État des lieux et horizon du soin psychique des blessés de guerre - 09/06/21
State of play and scope of mental health care for the war wounded
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Résumé |
Les enseignements des conflits armés ont participé à la structuration d’un soutien médico-psychologique opérationnel, inscrit dans un continuum décliné selon un avant, un pendant et un après la mission. C’est dans cette perspective que la doctrine de la psychiatrie de l’avant s’est construite, autour des principes fondateurs suivants : immédiateté, proximité, simplicité, expectative, non-obligation de retour au combat. Ainsi, le psychiatre en mission assure une présence, aussi accessible que disponible, autorisant l’accueil de l’intime d’une souffrance à l’échelle du sujet d’abord, mais aussi à celle du groupe, condition essentielle de l’engagement de l’action guerrière. Le risque pour le militaire au combat est celui de la blessure, physique comme psychique, qui engage dans ses effets un au-delà de ce qui pourrait en être mesuré au premier regard, et justifie une attention dans la durée. Il apparaît en effet que la blessure de guerre bouleverse les rapports du sujet à son environnement, ce qui vient mettre en exergue un des enjeux du soin psychique, qui outre la systématisation du repérage des troubles psychotraumatiques s’éprouve dans la continuité de la relation thérapeutique nouée avec le sujet. Enfin, la cohérence des soins s’organise autour d’une pluridisciplinarité qui engage aussi un travail institutionnel de réhabilitation participant pleinement au soutien des blessés.
Le texte complet de cet article est disponible en PDF.Abstract |
Objectives |
The changing nature of armed conflicts lead the defence community to confront new challenges. Deployed in either internal or external missions, soldiers are subjects to many constraints which test their mental and physical limits, and are exposed to unsafe situations which can become potentially traumatic. This psychological impact is a constant concern for Army's Health Service as well as for Commandment. Mental health specialists’ intervention in military environment had to adapt to soldiers and battle group's needs in accordance with the evolution of conflicts themselves.
Patients or materials and methods |
Lessons learned from armed conflicts participated in structuring of medical and psychological support, forming part of a continuum before, during and after the mission. In that context, battlefield psychiatric care's doctrine has been developed around the following founding principles: immediacy, proximity, simplicity, expectative, and non-obligation to return to battle. Classically, immediate phase is time for first aid, which is the only possible on the full forward war zone. Then, when fighting time is over and soldiers are in a secure space, the defusing, literally “psychological shock treatment”, engages in first dialogue after an experience which can be assimilated to a subjective disaster. This dialogue can re-establish a link of humanity with persons whose world perception might have been devastated. À few days after the potentially traumatic event, the post-immediate phase urges the caregivers in identifying disorders to provide a more structured care. It's the time of medico-psychological debriefing which can be either individual or collective. Beyond this phase, care is organized according to a coherent healthcare system, from the operational theatre to mainland, based on a network of mental health actors.
Results |
In this way, psychiatrists on mission provide an approachable and receptive presence which allows soldiers to express their pain in an individual or collective address, and therefore permit engagement on battlefield. The main risk for soldiers is to be injured, whether physically or psychologically, and justify a constant attention from health-care providers towards them.
Conclusions |
Indeed, we can see that battle wound has an influence on relationships between an individual and his environment which highlights one of the main challenges in mental healthcare, that in addition to the identification of postraumatic suffering involves in therapeutic continuity of the relationship with individual. Finally, consistency of care is organized around a multidisciplinary which requires an institutional work of rehabilitation fully participating in supporting injured persons.
Le texte complet de cet article est disponible en PDF.Mots clés : Environnement, Guerre, Lésion, Soin post-immédiat, Réhabilitation psychosociale, Traumatisme psychique
Keywords : Environment, Lesion, Post-immediate care, Psychosocial rehabilitation, Psychic trauma, War
Plan
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