Personnalité et troubles somatiques - 11/11/18
Personality and somatic disorders
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Résumé |
Depuis quarante ans, un courant de pensée a attiré l’attention des cliniciens avec pertinence sur les particularités psychiques de malades somatiques graves. Cependant, le renouveau du champ ancien des relations entre corps et psychisme (Briquet, Charcot, Janet et jeune Freud) conduit à réévaluer le sens des observations. Ce réexamen est balisé par plusieurs assertions. Deux fonctionnent comme des préliminaires d’argumentation : 1. les blessures existentielles peuvent générer des altérations durables de la personnalité ; 2. les blessures existentielles peuvent générer des troubles somatoformes. Deux thèses émergent dès lors : 1. les maladies somatiques peuvent générer des altérations durables de la personnalité ; 2. à ce jour aucune personnalité prémorbide prédisposant de manière univoque aux troubles somatiques n’a pu être isolée. Cette dialectique conduit au rapprochement de deux assertions corollaires : 1. la « pensée opératoire » ou « alexithymie » des malades somatiques pourrait ne représenter qu’un effet de l’annonce de la maladie organique ou de sa chronicité ; 2. la vieille « hystérie dissociative » avec manifestations somatiques trouve son substrat dans des blessures existentielles et non dans une personnalité prétraumatique. Malgré leurs différences, symptôme psychosomatique et conversion partagent dès lors la propriété d’être une réponse primitive à des blessures existentielles dans lesquelles le sujet ne peut produire aucune réponse appropriée – psychique ou comportementale – à sa détresse.
Le texte complet de cet article est disponible en PDF.Abstract |
In the title of this text, by somatic disorders we mean those physical illnesses clearly related to a non-psychiatric medical field, frequently termed psychosomatic illnesses and somatoform disorders. For forty years, a trend of thought has focused with pertinence on the psychological peculiarities in patients with severe somatic diseases. Moreover, causality was often supposed in the regularly mentioned association between personality features and somatoform disorders. However, the revival of the study of the earlier field of relationships between mind and body by Briquet, Charcot, Janet and Freud in his first period has led to the reassessment of the meaning of these observations. This reexamination is marked out by several assertions. Two of them work as preliminaries to argumentation: 1. existential wounds may produce long-lasting personality alterations; 2. existential wounds may produce somatoform disorders. These phenomena have been rediscovered over the last few years among assaulted subjects as well as war veterans in whom a frequent occurrence of somatizations has been, in addition, closely linked to the incidence of behavior or personality disorders. Two theses then emerge: 1. somatic diseases may produce long-lasting personality alterations; 2. until now no premorbid personality univocally predisposing to somatic diseases could be found. Indeed, during the 1980s a growing body of negative results coming from retrospective and prospective studies as well as anatomical comparisons have accumulated upon the potential role of certain personality factors in the incidence of somatic illnesses. This dialectic leads to the connection of two corollary assertions: 1. “pensée opératoire” and “alexithymia” in patients with somatic diseases may represent only an effect of the announcement or chronicity of the organic disease; 2. the old “dissociative hysteria” with somatic manifestations finds its substratum in existential wounds and not in pre-trauma personality. Indeed, on the one hand, recent publications do not allow the assertion to be confirmed that alexithymia and “pensée opératoire” predispose to somatizations. On the other hand, personality disorders in subjects with “dissociative hysteria” as well as their somatoform symptoms appear mainly as an effect of an existential wound and express in fact the Janetian concept of “a drop in Psychological Tension”. Then, in spite of their differences, conversion and psychosomatic symptoms share the property of being a primitive response to existential wounds in which the subject cannot produce any appropriate psychic or behavioral response to his distress. Light is shed on these phenomena when put alongside the field of “fixed ideas” thought of by Pierre Janet as the recourse to archaic automatisms. Indeed, the experience which contradicts the vision of existence provokes an “unspeakable terror”. It is mentally unrepresented or represented in too slight a way. In such cases, no previous personality prevails, but the resulting personality often appears modified, including when the breakdown of vision of the existence results from the diagnosis of an illness or its protracted course.
Le texte complet de cet article est disponible en PDF.Mots clés : Personnalité, Alexithymie, Trouble somatique, Psychosomatique, Dissociation somatoforme
Keywords : Personality, Alexithymia, Somatic disorder, Psychosomatics, Somatoform dissociation
Plan
Vol 44 - N° 5
P. 471-475 - novembre 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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