With adolescents presenting acute psychiatric disorders, and who are also isolated and foreign-born, doubts about the diagnosis are frequent, with the risk of diagnostic error – and inadequate care – as well of over-diagnosis of psychotic disorders as opposed to depression or post-traumatic syndrome. The course of the treatment of Lila, a sixteen year-old adolescent from Rwanda, illustrates the problematic of diagnostic erros or misdiagnosis which can be reduced by recourse to studies on diagnostic error and a transcultural approach to treatment.
Though the exepriences of isolated foreign youths are varied and each has his or her particular history, these adolescents have some psychopathological problems in common. A considerable number of these young people present clinical symptoms of trance or possession, called DTD (dissociative trance disorder) in the DSM IV. Symptoms of trance and possession are probably under-diagnosed in western countries because of cultural bias and an insufficient understanding of dissociative disorders. Patients who present these symptoms are often subject to diagnostic errors, especially diagnoses of psychosis or borderline states, leading to treatments that can aggravate symptoms. These symptoms have multiple functions in isolated foreign youths and should be analyzed in view of the specific stage of development which is adolescence, especially its issues of identity construction. In order to gain a better understanding of the subjective experience of these young people, it is necessary that the therapeutic setting take into account the transcultural dimension and pre-, peri-, and post-migratory issues. We will bring our hypotheses to bear on a review of the psychoanalytic literature and clinical observations.
This article shows that it is possible to evaluate in adults between seventy-six and eighty years of age the psychical effects of traumatic events experienced over sixty years ago. Here we present the constructive processes of an adolescent Jewish girl in France between 1940 and 1946. In addition to being robbed of her adolescence, the clinical situation shows psychopathological disorders linked to cumulative traumas : a thwarted adulthood, difficulty becoming a mother, troubled marital and maternal relations and a ponderous silence. Retirement permits the liberation she has been waiting for since 1945, in particular through group acknowledgement and the process of writing.
In Brazil between 2002 and 2010, more than 230 000 young people between the ages of 15 and 25 were murdered. This article attempts to analyze the vicissitudes of subjective construction of Brazilian adolescents living in poverty, social anomie and violence. Starting with the creation of a group clinical set-up, psychoanalytically oriented conversation groups conducted with adolescents at school, the author constructed the following hypothesis : given the violent disqualification of their life and the total absence of any prospect of even minimal inscription in a link indicative of phallic participation in the social field, some youngsters turn violence into their own fiction and a way of forging a social link. Using a fragment of one case, the author also tries to give an idea of the method used in conducting these conversation groups.
Adolescents living in suburban slums often express shame of their social, cultural and geographical origins. This problem is (re)inscribed in the world’s emotional geopoliutics, to give a better understanding the identity issues in the adolescents. Using two clinical vignettes with adolescents in the Maison d’Enfants à Caractère Social (socially-oriented child center), we demonstrate the importance cultural counter-transference and multi-level listening in elaborating the emotional baggage through the creative process.
This article attempts to show the importance of establishing an interdisciplinary dialogue when dealing with historical trauma. This can be fostered by complementarity, the bedrock of the transcultural, which enables a connection between psychoanalysis and anthropology, as well as between history and politics. This argument is supported by a study of the « rioters » of Fall 2005, who were identified as French adolescents of « foreign origin ». Confronted with a group disavowal of the colonial past, these adolescents, in revolt against the reality of their present lives, also echo their own and quite specific history of France.
The Transcultural Research and Intervention Team (ERIT) has developed an in-school preventative intervention for immigrant and refugee youths. It is composed of a program of creative expression workshops called Théâtre-Pluralité and uses social and theatrical play to help young people navigate among their multiple feelings of belonging and to elaborate their past and present experiences. The goal of the workshops is to facilitate the reappropriation and sharing of the personal and group histories of these adolescents.
In transcultural psychotherapy with an adolescent who is an isolated foreign minor, with medical personnel or social workers, the therapists come to know the patients psychical suffering, behaviors and demands within a setting where listening and elaboration can take place with all the complexity and multiplicity of the patient’s experience, using cultural and psychiatric materials, which helps to avoid diagnostic errors and frequent splitting between the native cultural and the host country. Faced with an external reality made up of uncertainty, precariousness and isolation, how can we take this reality into account without letting it take up too much psychotherpeutic space ? When a request for diagnostic evaluation is hanging over the treatment, what are the implications of this diagnosis for the transcultural work, particularly when the patient presents delusive elements suggestive of psychotic disorder ?
In Casablanca, as elsewhere in the world, children and adolescents live in the streets. They are caught between a traumatic past and an uncertain future. Meeting these children and adolescents, these « exiles outside », gives us an idea of the defective and traumatic environment that they are trying to flee by exiling themselves to the streets. This confers a disquieting foreignness on them, making them seem uncanny, feared and rejected. The street becomes the stage where the environment’s failings can be expressed, the place of survival, of both private and group experience.
Children and adolescents adopted internationally experience not only a passage from one kinship relation to another, but also from one country, one culture to another. To make sense of what is in play in the here-and-now of family interaction, we must view it from multiple angles, relying on a transcultural approach to treat the issue of the child’s otherness in all its complexity. This reading is carried out along several axes : the transgenerational history of the parent or parents, the child’s history and the consequences of his or her living conditions prior to the adoption, the adopted child’s multiple loyalties and sympathies, and the family’s representation of the child’s otherness. Only such a mixture of readings can re-establish a psychical truth that comes close to the child’s history, with no discontinuity between the before and after, and offer an approach to coexistence of diverse affiliations in the child adopted abroad without this threatening the parent-child bond.
Adolescence, 2013, T. 31, n°3, pp. 521-530.
Revue semestrielle de psychanalyse, psychopathologie et sciences humaines, indexée AERES au listing PsycINFO publiée avec le concours du Centre National du Livre et de l’Université de Paris Diderot Paris 7