Psychotic manifestations in adolescence can take on a defensive aspect when dealing with psychotic illness, a breakdown (Laufer, M. and M. E.). Fanny presented delusive and hallucinatory activity and her symptoms disappeared after two years of therapy. Psychotherapeutic technique must follow a common thread: the conviction that the delirious and the hallucinatory belong to the internal world of the patient and form part of her narrative about herself; the associative thread of the session makes it possible to suggest that the patient invite psychotic elements into her psychic space or world, thereby putting them into the “world,” which is an identity created by the psychotic person.
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Paula Vodickova : Autism and the Pubertal
Puberty compels the autistic subject to do some psychic work, and doing so via corporeity has integrative effects on the psyche. The enigmatic other becomes the target of eroticized demands. The sex drive is diverted to serve the purpose of an identity/narcissist construction. The autistic pubertal finds its denouement in a fetishist reality beyond adolescences.
Nicole Catheline : puberty and psychotic functioning : an inter-generational confusion
The symptomatology of early adolescence (13 to 15 years) raises a number of questions: is this the expression of changes induced by puberty, or should we see in it the seeds of an onset of mental illness (e. g., schizophrenia)? The parents’ reaction to their child’s adolescence seems to be a determining factor in any attempt to answer this question. Indeed, when the child’s puberty too strongly solicits the parents’ own experience of adolescence, inter-generational confusion can set in, weighing upon the process of disengagement from Œdipal bonds and hampering the adolescent’s identity process.
Anne Edan , Sophie Gasser, Laurent Frobert : Angélique and the three bears
The story of a seventeen year-old girl hospitalised for a psychotic breakdown illustrates the importance of preserving a diagnostic opening between psychosis in adolescence and the onset of psychosis, despite the case history and symptoms. The nurse referents were the thread linking different therapeutic spaces, enabling (re)structuring and a return to symbolization.
Gianluigi Monniello : Therapeutic Actions in Psychotherapy with Adolescents
Like other basic psychoanalytical constructions, the theory of therapeutic action is currently undergoing revision, and theorists of different persuasions are suggesting different mechanisms.
In the domain of clinical research, the author argues that psychoanalytical psychotherapy with adolescents enables us to describe both treatment goals, (that is, changes) and technique (that is, the strategies that can help to bring about these changes). Interventions that facilitate change can be placed in one of two categories : those which make use of several transformational aspects of the therapeutic relationship, and those which increase insight and reinforce identity.
In particular, the treatment of an adolescent suffering from personality disorder calls into question the identity of the analyst who is specifically engaged in the process of self-analyzing his own adolescence. The work of recognizing and elaborating this process can prove to be a fundamental therapeutic action.
The description of two clinical vignettes will illustrate the different therapeutic actions that are in play.
François Richard : The Work of Representation and the Psychotic Process
This paper supports the hypothesis that the process of subjectivation resorts to a firmness of personal or artistic style when the subject is threatened by psychotic attacks, especially during adolescence. Thought and representation are then seen to intensify in the subject, but it is difficult to distinguish between the excess of melancholic consciousness, psychotic anxiety, and a type of sublimation that is fascinated by drive chaos. The paper proposes a second hypothesis regarding, inversely, the usefulness of a kind of solitude and of masochistic compromise with object and reality. A moment of psychotic crisis in an adolescent girl with a neurotic problem is presented in terms of how the quest for the distinctiveness of style curbs her breakdown. The paper then analyzes the theatrical work of the playwright S. Kane in detail; indeed, here we find an example of the paradox of a suicide that follows successful representational mastery. Finally, we discuss Freud’s ideas about masochistic destructiveness and Winnicott’s ideas about the core of the true self as being non-communication.
Laurence Chekroun : The Evolution of a Psychotic Adolescent in Psychotherapy
Using E. and M. Laufer’s theories about adolescence and G. Haag’s theory about the normal development of babies, this article offers some reflections about the evolution of an adolescent girl in psychotherapy following a « development break » and the appearance of a delusion at the moment of puberty.
Ignacio Melo : Notes on the Hallucinatory
The outcome of psychotic disorders during puberty depends on how the adolescent and his therapeutic environment make use of the adolescent’s hallucinatory world. When used and worked on within the analytical relationship, the narcissistic part of primary identifications is preserved, and it is no longer necessary to disinvest the Unconscious, as Freud postulates in the case of President Schreber and in schizophrenia. The hallucinatory then becomes a precious tool for saving and expressing desires; putting it into words will help to lighten the economy of the adolescent’s psychological functioning. This is illustrated using two clinical cases.
Stéphane Bourcet : Acute Psychosis, Early Schizophrenia, and Adolescence
The evolution of acute delusive psychosis towards schizophrenia is far from prevalent, and in fact represents a minority of cases. However, it is indispensable that the care and treatment of every acute delusive episode continue for a period of one or two years after the symptoms have subsided. Specialized follow-up care allows for ongoing observation and evaluation of the patient, and enables us to give a more precise diagnosis, which may be that of mood disorder.
Daniel Marcelli: Adolescent Psychosis
The notion of schizophrenia often features in current psychiatric publications. What does this resurgence mean? Diagnosing an illness when the first symptoms are noticed, or even before, is an approach that is all the more justified because there is an effective treatment for it. But can the issue of adolescent psychosis simply be reduced to an illness that disturbs the normal functioning of the cerebral neuro-synaptic system, without taking into account the subject, his/her history, and the changes of his/her pubertal transformation? Effectively, every adolescent’s feeling of existential continuity is threatened by a risk of breakdown or rupture representing a real psychotic threat, which can be called “pubertal psychosis.” These are expressions describing a negative potential for disorganization that the contemporary person must surmount in order to fulfill the requirements of a subjectivation imposed on each as a mark of singularity. However, this work of subjectivation, which is never totally attained or completed, cannot start or continue if the narcissistic foundations of early childhood did not provide the subject with a sufficient basis of security. In the absence of this foundation, the gendered transformation of the body and pubertal fantasy become traumatic: in such a highly uncertain context, nosographic designation usually takes the form of a stigmatization for which the adolescent is at risk, especially given that one of the strategies for standing out consists of self-destructive activities. This justifies the importance of psychotherapeutic assistance to create with the adolescent a relational history that can serve as a prototype of a familiar foothold in the absence of the possibility of a return to self.