Bergeret psychoanalytic pathopsychology download in doc format. Psychoanalytic pathopsychology theory and clinic - F

Under the editorship of J. Bergeret, the book “Psychoanalytic pathopsychology. Theory and Clinic” is of great interest to psychologists, psychotherapists and psychiatrists, social workers. The book describes two forms of neuroses: obsessive neurosis and hysteria (fear and conversion hysteria).
We present a brief synopsis of this wonderful book on the modern psychoanalytic approach to the theory of Z. Freud.

Pregenital stages
1. Oral stage
With the development of the child, all stages gradually pass one into another and overlap each other and continues from the first year of life. Psychosexual development
Oral stage, there is a stage of dominance of the oral cavity as an erogenous zone or source of bodily attraction. But you should also keep in mind: - the entire respiratory and digestive tract;
- organs of phonation, therefore, speech;
- sense organs: tongue and taste; nose and sense of smell, eyes and vision;
- organs of touch and the skin itself.
Infantile sexuality includes forms of activity in the form of prepleasure in the form of oral stimulation (autoeroticism) rather than object-directed. The child perceives everything around as food or ingestion of objects. The need for saturation leads to separation from the object of feeding - to separation. Important note. The child puts everything that interests him into his mouth, and the pleasure of "having" is mixed with the pleasure of "being". The goals of absorption (incorporation) correspond to specific oral fears and phobias (for example, the fear of being eaten).
At the same time, the child develops oral sadism - aggression loaded with pleasure directed at the object.
2. Anal stage
During the 2nd and 3rd years of life, the child develops the ability to walk, talk, think, etc., gradually appears relative, but already real independence.
Of course, anal pleasure exists from the very beginning of life, but it does not constitute the main method of libidinal discharge and is not yet conflictualized.
Specific conflict does not occur until sphincter control is established during defecation. A child may acquire a sufficient level of defecation mastery, and in doing so, he develops a bipolar sadistic drive to control and own.
Sadism is aggression loaded with erotic pleasure directed at a controlled object.
Acquiring sphincter discipline allows the child to discover the concept of personal ownership (something he gives or not) and his power (autoerotic power over his body and emotional power over his mother, which he can alternately reward or frustrate). The child discovers in himself a sense of omnipotence and narcissistically exaggerated self-esteem (can oppose himself to his mother, control, subjugate and own).
Masochism
In the same period, the child develops masochism - the passive goal of obtaining pleasure through painful forms of experience, while the pain should not be strong and not too weak. Masochism uses the passive goal of obtaining pleasure through painful forms of experience. Masochism is the mental satisfaction brought about by punishment. With masochistic desires, a person sets the goal of provoking others to beat him.
There is a connection between sadism and masochism: it is used by a child who is extremely active or aggressive in order to provoke others to beat him. The child learns pleasure from a dependent or, conversely, from a dominant role.
Narcissism comes first
narcissism
Narcissism manifests itself in a person in the desire for independence, in the tendency to conquer, dominate. Narcissism is a manifestation of omnipotence and exaggerated self-esteem and can be attributed to homosexual manifestations of personality.

