destructiveness and Winnicott’s ideas about the core of the true self as being non-communication.
Laurence Chekroun : The Evolution of a Psychotic Adolescent in Psychotherapy
Using E. and M. Laufer’s theories about adolescence and G. Haag’s theory about the normal development of babies, this article offers some reflections about the evolution of an adolescent girl in psychotherapy following a « development break » and the appearance of a delusion at the moment of puberty.
Ignacio Melo : Notes on the Hallucinatory
The outcome of psychotic disorders during puberty depends on how the adolescent and his therapeutic environment make use of the adolescent’s hallucinatory world. When used and worked on within the analytical relationship, the narcissistic part of primary identifications is preserved, and it is no longer necessary to disinvest the Unconscious, as Freud postulates in the case of President Schreber and in schizophrenia. The hallucinatory then becomes a precious tool for saving and expressing desires; putting it into words will help to lighten the economy of the adolescent’s psychological functioning. This is illustrated using two clinical cases.