Contenu du sommaire : De la cause à l'effet

Brain construction is based on a series of processes including cell differentiation, neuronal migration, axonal guidance and formation of neuronal connections. These processes are tightly controlled by our genetic background. Nevertheless, it is now clearly established that affective and sensorial individual experience lead to multiple possibilities of brain rearrangement. This cerebral plasticity is largely observed during brain development but is also tremendously active throughout adult life. Our personal history therefore constantly lead to subtle structural and functional modifications of our nervous system which will be the support of the high diversity of our thought and our behaviours.

Thought is matter, messages, relations with the world are represented to various levels of nervous system. Psychotherapeutic words and psychotropic drugs would drow synaptic connections, plastic and variable forms by modulating genetic expression of neurons (individuel memory) without modifying genome (memory of the species).

Traumatism has acquired these last years a considerable place in its most simplified meaning, as the irrefutable cause taking into account a linear determinism. Considering this fact, the author develops the Freudian notion of traumatism as being linked to the diferred action, and therefore determining the double impact of the present on the past and of the past on the present. This allows the following precision : the psychical causality is linked to a certain type of temporality on the one side, and to a certain functioning of the memory and the trace on the other side. From this, the author extends her inquiry asking which causality is to be considered when the diferred action is not possible.This leads to the use of the Ferenczian conception of traumatism, that open the reflexion on the « non event » causality.

The author considers roots of resilience from a clinical psychoanalytical point of view. He points out the importance of trauma, Ego defense mechanisms and specially mentalization procedures to face the tensions linked to the trauma. He also develops a preventive perspective to facilitate resilience construction and propose some research ways.

To be exposed to a traumatic event can be a very big disruption in somebody's life. If the psychoanalysis has always been interested in traumatism, the study of neurosis has shown that the origine of symptoms can be found in an unconscious psychic conflict. In a traumatic neurosis, symptoms are not related to an unconscious conflict. The introduction of the concept of reality allows us to speak about the traumatic experience like an « unfortunate encounter ». The traumatic experience only turns the first trauma, which is linked to the first threat, the one of distress consecutive of the separation from the primal object, into a reality. Every trauma is structured in an afterward way. An unfortunate encounter is nothing else but an encounter with reality. This reality is the cause of the subject.

At the end of this century, the traditional mediation centers are in crisis. The unlinking process is increasing among the adults and the teenagers. Magistrates, psychologists, social workers are worried because adolescents proceed more and more often to put their feelings into action. Transgressing the rules or the prohibition imposed by human conventions, the violent lot isolates himself from community, braves it, having broken the borders determining common standards. The compulsory repetition draws our attention to the failure of the psychic elaboration and the impasses of subjectivating the isolated delinquant. Is it possible to prevent destructive acts ? How intercede in favour of these young people in break of a social link ? Is it not advisable to stand on the « other scene », precisely where the subject question is ?

Rafael's experience illustrates on the one hand how complex the building of a psychopathological case can be, on the other hand how intricate the underlying axioms of a clinical psychosomatic description prove to be. Rafael's case could be tackled in two different ways, if one should consider either the freudian theory of neurosis or the Paris Psychosomatic School teaching only. The nature of the diagnosis would change completely, should one theory be favoured rather than the other. In this particular instance, the terms of the discussion are constituted on the one hand by the various forms of a defective neurotical psychic organization, on the other hand by the particularities of an allergy-relating pregenital psychic organization. From a psychoanalytical viewpoint, allergy, described as a psychosomatic disorder, puts new life into the pre-œdipian three-characters figure without bringing in any of the œdipian compromise. Out of Rafael's case will be examined the building-power of the primary phobia, the signifiance of the desired object at the anal retentive phase and the incipient forms of hysterical identification.

The author emphasizes, at first, the demential singularities of language and thought among which there are a cut of the links with the disappearance of word representations and an important return to perception. Moreover, the attribution judgement seems to be more preserved than the existence one, the latter which dissolves where confusion between the inside and the outside lies. However, there are rich and poor dementias ; the first ones, in spite of mental deterioration, would manage to maintain a certain mental work, through, for example, memory hallucinations. This analysis leads, afterwords, to a comparison between the demential psychic functioning and the operative thought (Pierre Marty). From this comparison, two different models emerge, which lead us to a vast questioning about psyche-soma interactions in relation to trauma and regression.

The paedo-psychiatric clinic is so complex to cope with that causality is often misunderstood. There are lots of logical traps which may cause wrong therapeutical choices. A few examples are given here above.

The sexual symptom (impotence, frigidity, compulsive masturbation for instance) has, as any symptom, multiple determinations. That is what Freud thougt. Determinants related to organycity or to the relationship with the partner frequently come in addition. After having analyzed the causalities, real, imaginary en symbolic, the autor suggests that we examine these various causalities in their various interactions :conjonction, reciprocity, circularity and spirality.

Two different paradigms seem available in therapy : one which emphasizes linear causalities, the past and the truth, the other one, more constructivist, which emphasizes actual circular causalities

During meetings with the child and his family, the psychotherapist is immediately confronted with the many demands expressed. The auther proposes to analyse at front, with the help of clinic and psychanalytic concepts, the subjective position of the child and his different expectations. One needs to take into account the way the child expresses his suffering, his questions and what he expects, considering the elements of the transferal relation.

Summary In this interview, Antonino Ferro gives us his original point of view on the conception of analysis as an « open work ». Bion's contributions, his theory of an unconscious in constant formation and transformation and of projective identification as the basic emotional exchange, are the central points of reflection of this author. These ideas about the analytic field as a real emotional meeting place and so a place of psychic transformation, as well as his ideas about daydream thoughts are at the centre of his researchs. These are discussed in their connections with the analyst's work, his « negative capacity », his countertransference. The analytic field and the transformations which happen there, the stories which enable protœmotions to be thought, the unison between the analyst's unconscious and the patient's unconscious, all create the possibility of bequeathing the method to the patient, so he can know how to allow himself to develop his own capacity to think thoughts.