The anal stage is characterized by:
- opposition of activity-passivity;
- narcissistic increased sense of power.
3. Phalic stage
At the end of the 3rd year of life, the phallic stage begins - the primacy of the genital organs.
Psychosexual development
At this stage, the child develops urethral eroticism. The primary goal of this eroticism is the pleasure of urination, as well as of retention. This autoerotic pleasure is directed in the child to objects (for example, the fantasy of urinating on others) and the possibility of free flow, enuresis.
The pleasure of urinating is twofold:
a) the phallic, even sadistic meaning of urination is the equivalent of penetration, damage, destruction.
b) as a free flow, passive pleasure from the reduction or removal of control.
In boys, the passive free flow can be combined with other passive goals such as caressing the penis and arousing the perineum (prostate), with fantasies of accelerated ejaculation.
In girls, urethral eroticism serves to express conflicts with penis envy and the free flow of "urinal tears."
Sphincter Control Bladder develops narcissistic pride and ambition.
baby masturbation
During feeding, during hand games, hygienic care and urination, starting from the oral stage, erotic excitation of the genital organs occurs.
Childish sexual curiosity
For a child, there is only one gender - the one that is represented by beings endowed with a penis. For the child, the reality of discovering the anatomical difference between the sexes arises. At the same time, mysteries arise: the origin of children, birth, pregnancy ...
primary scene
This should be understood as a scene or scenes during which the child was - or imagines that he was - a witness to the sexual intercourse of the parents. From here fantasies are possible - seduction, castration, abandonment.
Primary scene contributes to:
- identification with one of the parents, and sometimes with both, often realized in the direction of "passivity" in front of the power of the "greater";
- projections of the subject's own aggressiveness and is experienced as sadistic in accordance with the noises, screams, groans created;
- a feeling of abandonment caused by the fact that the child is excluded from this relationship.
Childish sexual theories
Oral fertilization by eating miraculous food or through a kiss.
Theories involving urination (to urinate on a woman).
Theories of exchanging a penis for a child, showing the genitals.
anal theory. In the concept of a child, the birth of a child occurs through the anus, through the navel, or as a forced way to remove the child from the mother's body.
The child has a sadistic concept of sexual intercourse and depends on his fantasies.
3. Phalic stage
At the end of the 3rd year of life, the instincts unite under the influence of the genital organs.
The phallic stage is the stage of "discovering" the difference between the sexes (in the difference between a man and a woman) for a child. The presence of the penis as a genital organ is associated in a child with power and completeness. One of the parents is perceived by the child as powerful or weak.
In adulthood, the cliteral woman is passive, and the genital woman, without anxiety and without fear of fusion and destruction, finds pleasure in the active absorption of the penis, and not in the castration of her partner.
Child masturbation begins from the moment of feeding and is a specific erotic manifestation at the level of the genital organs during urination with a hedonistic manifestation during self-reproduction.
At this time, there is a discovery of the difference between the sexes, the primary scene (imaginary or real evidence of the sexual intercourse of the parents).
These discoveries lead the child to the idea of ​​the necessary identification with one of the parents (inclination to passivity in front of the big one), the projection of their own aggressiveness (because everything is perceived by them as sadism), feelings of abandonment, and this gives rise to vauerism and scoptophilia. Voyeurism (French voyer - caretaker, overseer) or scopophilia (Greek skopeo - to consider). Scopophilia - a periodic or constant tendency to secretly observe having sex or undressing; this usually results in sexual arousal and orgasm. It is predominantly found in men who have undergone a schizophrenic coat with psychopathic changes or a defect, as well as in a psychopathic variant of the psychoorganic syndrome. Scopophilia can turn into epistomophilia, that is, in the appearance of studies of all kinds.
Children's theories of fertilization
Oral - through a kiss.
Urinate on the object of fertilization.
Exchange of a penis for a child.
The problem of narcissism
Narcissus and Oedipus are two different models of affective and relational functioning and operate alternately in each person, throughout the entire length of being.
The Oedipus complex forms "I", "It", "Super-I", "Ideal-I" and "Ideal-Self".
Identification is the formation and assimilation of a subject in the image of another.
There are two attachments in the Oedipus complex: attachment to the mother and identification with the father.
"I" is the heir of narcissism. Do it, be big and strong. The child considers himself omnipotent.
"Super-I" is the heir of the Oedipus complex - do not do what you consider unworthy for yourself and for another. The demands of moral self-consciousness and self-respect are the "Super-I".
"Ideal-Self" is the heir of narcissism: be like your father and have a sense of self-respect.
Oedipus complex
The main conflict of the Oedipus complex occurs between 3 and 6 years of age and is a sexual and triangular conflict between child, mother and father.
The prohibition of incest is the law.
Latent period - from 5-6 years to puberty (until genital maturation)
Latent period - a phase of rest and consolidation of the achieved position. At this time, the child turns to areas other than sexuality. During this period, there is a predominance of tenderness over sexual feelings. The free energy of attraction is channeled into education, games, social life, into products of the imagination - fairy tales, stories, and not into abstract fantasies that can awaken sexual conflicts.
In children in the latent period, the "I" is relatively strong and safe with respect to sexual conflicts.
puberty
Puberty is a period of revival of sexual activity and intensification of Oedipal drives.
Puberty - from the Latin - pubertas - "maturity, puberty") reflect only those changes that occur in the reproductive system, but not the cultural and social aspects of growing up, for which the term "adolescence" is more acceptable. Adolescence not only includes puberty, but significantly overlaps it in duration. During this period, eccentricity and strangeness in a teenager are observed. Pollution and the first menstruation, secondary sexual characteristics (hair growth and change of voice) in a teenager are a consequence of the onset of sexual maturity.
The boy, throughout his life, will continue to measure significant narcissistic value against his penis for display. In girls, there is a change in narcissistic interests directed to the genital organs, to their entire body.
Masturbation
In boys, the growing genital tendencies find their expression in masturbatory activity. Masturbation produces feelings of guilt and anxiety with masturbatory fantasies of an Oedipal character.
In girls, masturbation is clitoral in nature and can be transferred to the hair, mouth, nose and is often masochistic in nature.
Complete suppression of autoerotic activity can lead to psychological conflicts and even to pathology.
If Puberty is passed, then sexuality is included in the personality and the Subject can have an orgasm. Those who fear the signs of maturity attempt to continue the real addiction with the surreal hope of omnipotence.
During the period of pre-adolescence, the task of the "I" is to destroy the parental choice (the choice between the object of love of one of the parents and the sexual partner). This “teenage rebellion” against parents, authorities and their symbolic substitutes (setting the child to obedience, the parent to blame) can reach total rejection and rupture and the choice of a completely different lifestyle, or the restoration of mutual tolerance and mutual feelings. The way out of this conflict depends not so much on the real attitude of the parents, but on the way of resolving or not resolving the Oedipal conflict. The teenager regresses from object love to narcissism, so teenagers often stick together (homosexual groups) to prove that "they are no worse than others" and can show their instinctive activity, which allows them to calm down in the exciting presence of the other sex, as well as from loneliness.

