De la séméiologie psychiatrique à la psycholinguistique : définition d'un nouveau modèle de la clinique post-traumatique

Abstract

ObjectivesThe clinical presentation of post-traumatic psychological disorders means that many cases are under-diagnosed. We need a better way to identify such disorders and to develop markers that can monitor the effectiveness of recommended treatments. Drawing upon an innovative approach based on psycholinguistic concepts, we describe a new clinical model specific to psychological trauma. Material and methodsFounded on quantitative and qualitative analyses of the discourse of psychologically injured patients, we describe the psycholinguistic disturbances they present, illustrating them with examples from clinical practice. ResultsPost-traumatic psycholinguistic syndrome is defined as a function of three symptoms: traumatic anomia, linguistic repetition and disorganised discourse. Traumatic anomia manifests in a quantitative reduction in discourse characterised by a lack of production, impaired verbal flow and lexical poverty. Anomia is partially palliated by diversionary behaviours (peripheral and circumlocutionary deviation, synonymic approximation, semantic paraphrasing) and filler expressions. Linguistic repetition takes the form of phonological and syntactic repetition (verbal stereotypes, predilections, intrusions, perseverations and echophrasia). The person may give a literal account of their traumatic experience, but without a narrative dimension. Phrasal and discursive disorganisation is characterised by time discordance, de-subjectivation (via indefinite and impersonal pronominal markers), and disfluency that can extend to agrammatism due to a lack of logical and chronological connectors. DiscussionPost-traumatic psycholinguistic syndrome is concomitant with the cardinal psychiatric symptoms of trauma. Traumatic anomia is evidence of the unspeakable moment of per-traumatic dissociation, linguistic repetition is consistent with flashbacks, disturbed discourse reproduces the experience of dissociation in sentence form. Evidence of de-subjectivation, the predominance of indefinite and impersonal forms reflects the depersonalization resulting from the trauma, while disorganised discourse reflects the derealization that was perceived as the horror arised. These disturbances in the speech of the psychologically injured person manifest as a consequence of traumatic linguistic dissociation. Extra-linguistic functions (cognitions, emotions, feelings, behaviours, memories, etc.) are not only dissociated from each other but, above all, are dissociated from the major components of language (syntactic and pragmatic signifiers and signified). This is undoubtedly why repetition syndrome lasts as long as it does, but it can also be seen as a therapeutic lever in the context of some types of debriefings that are designed to reconstruct non-pathological speech. ConclusionAt a time when a variety of competing psychotherapeutic protocols (behavioural and cognitive, hypnosis, eye movement therapies, psychodynamic therapies, narrative therapies, etc.) are vying for attention, the analysis of the restoration of normal language could offer a way to create a clearer understanding of psychological trauma and its clinical consequences. In this context, psycholinguistic studies that combine quantitative and qualitative analyses of the discourse of people suffering from post-traumatic stress disorders could help to define some markers of the effectiveness of psychotherapies.