Cet article propose une lecture spatio-temporelle du contrat de poids dans la prise en charge des patients anorexiques hospitalisés. Il y est envisagé comme une médiation thérapeutique à visée temporelle. Aux frontières spatiales du lieu de soin s’ajoutent en effet les frontières temporelles des poids de séparation et de sortie. Leur articulation produit un phénomène de « temps pondéral » qui se fait l’écho des mouvements psychiques du patient à l’égard de ses objets parentaux.
A decisive step in the construction of the child, hate expresses a destructiveness that overcomes the initial resistance to autonomy. Freud illustrates this with the Fort-Da wherein the child exercises, then overcomes, his controlling drive. And D. W. Winnicott insists on the crucial role of the mother during this step in which hate is redirected against her. For Freud as for D. W. Winnicott, hate is at the origin of thought: without hate, there would be no separation, and no construction of the psyche-body.
Étape décisive dans la construction de l’enfant, la haine exprime une destructivité qui surmonte la résistance initiale à l’autonomie. Freud l’illustre par le Fort-Da où l’enfant exerce, puis dépasse sa pulsion d’emprise. Et D. W. Winnicott insiste sur le rôle crucial de la mère durant cette étape où la haine se retourne contre elle. Pour Freud comme pour D. W. Winnicott, la haine est à l’origine de la pensée : sans haine, pas de séparation ; et sans séparation, pas de construction du corps-psyché.
It is standard to say that the psychical work an adolescent must accomplish is a work of separation, in particular with the objects of childhood. In fact it seems more accurate to speak of an adjustment of bonds between parents and adolescent. The former must be neither too lax (otherwise the adolescent may feel abandoned) nor too clinging (otherwise the individual may be kept from constructing a psychical space of his own). An institutional phase in which each, adolescent and parent, will be able to find his place can help in finding the right distance. Participation in a parents’ group at the time of an adolescent’s institutionalization allows for work on the adjustment of bonds.
Between fetishizing a body that has become a gauge of the subject’s value, and maintaining play as a way to obtain narcissistic and libidinal satisfaction, sports have become a source of investment where the subject, the social and the political meet. Using the biography of Andre Agassi, the famous tennis player of the 1990’s, we will explore the different aspects of parental control – in this case, a father’s – of the psychical fate of a top athlete.
Entre fétichisation du corps devenu un repère de la valeur du sujet et maintien du jeu comme modalité d’obtention de satisfactions narcissiques et libidinales, le sport est devenu une source d’investissement à la croisée du sujet, du social et du politique. À partir de la biographie d’Andre Agassi, célèbre joueur de tennis des années 1990, nous explorons les divers aspects de l’emprise parentale – ici un père – sur le destin psychique d’un sportif de haut niveau.
Adolescence is often considered as a passage. In every culture, there are ways of setlling and regulating problems of passage from one status to another – among these the status of adolescent – without too much anxiety for novices and already initiated adults. In ours o-called modern societies, which are complex and culturally mixed, there seems to be a greater risk of adolescents getting lost and remain on the margins. We would like to clarify the notion of rites of passage recall their definition and functions using the work of A. Van Gennep.
This article recounts individual psychotherapeutic work undertaken with a deaf adolescent, in the specialized institution where he was received, and shows to what extent adolescence can be a violently disorganizing crisis, but also a time when new resources can be mobilized. Separated from his family since the age of four years and ten months on account of his handicap, his entry into puberty brings the issue of this estrangement to the forefront. At this moment, Amadou evokes different versions of the separation, genuine « scènes pubertaires (pubertary scenes) » (Gutton, 1991) in which the childhood event is made present, the violence of this event linking it to the violence of puberty. The crisis he goes through is an opportunity to elaborate the childhood trauma, to find and investigate supports offered by his environment – psychotherapy, the institution, and the family. This case study helps us to reflect more generally upon the Oedipal issues of separation, the visit from his parents at the acme of his crisis having enabled him to get more involved in an adolescens process (Gutton, 1996). This work also provides an opportunity to study the work of anthropologists and psychoanalysts (Emy, 1972, 1988 ; Ortigues, 1966) whose work sheds precious light on the child’s separation from the mother and the family, and on the specific characteristics of the organization of the Oedipus complex in an African milieu.
The traumatic death of a member of her family seems to have thrown Sylvie, a teenage girl cared for in a day hospital, into an exclusive concern for the dead. However, this lack of separation from the dead is not the sign of a mourning process in progress, nor of a melancholic bond with an object already lost. It bears witness to a cryptic inclusion of a traumatic loss unelaborated by the former generation. This inclusion generates an incestual bond in the family, which Sylvie tries to process through her obsessive questionings about the dead.
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.
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