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Psychologie pathologique theorique et clinique

Sous la direction de J. BERGERET Professor a I "universite Lyon-ll

Avec la collaboration de

A. WECASN, J.-J. BQULANGER, J.-P. CHARTIER, P. DUBOR, M. HOUSER ET J.-J. LUSTIN Charges de cours a I "universite Lyon-ll Preface de D. WIDLOCHER Professeur au CHU Pitie-Salpetriere

8e edition

To the 250th anniversary of Moscow University

Series "CLASSICAL UNIVERSITY TEXTBOOK" Issue 7

Psychoanalytic pathopsychology theory and clinic

Edited by

J. BERGERET

professors at the University of Lyon-2

A. BEKASCH, J.-J. BOULANGE, P. DUBORTH, J.-J. LUSTEN, M. USER, J.-P. CHARTTIER

Translation from French Doctor of Psychology, Professor

A. Sh. TKHOSTOV

Recommended by the Council of Educational and Methodological Associations of Russia for classical university education as study guide for students of higher educational institutions studying in the direction and specialties "Psychology", "Clinical Psychology".

Moscow State University M.V. Lomonosov Moscow 2001

Chairman of the editorial board and founder of the series "Classical University Textbook" President of the Russian Union of Rectors, Rector of Moscow State University, Academician V.A. Sadovnichy.

J. Bergeret. Psychoanalytic pathopsychology: theory and clinic / Per. from fr. Dr. Psychol. sciences, prof.

A. Sh. Tkhostova. Series "Classical university textbook". Issue. 7- M: Moscow State University. M. V. Lomonosov, 2001.- 400 p.

For the first time in Russian, a classic university textbook on pathopsychology is presented, which went through 8 editions only in France and was translated into Italian, Spanish and Portuguese. This book has long become a basic textbook for psychologists in many universities in Europe and in most universities. South America. The unique combination of a clinical approach and classical psychoanalysis makes this publication indispensable for use by both practicing psychiatrists, psychologists and social workers, as well as for university students studying in the specialties "Psychology", "Clinical Psychology".

ISBN 5-9217-0015-0

General rebatch

Yu. P. Zinchenko

Editor N. A. Leontieva Computer layout and layout S. L. Zorabov Handed over to the set 05/10/2001. Signed for publication on 08.11.2001. Format 60x90 "/„ Offset paper. Offset printing. Printed sheets. 25. Circulation 3000 copies. Printing house of the Order of the Badge of Honor, MSU publishing house.

Moscow, Sparrow Hills.

Copyright © 2000 Masson.

© Moscow State University M.V. Lomonosov, 2001.

PREFACE TO THE FIRST FRENCH EDITION Pathopsychology owes much to psychoanalysis. It is no longer possible to study mental illness,

considering behavior without taking into account the psychodynamic point of view: it strives for the realization of a certain task and is subjected to a double system of compulsion contained in the organism itself, necessarily divided in its search for an impossible finality, in a world that counteracts this search or offers it its own ways. Thus, attraction and conflict clearly appear as necessary basic concepts of this point of view.

It is surprising that it took until the advent of psychoanalysis to realize this. Do not these concepts implicitly refer to the psychology of common sense and its literal expression? They explain ordinary actions and guide our actions in relation to others. And, no doubt, it is their banality that caused the lack of interest in them on the part of psychiatrists. Moreover, it has always seemed striking and implausible that these principles governing normal behavior can explain pathology, its illogicality and its persistence.

