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Le développement de paradigmes psycholinguistiques devient nécessaire à l’espace de la psychotraumatologie. Analyse critique de la littérature anglophone et des premiers travaux francophones. Vers un nouveau modèle du traumatisme psychique - 23/01/20

The development of psycholinguistic paradigms becomes necessary for the future of psychotraumatology. Critical analysis of English literature and early francophone works. Towards a new model of psychic trauma

Doi : 10.1016/j.amp.2020.01.004 
Yann Auxéméry a, , Cyril Tarquinio a, b
a EA 4360 APEMAC « Adaptation, mesure et évaluation en santé. Approches interdisciplinaires » – Équipe EPSAM, université de Lorraine, Metz, France 
b Centre Pierre-Janet, Île-du-Saulcy, 57000 Metz, France 

Auteur correspondant.
En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Thursday 23 January 2020
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Résumé

Objectifs

Si l’intérêt pour la psychotraumatologie s’est progressivement généralisé au cours de la dernière décennie, faute de repérage diagnostique, de nombreux patients restent sans soins tandis que parallèlement, l’offre de psychothérapies différenciées s’est majorée. Notons également que si les recherches en neurosciences ont explosé en nombre, leurs applications concrètes utiles à la pratique quotidienne semblent plus ténues, notamment au plan pharmacologique. De tels achoppements seraient-ils causés par une prééminence de la référence au « stress » au détriment de la considération du « trauma » ? Au-delà des picrocholines querelles d’écoles, il apparaît aujourd’hui nécessaire de construire une nouvelle phase d’analyse.

Méthodes

Nous exposons une revue critique de la littérature de langue anglaise avant de focaliser sur les quelques études francophones existantes.

Résultats

La majorité des études anglophones référencées se rattachent aux protocoles de deux travaux princeps sans que les paradigmes linguistiques en soutenant le design apparaissent très structurés. L’analyse linguistique s’y avère en fait limitée, sans mention des richesses apportées par les écoles de sémantique et de pragmatique. Il apparaît toutefois une lente complexification des méthodes d’analyse textuelle dans le temps. Pour l’espace francophone, seules deux études existent : l’une de Louis Crocq datant des années 1960, et une autre de Ribeton & Auxéméry mettant en évidence le syndrome psycholinguistique post-traumatique (anomie traumatique, répétitions linguistiques et désorganisation discursive).

Conclusion

Les troubles psychiques post-traumatiques bénéficient d’un renouveau d’intérêt pour la psychiatrie et la psychologie contemporaines. La densification de la description du trouble de stress post-traumatique dans le DSM-5 pourrait encore se compléter des différentes formes cliniques spécifiques constituant les troubles psychiques post-traumatiques. Aussi, à l’heure où différents protocoles psychothérapeutiques apparaissent concurrents (protocoles comportementaux et cognitifs, traitements par l’hypnose, thérapies par mouvements oculaires, thérapies psychodynamiques, thérapies narratives, etc.), l’analyse de la restauration du langage pourrait permettre d’unifier une conception spécifique du traumatisme psychique et de ses conséquences cliniques. Le paradigme que nous proposons développe la recherche clinique à l’aide de marqueurs psycholinguistiques offrant d’évaluer l’efficacité des psychothérapies.

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Abstract

Objectives

Gradually emerging from the military medicine, interest in psychotraumatology has gradually become widespread over the last decade. Due to societal evolution, the consideration of post-traumatic psychic disorders is developing with psychopathological, neurobiological and even sociological conceptions. However, because of the clinical presentation of the psychic trauma and its clinical consequences, underdiagnosis and late diagnosis remain numerous. These suffering, intense and rich on symptomatic levels, appear most often blind concerning their psychotraumatic origins and therefore, without adapted therapeutic answer. However, many psychotherapeutic protocols have been deployed these last years from many theoretical references (behavioral and cognitive protocols, treatments by hypnosis, eye movement therapies, psychodynamic therapies, narrative therapies, etc.). It should be noted too that while the number of psychotraumatology research has exploded, the concrete evolutions useful for daily practice seem to be more tenuous, particularly in pharmacology. Would such a stumbling be caused by a pre-eminence of the reference to “stress” to the detriment of the consideration of “trauma”? Beyond the quarrels of schools, it now seems necessary to build a new phase of analysis.

