Tentatives de suicide graves et répétées, et vicissitudes du travail de séparation à l’adolescence. Réflexions théoriques à partir d’un cas clinique

• Published in: Neuropsychiatrie de l'enfance et de l'adolescence Vol. 62; no. 7; pp. 437 - 445
• Main Authors: Mille, C., Agneray, F., Loget, M.
• Format: Journal Article
• Language: French
• Published: Paris Elsevier Masson SAS 01.11.2014; Elsevier
• Subjects: Etude clinique de l'adulte et de l'adolescent; Feelings of shame and suicide; Process of separation-individuation; Processus de séparation-individuation; Psychologie. Psychanalyse. Psychiatrie; Psychopathologie. Psychiatrie; Sciences biologiques et medicales; Sciences medicales; Sentiment de honte et suicide; Severe suicide attempts in adolescence; Suicide; Tentatives de suicide graves à l’adolescence; Travail de séparation psychique; Travail de séparation psychique; Processus de séparation-individuation; Severe suicide attempts in adolescence; Process of separation-individuation; Feelings of shame and suicide; Tentatives de suicide graves à l’adolescence; Sentiment de honte et suicide; Tentatives de suicide graves à l'adolescence; Homme; Perlaboration; Séparation individuation; Adolescent; Tentative suicide; Etude cas; Théorie
• ISSN: 0222-9617; 1769-6615
• DOI: 10.1016/j.neurenf.2014.07.008

Le but de cet article pourrait être de revisiter les concepts théoriques qui portent sur les aléas du travail de séparation psychique chez les adolescents gravement suicidaires en s’appuyant sur une situation clinique particulièrement éprouvante. La position « intraitable » de ce jeune patient semble en effet témoigner de la validité de l’hypothèse soutenant que la recherche active de la mort peut constituer un moyen de renouer avec un état d’indifférenciation. Tout se passe en effet comme si la disparition du sujet constituait la condition requise pour échapper aux tourments d’une conscience séparée, et récupérer ainsi, sous couvert d’un fantasme de fusion, l’amour inconditionnel des objets primaires. L’enjeu thérapeutique pourrait être d’accompagner les adolescents pris dans ce piège narcissique dans une élaboration de la honte liée à leur corps sexué et aux sentiments ambivalents éprouvés à l’égard de leurs parents, afin qu’ils soient moins en nécessité défensive de soutenir cette mortelle quête d’union symbiotique avec « l’objet primaire ». Clinicians who work with hospitalized teenagers often face some young patients’ relentless suicidal determination: these patients seem to have sentenced themselves to death. For several months, sometimes years, no one manages to revoke this incomprehensible capital punishment. This painful conviction that they are unworthy often comes with depressive affects that resist on a long-term basis, despite the combination of antidepressants and a psychotherapeutic approach. Thinking is too stressful: they long to suspend any psychic life, to stop the emergence of any desire and to end any relational impulse. They keep trying to stay in a factitious world, far from real life requirements, as a temporary alternative to death. Through the anaesthesia it produces, the use of drugs offers them a strong protection from their pain. The regressive search for a feeling of lacking psychic differentiation seems to confirm a defect of development within the first phase of the separation individuation process. Narcissistic vulnerability is often underlined in most psychopathological studies concerning suicide attempts during teenage years. Combined with the incapacity to endure any loss, this last element seems to imply that a “relationship of encroachment” exists between the subject and its environment, as well as a persistence of a broad area of lacking differentiation within the maternal imago. From this theoretical point of view, suicidal gestures from these patients are often understood as desperate and paradoxical attempts to reach their boundaries, to maintain their identity and to “withdraw themselves from the object of alienation”. These relevant interpretations hide the “search of a narcissistic state of undifferentiated union” that F. Ladame highlighted during the psychoanalytical counselling of numerous young and seriously suicidal patients. Through this article, we propose to try and re-examine the theoretical concepts related to the ups and downs of the psychic separation work needed by teenagers, particularly for those who went through serious suicide attempts. The presentation of a particularly difficult clinical situation will help us bring context to our subject. The uncompromising posture of this young patient seems to give credence to the hypothesis claiming that the active pursuit of death may be a way to reconnect with an undifferentiated state. In the case of our teenager, everything is going as if his disappearance was the only way to escape from the torments of a separate consciousness, and therefore recover the unconditional love from primary objects through the guise of a fusion fantasy. How can we guide adolescents caught in this narcissistic trap? The therapeutic challenge could be to guide them through the elaboration of the shame attached to their sexual body and of the ambivalent feelings they experience towards their parents. The aim would be to allow them be less dependent on their defensive way to support this deadly quest of symbiotic union with the “primary object”.