Using the case of Sophie, who exhibits a “school phobia”, this article will examine the metapsychological issues of a symptom whose nosographic evidence encompasses the complexity of adolescent reorganizations. The connections between actual neurosis and transference neurosis lead one to think of school as a locus for the displacement of Oedipal conflicts and the after-effects of the pubertary processes (pubertaire). Expressive arts therapies appear as essential for re-starting figuration, transference and subjectivation work.
The reclusiveness sometimes associated with school phobia in the adolescent adds to its severity. Meeting a housebound adolescent in consultation has something paradoxical about it that echoes specific clinical features of this disorder. Three possible meeting formats are suggested, depending on the degree of avoidance and the dialectic of container and contained. Establishing a therapeutic frame in such situations confronts us with the pitfall of a paradoxical bond.
Becoming an adult is a step in the process of subjectivation, insofar as it initiates a new encounter with external reality and causes a confrontation with many anxieties of abandonment and castration, which can take the form of school phobia. The author uses a reading of Georges Perec’s novel A Man Asleep, along with a clinical situation, to shed light on the nature and function of this symptom in the dynamic of post-adolescence.
After talking about the growing rift between child psychiatry and psychoanalysis, the author recalls the models (medical, psychopathological, and child psychiatric) we use to conceptualize mental disorders in children and adolescents. He then examines the nature of diagnostic types (descriptive, etiological, and structural) within the major international classifications. The concept of school phobia calls for a structural diagnosis, while that of school refusal is purely descriptive.
Adolescent school phobia is associated with an anxiety so great that the resulting inhibition becomes an obstacle to the patient’s access to a fantasy life. It is often coupled with the conduct of at-home claustration, which calls our attention to the archaic fantasy of the Claustrum developed by D. Meltzer. This is a form of intrusive projective identification that thwarts the oedipal conflict by opposing the differentiation process. We will develop these notions using a clinical case.
With puberty, the experience of time becomes conflicted and emerges from the linearity of childhood. This process is thwarted when school phobia occurs in adolescence without any warning signs. The drives seem to be as frozen just as time seems to stop. In this may be seen a search for immutability characteristic of autistic syndromes. In this case the delayed action, instead of opening the way for temporality, revives a flaw at the origins.
The author illustrates how parental resistances can lay the groundwork for the adolescent’s psychopathology. The presentation of a problematic therapeutic situation helps remind us of several principles about the treatment of families. We would suggest that school phobia be considered as post-traumatic syndrome rather than a neurotic problem, while emphasizing the burden of the parents’non-introjected infantile ideals on the development of the adolescent.
Adolescence, 2014, 32, 3, 464-479.
Revue semestrielle de psychanalyse, psychopathologie et sciences humaines, indexée AERES au listing PsycINFO publiée avec le concours du Centre National du Livre et de l’Université de Paris Diderot Paris 7