Using two brief clinical vignettes showing two young adults – one who never presented any troubling signs in childhood, the other treated for psychotic symptoms – the author will look retroactively at the twists and turns of the adolescent process and the role that this psychic experience may or may not have played in the evolution of their lives. Is it possible that this psychic experience of adolescence is not accessible to everyone?
Adolescence, 2020, 38, 2, 423-433.
In this article, the author shows how the concept of subjectivation grew out of clinical work on psychotic states in adolescence. These are related to a melancholic core that is sometimes difficult to discern beneath the drive conflicts of puberty. Using a clinical case of adolescent-onset psychosis, the problem of the fundamental relation between psychosis, temporality and melancholy is restated in a way that can account for “ borderline ”-looking symptomotologies, within a post-Freudian theoretical framework and with reference to certain contributions of Green and Racamier.
The evolution of acute delusive psychosis towards schizophrenia is far from prevalent, and in fact represents a minority of cases. However, it is indispensable that the care and treatment of every acute delusive episode continue for a period of one or two years after the symptoms have subsided. Specialized follow-up care allows for ongoing observation and evaluation of the patient, and enables us to give a more precise diagnosis, which may be that of mood disorder.
The notion of schizophrenia often features in current psychiatric publications. What does this resurgence mean? Diagnosing an illness when the first symptoms are noticed, or even before, is an approach that is all the more justified because there is an effective treatment for it. But can the issue of adolescent psychosis simply be reduced to an illness that disturbs the normal functioning of the cerebral neuro-synaptic system, without taking into account the subject, his/her history, and the changes of his/her pubertal transformation? Effectively, every adolescent’s feeling of existential continuity is threatened by a risk of breakdown or rupture representing a real psychotic threat, which can be called “pubertal psychosis.” These are expressions describing a negative potential for disorganization that the contemporary person must surmount in order to fulfill the requirements of a subjectivation imposed on each as a mark of singularity. However, this work of subjectivation, which is never totally attained or completed, cannot start or continue if the narcissistic foundations of early childhood did not provide the subject with a sufficient basis of security. In the absence of this foundation, the gendered transformation of the body and pubertal fantasy become traumatic: in such a highly uncertain context, nosographic designation usually takes the form of a stigmatization for which the adolescent is at risk, especially given that one of the strategies for standing out consists of self-destructive activities. This justifies the importance of psychotherapeutic assistance to create with the adolescent a relational history that can serve as a prototype of a familiar foothold in the absence of the possibility of a return to self.
This article presents two clinical cases of probable onset of schizophrenia, characterized by the organization of a central symptom of hypochondria, signaling the subject’s non-belonging to the moment of pubertary transformation. In both cases, neuroleptics proved to be less useful than anti-depressants. This observation prompts three comments. The first is that it is necessary to respect a certain coherence between the rules of prescription and the clinical field of reference. The second is that antidepressants may be useful in this type of onset of schizophrenia with hypochondriacal symptoms. The third is that the neuroleptic treatment is interwoven with the subject’s narcissistic economy, an economy already implicated in the formation of the hypochondriacal symptom, which would explain the usefulness of antidepressants in this case.
Adolescence, 2009, T. 27, n°3, pp. 797-807.
Adolescence is a key period in the development of brain circuits that underlie the regulation of affects and behavior. Research on neuroimaging allows for a better understanding of the courses of normal and pathological brain development in adolescence. Thus, modifications of normal development seem to be implicated in the physiopathology of disorders like schizophrenia and various forms of depression.
Adolescence, 2009, T. 27, n°3, pp. 733-744.