Antoine Hibon : towards a child-psychiatry with a psychoanalytic orientation with the incarcerated adolescents

This article exposes and supports a research-action held during the past two years at the « minors’area » at Aix-en-Provence’s prison (theoretical number of youngsters : 33), by a child-psychiatrist team with a psychoanalytic orientation. The team believes it has gathered significant elements to establish a potentially therapeutic relationship with almost all of the incarcereted adolescents.This approach requires a deontological-technical methodology based on independance of the health department from the judiciary-penitentiary Complex.
Considering the broken histories of these adolescents, their subjectivation disorders, the danger they encounter and the danger they pose to others, their reluctance to meet psychists out of prison, one can read this article with a Public Health dimension.
The author describes the conditions of team work. Meetings are held in the « minor’s area » itself, in a close relationship with these adolescents and other adults  (teachers, wards). This framework contributes to the establishment of a group transference base from adolescents to « psychists » and vice-versa (counter-transference). Such a proximity stimulates different levels of conflictuality between the child-psychiatric team and the penitentiary administration, which can be observed and progressively treated.
This framework gives support an extensive approach (almost all) of the incarcerated adolescents. The possibility and the therapeutical potential of this approach has been checked by the team at a certain stage of the research. Two clinical vignettes will give account of two very difficult to reach adolescents. Two limits of the extensive approach are studied. The main one is related to Winnicott’s « anti-social tendency » theory : the demographic increase of the « minors’area » (beyond a 20-25 threshold), lead to the abandonment of some adolescents who were benefiting from a continuous care frame, which can cause some antisocial recurrence. Hence, the team tries to work under the level which it knows would be possible and desirable, waiting for better means to be allocated by a non-listening administration.
The surprising openness to others that these incarcereted adolescents, reluctant to meet psychists out of prison, is thrown light on by what the author calls « the nursing side of prison ». It is understood according to a metapsychological model whereby items are linked into an « idealtype » : reintroduction of the dimension of the Real through arrest-incarceration; confrontation with the constant counter-excitation strength of the state; lowering of unconscious guilt through the lived experience of sanction; triangulation through justice and penitentiary administration of mother and child relationship; restoration of deprivation and maltreatment through the positive side of surveillance and authority. A series of vignettes supports each of these items. Another vignette shows the extreme limit of this frame of thought, where prison was not tolerated, essentially because of an unsustainable sense of loss. The relative and revisable limits of the model are brought up. The catastrophic picture of abolitionists (opposed to prison for minors) is objected to, holding in mind the team’s global experience of these adolescents’evolution.
The account of the deontological-technical methodology of the team is preceded by an analysis of the health, penitentiary and youth protection guidelines, linked to a so-called pluridisciplinarity in minors’area. The author states that these texts as well as the monodisciplinary exercise stemming from them are anti-deontological and do not favor the process of subjectivation. He exposes the interest of a method which offers to the adolescent a high level of confidentiality during clinical meetings, as well as his true implication in contacts between the psychiatric team and other intervening staff.
The current idea about the necessity of mediators, indispensable to psychists in order to approach these adolescents, is relativised. The team believes in a therapeutic couple (or pair), for a better base to transference-countertransference than dual relationship. The main hypothesis is that this couple acts as the attractor-reorganisator of the « primal scene », too chaotic or violent, split off or foreclosed by the patient. A clinical vignette shows the use of this technique in particularly active modality with a difficult adolescent for whom we have a one year step back about his evolution after prison.
Some perspectives of the research-action are developped. The team’s position is undertoned by the new order about the presence of educators from the « youth judiciary protection » at the minors’area. The crucial question of the means is evoked again, in terms of post-penal follow-up, psychiatrists training, and comparative study of child-psychiatry approachs within « minors’areas ».
The main theoretical references are given, permitting theoretical and clinical developments. The author and his team are conscious that youth delinquency and its treatment are the object of socio-political constructions, with medias’intermediary, which have their considerable weight on clinical work. The reader will also have a sense of the « all prison » approach, opposed to a measured approach which has to treat on the same level the unbearable lack of means of the outside prison care and the improvement within the existing « minors’area ». The history of youth delinquency treatment has shown that any unilateral view was immediately followed by refutation.