J. BERGERET and P. DUBORD
We will not talk here about the specific research carried out by the psychologist (such as projective tests or 1Q measurement, etc.), but will focus on the moment when the medical research is completed, referring to the meeting itself psychological type.
Classical “observations” can exist at various levels, starting with the observation of the “botanical” type, viewing its object from the outside, and ending with psychoanalytic observation (when, thanks to transference, the integration of the historical dimension of the object observed from the inside is discovered in the subject) through the phenomenological description of the patient being considered “ in the situation."
A psychological conversation is a common practice for a psychiatrist and clinical psychologist and is carried out either before a medical examination in order to prepare the patient, or after an examination in order to supplement it, or outside of any purely medical examinations in some institutionally non-medical cases (school problems, career guidance), when they may reveal pathological difficulties, leading us then to the first option.
Psychological conversation, and we will not tire of repeating this, first of all should not be considered in its form, as well as its goals, as
CLINIC for medical examination, but it cannot be turned into such a tempting occasion for the doctor
elude or eliminate part of your responsibility; he can share it in order to take it upon himself, without refusing, on the basis of a wider range of possibilities.
Within the framework of a psychological meeting, we are not interested in either the symptoms themselves or their somatic manifestation. The patient is not limited to the role of a passive object, as in ordinary questioning or technical examination; from the very beginning he takes place active subject, a real organizer of his own way of communicating with a psychologist, acting as a “recipient” and “witness”. This is a purely intersubjective position.
The psychologist must beware of interpreting from the very first moment (especially in terms of "Oedipus", whereas much more often we're talking about about the protective “pseudo-Oedipus”) the patient’s speech until full understanding whole organization discourse. You shouldn’t imagine anything on your own or in advance.
The first part of the conversation is not questioning, but listening. The subject should be placed as comfortably as possible.
Material (time, place, distance, money) and affective (unconstrained, sincerity, empathy) conditions become extremely important. The duration of the conversation can be from several minutes (with the risk of repeating the meeting in case of too obvious and seemingly unbearable fear) to an hour, but you should never cross these boundaries. It should be clear in advance whether this act is paid (directly or indirectly) or free - a circumstance that should not be underestimated.
The patient must have the freedom to spontaneously organize his way of expressing relationships (fusion, anaclicism, triangularity), his type of fear (dismemberment, loss of an object or castration), which should not be confused; it is necessary to highlight the main options for defense, which can extend from repression (the main type of defense in neurotics) to splitting of the ego (in psychotic patients), splitting of the imago, refusal (from what?) or projection (in transitional states), as well as the mechanisms accompanying repression, such as displacement, negation, etc.
It is better not to talk about the symptom yourself, leaving the patient to talk about it when and how he wants. "Information hunting" is a style to be wary of.
And, on the contrary, we should not forget how important it is for a psychologist to accurately assess the verbal style of expression, the level of emotional
CLINICAL CONVERSATION WITH THE PATIENT
development, degree of adaptation to reality, density of discourse, flexibility or rigidity of behavior, more or less eroticized atmosphere of dialogue, facial expressions.
The way in which these remarks are collected and experienced by the psychologist needs a personal internal re-examination in the second stage, involving a certain distance necessary to better listen to own feelings in relation to another, i.e. to your own countertransference. Under the same conditions, we note the beginning of the patient’s speech, tone, establishment of distance in the discourse (silence, pause, rejection, stopping the dialogue), the need to isolate the listener, control him, neutralize (some patients speak without stopping to avoid dialogue), the way to discuss fear or aggressiveness, identification capabilities, suppression (intellectual or affective), adaptive or protective abilities in a new and unexpected situation, ease of recall and processing of memories, style of mental activity (fantasies, dreams, behavior, reticence, projections), conflicts and defenses in their interaction.
It becomes clear how the method of separation between the conscious, unconscious and phantasmatic representations is established; the location of the symptom is identified at the mental level, at the level of behavior or at the somatic level.
There is a distinction between the “action” of discharge (aimed at avoiding the stage of desire and its representations) and the “action” as an introduction to verbal elaboration.
The second part of the conversation This part includes what was not expressed spontaneously and what should, however, be clarified without giving
the opportunity for the patient to doubt the technique, to one degree or another inspired by the classical “interrogation”, always felt like a prosecutor’s or police technique and cannot help even a masochist. We would like to be careful to clarify that “conversation,” the subject of this chapter, is actually about the totality psychological research through direct dialogue in the broadest sense of the concept and is not necessarily limited to a single face-to-face session (preferably without the mediation of any person, table, or even less “bureau”). Sometimes it is desirable, if not necessary (especially with regard to this second part), to increase the number of dialogical sessions, without nevertheless turning it into psychotherapy (narrowing the scope for this purpose).
CLINIC well, interest to specific moments, and not expanding to the random “tell me about your life”).
With some subjects you sometimes have to be persistent, then leaving them, as far as possible, to speak alone. Often a chuckle or a questioning facial expression helps a lot.
The point is to fill the main gaps in the discourse (and without excessive zeal and lack of perfectionism, which quickly become disturbing and useless), trying first to find out where the “holes” of the first part lead.
During the first conversation or subsequent ones (it doesn’t matter), certain points need to be established:
Past events in the subject's personal life. Where he was born. Where are his parents from? Where he consistently lived. How did his childhood go? His adolescence. His studies. Her difficulties. His possible military or civilian service. Naturally, speaking about himself, he must communicate his age, profession, his difficulties and desires.
Parents. You should unobtrusively collect information about the father and mother: whether they are alive or not. They live together or separately. Their profession. Age. Health status. Character. How they get along with each other. Who is in charge? The subject's previous and current relationship style with both parents. Who does he think he is more like?
Siblings. How many brothers and sisters does he have? Alive. Died (from what, at what age). Their gender, age, profession, health. Are they married? With whom. Is their marriage successful? Do they have children? The subject's past and current relationships with his siblings.
Spouse (if exists). Age. Profession. Health. Character. Wedding date. Duration and circumstances of “grooming” (events related to this: “love at first sight”, forced marriage, family drama or unusual circumstances, etc.). How did we meet? What was the mutual understanding at the beginning of the marriage? Subsequently. Who initiated the marriage: one of the spouses, parents, another person. Waiting for a child. How the choice was made. Does this remind you of your relationship with either of your parents? Was it really out of love, or was this hidden resistance, dominance over the other (the spouse is weak, sick, has no prospects...).
