Après l’urgence chirurgicale du traumatisme physique vient le temps de la reconstruction faciale, physique, mais aussi psychique, moins visible et parfois bien plus complexe. L’auteur se base sur le travail clinique d’un atelier thérapeutique autour du portrait, plus précisément en se référant à deux séquences cliniques de ce groupe pour examiner les liens étroits entre la création et la restauration de l’image de soi. Cette étude monocentrique a été menée dans une unité de chirurgie réparatrice à Amman (Jordanie), avec près de 200 victimes civiles de la guerre civile en Irak sur une durée de six mois. Ce travail sur le terrain permet de mettre à jour la diversité des mécanismes et des étapes par lesquelles passent les mutilés de guerre afin de se reconstruire une identité. À travers l’atelier portrait apparaît la symbolisation de la phase dépressive qui précède la reconstruction identitaire.

Reconstruction comes after the surgical intervention for a physical trauma. The rebuilding of the face involves psychological as well as physical processes. The psychological aspect of reconstruction is less visible but more complex. The findings of therapeutic workshops based on the concept of “the face” have been invaluable. Clinically, the workshops referred specifically to an examination of the links between the creation of and restoration of self-image. This six-month long, mono-centric study took place in a surgical ward in Amman (Jordan) which treated almost 200 civilian casualties of the Iraqi civil war. The results improve our knowledge of the diversity of the mechanisms and stages that the casualties experienced to rebuild their identity. The first stage was to ask the patients to draw a self-portrait. All the patients portrayed themselves before their trauma. Then they were then asked to draw themselves as they were “now”, ie: after the trauma. Dira, a young burns patient, looked at himself in a mirror for the first time since the accident. For his second self-portrait he chose a variety of different papers and materials to portray the scars and the different textures of his skin. Another child used stickers to portray himself like a mosaic. Most of the patients started their work with a pencil paper and drew an oval. This portrayed the “real face”, the one hidden under the scars, the burnt skin, the bandages… Hidden, like in Dira's self-portrait, under the different layers of paper. By hiding his original face, which was still there but unattainable, he portrayed his loss and fragility. It can be seen from this workshop that the whole body image is modified after physical trauma. The intensity of the care, the pain, and the bandages is an emotional investment. They become a type of protection but also an obstacle to the process of restoring the body image. The perception of one's body as “damaged” causes a serious imbalance of the patient's self-image because of the emotional association with a deep feeling of fragility. In turn, this sense of physical fragility is closely connected to its mental equivalent. The patient's spirit goes through a destructive phase because of the external and internal emotional overload. This mechanism, which drives the body image, can slow down mental development when the patient is a child or a teenager. This destructive stage of recovery precedes the reconstruction of the patient's identity. The therapeutic workshop illustrates the symbolic importance of this stage by exposing the link between the wish to gather together the fragmented body image post-trauma and the cutting-out that Dira did for his post-trauma self-portrait. The patient rebuilds his self-image by gathering it together piece by piece. Therapeutic workshops and individual therapy enables patients to verbalize their anxieties. Therapy helps them to overcome their fear of the physical reality of their trauma and to reconstruct their psychological identity simultaneous to the surgical reconstruction.