Freud's notion of the dynamic unconscious bridges this gap: absurd behavior, the symptom has a meaning hidden in some remote limit. This discovery makes it possible to use what is known from the study of drives and conflicts. How numerous are the psychiatrists who derive from psychoanalysis the additional meaning it brings; they expect the psychoanalyst to interpret the underlying meaning of the symptom and also to expand the field of psychological understanding without pretension to explaining the illness. And the success that psychoanalysis has won among the general public and in numerous fields of the humanities or literature is largely due to this visionary ability. The science of the unconscious is fascinating because it allows you to understand something better than the intuition of common sense would. But the right of interpretation is remembered, and it applies to any material. It is forgotten that an analytic interpretation is confirmed either by its effect or its predictive power, and that it is risky to extend its application beyond the field of treatment without specifying the system of confirmation to which it might refer.

Psychoanalytic psychopathology does not coincide with this extended understanding of interpretation. The totality of private interpretations made about the clinical case does not fail the psychopatho-

logical outcome. It is not enough to collect hypotheses about the meaning of symptoms, intentions, and behaviors. Far more radically, psychoanalysis has modified the dynamic point of view to apply it to pathology. The motivating forces of a person are not organized by chance, but systematically, internal conflicts express incompatibility between individual personality structures. Moreover, this organization is not given all at once, it is born and develops in the course of the history of the subject in accordance with the conflicts that necessarily mark the stages of this history. Through the plan they have chosen, the authors of this book clearly show that these structural and genetic perspectives are fundamental and their study should precede the study of various forms of pathological organization. What is called metapsychology in psychoanalysis not only provides the opportunity to have theoretical model, but also allows you to create a completely new (defensive formations, laws of primary processes, derivatives of the unconscious) and clear semiology of specific meanings. Its knowledge is absolutely necessary for the clinician, and its application outside the field of the medical process is even more justified.

It would be absurd to oppose the two methods. What can be said about a surgeon who refuses any diagnosis and any pathophysiological hypothesis, confining himself to correcting anomalies that allow him to see the surgical field? In the process of treatment, meta-psychological references are obscured to make room for the study of particular manifestations. But their use in a new way clarifies clinical observation and some of its particular variants, such as, for example, the projective situation.

J. Bergeret and his colleagues have all the necessary qualities to introduce clinicians, psychiatrists and psychologists into this modern psychopathology. Practitioners and teachers, they have long been united for the tasks of clinical research and teaching. Hence this wholeness of the work, this equally high level of demonstration of how theoretical models can elucidate true semiology and better understand traditional clinical syndromes. The pedagogical meaning is very important: psychoanalytic psychopathology can still develop. It forms one of the fertile fields of research in general psychopathology, and only continued progress in this field will prevent us from returning to shortsighted empiricism and dogmatism.

Daniel Widlöscher, professor at the Pittier-Salpêtrière Medical University Center, Paris,

President of the International Psychoanalytic Association

Part Two CLINIC

5. Clinical conversation with patients. J Bergeret and L. Dubor ... 157

J. BERGERET and P. DUBOR

We will not talk here about the specific research conducted by the psychologist (such as projective tests or measurement of 1Q, etc.), but we will stop at the moment when medical research is completed, referring to the meeting itself. psychological type.

Classical "observations" can exist at various levels, starting with the observation of the "botanical" type, considering its object from the outside, and ending with psychoanalytic observation (when, thanks to the transfer, the integration of the historical dimension of the object observed from the inside, in the subject) is revealed through the phenomenological description of the patient, considered " in the situation."

Psychological interview is a common practice for a psychiatrist and clinical psychologist and is carried out either before a medical examination in order to prepare the patient, or after an examination to supplement it, or outside of any purely medical examinations in some institutional non-medical cases (school problems, career guidance) when pathological difficulties, leading us then to the first option.

Psychological conversation, and we will not get tired of repeating this, first of all should not be considered in its form, as well as its purpose, as

CLINIC of the medical examination, but you can’t turn it into such a tempting reason for the doctor

elude or withdraw from part of his responsibility; he can divide it so that, without refusing, he can take it upon himself on the basis of a wider set of possibilities.

In the framework of a psychological meeting, we are not interested in the symptoms themselves, nor in their somatic manifestation. The patient is not limited to the role of a passive object, as in a normal questioning or technical examination; from the start he takes the place active subject, a real organizer of his own way of communicating with a psychologist acting as a "recipient" and "witness". This is a purely intersubjective position.