What were the changes in the situation family life: physical, social or emotional. Possible extramarital affairs on one side or the other.
Children. Quantity. Age. Floor. Health. Study or profession. Whether they were welcome or not. Relationship problems with or between them. How they are dealt with (connivance, coercion, absence of any coercion).
CLINICAL CONVERSATION WITH THE PATIENT |
Current health status patient. Weight in relation to height. General appearance. Note that morphology must also be taken into account, as well as our reactions of sympathy or distance towards the interlocutor. It is also necessary to know about internal diseases, possible accidents or surgical interventions performed. Then you should find out the current condition, possible disorders of digestion, sleep, menstruation, appetite, behavior in relation to tobacco, alcohol, coffee, etc., in the most ordinary and, as far as possible, natural way. This part of the meeting should not be separated from the rest of the dialogue.
Pregenitality. Orality (food and sensual appetite, needs, greed, resistance to frustration) and anality (physical and “moral” digestion, cleanliness, pedantry, viscosity, attitude towards money, style of digestive secretions and affective expression). Genitality. In a completely natural, self-evident way, we should touch upon the problems of masturbation (obsessive, absent, ordinary, with what fantasies), consistent
sexual attractions1 (to men, women, or changing depending on the case), sexual relationships (at what age was the first, how was it experienced, how did it proceed subsequently), casual relationships (for what exact purpose - filling the void, to avoid loneliness or, on the contrary, to avoid contact limited to two persons).
The difficulty of psychoanalysis always lies in the choice whether to ask questions immediately, faced with the patient's "silence" in the interim, or to wait for the next meeting. If there is nothing intimidating about asking direct questions, it will be much more awkward if it is perceived as shyness and anxiety in asking these very questions. It is very important to keep the style used in listening to the subject simple and sane. Without excessive modesty, but without “nudity”. There are as many awkward ways to be too modest as there are to be too nosy...
We should briefly touch on dreams. Without having in mind (and without the ability) to interpret dreams, one should nevertheless clarify the patient's situation in relation to sleep and oneiric elaboration. Does he always dream? What type of dreams are most frequent during the night? In the old days. At present.
Must then be accurately and carefully assessed social connections: problem of the profession (prospects, satisfaction, desirability).
1 In the original: “attirancc” - attractiveness, attractiveness, craving, i.e. attraction that has the connotation of evaluation (approx.).
CLINIC Relationships with superiors. With colleagues. With subordinates. Does the patient have friends (“real” or
just "buddies"). Many or few. Earlier. Currently. How he entertains himself (Sundays, holidays). His hobbies (sports, art). And carefully asked and recorded precisely, but with tact, an important question: does he prefer to live alone or in a group?
It is always appropriate to end the conversation with three questions: what else would he like to say? What does he expect from this meeting? What, in his opinion, with him not this way?
Understanding What happens during a conversation is neither an “accident”, nor a “test”, nor an “accusation”. This is a slice
life. This is a relatively typical and repeated experience of the patient concerning his conflicts, his failures, his desires and his shortcomings, his adaptations or less successful defenses.
During this conversation (or these several consecutive conversations) a moment comes when the subject can no longer act out the situation in such a way as to hide his deep personality. If the psychologist takes all the required precautions, the subject will soon consistently and automatically bring here his living way of relating to his fears and frustrations, anger and claims. The deep structure has no choice but to slowly manifest itself before the one who knows how to hear, listen, without forcing anything and accepting everything without making a choice.
The psychologist should show neither fear nor irritation; he should find a natural and calm style for everyone, albeit somewhat sly, but real and deep affectively sincere, which is wonderful and immediately felt by any interlocutor.
You should not be too ambitious, too hasty or too “pressuring”; the frequent “bullfight” of conversations conducted by overzealous “investigators” should also be carefully avoided, as is the desire to quickly achieve the “goal” (as if it were a question of execution); listening inevitably remains incomplete, fragmentary, tending to continue over time. One must be able to stop after thirty to fifty minutes (most often), depending on the subject, before the patient develops an annoying feeling of emptiness, “gutted™.” The problem of silence rarely mentioned by authors, but one should be able to endure it without impatience, but also without indulgence. The patient has the right to remain silent, but the purpose of the conversation presupposes that he is here
CLINICAL CONVERSATION WITH THE PATIENT
in order to speak. “Listening to silence” should not cause the psychologist either anger or a desire to complicate.
In this regard, it would not be superfluous to insist on the danger of showing a certain “courtesy” towards the patient. Often this is a form of refined neglect, so painfully perceived by the patient that his hostile tension and protest reaction are often justified.
One should carefully avoid responding to the subject’s sadistic or masochistic provocations, and avoid the temptation to dominate him (whether it be the desire to “know everything” about him).
One should also be aware of another classic trap: every time the patient overemphasizes the genital and oedipal components, it is in order to disguise well-hidden pregenital conflicts, and every time the patient demonstratively emphasizes the pregenital elements (oral and anal), then this in order to hide underlying oedipal and genital conflicts. This is a completely common trick, but even the most seasoned analysts fall for it, especially those who work with children or with developmentally delayed adults.
Anyone who deals with the “psyche” should definitely take precautions (no matter what, often insufficient) so as not to provoke the subject into aggressive, amorous or homosexual feelings. Of course, cases of “action” of this kind remain as extreme as they are known, but unpleasant experiences can be destabilizing without any action, and good faith requires them to be avoided nonetheless.
"End of Conversation"- this is an expression that does not reflect the way of separating two interlocutors: a psychological conversation does not actually have an “end”; even if the psychologist is not subsequently required to meet with the subject, the conversation may remain open. Its goal is to present the patient with problems that are more genuine and deeper than those with which he came to us. The patient must understand that there is no point in simulating an immediate (here and now) solution to his problems, real but superficial ones that he feels and which he brings to the fore.
Psychological conversation cannot constitute depth psychotherapy. If it sometimes takes on the aspect of urgent psychotherapy and narcissistic support, it is only as a side effect and without long-term consequences. Psychological conversation more often takes the place of an introduction, as much for the patient as for the therapeutic team, to reflection and decisions regarding the choice of treatment and, of course, possible psychotherapy as changes, introducing
CLINIC sims in case of need in the patient’s life (change of profession, lifestyle or even hospitalization).
