Nous présentons le cas clinique d’une jeune fille de 22 ans hospitalisée sous contrainte dans notre service de psychiatrie de secteur, suite à des événements traumatiques : déni de grossesse et accouchement au domicile dans un contexte d’inceste père-fille. À partir du cas clinique de cette jeune fille, victime d’inceste, nous essayons de mettre en évidence comment le processus de parentification s’articule avec l’inceste subi. L’inceste semble en lien avec la parentification de Léa, qui prend en charge ses parents très fragiles, en apercevant très précocement leurs troubles psychiques, troubles diagnostiqués plus tard par des expertises psychiatriques : trouble grave de la personnalité, versant personnalité narcissique chez la mère et une pathologie psychotique paranoïaque chez son père. Dans une perspective intergénérationnelle, Léa apparaît comme la femme de son père, la mère de ses frères et sœurs et une mère ou une grande sœur pour sa propre mère. L’histoire de Léa évoque les liens d’une emprise extrême des parents sur leurs enfants et l’enfermement d’une famille sur elle-même, un univers où l’intimité, l’intime n’existent pas, où tout se partage, où les places sont interchangeables, dans les chambres, dans les lits, fonctionnement soutenant le fantasme d’une famille où les frontières entre les générations n’existent pas. La longue prise en charge dans un service intra-hospitalier psychiatrique a pu constituer pour Léa un premier lieu d’écoute, qui lui a permis de sortir de son enfermement, d’avoir d’autres modèles identificatoires et de découvrir d’autres manières possibles de fonctionner.

From the clinical case of this young woman, victim of incest, we try to highlight how the process of parentification is articulated with the incest suffered. The concept of parentification seems very useful to us in order to understand some functions of the incestuous families and especially the place of this child in the family dynamics.

We present the clinical case of a 22-years-old girl hospitalized under duress in our adult psychiatry department, as a consequence of traumatic events: denial of pregnancy and delivery in the place of residence in a context of incest. Léa, the eldest of her siblings, suffers the sexual abuse of her father at the age of twelve.

For this clinical study, we use the clinical and psychotherapeutic interviews and a psychological examination, made during her long intra-hospital management in our psychiatric service.

The psychological examination (WAIS-IV, Rorschach, TAT) highlighted a limited intellectual level and a psychic functioning governed by fears and defenses of the psychotic register. For Léa it is impossible to question his parents or to express of her aggressiveness or her feelings of injustice or damage towards them. How far can this submission go? Submit herself to all the desires of the parents, including the fulfilling of their needs or sexual desires? In the case of Léa, parental influence seems absolute, overwhelming. No undifferentiation and individuation, Lea always uses the plural (she and her brothers and sisters or she and her parents) as if they were functioning as a whole, as if they were extensions of herself, we evoke the family clan, where the undifferentiation reigns and all of them seem to be interchangeable. Léa seems to be masochistically aware receptive, always responding to the physical and emotional needs of others: her parents, siblings and later patients in the hospital. During her hospitalization, Léa seems to spontaneously assume the role of caregiver, as she had assumed this role with her sick parents before, a position that is related to Léa's choice to undergo training in a medical social field. Lea took the role of caregiver and confidante for her mother, described as very fragile and depressed. Her mother, also the eldest of her siblings, has always been “very family” (just like Lea) and has never been able to leave her parents’ home. One could ask the question of a possible parentification in the mother, whose parents would have been followed in psychiatry, which could support the hypothesis of a possible transgenerational transmission of the process of parentification in this family. Lea seems to be like a “little wife” for her father. At the announcement of the test results confirming incest, Lea appears for the first time, during this hospitalization, totally disorganized and in the grip of terrible anxiety.

From an intergenerational perspective, Léa appears as the wife of her father, the mother of her brothers and sisters and a mother or a big sister for her own mother. She shares the intimacy of her parents and even the bed of the father, being no longer here in the register of fantasy, but in that of an incestuous passage to the act. The father, described as very violent, will attack his own daughter, substituting her for his wife. In this way, mother and daughter share the same fate, the differentiation of generations being canceled and the subjects being interchangeable. Incest seems to be linked to Léa's parentification, who takes care of her very fragile parents, by seeing their mental disorders. Later, the psychiatric expertise diagnosed a serious narcissistic personality disorder in his mother and a psychotic pathology in his father. Parents exercise extreme control over their children, in order to “protect” them from the outside world, perceived as hostile and dangerous. They set up a closed, self-sufficient family system. The psychic disorder (in a psychotic register) of his father seems to be the most destructive factor of parentification. The generational reversal and fantasy of saving one's parents as a consequence of the process of parentification engenders parental care and extreme dependence in parent-child relationships. Lea's empowerment process is stalled and leaving those parents is impossible, as their survival will be threatened without her help. The care in psychiatry and the effective removal of all his family could allow the empowerment, which will help her out of their alienating influence and become aware little by little of his position victim. Léa's early maturity (in connection with her fantasies of “little mother” for her siblings and the savior of her parents) seems to correspond to this “traumatic progression” of children (described by Ferenczi) who are confronted very early with situations of deficiency and abuse. Léa's story evokes the bonds of an extreme hold of parents on their children and the confinement of a family to itself, a universe where intimacy, the idea of intimate does not exist, where everything is shared, where the places are interchangeable, in the rooms, in the beds, functioning that supports the fantasy of a family where the borders between the generations do not exist. The lack of integration of social and moral laws in the family seems to generate violent behavior, the confinement becoming stifling and deadly, tipping children and parents in a total drama and Lea in an “endless nightmare”. The management of a psychiatric intra-hospital service was able to represent for Léa a first listening place, which enabled her to get out of her confinement, to have other identifying models and to discover other possible ways of function.