The psychologist must beware of interpreting from the first moment (especially in terms of "Oedipus", while more often it is a defensive "pseudo-Oedipus") the patient's speech until full understanding holistic organization discourse. You don't need to imagine anything from yourself or in advance.

The first part of the conversation This is not questioning, but listening. The subject should be as comfortably positioned as possible.

Material (time, place, distance, money) and affective (non-constriction, sincerity, empathy) conditions become extremely important. The duration of the conversation can be from several minutes (with the risk of repeating the meeting in case of too obvious and seemingly unbearable fear) to an hour, but you should never cross these boundaries. It should be clear in advance whether this act is paid (directly or indirectly) or free - a circumstance that should not be underestimated.

The patient must have the freedom to spontaneously organize his way of expressing relationships (fusion, anacliticism, triangularity), his type of fear (dismemberment, loss of object or castration), which should not be confused; it is necessary to single out the main variants of defense, which can range from repression (the main type of defense in neurotics) to split self (in psychotic patients), split imago, refusal (from what?) or projection (in transitional states), as well as the mechanisms accompanying repression, such as displacement, negation, etc.

It is better not to talk about the symptom yourself, leaving the patient to talk about it when and how he wants to. Information hunting is a style to be wary of.

And, on the contrary, we should not forget how important it is for a psychologist to accurately assess the verbal style of expression, the level of emotional development.

CLINICAL INTERVIEW WITH THE PATIENT

orgy, the degree of adaptation to reality, the density of discourse, the flexibility or rigidity of behavior, the more or less erotic atmosphere of dialogue, facial expressions.

The way in which these remarks are collected and experienced by the psychologist needs a personal internal re-examination in the second stage, which includes a certain distance necessary in order to better listen to one's own feelings towards the other, i.e. to his own countertransference. Under the same conditions, we note the beginning of the patient’s speech, the tone, the establishment of a distance in the discourse (silence, pause, rejection, stops of dialogue), the need to isolate the listener, control him, neutralize (some patients speak without stopping to avoid dialogue), the way to discuss fear or aggressiveness, possibilities of identification, suppression (intellectual or affective), adaptive or defensive abilities in a new and unforeseen situation, ease of remembering and working through memories, style of mental activity (fantasies, dreams, behavior, silence, projections), conflicts and defenses in them interaction.

It turns out how the mode of separation between conscious, unconscious and fantasmatic representations is established; the place of the symptom is revealed at the mental level, at the level of behavior or at the somatic level.

A distinction is made between the "action" of discharge (aimed at avoiding the stage of desire and its representations) and "action" as an introduction to verbal processing.

The second part of the conversation This part includes what was not said spontaneously and what should, however, be clarified without giving

the possibility for the patient to question the technique, more or less inspired by the classic "interrogation", always felt like a prosecutor's or a policeman's and cannot help even a masochist. We would like to make it clear that "conversation", the subject of this chapter, is really about the body of psychological research through direct dialogue in the broadest sense of the term, and is not necessarily limited to a single face-to-face session (preferably without the mediation of any person, table or especially the "bureau"). Sometimes it is desirable, if not necessary (especially with regard to this second part), to increase the number of dialogic sessions, without, nevertheless, turning it into psychotherapy (narrowing the zone for this purpose).

CLINIC well of interest to point moments, and not expanding to a random "tell me about your life").

With some subjects it is sometimes necessary to be persistent, then leaving them, as far as possible, to speak alone. Often a grunt or an interrogative facial expression helps a lot.

It is about filling in the main gaps in the discourse (and without overzealousness and nerfectionism, which quickly become disturbing and useless), trying first to find out where the “holes” of the first part lead.

During the first conversation or subsequent (it does not matter) it is necessary to establish certain points:

Past events in the subject's personal life. Where he was born. Where are his parents from? Where consistently he lived. How was his childhood. His adolescence. His study. Her predicament. His possible military or civilian service. Naturally, speaking about himself, he must tell his age, profession, his difficulties and desires.

Parents. Information about the father and mother should be collected in an unobtrusive way: whether they are alive or not. They live together or separately. Their profession. Age. Health status. Character. How they get along with each other. Who is in charge. Subject's previous and current style of relationship with both parents. Who do you think he looks more like?

Sibs. How many brothers and sisters does he have. Alive. Deceased (from what, at what age). Their gender, age, profession, health. Are they married. With whom. Is their marriage successful? Do they have children. Subject's past and current relationship with his siblings.