As for the generalized and materialized (more or less) recording of the conversation, its volume and style significantly depend on the personality of the psychologist and the type of case presented by the patient. In any case, you should know that making a minimum of notes in the presence of the patient and a maximum after his departure is the wisest practice, on the one hand, allowing to avoid unnecessary fear in the patient and, on the other hand, providing the psychologist with the best synthesis of his problem.
THE CONCEPT OF SEMIOTICS P. DUBORD
DEFINITION AND GENERAL PRESENTATION According to general principle studying signs of clinical manifestations meaning is assigned
(semiano: I mean).
Being authentic differential highlighting, inspiring the meaning generated by the patient’s experience, whether we are talking about externally experienced, behavioral and objective or about his internal experience, his own subjective experience, semiotics studies the manifestations of the psychopathological organization of patients as perceived by the observer in his visual, sensory and emotional presentations.
It introduces selection already in the very preliminary attempt of grouping, from the first signifying organization, immediately subjecting the sign to comprehension in the context of a broader totality, which it merely formalizes.
Differentiality it brings as a word in a sentence (and if I may be allowed to continue this linguistic comparison, which does not appear inadvertently), as a paradigm included in the syntagmatic organization, to contribute to what it intends structuring own
synificatory shades.
166 CLINIC It is in this double perspective of the sign, on the one hand, perceived as an element of reliable
differentiation semiotic, paradigmatic 1 meaning, and, on the other hand, as the same sign, syntagmized from a larger totality, in which it appears as part of a whole, greater than the totality of its inherent parts, and the so-called semantic dimension, the second i side of this signifier, is contained element.
These are the two “basic” operations of clinical perception of signs that should be highlighted. We propose to begin now to study them, having clarified at the beginning that in essence we are talking about a certain way of interpreting the problem, which does not in any way involve any denial of other semiotic taxonomies, in fact numerous and complementary, as he clearly notes in his treatise A. Hey.
How: any attempt to understand the variations of personal connections in development is a study of the subject in relationship situations can only be arbitrarily separated from therapeutic activity, since in itself any entry into interpersonal contact entails dynamic manifestations at the level of the patient’s personality, which are capable of modifying the constitution of his self.
For didactic reasons, we will move towards in this case and from outside to inside, from objective to subjective, or more precisely from the level at maximum objectification, approaching his subjectivity, never forgetting that we are always talking about the same experience.
Beginning with a general and external description, we move through the patient's lived experience to the meaning current state its organization in order to later reach a more fundamental moment of fixing it object relations and the so-called basic structural organization.
It should be noted that, although this program does not contradict the medical concept of diagnosis, it should, however, be more clearly differentiated from it due to the meaning given to this elaboration: I want to talk here mainly about the pragmatic meaning of this structural definition, which in no case should be considered as self-finishing, making one forget about the patient and his truth ---- it is he who is ultimately the object of any action
in pathopsychology and under no circumstances can remain simple observation 1st simple classification.
1 The author uses the concepts of structural linguistics: a paradigmatic sign relationship connects at the level of the signified with a potential stock of other signs related in meaning; syntagmatic - at the level of the signifier, coexistence with adjacent signs of the same message
Year of manufacture: 2001
Genre: Psychology
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Description: Pathopsychology owes a lot to psychoanalysis. It is no longer possible to study mental illness by considering behavior without taking into account the psychodynamic point of view: it strives to achieve a certain task and is subjected to dual system compulsion contained in the organism itself, necessarily disunited in its search for impossible completeness, in a world that opposes these searches or offers it its own paths. Thus, attraction and conflict clearly appear as necessary basic concepts this point of view.
It is surprising that it took until the advent of psychoanalysis to realize this. Do these concepts not implicitly refer to common sense psychology and its literal expression? They explain everyday actions and guide our actions towards others. And, without a doubt, it is their banality that causes the lack of interest in them on the part of psychiatrists. Moreover, it has always seemed astonishing and implausible that these principles governing normal behavior could explain pathology, its illogicality and its persistence.
Freud's concept of the dynamic unconscious allows us to bridge this gap: absurd behavior, a symptom, have a meaning hidden in some distant limit. This discovery allows us to use what is known from the study of drives and conflicts. How numerous are the psychiatrists who extract from psychoanalysis the additional meaning it brings; they expect the psychoanalyst to interpret the hidden meaning of the symptom and also to expand the scope psychological understanding without claiming to explain the disease. And the success that psychoanalysis has gained among the general public and in numerous fields humanities or literature, is largely endowed with this visionary ability. The science of the unconscious is fascinating because it allows us to understand something better than common sense intuition could. But the right of interpretation is remembered, and it applies to any material. It is forgotten that an analytic interpretation is supported either by its effect or by its predictive power, and that it is risky to extend its application beyond the boundaries of the treatment area without specifying the system of confirmation to which it might refer.
Psychoanalytic psychopathology does not coincide with this expanded understanding of interpretation. The totality of private interpretations made about a clinical case does not sum up the psychopathological outcome. It is not enough to collect hypotheses about the meaning of symptoms, intentions, and behavior. Far more radically, psychoanalysis modified the dynamic view to apply it to pathology. The motivational forces of a person are organized not randomly, but systematically, internal conflicts express the incompatibility between individual personal structures. Moreover, this organization is not given immediately, it is born and develops in the course of the history of the subject in accordance with the conflicts that necessarily mark the stages of this history. Through the design they have chosen, the authors of this book make clear that these structural and genetic perspectives are of a fundamental nature and their study must precede the study of the various forms of pathological organization. What is called metapsychology in psychoanalysis not only provides the opportunity to have a theoretical model, but also makes it possible to create a completely new one (defensive formations, laws of primary processes, derivatives of the unconscious) and a clear semiology of specific meanings. Its knowledge is absolutely necessary for the clinician, and its use outside the area of the treatment process is even more justified.
It would be absurd to oppose the two methods. What can be said about a surgeon who refuses any diagnosis and any pathophysiological hypothesis, limiting himself to correcting anomalies that allow him to see the surgical field? In the process of treatment, meta-psychological references are obscured to make way for the study of specific manifestations. But their use sheds new light on clinical observation and some of its particular variants, such as the projective situation.
