Claustration, hikikomori, visites à domicile : la Société Médico-Psychologique en 1953 avec Louis Gayral

Abstract

The 170th anniversary of the Société Médico-Psychologique is an opportunity to update the work of a great clinician from Toulouse, Professor Louis Gayral, and the foresight of the Annales Médico-Psychologiques for having published in 1953 his voluminous article of 27 pages on “claustration”, we say today “acute social withdrawal/hikikomori”. This conduct consists in withdrawing from society and relationships with others, at least from real life relationships. This is a difficulty encountered by our contemporary societies which, like an addiction, tends to recur. It includes a young person, an entourage, a particular state of society. Gayral's work shows that this conduct was described in 1953, and we propose to compare his description with the current description. This clinician generally identifies the transnosographic and dimensional aspects, what he calls the “choice of the symptom”, approached at the level of the individual, his unconscious and his own experience. This symptom seems to him a major symptom in mental pathology. It would not only be symptoms of a disease but of a conflict between a sick person and the world, while recognizing that the societal aspect cannot be identical today. It supports ideas that are the common thread today of transnosographic and societal reflection concerning social withdrawal/hikikomori. Thus, mental illness is for him the encounter of a personality, at a particular given moment, with a series of circumstances or multiple and entangled causes. Clinician “from theorization to pragmatism”, he therefore develops the dimensional aspects. His definition of claustration is that of a narrowing of existence to a restricted and materially enclosed space, with a reference to the rules and uses of social life. There are negative signs such as the absence of organic disorders and in particular paralyzing neurological disorders, the absence of psychomotor disorders, the absence of asthenia of organic origin. The refusal of receiving visits from doctors would in practice be an excellent symptom of morbidity. It compares to the definition of hikikomori as confinement at home for more than 6 months, with a significant restriction of social and family relations, without motor or psychiatric disorders likely to explain the confinement, associated with impaired faculties or a feeling of hardship. Several questions are detailed in the article according to the 2 clinical themes of claustration and social withdrawal/hikikomori: transnosographic aspects at the borders of psychosis or its prodromal stage, psychopathological aspects with attachment ties, sociological aspects of opposition to the world, the position of the entourage in the face of such a conduct disorder. Returning as Gayral suggests to a clinical attitude joins the current advances in the field.