Spouse (if any). Age. Profession. Health. Character. Wedding date. The duration and circumstances of the "grooming" (events associated with this: "love at first sight", forced marriage, family dramas or unusual circumstances, etc.). How did the acquaintance happen? What was the mutual understanding at the beginning of the marriage. Subsequently. Who initiated the marriage: one of the spouses, parents, another person. Waiting for a child. How the choice was made. Does it remind you of a relationship with one of the parents. Was it really out of love, or is it hiding resistance, dominance over another (spouse is weak, sick, with no prospects ...).

What were the changes in the situation of family life: physical, social or emotional. Possible extramarital affairs on one side or the other.

Children. Quantity. Age. Floor. Health. study or profession. Whether they were desired or not. Relationship problems with or between them. How they are dealt with (connivance, coercion, the absence of any coercion).

Current state of health patient. Weight in relation to height. General appearance. Note that morphology must also be taken into account, as well as our reactions of sympathy or distance in relation to the interlocutor. It is also necessary to know about internal diseases, possible accidents or surgical interventions performed. Then you should find out the present state, possible disorders of digestion, sleep, menstruation, appetite, behavior in relation to tobacco, alcohol, coffee, etc., and in the most ordinary and, as far as possible, in a natural way. This part of the meeting should not be separated from the rest of the dialogue.

Pregenitality. Orality (food and sensual appetite, needs, greed, resistance to frustration) and anality (physical and "moral" digestion, cleanliness, pedantry, viscosity, attitude towards money, style of digestive secretions and affective expression). Genitality. In a completely natural, self-evident way, one should touch on the problems of masturbation (obsessive, absent, ordinary, with what fantasies), consistent

sexual desires1 (for men, women, or changing depending on the case), sexual relations (at what age was the first, how it was experienced, how it proceeded subsequently), casual relations (for what exact purpose - to fill the void in order to avoid loneliness or, on the contrary, to avoid contact limited to two persons).

The difficulty of psychoanalysis always lies in the choice of whether to ask questions immediately, faced with the patient's "silence" in between, or to wait for the next meeting. If nothing inspires fear in asking direct questions, it will be much more embarrassing if this is perceived as shyness and anxiety in asking these very questions. It is very important to keep the style used in listening to the subject simple and "healthy". Without excessive modesty, but without "nakedness". There are as many awkward ways to be too humble as there are too curious...

Dreams should be touched upon rather briefly. Without having in mind (and not being able to) interpret dreams, one should nevertheless clarify the patient's situation with regard to sleep and oneiric working through. Does he always dream? What type of dreams are most frequent during the night. In the old days. At present.

Then must be accurately and carefully evaluated social connections: the problem of the profession (prospects, satisfaction, desirability).

1 Original: "attirancc" - attractiveness, attractiveness, attraction, i.e. an attraction that has connotations of appreciation.

CLINIC Relations with superiors. With colleagues. With subordinates. Does the patient have friends (“real” or

just "friends"). Many or few. Before. Currently. How he has fun (Sundays, holidays). His hobby (sports, art). And neatly asked and fixed precisely, but with tact, the important question: does he prefer to live alone or in a group?

It is always appropriate to end the conversation with three questions: what else would he like to say? What does he expect from this meeting? What, in his opinion with him not this way?

Reflection What happens during a conversation is neither "accident", nor "trial", nor "accusation". It's a cut

life. This is a relatively typical and repetitive experience of the patient regarding his conflicts, his failures, his desires and his shortcomings, his adaptations or less successful defenses.

During this conversation (or these several consecutive conversations) there comes a point when the subject can no longer act out the situation in such a way as to hide his deep personality. If all the required precautions are observed by the psychologist, the subject will soon bring in his living way of dealing with his fears and frustrations, his anger and claims, consistently and automatically. The Deep Structure has no choice but to slowly manifest itself to those who can hear, listen without forcing anything and accepting everything without making a choice.

The psychologist should show neither fear nor irritation, he should find for everyone a natural and calm style, albeit somewhat sly, but real and deep. affectively sincere, which is wonderful and immediately felt by any interlocutor.

One should not be too ambitious, nor too hasty or too "pressing"; one should also carefully avoid the frequent "corrida" of conversations conducted by overzealous "investigators", as unacceptable is the desire to quickly achieve the "goal" (as if it were an execution); listening willy-nilly remains incomplete, fragmented, tending to continue over time. One must be able to stop after thirty to fifty minutes (most often) depending on the subject, before the patient has an unfortunate feeling of being "gutted" out. The Problem of Silence rarely mentioned by authors, but one should be able to endure it without impatience, but also without indulgence. The patient has the right to remain silent, but the purpose of the conversation suggests that he is here.