J. Bergeret and his colleagues have everything necessary qualities, to introduce clinicians, psychiatrists and psychologists to this modern psychopathology. Practitioners and educators have long been united for the purposes of clinical research and teaching. Hence this integrity of work, this same high level demonstrating how theoretical models can clarify true semiology and better understand traditional clinical syndromes. The pedagogical meaning is very important: psychoanalytic psychopathology can still develop. It forms one of the fertile fields of research in general psychopathology, and only continued progress in this field will protect us from returning to short-sighted empiricism and dogmatism.
“Psychoanalytic pathopsychology theory and clinic”
THEORY
- Genetic aspect
- Pre- and neonatal influence
- Pregenital stages
- Oral stage
- Anal stage
- Phallic stage
- Narcissism and genitality (or sexuality and narcissism)
- The problem of the phallus
- The Problem of Narcissism
- Phallic "stage"
- Ideal-“I” and Ideal-“Self”
- Depression
- Therapeutic notes
- Genital stages
- Oedipus complex
- Latent period
- Puberty
- Metapsychological aspect
- Metapsychological approach
- Topological point of view
- First topic
- Second topic
- Economic point of view
- Introduction to the doctrine of drives
- Drive theory
- Theory of fear
- Dreams, reveries, phantasms
- Beyond Freud: Other Conceptualizations
- Violence and human affective development
- The problem of protections
- Reactive education
- Substitute education
- Compromise education
- Symptom formation
- crowding out
- Primary displacement
- Secondary repression, or repression in the proper sense of the word
- Return of the repressed
- Identification
- Identification with the aggressor
- Projective identification
- Projection
- Introjection
- Cancellation (cancellation)
- Negation
- Refusal (ignoring)
- Insulation
- Bias
- Thickening
- Split Self
- Imago bifurcation
- Sublimation
CLINIC
- Clinical conversation with patients
- First part of the conversation
- Second part of the conversation
- Comprehension
- Concept of semiotics
- More specific general idea
- Semiotics of behavior
- The concept of norm
- Concept of structure
- Neurotic structures
- Neurosis concept
- Individual neurosis
- Family neurosis
- Typological Oedipal core
- Oedipal identifications
- Oedipal castration
- Pseudoneurotic forms of mental pathology
- Authentic neuroses
- Conversion hysteria
- Story
- Clinic
- Economic structure
- Hysteria and psychosis
- Hysteria of fear
- Clinic
- Economic structure
- Obsessive neurosis
- Story
- Clinic
- Economic structure
- Obsessive neurosis, borderline states and psychoses
- Neurotic depression
- Psychotic structure
- Psychotic object relation
- Mother of a psychotic
- Organization I
- Imprinting Mechanisms
- Clinical organization
- Autism
- Catatonia
- Paranoid delusions
- Paranoid delusion
- Depression
- Relationships between derealization, depersonalization, and delusions
- Psychotic universe
- Borderline states and their forms
- The Problem of Existence
- Genetic point of view
- Nosological position
- Border clearance
- Economic organization
- Acute development
- Sustainable development
- Psychosomatic illnesses
- Clinic childhood
- Theory of the pediatric clinic
- Mother and child: “transactional spiral” in the family
- Object and objects
- Identity and Identifications
- Identity
- Congenital and acquired: equipment
- Tools and Features
- Children's fears and defenses
- Ontogenesis of fear
- Fear Clinic
- Metapsychology of fear
- Phantasms and fantasy
- Fixation, regression and traumatization
- The use of three metapsychological axes and the childhood clinic
- Topological point of view
- Dynamic point of view
- Economic point of view
- Narcissism and body image
- Aggressiveness and action
- Mentalization
- Different types of organization
- Deficient types of mental organization
- Classic concept of scarcity
- A modern revision of the concept of scarcity
- Psychosomatic types of organization and syndromes
- Early psychosomatic disorders
- Late psychosomatic disorders
- Specifics of psychosomatic organization in a child
- Psychopathic and perverse types of organization
- Various types of depressive and borderline mental organization in a child
- Psychotic types of mental organization
- Clinic
- Development
- Phenomenology
- Structure of childhood psychoses
- Neurotic types of mental organization
- Childhood hysteria and hysteria of fear
- Obsessive mental organization
- Psychotherapy in children
- Review of the basic principles of psychotherapy
ORGANIZATIONAL ASPECTS
- Medical institutions
- Overview of institutional structures
- Institutions for adults
- Institutions for children and adolescents
- General principles of organization
PREFACE TO THE FIRST FRENCH EDITION
Pathopsychology owes a lot to psychoanalysis. It is no longer possible to study mental illness
considering behavior without taking into account the psychodynamic point of view: it strives for realization
specific task and is subject to a double system of coercion contained in the body itself, with
separated by necessity in its search for impossible completeness, in a world that resists
this search or offering him his own paths. Thus, attraction and conflict are clearly manifested
as necessary basic concepts of this point of view.
It is surprising that it took until the advent of psychoanalysis to realize this. Don't they relate
these concepts implicitly to common sense psychology and its literal expression? They
explain everyday behavior and guide our actions towards others. And without a doubt
it is their banality that causes the lack of interest in them on the part of psychiatrists. Moreover, always
it seemed astonishing and implausible that these principles governing normal behavior
can explain the pathology, its illogicality and its persistence.
Freud's concept of the dynamic unconscious helps bridge this gap: the absurd
behavior, symptom have a meaning hidden in some distant limit. This discovery allows
use what is known from the study of drives and conflicts. How numerous
psychiatrists who extract from psychoanalysis the additional meaning it brings; they expect from
psychoanalyst that he will interpret the hidden meaning of the symptom and also expand the scope
psychological understanding without claiming to explain the disease. And the success that psychoanalysis has gained
among the general public and in numerous fields of humanities or literature, largely
degree provided by this visionary ability. The science of the unconscious mind is fascinating because
allows you to understand something better than common sense intuition would. But the right thing is remembered
interpretation, and it applies to any material. It is forgotten that analytical interpretation
confirmed either by its effect or predictive ability and that it is risky to expand it
application beyond the boundaries of the treatment area without specifying the confirmation system on which it could
refer.
Psychoanalytic psychopathology does not coincide with this expanded understanding of interpretation.
The totality of private interpretations made about a clinical case does not fail the psychopatho-
logical outcome. It is not enough to collect hypotheses about the meaning of symptoms, intentions, and behavior.