Methods

As it seems to us to constitute clinically what we call a “language injury”, the psycholinguistic study appears as a space of heuristic research in order to explain the etiopathogenesis, the clinical presentations, and especially the offer of proposed care to patients suffering from post-traumatic stress disorder. If the linguistic theories have evolved a lot in the last fifty years, sometimes to the point of appearing contradictory, the tools generated today benefit from the development of logician's models and computing power. We present here a critical review of the literature of international works before focusing on the few existing francophone studies.

Results

Most referenced Anglophone studies relate to the protocols of two original works without the linguistic paradigms in supporting the design appear obvious. Linguistic analysis in fact turns out to be limited, without mentioning the wealth provided by schools of semantics and pragmatics. However, it appears a slow complexification of textual analysis methods over time. For the francophone space, only two studies exist: one from Louis Crocq dating from the 60s, and another from Ribeton & Auxéméry, more recent and for which we present a more exhaustive reading of the results. Post-traumatic psycholinguistic syndrome is here defined as a function of three symptoms: traumatic anomia, linguistic repetition and disorganised discourse. Traumatic anomia manifests in a quantitative reduction in discourse characterised by a lack of production, impaired verbal flow and lexical poverty. Linguistic repetition takes the form of phonological and syntactic repetition (verbal stereotypes, predilections, intrusions, perseverations and echophrasia). Phrasal and discursive disorganisation is characterised by time discordance, de-subjectivation (via indefinite and impersonal pronominal markers), and disfluency that can extend to agrammatism due to a lack of logical and chronological connectors.

Discussion

In order to better understand the nature and evolution of post-traumatic stress disorder, different language markers could be associated: length of production (number of words, number of letters per word, number of words per sentence, etc.), fields lexical (sensations, negative emotions, themes related to traumatic circumstances, etc.), qualities of language units (referencing to a word, an act, a movement, an idea, a sensation, etc.), syntactic structure (discursive disorganization, textual fragmentation, preeminence and discordance of time, logical inconsistencies, etc.), references to the self and others, capacities for synthesis or expansion of an idea (by dividing access to internal and external details). Ratios can be made, for example between the perceptive and cognitive terms, which would bring closer to the subjectivity. Finally, the notion of quality of transmitted information can be approached. Here, there is little consensus between studies on what is called “disorganization” and its “coherence”. The verbal production may be different from the usual speech while keeping an organization of its own, even if it would be pathological and therefore isolated from the normal Gaussian or bimodal. As a rule, textual coherence and disorganization are analyzed from several linguistic markers (possible global understanding by others, adapted spatio-temporal contextuality, time matches, concordance of themes). Finally, the characterization of a single element seems insufficient: it appears necessary to study the links between emerging language markers.

Conclusion

The understanding of post-traumatic psychic disorders benefits from a renewed interest in contemporary psychiatry and psychology. The densification of the description of post-traumatic stress disorder in DSM-5 could be further supplemented by the different specific clinical forms of post-traumatic stress disorder. But, for reasons inherent to the psychic injury, the post-traumatic symptoms remain most often marked by ineffability, post-traumatic symptom in itself which limits the diagnostic sensitivity referenced to the psychiatric symptomatology. From the systematic analysis of their discourse, we defined a new clinical approach to psychic injured patients: the post-traumatic psycholinguistic syndrome testifies to an injury of the language. Conversely, towards the care, it is the words which make it possible to be extracted from the revivals. At a time when different psychotherapeutic protocols may be concurrent (behavioral and cognitive protocols, hypnosis, eye movement therapies, psychodynamic and narrative therapies, etc.), the analysis of language restoration could unify a specific view of psychic trauma and its clinical consequences. Thus, while a new clinical model specific to psychic trauma should federate theoretical conceptions, our goal is primarily to better diagnose people suffering from post-traumatic stress disorder in daily practice. Also, the paradigm that we propose will develop research using psycholinguistic markers to evaluate the effectiveness of psychotherapies.

El texto completo de este artículo está disponible en PDF.

Mots clés : Psycholinguistique, Psychothérapies, Syndrome psycholinguistique post-traumatique, Traumatisme psychique, Trouble de stress post-traumatique

Keywords : Efficacy, Post traumatic stress disorder, Psychic trauma, Psycholinguistic, Psychotherapy, Post-traumatic psycholinguistic syndrome


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