CLINICAL INTERVIEW WITH THE PATIENT

in order to speak. "Listening to silence" should not cause the psychologist neither anger nor complicity.

On this point it will not be superfluous to insist on the danger of showing a certain "courtesy" towards the patient. It is often a form of refined neglect, so painfully perceived by the patient that his hostile tension and reaction of protest are very often justified.

One should carefully avoid responding to the subject's sadistic or masochistic provocations, avoiding the temptation to dominate him (be it the desire to "know everything" about him).

Another classic trap to be aware of is that every time the patient emphasizes the genital and oedipal elements too strongly, this is to mask well-hidden pregenital conflicts, and every time the patient defiantly emphasizes the pregenital elements (oral and anal), it is in order to hide underlying oedipal and genital conflicts. This is a perfectly common ploy, but even the most venerable analysts fall for it, especially those who work with children or retarded adults.

Anyone dealing with the "psyche" must take precautions (despite everything, often insufficient) not to provoke the subject to aggressive, amorous or homosexual feelings. Of course, cases of "action" of this kind remain as extreme as they are known, but unpleasant experiences can destabilize without any action, and conscientiousness requires them to be avoided nonetheless.

"End Conversation"- this is an expression that does not reflect the way the two interlocutors are separated: a psychological conversation does not really have an "ending"; even if the psychologist does not have to meet with the subject afterwards, the conversation can remain open. Its purpose is to confront the patient with problems that are more genuine and deeper than those with which he came to us. The patient must understand that there is no point in imitating the immediate (here and now) resolution of his problems, real but superficial, which he feels and which he brings to the fore.

Psychological conversation cannot constitute deep psychotherapy. If it sometimes takes on the aspect of urgent psychotherapy and narcissistic support, then only as side effect and without long-term effects. Psychological conversation often takes the place of entry, to the same extent for the patient as for the therapeutic team, to reflection and decisions regarding the choice of treatment and, of course, possible psychotherapy as changes,

CLINIC Simim if necessary in the life of the patient (change of profession, lifestyle or even hospitalization).

As for the generalizing and materialized (more or less) recording of the conversation, its length and style depend significantly on the personality of the psychologist and the type of case presented by the patient. In any case, you should know that making a minimum of notes in the presence of the patient and a maximum after his departure is the wisest practice, on the one hand, avoiding excessive fear in the patient and, on the other hand, providing the psychologist with the best synthesis of his problem.

THE CONCEPT OF SEMIOTICS P. DUBOR

DEFINITION AND GENERAL REPRESENTATION According to general principle studying the signs of clinical manifestations value is attributed

(semiano: i mean).

Being authentic differential highlighting, inspiring the meaning generated by the patient's experience, whether it is about externally experienced, behavioral and objective, or about his internal experience, his own subjective experience, semiotics studies the manifestations of the psychopathological organization of patients as perceived by the observer in their visual, sensory and emotional presentations.

It introduces selection already in the very preliminary attempt at grouping, from the first signifying organization, immediately subjecting the sign to comprehension in the context of a larger totality, which it only forms.

Differentiality it brings, as a word in a sentence (and if I may be allowed to continue this linguistic comparison, which does not appear inadvertently), as a paradigm included in the syntagmatic organization, to bring into its intended structuring own

synergistic shades.

166 CLINIC It is in this double perspective that the sign, on the one hand, is perceived as an element of reliable

differentiation semiotic, paradigmatic 1 meaning, and, on the other hand, as the same sign, syntagmated from a larger totality in which it appears as part of a whole greater than the totality of its inherent parts, and the so-called semantic dimension is concluded, the second i side of this signifier element.

These are the two "basic" operations of the clinical perception of signs, which should be singled out. We propose to proceed now to their study, clarifying at the outset that, in essence, we are talking about a certain way of interpreting the problem, which does not at all provide for any kind of denial of other semiotic taxonomies, in fact, numerous and complementary, as he clearly notes in his treatise A. Hey.

How: Any attempt to understand the variants of personality relationships in development is a study of the subject in relationship situations can only be arbitrarily separated from therapeutic activity, since in itself any entry into interpersonal contact entails dynamic manifestations at the level of the patient's personality, which are capable of modifying the constitution of his ego.

For didactic reasons, we will proceed in this case and from the outside inward, from the objective to the subjective, or more precisely from the level at maximum objectification, approaching its subjectivity, never forgetting that it is always about the same experience.

Starting with a general and external description, we will proceed through the patient's experience to the meaning current state its organization in order to later reach the more fundamental point of fixing it object relations and the so-called basic structural organization.