Far more radically, psychoanalysis modified the dynamic point of view to apply
her to pathology. The motivational forces of a person are organized not randomly, but systematically, internally.
conflicts express incompatibility between individual personality structures. Moreover, this
organization is not given immediately, it is born and develops in the course of the history of the subject in accordance with
conflicts that necessarily mark the stages of this history. Thanks to the plan they chose
fundamental nature and their study should precede the study of various forms
pathological organization.
what is called metapsychology in psychoanalysis not only provides
the opportunity to have a theoretical model, but also allows you to create a completely new one (protective formations,
laws of primary processes, derivatives of the unconscious) and a clear semiology of specific meanings.
Its knowledge is absolutely necessary for the clinician, and its application outside the area of the treatment process is even more important.
justified.
It would be absurd to oppose the two methods. What can you say about a surgeon who refuses
any diagnosis and any pathophysiological hypothesis, limited to the correction of anomalies,
allowing him to see the surgical field? During treatment meta-psychological references
are obscured to make way for the study of particular manifestations. But using them in new ways
clarifies clinical observation and some of its particular variants, such as projective
situation.
J. Bergeret and his colleagues have all the necessary qualities to introduce clinicians,
psychiatrists and psychologists into this modern psychopathology. Practitioners and teachers, they are on
have long been combined for clinical research and teaching purposes. From here
this integrity of the work, this equally high level of demonstration of how theoretical models
allow the true semiology to be clarified and traditional clinical syndromes to be better understood.
The pedagogical meaning is very important: psychoanalytic psychopathology can still develop. She
forms one of the fertile fields of research in general psychopathology, and is only continuing
progress in this area will protect us from returning to short-sighted empiricism and dogmatism.
Daniel Widlescher,
professor at the University Medical Center
Pitié-Salpêtrière, Paris,
President of the International Psychoanalytic Association
Edited by J. Bergeret, the book “Psychoanalytic pathopsychology. Theory and Clinic" is of great interest to psychologists, psychotherapists and psychiatrists, and social workers. The book describes two forms of neuroses: obsessive neurosis and hysteria (fear and conversion hysteria).
Introducing short summary this wonderful book about the modern psychoanalytic approach to the theory of S. Freud.
Pregenital stages
1. Oral stage
During the development of a child, all stages gradually transform into one another and overlap each other and continues from the first year of life. Psychosexual development
The oral stage is the stage of dominance of the oral cavity as an erogenous zone or source of bodily desire. But you should also keep in mind: - the entire respiratory and digestive tract;
- organs of phonation, therefore, speech;
- sense organs: tongue and taste; nose and smell, eyes and vision;
- organs of touch and the skin itself.
Childhood sexuality includes forms of activity in the form of preliminary pleasure in the form of stimulation of the oral cavity (autoeroticism), rather than aimed at an object. The child perceives everything around him as food or swallowing objects. The need for saturation leads to separation from the object of feeding - to separation. Important note. The child puts into his mouth everything that interests him, and the pleasure of “having” is mixed with the pleasure of “being.” The goals of absorption (incorporation) correspond to specific oral fears and phobias (for example, the fear of being eaten).
At the same time, the child develops oral sadism - pleasure-laden aggression directed at an object.
2. Anal stage
During the 2nd and 3rd years of life, the child develops the ability to walk, talk, think, etc., and gradually becomes relatively independent.
Of course, anal pleasure exists from the very beginning of life, but it does not constitute the main method of libidinal release and is not yet conflictualized.
Specific conflict does not occur until control of the sphincters during defecation is established. A child may acquire a sufficient level of mastery of defecation, and at the same time he develops a bipolar sadistic desire to control and possess.
Sadism is aggression loaded with erotic pleasure, directed at a controlled object.
Gaining sphincteric discipline allows the child to discover the concept of personal ownership (something that he gives or does not give) and his power (autoerotic power over his body and emotional power over his mother, which he can alternately reward or frustrate). The child discovers in himself a feeling of omnipotence and narcissistically exaggerated self-esteem (he can oppose himself to his mother, control, subjugate and possess).
Masochism
During this same period, the child develops masochism - a passive goal of obtaining pleasure through painful forms of experience, while the pain should not be strong and not too weak. Masochism uses the passive goal of obtaining pleasure through painful forms of experience. Masochism is mental satisfaction caused by punishment. With masochistic drives, a person sets a goal to provoke others to beat him.
There is a certain connection between sadism and masochism: it is used by a child who behaves extremely actively or aggressively in order to provoke others to beat him. The child learns pleasure from a dependent or, conversely, from a dominant role.
Narcissism stands out in the foreground
Narcissism
Narcissism manifests itself in a person in the desire for independence, in the tendency to conquer, dominate. Narcissism is a manifestation of omnipotence and exaggerated self-esteem and can be classified as a homosexual personality manifestation.
The anal stage is characterized by:
- opposition between activity and passivity;
- narcissistic increase in feelings of power.
3. Phalic stage
At the end of the 3rd year of life, the phallic stage begins - the primacy of the genital organs.
Psychosexual development
At this stage, the child experiences urethral eroticism. The primary goal of this eroticism is the pleasure of urination, as well as of retention. This autoerotic pleasure is directed in the child towards objects (for example, the fantasy of urinating on others) and the possibility of free flow, enuresis.
The pleasure of urinating is twofold:
a) the phallic, even sadistic meaning of urination is the equivalent of penetration, damage, destruction.
b) as free flow, passive pleasure from reduction or removal of control.
In boys, passive free flow can be combined with other passive goals such as caressing the penis and stimulation of the perineum (prostate), with phantasms of accelerated ejaculation.
In girls, urethral eroticism serves to express conflicts with envy of the penis and the free flow of “urinary tears.”
Sphincter control Bladder develops narcissistic pride and ambition.
Child masturbation
When feeding, during hand games, hygienic care and urination, starting from the oral stage, erotic stimulation of the genital organs occurs.
Children's sexual curiosity
For a child, there is only one gender - the one represented by creatures endowed with a penis. For the child, the reality of discovering the anatomical differences between the sexes arises. At the same time, mysteries arise: the origin of children, birth, pregnancy...
Primary scene
By this we mean a scene or scenes during which the child was - or imagines that he was - a witness to the parents' sexual intercourse. Hence, fantasies are possible - seduction, castration, abandonment.
