In France, for several years, special medical wards for adolescents have been created, whose targets are multiple : to evaluate the clinical situation, to contain the symptomatology, to bring an adapted answer and an appropriate treatment according to established diagnosis. This kind of ward, playing the part of substitute and containing agent, have to offer a transitional place in which the psychical workings of an adolescent will be able to spread, an adolescent who is looking for an external object it is possible to invest. Hospital staff meet with many difficulties (violence against others and oneself, work with the family, etc.) These wards have to define the treatment tool they represent and to their characteristics, their limits and their targets.
Based on a study conducted in a monastery, this article examines the meanings that can be ascribed to liturgy and rituals: through the importance they attach to the body and their performance in a place shared by the Other and oneself, can they be seen as a portal to a transitional space?
The particularity of drug-addicted youth living in the street is that they are shut out of themselves. The “ methadone bus ” tries to create a meeting within a “ transitional ” space to the rhythm of a recovered temporality, in order to provide a outline for something like desire’s inscription in “ the Other ”.
The weight contract in hospital treatment of mental anorexia, first inscribes in the heads of the patient and her family the disavowal of concern for somatic reality and its outcome, at risk of grave complications. Then it quickly becomes clear that the question is not the fantasized one of « force feeding » through a medical technique that will make her fat, but that of the process of becoming a woman, hampered by the girl who actively and willingly aborts her adolescent process. This symbolic effect of the contract has effects on the body and thought processes of the patient, allowing for revision of identifications. The constraint experienced in the therapeutic act is always much less than the violence of primitive relations of the subject of the ego with its archaic superego and aims to ease the interior constraints at the origin of food restriction and weight loss. « External » persecution opposes an internal dictator … the conflict is displaced onto the relation with the treatment (which figures the conflicts with the parents) and allows for the emergence of new possibilities of representation. The conflict is human again and for a while disavowal, splitting and projection will occur, as defenses, before the encounter within the conflict becomes possible, an encounter which protects the patient’s narcissism (she is not humiliated by asking for help, the bond having been imposed upon her). This encounter allows for an exploration of the patient’s deep desires, and her degree of resistance in disavowal or the veneer of conformism. It is this dialectic of desire and resistance which allows a diagnosis to be made in economic terms since, fundamentally, it is desire that builds alienation. The contract is a technical artifice, which provokes a separation situation deeply feared by both the patient and her family, and which reveals the complexity (nature, intensity, ambivalence) of parent-child bonds and the fantasies they have generated. It allows us to study the central issue of separation: procrastination about the weight at the moment of separation and the weight at the moment of leaving the hospital, fetishism of a certain weight, reactivation of separation issues when the patient is discharged from the institution. Adopting the language of the symptom and placing it within the framework of the weight contract, the psychiatrist can then deploy his offer of living treatment within the psychotherapeutic space.
The aim of this article is to offer some thoughts about the place of the pharmacological prescription within the framework of the institutional treatment of children and adolescents who present severe psychological disorders. Far from being a simply technical approach, prescribing medication to an adolescent within an institution corresponds to the construction of a transitional space which is the fruit of the encounter between the adolescent and the staff. The action of the psychotropic drugs must be inscribed in the overall psychical economy of the subject, taking into account the relationship between medication and the question of dependence and the inevitable issues of mastery and control that this engenders in adolescence, which are amplified by the institutional setting. Lastly, it is important to emphasize that this problematic must not be seen as confined to the specific institution which receives the adolescent, but applies more widely to the different institutions and referents which deal with the adolescent in the perspective of a multi-focus treatment among institutions and a longitudinal and parallel conception of treatment.
Starting from a case study, this paper addresses the complexity of simultaneously performing a « work of adolescence » and a « work of disease » for adolescents suffering from a serious somatic disease since childhood and being also under dialysis for a shorter amount of time. Being dependent on an artificial kidney, a nursing team, and his mother, the adolescent can hardly also grow as an adolescent. Dmitri is an adolescent who whose corporal changes have been thwarted by disease and death. During psychoanalytic work, he tries to elaborate this, starting with some video game experience. In video games, and hence, through another machine (the computer), he creates and then incarnates an avatar that lies between two universes, the real one, and a virtual one. From this state, he constructs a tale in which life and game fade into each other, where reality and the virtual world melt together in order to make the latter more bearable and also in order to make more bearable the idea that he is bound to live with a machine. This idea materializes by means of a game which he can both control and share, and which therefore serves as a transitional space
Adolescence, 2012, 30, 1, 199-215.
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