It should be noted that, although this program does not contradict the medical concept of diagnosis, it should, however, be more clearly differentiated from it in view of the significance attached to this study: I want to talk here mainly about the pragmatic meaning of this structural definition, which in no case should be considered as self-finished, forcing one to forget about the patient and his truth ---- it is he who, in the end, is the object of any action

in pathopsychology and in no case can remain simple observation 1st simple classification.

1 The author uses the concepts of structural linguistics: the paradigmatic sign relation connects at the level of the signified with the potential stock of other signs related in meaning; syntagmatic - at the level of the signifier, coexistence with adjacent signs of the same message

PREFACE TO THE FIRST FRENCH EDITION

Pathopsychology owes much to psychoanalysis. It is no longer possible to study mental illness,

considering behavior without taking into account the psychodynamic point of view: it tends to be realized

certain task and is subjected to a double system of compulsion contained in the organism itself, with

disunited by necessity in its quest for an impossible finality, in a world opposing

this quest or offering him his own paths. Thus, attraction and conflict are clearly manifested.

as necessary basic concepts of this point of view.

It is surprising that it took until the advent of psychoanalysis to realize this. Do not apply

these concepts implicitly to the psychology of common sense and its literal expression? They are

explain ordinary actions and guide our actions in relation to others. And without a doubt

it is their banality that causes the lack of interest in them on the part of psychiatrists. In addition, always

it seemed startling and implausible that these principles governing normal behavior

can explain the pathology, its illogicality and its persistence.

Freud's notion of the dynamic unconscious bridges this gap: the absurd

the behavior, the symptom has a meaning hidden in some remote limit. This discovery allows

use what is known from the study of drives and conflicts. How numerous

psychiatrists extracting from psychoanalysis the additional meaning it brings; they expect from

psychoanalyst that he interprets the hidden meaning of the symptom, and also expands the scope

psychological understanding without claiming to explain the disease. And the success that psychoanalysis has

among the general public and in numerous fields of the humanities or literature, largely

degree is endowed with this visionary ability. The science of the unconscious is fascinating because

allows you to understand something better than common sense intuition would. But the right is remembered

interpretation, and it applies to any material. It is forgotten that the analytic interpretation

confirmed either by its effect or its predictive power, and that it is risky to extend it

application beyond the boundaries of the treatment area without specifying the confirmation system to which it could

refer.

Psychoanalytic psychopathology does not coincide with this extended understanding of interpretation.

The totality of private interpretations made about the clinical case does not fail the psychopatho-

logical outcome. It is not enough to collect hypotheses about the meaning of symptoms, intentions, and behaviors.

Far more radically, psychoanalysis has modified the dynamic point of view to apply

her to pathology. The motivating forces of a person are not organized randomly, but systematically, internal

conflicts express incompatibility between individual personality structures. Moreover, this

organization is not given at once, it is born and develops in the course of the history of the subject in accordance with

conflicts that necessarily mark the stages of this history. Thanks to the plan they chose

fundamental nature and their study should precede the study of various forms

pathological organization.

what is called metapsychology in psychoanalysis, not only provides

the opportunity to have a theoretical model, but also allows you to create a completely new one (protective formations,

laws of primary processes, derivatives of the unconscious) and a clear semiology of concrete meanings.

Its knowledge is absolutely necessary for the clinician, and its application outside the field of the medical process is even more

reasonably.

It would be absurd to oppose the two methods. What can you say about a surgeon who refuses to

any diagnosis and any pathophysiological hypothesis, limited to the correction of anomalies,

allowing him to see the operating field? In the process of treatment meta-psychological references

obscured to make room for the study of particular manifestations. But their use in a new way

clarifies clinical observation and some of its particular variants, such as projective

situation.

J. Bergeret and his colleagues have all the necessary qualities to introduce clinicians,

psychiatrists and psychologists into this modern psychopathology. Practitioners and teachers, they are on

have been combined for a long time for the tasks of clinical research and teaching. From here

this integrity of work, this equally high level of demonstration of how theoretical models

allow the true semiology to be clarified and the traditional clinical syndromes to be better understood.

The pedagogical meaning is very important: psychoanalytic psychopathology can still develop. She

forms one of the fertile fields of research in general psychopathology, and only an ongoing

progress in this area will protect us from a return to short-sighted empiricism and dogmatism.

Daniel Widlöscher,

professor at the Medical University Center

Pittier-Salpêtrière, Paris,

President of the International Psychoanalytic Association