The primary scene promotes:
- identification with one of the parents, and sometimes with both, often realized in the direction of “passivity” before the power of the “greater”;
- projection of the subject’s own aggressiveness and is experienced as sadistic in accordance with the noises, screams, moans created;
-the feeling of abandonment caused in the child by the fact that he is excluded from this relationship.
Children's sex theories
Oral insemination through eating miracle food or through kissing.
Theories that attract urination (urine on a woman).
Theories of exchanging a penis for a child, showing the genitals.
Anal theory. In the child's mind, childbirth occurs through the anus, through the navel, or as a forced way of removing the child from the mother's body.
The child has a sadistic concept of sexual intercourse and depends on his fantasies.
3. Phalic stage
At the end of the 3rd year of life, the instincts are united under the influence of the genital organs.
The phallic stage is the stage of “discovery” of the difference between the sexes (in the difference between men and women) for the child. The presence of a penis as a genital organ is associated in a child with power and completeness. One of the parents is perceived by the child as powerful or weak.
In adulthood, the clitoral woman is passive, and the genital woman, without anxiety and without fear of fusion and destruction, finds pleasure in the active absorption of the penis, and not in the castration of her partner.
Child masturbation begins from the moment of feeding and is a specific erotic manifestation at the level of the genital organs during urination with a hedonic manifestation during self-reproduction.
At this time, the discovery of the difference between the sexes, the primary scene (imaginary or real evidence of the parents' sexual intercourse), occurs.
These discoveries lead the child to the idea of the necessary identification with one of the parents (a tendency toward passivity in front of the larger one), the projection of his own aggressiveness (for he perceives everything as sadism), feelings of abandonment, and this gives rise to voyeurism and scoptophilia. Voyeurism (French voyer - caretaker, overseer) or scopophilia (Greek skopeo - to consider). Scopophilia is a periodic or constant tendency to secretly watch people having sex or undressing; this usually leads to sexual arousal and orgasm. Mostly occurs in men who have suffered a schizophrenic fur coat with psychopathic changes or a defect, as well as in a psychopathic variant of the psychoorganic syndrome. Scopophilia can turn into epistomophilia, that is, in the appearance of studies of all kinds.
Baby theories of fertilization
Oral - through a kiss.
Urinate on the object of fertilization.
Exchange of a penis for a child.
The Problem of Narcissism
Narcissus and Oedipus two different models affective and relational functioning and act alternately in each person, throughout the entire duration of existence.
The Oedipus complex forms the “I”, “It”, “Super-I”, “Ideal-I” and “Ideal-Self”.
Identification is the formation and assimilation of a subject in the image of another.
In the Oedipus complex there are two attachments: attachment to the mother and identification with the father.
The "I" is the heir of narcissism. Do it, be big and strong. The child considers himself omnipotent.
The “super ego” is the heir of the Oedipus complex - do not do what you consider unworthy for yourself and for others. The demands of moral self-awareness and self-respect are the “Super-Ego.”
The “Self-Ideal” is the heir of narcissism: be like your father and a sense of self-esteem.
Oedipus complex
The main conflict of the Oedipus complex arises between the ages of 3 and 6 and is a sexual and triangular conflict between the child, mother and father.
The prohibition of incest is the law.
Latent period – from 5-6 years to puberty (before genital maturation)
The latent period is the resting phase and consolidation of the achieved position. At this time, the child turns to areas other than sexuality. During this period, there is a predominance of tenderness over sexual feelings. Free energy drives are channeled into education, into games, into social life, into products of the imagination - fairy tales, stories, and not into abstract fantasies that can cause the awakening of sexual conflicts.
In children during the latent period, the “I” is relatively strong and safe regarding sexual conflicts.
Puberty
Puberty is a period of revitalization of sexual activity and intensification of Oedipal drives.
Puberty - from the Latin - pubertas - “maturity, sexual maturity”) reflects only those changes that occur in the reproductive system, but not the cultural and social aspects of growing up, for which the term “adolescence” is more appropriate to characterize. The teenage period not only includes puberty, but significantly overlaps it in duration. During this period, eccentricity and strangeness are observed in the teenager. Pollution and first menstruation, secondary sexual characteristics (hair growth and change of voice) in a teenager are a consequence of the onset of sexual maturity.
The boy will continue throughout his life to weigh significant narcissistic value against his penis being convenient for display. In girls, there is a change in narcissistic interests aimed at the genital organs, at their entire body.
Masturbation
In boys, increasing genital tendencies find expression in masturbatory activity. Masturbation generates feelings of guilt and anxiety with masturbatory fantasies of an Oedipal nature.
In girls, masturbation is clitoral in nature and can be transferred to the hair, mouth, nose and it is often masochistic in nature.
Complete suppression of autoerotic activity can lead to psychological conflicts and even pathology.
If Puberty is passed, then sexuality is included in the personality and the Subject can have an orgasm. Those who are afraid of the signs of maturity try to continue real dependence with an unrealistic hope of omnipotence.
During the period of pre-adolescence, the task of the “I” is to destroy the parental choice (the choice between the love object of one of the parents and the sexual partner). This “teenage rebellion” against parents, authorities and their symbolic substitutes (the child’s attitude towards obedience, the parent’s towards censure) can achieve total rejection and rupture and the choice of a completely different way of life, or the restoration of mutual tolerance and mutual feelings. The way out of this conflict depends not so much on the actual attitude of the parents, but on the method of resolving or not resolving the Oedipal conflict. The teenager regresses from object love to narcissism, so teenagers often stick together (homosexual groups) to prove that “they are no worse than others” and can show their instinctive activity, which allows them to calm down in the exciting presence of the other sex, as well as from loneliness.
Text taken from the psychological site http://www.myword.ru
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Psychologie pathologique theory et clinique
Sous la direction J. BERGERET Professeur a I"universite Lyon-ll
Avec la collaboration de
A. VOSASN, J.-J. BQULANGER, J.-P. CHARTIER, P. DUBOR, M. HOUSER ET J.-J. LUSTIN Charges de cours a I"universite Lyon-ll Preface de D. WIDLOCHER Professeur au CHU Pitie-Salpetriere
8e edition
To the 250th anniversary of Moscow University
Series “CLASSICAL UNIVERSITY TEXTBOOK” Issue 7
Psychoanalytic pathopsychology theory and clinic
Edited by
J. BERGERET
Professor at the University of Lyon 2
A. BEKASH, J.-J. BOULANGE, P. DUBORD, J.-J. LUSTIN, M. HOUZER, J.-P. CHARTIER
Translation from French by doctor psychological sciences, professor
A. SH. TKHOSTOVA
Recommended by the Council Educational and methodological associations Russia in classical university education as teaching aid for students of higher educational institutions studying in the direction and specialties of “Psychology”, “Clinical Psychology”.
