The phenomenon of the imaginary companion is well described among children and elderly people, but is rarely evoked in adolescents. Its manifestation at the age of adolescence is often misinterpreted as delirium and a sign of beginning schizophrenia. In this article we present the case of Julie, a seventeen-year-old teenager, in order to illustrate the hypothesis that the imaginary companion can appear within other psychopathologies than those of psychosis and schizophrenia. The young woman uses an imaginary companion she calls « Monseigneur » (« Mylord ») to compensate for an underlying depression. We describe in detail this clinical situation, the different stages of the therapeutic treatment and the psychological evolution of Julie.
The mother-baby relation corresponds for both to a trap in which the time of development shuts down. Our observations of dyads we were close to in nursery, mother-baby center and pediatric care settings argue in favor of a characteristic mother-baby distance disorder. The infant is invested as a « transition object », used by the mother as transitory support for her parental imagoes in the course of de-idealization, within an unaccomplished post-adolescent process. This results in a behavioral and emotional « house arrest » for the baby, which will have to conform to maternal expectations if it wants to be spared the abrupt experience of defensive withdrawal of maternal investment. Caught between idealization and refusal, the baby experiences early conflict only in its aspect of rupture, which causes a problem for the construction of its subjectivity.
If there one really complex subject in psychiatry, it is the prescription of medication and the analysis of its objective and subjective effects, particularly in the adolescent, for whom the use of psychotropic drugs is relatively recent, even though it has quickly expanded. The model of institutional treatment developed here rests on the theory proposed by experienced practicians: the institutional therapeutic setting is metaphorized as a transitional space. The medication is therefore conceived of as one of the concrete objects which will allow for mediation of the bond and the establishment of a common, malleable object within the transference relation with the young patient. We discuss the possible pitfalls of the prescription and try to highlight its subjective and intersubjective aspects. If the medication must allow for the containment of intra-psychical drive activity that is too overwhelming for the adolescent, it should nevertheless not be used as a tool to obtain mastery or control over him. A « well-tempered » use of psychotropic drugs would enable one to work usefully with the patient on his inner conflicts, within the institution.
Adolescence, 2009, T. 27, n°3, pp. 759-768.