Moscow State University them. M.V. Lomonosov Moscow 2001
Chairman editorial board and the founder of the “Classical University Textbook” series, President of the Russian Union of Rectors, Rector of Moscow State University, Academician V.A. Sadovnichy.
J. Bergeret. Psychoanalytic pathopsychology: theory and clinic / Transl. from fr. Doctor of Psychology sciences, prof.
A. Sh. Tkhostova. Series "Classical University Textbook". Vol. 7- M: Moscow State University named after. M. V. Lomonosov, 2001. - 400 p.
For the first time in Russian, the classic university textbook on pathopsychology is presented, which went through 8 editions in France alone and was translated into Italian, Spanish and Portuguese. This book has long become a basic textbook for psychologists in many European universities and in most universities South America. A unique combination of clinical approach and classical psychoanalysis makes this publication indispensable for use by both practicing psychiatrists, psychologists and social workers and for university students studying in the specialties “Psychology”, “Clinical Psychology”.
ISBN 5-9217-0015-0
General answer
Yu. P. Zinchsnko
Editor N. A. Leontyeva Computer layout and layout S. L. Zorabov Delivered on May 10, 2001. Signed for publication on November 8, 2001. Format 60x90 "/„ Offset paper. Offset printing. Print sheet. 25. Circulation 3000 copies. Printing house of the Order of the Badge of Honor, Moscow State University Publishing House.
Moscow, Vorobyovy Gory.
© Masson, 2000.
© Moscow State University named after M.V. Lomonosov, 2001.
PREFACE TO THE FIRST FRENCH EDITION Pathopsychology owes much to psychoanalysis. It is no longer possible to study mental illness
considering behavior without taking into account the psychodynamic point of view: it strives for the realization of a certain task and is subjected to a double system of coercion contained in the organism itself, necessarily disunited in its search for impossible completion, in a world that opposes these searches or offers it its own paths. Thus, attraction and conflict clearly appear as necessary basic concepts of this point of view.
It is surprising that it took until the advent of psychoanalysis to realize this. Do these concepts not implicitly refer to common sense psychology and its literal expression? They explain everyday actions and guide our actions towards others. And, without a doubt, it is their banality that causes the lack of interest in them on the part of psychiatrists. Moreover, it has always seemed astonishing and implausible that these principles governing normal behavior could explain pathology, its illogicality and its persistence.
Freud's concept of the dynamic unconscious allows us to bridge this gap: absurd behavior, a symptom, have a meaning hidden in some distant limit. This discovery allows us to use what is known from the study of drives and conflicts. How numerous are the psychiatrists who extract from psychoanalysis the additional meaning it brings; they expect the psychoanalyst to interpret the hidden meaning of the symptom and to expand the scope of psychological understanding without claiming to explain the disease. And the success that psychoanalysis has gained among the general public and in numerous fields of humanities or literature is largely due to this visionary ability. The science of the unconscious is fascinating because it allows us to understand something better than common sense intuition could. But the right of interpretation is remembered, and it applies to any material. It is forgotten that an analytic interpretation is supported either by its effect or by its predictive power, and that it is risky to extend its application beyond the boundaries of the treatment area without specifying the system of confirmation to which it might refer.
Psychoanalytic psychopathology does not coincide with this expanded understanding of interpretation. The totality of private interpretations made about a clinical case does not fail the psychopatho-
logical outcome. It is not enough to collect hypotheses about the meaning of symptoms, intentions, and behavior. Far more radically, psychoanalysis modified the dynamic view to apply it to pathology. The motivational forces of a person are organized not randomly, but systematically, internal conflicts express the incompatibility between individual personal structures. Moreover, this organization is not given immediately, it is born and develops in the course of the history of the subject in accordance with the conflicts that necessarily mark the stages of this history. Through the design they have chosen, the authors of this book make clear that these structural and genetic perspectives are of a fundamental nature and their study must precede the study of the various forms of pathological organization. What is called metapsychology in psychoanalysis not only provides the opportunity to have a theoretical model, but also makes it possible to create a completely new one (defensive formations, laws of primary processes, derivatives of the unconscious) and a clear semiology of specific meanings. Its knowledge is absolutely necessary for the clinician, and its use outside the area of the treatment process is even more justified.
It would be absurd to oppose the two methods. What can be said about a surgeon who refuses any diagnosis and any pathophysiological hypothesis, limiting himself to correcting anomalies that allow him to see the surgical field? In the process of treatment, meta-psychological references are obscured to make way for the study of specific manifestations. But their use sheds new light on clinical observation and some of its particular variants, such as the projective situation.
J. Bergeret and his colleagues have all the necessary qualities to introduce clinicians, psychiatrists and psychologists to this modern psychopathology. Practitioners and educators have long been united for the purposes of clinical research and teaching. Hence this integrity of the work, this equally high level of demonstration of how theoretical models can clarify the true semiology and better understand traditional clinical syndromes. The pedagogical meaning is very important: psychoanalytic psychopathology can still develop. It forms one of the fertile fields of research in general psychopathology, and only continued progress in this field will protect us from returning to short-sighted empiricism and dogmatism.
Daniel Wiedlescher, Professor at the Pitié-Salpêtrière University Medical Center, Paris,
President of the International Psychoanalytic Association
Part one THEORY |
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1. Genetic aspect. M.Uzer ..................................................... ...... |
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Pre- and neonatal influence................................................... .......... |
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Pregenital stages......................................................... ............. |
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Oral stage................................................... ........................ |
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Anal stage................................................... ........................ |
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Phallic stage................................................... ................... |
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Narcissism and genitality |
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(or sexual and narcissistic) .................................................... |
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The problem of the phallus................................................... ............... |
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The problem of narcissism................................................... .......... |
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Phallic “stage” .................................................... ............. |
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Ideal-“I” and Ideal-“Self” ........ |
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Depression................................................. ............................... |
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Therapeutic notes................................................... |
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Genital stages........................................................ ....................... |
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Oedipus complex................................................... ........................... |
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Latent period................................................... ...................... |
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Puberty........................................................ .................................... |
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2. Metapsychological aspect. J. J. Boulanger |
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Metapsychological approach................................................... ....... |
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Topological point of view................................................... ......... |
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First topic................................................... ............................ |
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Second topic........................................ ............................ |
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Economic point of view................................................... .......... |
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Introduction to the doctrine of drives.................................................... ....... |
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Drive theory......................................................... ............................ |
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Theory of fear................................................... ........................................ |
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Dreams, reveries, phantasms.................................................... ........ |
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Beyond Freud: |
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other conceptualizations................................................... ............ |
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3. Violence and human affective development. |
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J. Bergeret .................................................... .................................... |
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4. The problem of protection. J. Bergeret .................................................... .... |
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Reactive education......................................................... ............... |
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Substitute education........................................................ .......... |
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Compromise education............................................................. ....... |
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Symptom formation......................................................... ............. |
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Crowding out................................................. ........................................ |
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Primary displacement......................................................... ........ |
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Secondary repression, or repression |
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in the true sense of the word................................................... . |
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Return of the repressed................................................... . |
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Identification................................................. ............................ |
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Identification with the aggressor.................................................... |
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Projective identification......................................................... |
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Projection................................................. ...................................... |
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Introjection........................................................ ........................................ |
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Cancellation (cancellation) .................................................... ................ |
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Negation................................................. .................................... |
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Refusal (ignoring)................................................... ................... |
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Insulation................................................. ....................................... |
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Bias................................................. .................................... |
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Thickening................................................. ...................................... |
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Split Self ..................................................... ................................... |
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Bifurcation of the imago................................................... ........................... |
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Sublimation................................................. ........................................ |
Part two CLINIC
5. Clinical conversation with patients. J. Bergeret and L. Dubord ... 157
The first part of the conversation................................................... ............... |
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Second part of the conversation................................................... ................... |
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Understanding........................................................ ........................... |
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6. The concept of semiotics. P. Dubord |
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More specific general idea............................................. |
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Semiotics of behavior......................................................... ................... |
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7. The concept of norm. F Beru/sulfur .................................................... ...... |
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8. The concept of structure. J Bergeret ..................................... |
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9. Neurotic structures. J. ........................... -P. Chartier |
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The concept of neurosis................................................... ........................... |
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Individual neurosis................................................... .......... |
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Family neurosis.......... |
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Typological oedipal core.................................................... |
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Oedipal Identifications......................................................... .... |
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Oedipal castration ................................................... .............. |
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Pseudo-neurotic forms of mental................pathology |
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Authentic neuroses................................................... ............... |
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Conversion hysteria................................................... ............ |
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Story.............................................. |
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Hysteria and psychosis................................................... ................... |
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Hysteria of fear................................................... ........................... |
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Clinic................................................. ................................ |
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Economic structure........................................................ .... |
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Obsessive neurosis................................................................ ................ |
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Story................................................. ................................... |
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Clinic................................................. ................................ |
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Economic structure.......................................................... .... |
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Obsessive neurosis, borderline.... states and psychoses |
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Neurotic depression......................................................... ........ |
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10. Psychotic structure. P. Dubord ..................................... |
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Psychotic object relation................................................... |
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Mother of a psychotic................................................... ........................ |
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Organization I................................................... ........................... |
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Imprinting mechanisms................................................... ......... |
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Clinical organization........................................................ ............ |
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Autism................................................. ....................................... |
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Catatonia........................................................ ........................................ |
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Paranoid delusion................................................... .................... |
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Paranoid delusion................................................... ............... |
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Depression................................................. ................................... |
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Relationship between derealization, depersonalization |
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and delirium........................................ ......................................... |
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Psychotic universe................................................... ............ |
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11. Borderline states and their forms. J Bergeret .......... |
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The problem of existence................................................... ........ |
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Genetic point of view................................................................... ....... |
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Nosological position......................................................... ..... |
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Border clearance......................................................... ........ |
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Economic organization........................................................ .... |
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Acute development........................................................ ........................ |
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Sustainable development................................................ ................ |
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12. Psychosomatic diseases. A. Bekash ................................... |
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13. Pediatric clinic. J.-J. Lusten ........................ |
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Introduction........................................................ ................................... |
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Theory of the pediatric clinic.................................................................. |
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Mother and child: “transactional spiral” in the family.................. |
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Object and objects........................................................ ...................... |
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Identity and identifications........................................................ |
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Identity................................................. ....................... |
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Congenital and acquired: equipment................................... |
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Tools and functions................................................................... .......... |
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Children's fears and defenses.................................................. .......... |
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Ontogenesis of fear................................................... ............... |
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Fear Clinic......................................................... .................... |
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Metapsychology of fear................................................... ........ |
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Phantasms and phantasms................................................... ............. |
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Fixation, regression and traumatization.................................................... |
Using three metapsychological axes |
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and pediatric clinic.................................................................. ..... |
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Topological point of view................................................... |
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Dynamic point of view................................................... .. |
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Economic point of view................................................... |
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Narcissism and body image.................................................... .......... |
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Aggressiveness and action.................................................... ........ |
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Mentalization......................................................... ........................... |
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Different types of organization................................................................... ...... |
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Introduction........................................................ ................................... |
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Deficient types of mental organization.................................... |
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The classical concept of scarcity................................... |
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A modern revision of the concept of scarcity..... |
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Psychosomatic types of organization and syndromes........ |
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Early psychosomatic disorders................................................. |
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Late psychosomatic disorders................................... |
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Specifics of psychosomatic organization in a child..... |
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Psychopathic and perverse types of organization.................. |
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Different types of depression and borderline |
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mental organization in a child................................................... |
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Psychotic types of mental organization.................................... |
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Clinic................................................. ................................ |
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Development................................................. ................................ |
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Phenomenology................................................. .................... |
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Structure of childhood psychoses................................................................... |
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Neurotic types of mental organization...... |
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Children's hysteria and hysteria of fear.................................................. |
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Obsessive mental organization................................................. |
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Psychotherapy in children........................................................ ................ |
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14. Review of the basic principles of psychotherapy. J. Berzkere .....379 |
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Part three ORGANIZATIONAL ASPECTS |
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15. Medical institutions. A. Bekash .................................................... |
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Overview of institutional structures......................................................... |
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Institutions for adults................................................................... ........ |
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Institutions for children and adolescents................................................... |
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General principles of organization........................................................ |
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